Wrist Robot-Assisted Rehabilitation Treatment in Subacute and Chronic Stroke Patients: From Distal-to-Proximal Motor Recovery

Abstract

In this study, the recovery of proximal and distal segments in stroke patients who received distal training alone was investigated. Forty (20 subacute and 20 chronic) stroke patients were recruited to perform wrist robot-assisted rehabilitation training. The upper extremity, shoulder-elbow and wrist subsections of the Fugl-Meyer Assessment Scale were used to assess the motor recovery of distal and proximal segments. In addition, the Modified Ashworth Scale, the Motricity Index and the Box & Block test were used as clinical outcome measures together with kinematic parameters to evaluate the effects of the training. Significant increases in the wrist and shoulder-elbow subsections of the Fugl-Meyer Assessment Scale, Motricity Index and Box & Block test were found in both groups. Average changes in shoulder-elbow and upper extremity subsections of the Fugl-Meyer Assessment Scale in the subacute group (6.10 ± 6.60 and 15.65 ± 14.04) were significantly higher (p < 0.05) than those in the chronic group (2.30 ± 2.76 and 6.60 ± 4.64). In addition, significant increases in the movement velocity, movement smoothness and movement quality were observed in the subacute group. Our findings provide evidence that following a robot-assisted rehabilitation treatment there is a distal-to-proximal generalization in subacute stroke patients.

Distal versus proximal - an investigation on different supportive strategies by robots for upper limb rehabilitation after stroke: a randomized controlled trial

“…For the FMA-SE, the average scores increased by 42.4% (post-assessment) and 54% (3MFU) in the robotic hand group, with the ratio of 41.1% (post-assessment) and by 44.8% (3MFU) in the robotic sleeve group. The motor improvements in the FMA-SE subscale for the robotic hand group confirmed that robotic support at the distal fingers could also benefit the proximal joint recovery (i.e., shoulder/elbow), similar to the observations reported in the literature [31, 64]. The motor gain achieved in the robotic hand group was comparable to that for the sleeve group where direct robotic supports were provided to the proximal joints.…”

Usability Assessment of a Cable-Driven Exoskeletal Robot for Hand Rehabilitation

“…Robot-assisted rehabilitation has become increasingly popular in recent decades, and there are more and more therapy concepts that attributed to various novel rehabilitation robots (Shields et al, 1997; DiCicco et al, 2004; Wege and Hommel, 2005; Hasegawa et al, 2008; Chiri et al, 2009; Tadano et al, 2010; Brokaw et al, 2011; In et al, 2011; Kadowaki et al, 2011; Ueki et al, 2012; Villafañe et al, 2017; Cerasa et al, 2018; Jakob et al, 2018; Mazzoleni et al, 2018; Pila et al, 2018). In robot-assisted rehabilitation, patients can receive standardized and repetitive training controlled by robot actuators (Takahashi et al, 2005; Chang and Kim, 2013).…”

Bioinspired Musculoskeletal Model-based Soft Wrist Exoskeleton for Stroke Rehabilitation

“…These results prove the motion function recovery effect of the stroke patient with the exoskeleton in ADLs. And, most of current devices are large in size and need to be fixed and trained in specific positions [45] . The proposed exoskeleton is portable and could be worn when the wearers move around.…”

“…It's well known that rehabilitation is a long-term progress [45] . A lightweight and comfortable exoskeleton robot with high degree of human-robot fusion can be better accepted by patients.…”