Robotic Assisted Upper Limb Training Post Stroke: A Randomized Control Trial Using Combinatory Approach Toward Reducing Workforce Demands

Abstract

Post stroke upper limb rehabilitation is a challenging problem with poor outcomes as 40% of survivors have functionally useless upper limbs. Robot-aided therapy (RAT) is a potential method to alleviate the effort of intensive, task-specific, repetitive upper limb exercises for both patients and therapists. The present study aims to investigate how a time matched combinatory training scheme that incorporates conventional and RAT, using H-Man, compares with conventional training toward reducing workforce demands. In a randomized control trial (NCT02188628, www.clinicaltrials.gov), 44 subacute to chronic stroke survivors with first-ever clinical stroke and predominant arm motor function deficits were recruited and randomized into two groups of 22 subjects: Robotic Therapy (RT) and Conventional Therapy (CT). Both groups received 18 sessions of 90 min; three sessions per week over 6 weeks. In each session, participants of the CT group received 90 min of 1:1 therapist-supervised conventional therapy while participants of the RT group underwent combinatory training which consisted of 60 min of minimally-supervised H-Man therapy followed by 30 min of conventional therapy. The clinical outcomes [Fugl-Meyer (FMA), Action Research Arm Test and, Grip Strength] and the quantitative measures (smoothness, time efficiency, and task error, derived from two robotic assessment tasks) were independently evaluated prior to therapy intervention (week 0), at mid-training (week 3), at the end of training (week 6), and post therapy (week 12 and 24). Significant differences within group were observed at the end of training for all clinical scales compared with baseline [mean and standard deviation of FMA score changes between baseline and week 6; RT: Δ4.41 (3.46) and CT: Δ3.0 (4.0); p < 0.01]. FMA gains were retained 18 weeks post-training [week 24; RT: Δ5.38 (4.67) and week 24 CT: Δ4.50 (5.35); p < 0.01]. The RT group clinical scores improved similarly when compared to CT group with no significant inter-group at all time points although the conventional therapy time was reduced to one third in RT group. There were no training-related adverse side effects. In conclusion, time matched combinatory training incorporating H-Man RAT produced similar outcomes compared to conventional therapy alone. Hence, this study supports a combinatory approach to improve motor function in post-stroke arm paresis.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT02188628.

ROBOCOP (ROBOtic Care of Poststroke Pain): Study Protocol for a Randomized Trial to Assess Robot-Assisted Functional and Motor Recovery and Impact on Poststroke Pain Development

“…In fact, ARAMIS consists of two exoskeletons with 6 degrees of freedom driven by two engines and controlling the shoulder joints to compensate for the inadequate motility and strength of the paretic arm (51). Robot-assisted motor rehabilitation and myoelectrical stimulation are demonstrated to provide reduction of the upper limb impairment (38,39,(54)(55)(56) and pain improvement (40,57,58). Also, actigraphic measure systems can predict acute phase stroke prognosis (59), supporting the role of technological progress in stroke.…”

Effect of Transcranial Direct Current Stimulation Augmented with Motor Imagery and Upper-Limb Functional Training for Upper-Limb Stroke Rehabilitation: A Prospective Randomized Controlled Trial

“…A recent study conducted among 22 patients with chronic stroke receiving robotic therapy for three sessions per week for 6 weeks showed a 4.41-point change in FMA scores. This discrepancy could be due to the small sample size and post-stroke duration (458 days) [ 54 ]. Another study using a robotic rehabilitation module coupled with tDCS thrice per week for 6 weeks reported clinically significant improvement [ 55 ].…”

Feasibility and cost description of highly intensive rehabilitation involving new technologies in patients with post-acute stroke—a trial of the Swiss RehabTech Initiative

“…However, the specialized equipment also requires adequately trained personnel in order to set up therapy plans fulfilling the criteria for highly intensive TAT as used in this trial. Current rehabilitation devices unfold their therapeutic potential only if they are used in conjunction with skilled therapeutic staff [ 50 , 55 ]. Interestingly, the study could be successfully performed under in- and outpatient conditions.…”