Abstract
BackgroundOver fifty percent of stroke patients experience chronic arm hand performance problems, compromising independence in daily life activities and quality of life. Task-oriented training may improve arm hand performance after stroke, whereby augmented therapy may lead to a better treatment outcome. Technology-supported training holds opportunities for increasing training intensity. However, the effects of robot-supported task-oriented training with real life objects in stroke patients are not known to date. The aim of the present study was to investigate the effectiveness and added value of the Haptic Master robot combined with task-oriented arm hand training in chronic stroke patients.MethodsIn a single-blind randomized controlled trial, 22 chronic stroke patients were randomly allocated to receive either task-oriented robot-assisted arm-hand training (experimental group) or task-oriented non-robotic arm-hand training (control group). For training, the T-TOAT (Technology-supported Task-Oriented Arm Training) method was applied. Training was provided during 8 weeks, 4 times/week, 2× 30 min/day.ResultsA significant improvement after training on the Action Research Arm Test (ARAT) was demonstrated in the experimental group (p = 0.008). Results were maintained until 6 months after cessation of the training. On the perceived performance measure (Motor Activity Log (MAL)), both, the experimental and control group improved significantly after training (control group p = 0.008; experimental group p = 0.013). The improvements on MAL in both groups were maintained until 6 months after cessation of the training. With regard to quality of life, only in the control group a significant improvement after training was found (EuroQol-5D p = 0.015, SF-36 physical p = 0.01). However, the improvement on SF-36 in the control group was not maintained (p = 0.012). No between-group differences could be demonstrated on any of the outcome measures.ConclusionArm hand performance improved in chronic stroke patients, after eight weeks of task oriented training. The use of a Haptic Master robot in support of task-oriented arm training did not show additional value over the video-instructed task-oriented exercises in highly functional stroke patients.Clinical trial registration informationCurrent Controlled Trials ISRCTN82787126
Highlights
Over fifty percent of stroke patients experience chronic arm hand performance problems, compromising independence in daily life activities and quality of life
Exclusion criteria were: 1) severe neglect (Bell Test [29], Letter Cancellation Test: minimum omission score of 15% [30]), 2) hemianopsia, 3) severe spasticity (Modified Ashworth Scale total arm > 3), 4) severe additional neurological, orthopaedic or rheumatoid impairments prior to stroke which could interfere with task performance, 5) Broca aphasia, Wernicke aphasia, global aphasia apraxia and 7) attending another study or therapy to improve arm-hand function
The highly functional chronic stroke patients in this study did not seem to benefit from the addition of a Haptic Master robot to execute task-oriented training with real life objects over training with the same video instructed exercises and real life objects alone
Summary
Over fifty percent of stroke patients experience chronic arm hand performance problems, compromising independence in daily life activities and quality of life. Task-oriented training may improve arm hand performance after stroke, whereby augmented therapy may lead to a better treatment outcome. The effects of robot-supported task-oriented training with real life objects in stroke patients are not known to date. The aim of the present study was to investigate the effectiveness and added value of the Haptic Master robot combined with task-oriented arm hand training in chronic stroke patients. Chronic arm hand performance problems are present in over 50% of the stroke patients [3], limiting the use of their arm and hand in everyday life activities [4,5], and limiting engagement in social life, and quality of life in general [6]. Technologysupported training is emerging as a solution to support therapists in their efforts and to relieve pressures on the health system
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