Abstract
Introduction: Robot-assisted therapy for upper extremity (UE) impairments post-stroke has yielded modest gains in motor capacity and little evidence of improved UE performance during activities of daily living. A paradigm shift that embodies principles of motor learning and exercise dependent neuroplasticity may improve robot therapy outcomes by incorporating active problem solving, salience of trained tasks, and strategies to facilitate the transfer of acquired motor skills to use of the paretic arm and hand during everyday activities.Objective: To pilot and test the feasibility of a novel therapy protocol, the Active Learning Program for Stroke (ALPS), designed to complement repetitive, robot-assisted therapy for the paretic UE. Key ALPS ingredients included training in the use of cognitive strategies (e.g., STOP, THINK, DO, CHECK) and a goal-directed home action plan (HAP) to facilitate UE self-management and skill transfer.Methods: Ten participants with moderate impairments in UE function >6 months after stroke received eighteen 1-h treatment sessions 2–3/x week over 6–8 weeks. In addition to ALPS training, individuals were randomly assigned to either robot-assisted therapy (RT) or robot therapy and task-oriented training (RT-TOT) to trial whether the inclusion of TOT reinforced participants' understanding and implementation of ALPS strategies.Results: Statistically significant group differences were found for the upper limb subtest of the Fugl-Meyer Assessment (FMA-UE) at discharge and one-month follow-up favoring the RT group. Analyses to examine overall effects of the ALPS protocol in addition to RT and RT-TOT showed significant and moderate to large effects on the FMA-UE, Motor Activity Log, Wolf Motor Function Test, and hand portion of the Stroke Impact Scale.Conclusion: The ALPS protocol was the first to extend cognitive strategy training to robot-assisted therapy. The intervention in this development of concept pilot trial was feasible and well-tolerated, with good potential to optimize paretic UE performance following robot-assisted therapy.
Highlights
Robot-assisted therapy for upper extremity (UE) impairments poststroke has yielded modest gains in motor capacity and little evidence of improved UE performance during activities of daily living
It is likely that individuals in the Active Learning Program for Stroke (ALPS) + Robot-Assisted Therapy (RT) group completed more movement repetitions than those in the RT-Task-Oriented Training (TOT) group, which may have contributed to greater improvement in UE motor capacity, as measured by the Fugl-Meyer Assessment—UE (FMA-UE)
The novel Active Learning Protocol for Stroke (ALPS) has the potential to shift current research paradigms for intensive robotassisted therapy by training stroke participants to engage in selfanalysis and active problem solving to better utilize recovered UE motor skills during daily living tasks
Summary
Robot-assisted therapy for upper extremity (UE) impairments poststroke has yielded modest gains in motor capacity and little evidence of improved UE performance during activities of daily living. These findings may be attributed to the limited development of rehabilitation robots that train voluntary control of finger flexion and extension of the paretic hand, and a primary focus on intensity of practice with little regard for other principles of motor learning and experience-dependent neuroplasticity [7, 8] These principles, including the salience of training tasks, transfer of acquired skills to similar activities, and active engagement and problem solving, are key to task-oriented training paradigms in stroke but have not been well-integrated into robot-assisted therapy protocols. While these treatment components are instrumental to the transfer of motor skills acquired during task-oriented training, they previously have been absent in robot-assisted therapy trials
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