Abstract P289: Therapist-Based and Robot-Assisted Physical Training Have Differential Effects on Motor Control of Upper Limb and Quality of Life after Chronic Stroke

Abstract

Introduction: Compensatory strategies for stroke-related motor impairment may cause a pattern of disuse that might limit the improvement of upper limb (UL) motor function, and incomplete UL motor recovery might detrimentally impact quality of life. Previous studies showed that bilateral arm physical training (BAT) can improve UL function after stroke and improves trunk stabilization. However, it remains uncertain that whether BAT can reduce trunk compensation during reaching. Furthermore, there is no study investigating therapist-guided bilateral arm training (TBAT) versus robot-assisted bilateral arm training (RBAT). Hypothesis: We tested the hypothesis that TBAT and RBAT, compared with control treatment (CT), would result in the better outcomes on movement control in the affected UL and less trunk compensation in reaching tasks and would improve quality of life. In addition, TBAT and RBAT may have differential effects on motor control and quality of life. Methods: Forty-two community dwelling chronic stroke survivors (54 years old; 18 months after stroke) were randomized to TBAT (N=14), RBAT (N=14), or CT (N=14) groups. Each group received a 90- to 105-minute training session, 5 days/week, for 4 weeks. The TBAT participants practiced a variety of bilateral functional tasks with each arm simultaneously under one-on-one supervision of therapists. In the RBAT, the robot-assisted arm trainer, Bi-Manu-Track, was introduced. The CT group involved some conventional therapeutic activities on the paretic arms, unilateral and bilateral fine motor tasks, and compensatory practice on functional tasks. Outcome measures consisted of kinematic analyses for motor control in unilateral and bilateral reaching tasks, and the Stroke Impact Scale for quality of life. Results: The kinematic results indicated that the TBAT group experienced better temporal efficiency and smoothness in unilateral reaching than the CT group. The TBAT group demonstrated less compensatory trunk movement than the CT or RBAT groups in both unilateral and bilateral tasks. In contrast, the RBAT engendered a larger improvement in shoulder flexion than the other groups. The RBAT demonstrated improved quality of life than the CT group characterized by better strength, physical function, and total scores of Stroke Impact Scale. Conclusions: TBAT and RBAT engendered differential effects on outcome measures than CT. TBAT may have better results on temporal efficiency, smoothness, and trunk control. In contrast, RBAT may experience the improved shoulder flexion and quality of life.