Robot training for hand motor recovery in subacute stroke patients: A randomized controlled trial

Orihuela‐Espina, Felipe; Femat-Roldán, Giovana; Sánchez-Villavicencio, Israel; Palafox, Lorena; Leder, Ron S.; Sucar, L. Enrique; Hernández-Franco, Jorge

doi:10.1016/j.jht.2015.11.006

Cited by 79 publications

(87 citation statements)

References 44 publications

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“…In fact, these devices allow to increase of the amount and intensity of the therapy, to standardize the treatment, providing a complex but controlled multisensory stimulation [9,10] and helping the patient to complete the required task while preventing inappropriate movements [11]. Even if most of the robots focuses on the more proximal joints (shoulder and elbow) [12], some devices have been specifically developed to target the hand, using either end-effector [13][14][15] or exoskeleton [16,17] design, with encouraging results in terms of motor recovery [12,[18][19][20][21][22].…”

Section: Introductionmentioning

confidence: 99%

Reliability, validity and discriminant ability of a robotic device for finger training in patients with subacute stroke

Germanotta

Gower

Papadopoulou

et al. 2020

J NeuroEngineering Rehabil

105

116

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Background: The majority of stroke survivors experiences significant hand impairments, as weakness and spasticity, with a severe impact on the activity of daily living. To objectively evaluate hand deficits, quantitative measures are needed. The aim of this study is to assess the reliability, the validity and the discriminant ability of the instrumental measures provided by a robotic device for hand rehabilitation, in a sample of patients with subacute stroke. Material and methods: In this study, 120 patients with stroke and 40 controls were enrolled. Clinical evaluation included finger flexion and extension strength (using the Medical Research Council, MRC), finger spasticity (using the Modified Ashworth Scale, MAS) and motor control and dexterity during ADL performance (by means of the Frenchay Arm Test, FAT). Robotic evaluations included finger flexion and extension strength, muscle tone at rest, and instrumented MAS and Modified Tardieu Scale. Subjects were evaluated twice, one day apart, to assess the test-retest reliability of the robotic measures, using the Intraclass Correlation Coefficient (ICC). To estimate the response stability, the standard errors of measurement and the minimum detectable change (MDC) were also calculated. Validity was assessed by analyzing the correlations between the robotic metrics and the clinical scales, using the Spearman's Correlation Coefficient (r). Finally, we investigated the ability of the robotic measures to distinguish between patients with stroke and healthy subjects, by means of Mann-Whitney U tests. Results: All the investigated measures were able to discriminate patients with stroke from healthy subjects (p < 0.001). Test-retest reliability was found to be excellent for finger strength (in both flexion and extension) and muscle tone, with ICCs higher than 0.9. MDCs were equal to 10.6 N for finger flexion, 3.4 N for finger extension, and 14.3 N for muscle tone. Conversely, test-retest reliability of the spasticity measures was poor. Finally, finger strength (in both flexion and extension) was correlated with the clinical scales (r of about 0.7 with MRC, and about 0.5 with FAT). Discussion: Finger strength (in both flexion and extension) and muscle tone, as provided by a robotic device for hand rehabilitation, are reliable and sensitive measures. Moreover, finger strength is strongly correlated with clinical scales. Changes higher than the obtained MDC in these robotic measures could be considered as clinically relevant and used to assess the effect of a rehabilitation treatment in patients with subacute stroke.

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Section: Introductionmentioning

confidence: 99%

Reliability, validity and discriminant ability of a robotic device for finger training in patients with subacute stroke

Germanotta

Gower

Papadopoulou

et al. 2020

J NeuroEngineering Rehabil

105

116

View full text Add to dashboard Cite

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“…In the past decade alone, over 140 hand exoskeletons have been developed, 46 of which were declared as daily assistive devices [1]. In contrast to stationary rehabilitation devices [2], [3], wearable assistive tools are designed to be used and worn throughout the entire day and, therefore, are dramatically restricted in size and weight. In a study with 242 upper limb prosthesis users, low added weight to the arm was found to be the most important design factor [4] and in neurological patients added weight leads to faster fatigue.…”

Section: Introductionmentioning

confidence: 99%

Design and Evaluation of a Bowden-Cable-Based Remote Actuation System for Wearable Robotics

Hofmann

Bützer

Lambercy

et al. 2018

IEEE Robot. Autom. Lett.

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“…54 [2,3]. Similarly, other studies focusing solely on robot-assisted rehabilitation of hand function in chronic [48][49][50][51] or subacute stroke [12,52,53] were not able to show statistically significant differences between robot and control therapy groups, or reported minor differences in secondary outcome measures [10,54,55]. The present RCT directly investigated equivalence in motor impairment reduction between a robot-assisted and a conventional therapy group focusing on the training of the upper limb, and in particular the hand.…”

Section: Changes In Secondary Outcome Measuresmentioning

confidence: 73%

Neurocognitive robot-assisted rehabilitation of hand function: a randomized control trial on motor recovery in subacute stroke

Ranzani

Lambercy

Metzger

et al. 2020

Preprint

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Background: Hand function is often impaired after stroke, strongly affecting the ability to perform daily activities. Upper limb robotic devices have been developed to complement rehabilitation therapy offered to persons who suffered a stroke, but they rarely focus on the training of hand sensorimotor function. The primary goal of this study was to evaluate whether robot-assisted therapy of hand function following a neurocognitive approach (i.e., combining motor training with somatosensory and cognitive tasks) produces an equivalent decrease in upper limb motor impairment compared to dose-matched conventional neurocognitive therapy, when embedded in the rehabilitation program of inpatients in the subacute stage after stroke. Methods: A parallel-group, randomized controlled trial was conducted on subjects with subacute stroke receiving either conventional or robot-assisted neurocognitive hand therapy using a haptic device. Therapy was provided for 15, 45-minute sessions over four weeks, nested within the standard therapy program. Primary outcome was the change from baseline in the upper extremity part of the Fugl-Meyer Assessment (FMA-UE) after the intervention, which was compared between groups using equivalence testing. Secondary outcome measures included upper limb motor, sensory and cognitive assessments, delivered therapy dose, as well as questionnaires on user technology acceptance. Results: 33 participants with stroke were enrolled. 14 subjects in the robot-assisted and 13 subjects in the conventional therapy group completed the study. At the end of intervention, week 8 and week 32, the robot-assisted/conventional therapy group improved by 7.14/6.85, 7.79/7.31, and 8.64/8.08 points on the FMA-UE, respectively, establishing that motor recovery in the robot-assisted group is non-inferior to that in the control group. Conclusions: Neurocognitive robot-assisted therapy of hand function allows for a non-inferior motor recovery compared to conventional dose-matched neurocognitive therapy when performed during inpatient rehabilitation in the subacute stage. This allows the early familiarization of subjects with stroke to the use of such technologies, as a first step towards minimal therapist supervision in the clinic, or directly at home after hospital discharge, to help increase the dose of hand therapy for persons with stroke. Trial registration: EUDAMED database (CIV-13-02-009921), clinicaltrials.gov (NCT02096445). Registered 26 March 2014 – Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT02096445

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Robot training for hand motor recovery in subacute stroke patients: A randomized controlled trial

Cited by 79 publications

References 44 publications

Reliability, validity and discriminant ability of a robotic device for finger training in patients with subacute stroke

Reliability, validity and discriminant ability of a robotic device for finger training in patients with subacute stroke

Design and Evaluation of a Bowden-Cable-Based Remote Actuation System for Wearable Robotics

Neurocognitive robot-assisted rehabilitation of hand function: a randomized control trial on motor recovery in subacute stroke

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