Abstract
Background and purposeThere is little evidence available on the use of robot-assisted therapy in subacute stroke patients. A randomized controlled trial was carried out to evaluate the short-time efficacy of intensive robot-assisted therapy compared to usual physical therapy performed in the early phase after stroke onset.MethodsFifty-three subacute stroke patients at their first-ever stroke were enrolled 30 ± 7 days after the acute event and randomized into two groups, both exposed to standard therapy. Additional 30 sessions of robot-assisted therapy were provided to the Experimental Group. Additional 30 sessions of usual therapy were provided to the Control Group.The following impairment evaluations were performed at the beginning (T0), after 15 sessions (T1), and at the end of the treatment (T2): Fugl-Meyer Assessment Scale (FM), Modified Ashworth Scale-Shoulder (MAS-S), Modified Ashworth Scale-Elbow (MAS-E), Total Passive Range of Motion-Shoulder/Elbow (pROM), and Motricity Index (MI).ResultsEvidence of significant improvements in MAS-S (p = 0.004), MAS-E (p = 0.018) and pROM (p < 0.0001) was found in the Experimental Group. Significant improvement was demonstrated in both Experimental and Control Group in FM (EG: p < 0.0001, CG: p < 0.0001) and MI (EG: p < 0.0001, CG: p < 0.0001), with an higher improvement in the Experimental Group.ConclusionsRobot-assisted upper limb rehabilitation treatment can contribute to increasing motor recovery in subacute stroke patients. Focusing on the early phase of stroke recovery has a high potential impact in clinical practice.
Highlights
A progressive decrease in stroke mortality has been observed over the past years in western Countries together with a subsequent increase in survivors with residual impairments and disabilities that require assistance [1]
Only 3 randomized controlled trials (RCTs) with different methodological approaches have been carried out [18]: the results showed that upper limb robotic training during the subacute phase can contribute to improving functional abilities more than chronic phase training without any comparison with usual rehabilitative treatment
It is noteworthy that the statistical analysis of the change in Fugl-Meyer Assessment Scale (FM) between T0 and T1 and between T0 and T2 provided by a Wilcoxon signed rank test showed a greater improvement in the Experimental Group (EG) than the Control Group (CG) after the first 15 sessions (p < 0.0001 and p < 0.001, respectively)
Summary
A progressive decrease in stroke mortality has been observed over the past years in western Countries together with a subsequent increase in survivors with residual impairments and disabilities that require assistance [1]. The most frequent impairment caused by stroke is the restriction of motor activity, which reduces muscle movement and mobility [2], stroke may lead to sensory and cognitive impairment as well. Different intensive methods can be used to achieve these results but no clear evidence for the best treatment is yet available [5]. Intensive task-oriented training could contribute to achieving upper and lower limb impairment reduction even if this process is driven mainly by adaptive strategies that provide a compensation of impaired motor activity [6,7,8]. There is little evidence available on the use of robot-assisted therapy in subacute stroke patients. A randomized controlled trial was carried out to evaluate the short-time efficacy of intensive robot-assisted therapy compared to usual physical therapy performed in the early phase after stroke onset
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