Abstract
BackgroundRobot-assisted therapy (RT) is a widely used intervention approach to enhance motor recovery in patients after stroke, but its effects on functional improvement remained uncertain. Neuromuscular electrical stimulation (NMES) is one potential adjuvant intervention approach to RT that could directly activate the stimulated muscles and improve functional use of the paretic hand.MethodsThis was a randomized, double-blind, sham-controlled study. Thirty-nine individuals with chronic stroke were randomly assigned to the RT combined with NMES (RT + ES) or to RT with sham stimulation (RT + Sham) groups. The participants completed the intervention 90 to 100 minutes/day, 5 days/week for 4 weeks. The outcome measures included the upper extremity Fugl-Meyer Assessment (UE-FMA), modified Ashworth scale (MAS), Wolf Motor Function Test (WMFT), Motor Activity Log (MAL), and Stroke Impact Scale 3.0 (SIS). All outcome measures were assessed before and after intervention, and the UE-FMA, MAL, and SIS were reassessed at 3 months of follow-up.ResultsCompared with the RT + Sham group, the RT + ES group demonstrated greater improvements in wrist flexor MAS score, WMFT quality of movement, and the hand function domain of the SIS. For other outcome measures, both groups improved significantly after the interventions, but no group differences were found.ConclusionRT + ES induced significant benefits in reducing wrist flexor spasticity and in hand movement quality in patients with chronic stroke.Trial registrationClinicalTrials.gov. NCT01655446
Highlights
The goal of neurorehabilitation is to restore and maximize physiological function, activities of daily living (ADL), and quality of life for patients with neurological disorders [1]
A significant time main effect was found (F2, 74 = 11.852, p = .001, η2 = .243), with no significant group main effect (F1, 37 = 1.635, p = .209, η2 = .042). This result showed that the upper extremity (UE)-Fugl-Meyer Assessment (FMA) score improved significantly after the bimanual Robot-assisted therapy (RT) intervention, but the 2 groups did not differ in the amount of improvement (Table 2)
A systematic review found that the effects of RT on muscle spasticity were inconsistent [11], suggesting that the reduction in spasticity observed in this study was probably attributed to the adjuvant treatment effects of Neuromuscular electrical stimulation (NMES)
Summary
The goal of neurorehabilitation is to restore and maximize physiological function, activities of daily living (ADL), and quality of life for patients with neurological disorders [1]. Robot-assisted therapy (RT) has recently been widely investigated as an effective neurorehabilitation approach that may augment the effects of therapists’ training and facilitate motor recovery [2]. RT has the advantages of providing highintensity and repetitive arm practice, it cannot directly activate the paretic muscles to enhance motor control of the muscles [4]. This insufficient sensorimotor control of the muscles may limit the functional use of the paretic limb in daily living [12]. Robot-assisted therapy (RT) is a widely used intervention approach to enhance motor recovery in patients after stroke, but its effects on functional improvement remained uncertain. Neuromuscular electrical stimulation (NMES) is one potential adjuvant intervention approach to RT that could directly activate the stimulated muscles and improve functional use of the paretic hand
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