scholarly journals A RANDOMIZED CONTROLLED TRIAL ON THE EFFECTS OF OCCUPATIONAL THERAPY INTERVENTIONS USING PATIENT-CENTERED ROBOT-ASSISTED REHABILITATION FOR FUNCTIONAL IMPROVEMENT IN SUBACUTE STROKE PATIENTS

2021 ◽  
pp. 2140040
Author(s):  
DAESEOK YOON ◽  
SEUNGBOK LEE ◽  
SANG-HYUN CHO ◽  
HAEYEAN PARK ◽  
JONGBAE KIM
Keyword(s):  
Upper Limb ◽  
Controlled Trial ◽  
Stroke Patients ◽  
Robot Assisted ◽  
Patient Centered ◽  
Limb Function ◽  
Randomized Controlled ◽  
Upper Limb Function ◽  
Experimental Group ◽  
Adl Performance

The objective of this research study was to investigate the effect of patient-centered robot-assisted intervention for upper limb function improvement in stroke patients. Design: A double-blind randomized controlled trial. Intervention: Subjectively preferred areas of need for performing daily activities were identified by pre-interviewing and applied as target goals in the experimental group using a robotic device. Control-1 underwent a program focused on the robot system involving movements of upper limb joints. Control-2 participated in a conventional rehabilitation program. Methods: Forty-five participants engaged in 60 min of daily therapy, five times weekly for 3 weeks. The experimental group used the Canadian occupational performance measure (COPM) to identify subjectively preferred “patient-centered” focus needed areas to perform robotic device aided daily activities. Control-1 used a robot device-focused rehabilitation involving upper limb joint movements. Control-2 participated in conventional rehabilitation. Pre-post intervention measurements of hand, grip, power, and upper limb ROM were acquired by FMA-UE, MFT, and K-MBI. Results: A significant increase of function in the experimental group was observed in each subclass of function and activities of daily living (ADL) performance. Control-1 showed an increase in function without ADL improvement. Control-2 showed an increase in ADL and proximal areas of upper limb function without an increase in other areas. Conclusion: The “patient-centered” approach significantly improved upper limb function and ADL performance compared to “robot-centered” rehabilitation. Further studies are warranted to confirm these results and for generalizability in clinical application.

scholarly journals Augmented efficacy of intermittent theta burst stimulation on the virtual reality-based cycling training for upper limb function in patients with stroke: a double-blinded, randomized controlled trial

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Yu-Hsin Chen ◽  
Chia-Ling Chen ◽  
Ying-Zu Huang ◽  
Hsieh-Ching Chen ◽  
Chung-Yao Chen ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Outcome Measures ◽  
Upper Limb ◽  
Controlled Trial ◽  
Theta Burst Stimulation ◽  
Limb Function ◽  
Randomized Controlled ◽  
Upper Limb Function ◽  
Theta Burst ◽  
Cycling Training

Abstract Background Virtual reality and arm cycling have been reported as effective treatments for improving upper limb motor recovery in patients with stroke. Intermittent theta burst stimulation (iTBS) can increase ipsilesional cortical excitability, and has been increasingly used in patients with stroke. However, few studies examined the augmented effect of iTBS on neurorehabilitation program. In this study, we investigated the augmented effect of iTBS on virtual reality-based cycling training (VCT) for upper limb function in patients with stroke. Methods In this randomized controlled trial, 23 patients with stroke were recruited. Each patient received either 15 sessions of iTBS or sham stimulation in addition to VCT on the same day. Outcome measures were assessed before and after the intervention. Primary outcome measures for the improvement of upper limb motor function and spasticity were Fugl-Meyer Assessment-Upper Extremity (FMA-UE) and Modified Ashworth Scale Upper-Extremity (MAS-UE). Secondary outcome measures for activity and participation were Action Research Arm Test (ARAT), Nine Hole Peg Test (NHPT), Box and Block Test (BBT) and Motor Activity Log (MAL), and Stroke Impact Scale (SIS). Wilcoxon signed-rank tests were performed to evaluate the effectiveness after the intervention and Mann–Whitney U tests were conducted to compare the therapeutic effects between two groups. Results At post-treatment, both groups showed significant improvement in FMA-UE and ARAT, while only the iTBS + VCT group demonstrated significant improvement in MAS-UE, BBT, NHPT, MAL and SIS. The Mann–Whitney U tests revealed that the iTBS + VCT group has presented greater improvement than the sham group significantly in MAS-UE, MAL-AOU and SIS. However, there were no significant differences in the changes of the FMA-UE, ARAT, BBT, NHPT and MAL-QOM between groups. Conclusions Intermittent TBS showed augmented efficacy on VCT for reducing spasticity, increasing actual use of the affected upper limb, and improving participation in daily life in stroke patients. This study provided an integrated innovative intervention, which may be a promising therapy to improve upper limb function recovery in stroke rehabilitation. However, this study has a small sample size, and thus a further larger-scale study is warranted to confirm the treatment efficacy. Trial registration This trial was registered under ClinicalTrials.gov ID No. NCT03350087, retrospectively registered, on November 22, 2017

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