Abstract
BackgroundEffectiveness of robotic therapy and transcranial direct current stimulation is conventionally assessed with clinical measures. Robotic metrics may be more objective and sensitive for measuring the efficacy of interventions on stroke survivor’s motor recovery. This study investigated if robotic metrics detect a difference in outcomes, not seen in clinical measures, in a study of transcranial direct current stimulation (tDCS) preceding robotic therapy. Impact of impairment severity on intervention response was also analyzed to explore optimization of outcomes by targeting patient sub-groups.MethodsThis 2020 study analyzed data from a double-blind, sham-controlled, randomized multi-center trial conducted from 2012 to 2016, including a six-month follow-up. 82 volunteers with single chronic ischemic stroke and right hemiparesis received anodal tDCS or sham stimulation, prior to robotic therapy. Robotic therapy involved 1024 repetitions, alternating shoulder-elbow and wrist robots, for a total of 36 sessions. Shoulder-elbow and wrist kinematic and kinetic metrics were collected at admission, discharge, and follow-up.ResultsNo difference was detected between the tDCS or sham stimulation groups in the analysis of robotic shoulder-elbow or wrist metrics. Significant improvements in all metrics were found for the combined group analysis. Novel wrist data showed smoothness significantly improved (P < ·001) while submovement number trended down, overlap increased, and interpeak interval decreased. Post-hoc analysis showed only patients with severe impairment demonstrated a significant difference in kinematics, greater for patients receiving sham stimulation.ConclusionsRobotic data confirmed results of clinical measures, showing intensive robotic therapy is beneficial, but no additional gain from tDCS. Patients with severe impairment did not benefit from the combined intervention. Wrist submovement characteristics showed a delayed pattern of motor recovery compared to the shoulder-elbow, relevant to intensive intervention-related recovery of upper extremity function in chronic stroke.Trial registrationhttp://www.clinicaltrials.gov. Actual study start date September 2012. First registered on 15 November 2012. Retrospectively registered. Unique identifiers: NCT01726673 and NCT03562663.
Highlights
Effectiveness of robotic therapy and transcranial direct current stimulation is conventionally assessed with clinical measures
Analysis of kinematic and kinetic data: effectiveness of transcranial direct current stimulation (tDCS) Completed robotic evaluation results were available for 76/82 enrolled subjects at discharge and 72 at six-month follow-up (Fig. 1)
There was no noteworthy difference in any metric between the RobottDCS and RobotSham groups at admission, discharge, or follow-up for the shoulder-elbow or wrist data of all patients
Summary
Effectiveness of robotic therapy and transcranial direct current stimulation is conventionally assessed with clinical measures. This study investigated if robotic metrics detect a difference in outcomes, not seen in clinical measures, in a study of transcranial direct current stimulation (tDCS) preceding robotic therapy. Edwards et al, 2019 investigated the effectiveness of combining intensive robotic therapy for the UE with anodal transcranial direct current stimulation (tDCS, RobottDCS) compared to sham-tDCS (RobotSham) in a chronic stroke population. Results showed 36 therapy sessions produced significant and clinically meaningful improvements in motor recovery (as measured by the FuglMeyer Assessment of Upper Extremity Motor Recovery after Stroke (FMA-UE)) of both the RobottDCS and RobotSham groups. The application of anodal tDCS did not confer further advantage as measured by clinical outcome measures (Edwards et al, 2019)
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