Abstract
Post stroke upper limb rehabilitation is a challenging problem with poor outcomes as 40% of survivors have functionally useless upper limbs. Robot-aided therapy (RAT) is a potential method to alleviate the effort of intensive, task-specific, repetitive upper limb exercises for both patients and therapists. The present study aims to investigate how a time matched combinatory training scheme that incorporates conventional and RAT, using H-Man, compares with conventional training toward reducing workforce demands. In a randomized control trial (NCT02188628, www.clinicaltrials.gov), 44 subacute to chronic stroke survivors with first-ever clinical stroke and predominant arm motor function deficits were recruited and randomized into two groups of 22 subjects: Robotic Therapy (RT) and Conventional Therapy (CT). Both groups received 18 sessions of 90 min; three sessions per week over 6 weeks. In each session, participants of the CT group received 90 min of 1:1 therapist-supervised conventional therapy while participants of the RT group underwent combinatory training which consisted of 60 min of minimally-supervised H-Man therapy followed by 30 min of conventional therapy. The clinical outcomes [Fugl-Meyer (FMA), Action Research Arm Test and, Grip Strength] and the quantitative measures (smoothness, time efficiency, and task error, derived from two robotic assessment tasks) were independently evaluated prior to therapy intervention (week 0), at mid-training (week 3), at the end of training (week 6), and post therapy (week 12 and 24). Significant differences within group were observed at the end of training for all clinical scales compared with baseline [mean and standard deviation of FMA score changes between baseline and week 6; RT: Δ4.41 (3.46) and CT: Δ3.0 (4.0); p < 0.01]. FMA gains were retained 18 weeks post-training [week 24; RT: Δ5.38 (4.67) and week 24 CT: Δ4.50 (5.35); p < 0.01]. The RT group clinical scores improved similarly when compared to CT group with no significant inter-group at all time points although the conventional therapy time was reduced to one third in RT group. There were no training-related adverse side effects. In conclusion, time matched combinatory training incorporating H-Man RAT produced similar outcomes compared to conventional therapy alone. Hence, this study supports a combinatory approach to improve motor function in post-stroke arm paresis.Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT02188628.
Highlights
There is a growing number of patients who are suffering from sensorimotor disabilities [1], in part due to the aging population
The proportion of time spent on 1:1 conventional therapy was one third of the total therapy time and we examine if this combinatory approach, with two thirds substitution using an arm robot, compares with conventional therapy alone
An equal number of dominant and non-dominant arms were trained in both groups (15 dominant and 7 nondominant arms trained in each Robotic Therapy (RT) and Conventional Therapy (CT) training groups)
Summary
There is a growing number of patients who are suffering from sensorimotor disabilities [1], in part due to the aging population. Stroke remains a leading cause of death and disability globally. Findings from the Global Burden of Disease Study of 2017 [2, 3] indicate that stroke was the third leading cause of mortality (accounting for over 6.1 million deaths) and one of five leading causes of morbidity worldwide (accounting for 132 millions disability-adjusted life-years). Hemiparetic weakness is common after stroke [4], affecting over 70% of stroke survivors and demands the need for intensive training as upper limb impairments remain in 40% of survivors [5, 6]. There is a pressing need for physical therapy and insufficient therapists to meet the high demand for intensive upper limb therapy. Robotic devices are introduced as a potential solution to provide quality ensured upper limb intensive therapy and decrease therapists’ workload [7,8,9,10]
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