scholarly journals Robot-Assisted Arm Training versus Therapist-Mediated Training after Stroke: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Zejian Chen ◽  
Chun Wang ◽  
Wei Fan ◽  
Minghui Gu ◽  
Gvzalnur Yasin ◽  
...  
Keyword(s):  
Systematic Review ◽  
Activities Of Daily Living ◽  
Upper Extremity ◽  
Social Participation ◽  
Effect Size ◽  
Daily Living ◽  
Meta Analysis ◽  
Motor Impairment ◽  
Robot Assisted ◽  
Arm Rehabilitation

Background. More than two-thirds of stroke patients have arm motor impairments and function deficits on hospital admission, leading to diminished quality of life and reduced social participation. Robot-assisted training (RAT) is a promising rehabilitation program for upper extremity while its effect is still controversial due to heterogeneity in clinical trials. We performed a systematic review and meta-analysis to compare robot-assisted training (RAT) versus therapist-mediated training (TMT) for arm rehabilitation after stroke. Methods. We searched the following electronic databases: MEDLINE, EMBASE, Cochrane EBM Reviews, and Physiotherapy Evidence Database (PEDro). Studies of moderate or high methodological quality (PEDro score ≥4) were included and analyzed. We assessed the effects of RAT versus TMT for arm rehabilitation after stroke with testing the noninferiority of RAT. A small effect size of −2 score for mean difference in Fugl-Meyer Assessment of the Upper Extremity (FMA-UE) and Cohen’s d = −0.2 for standardized mean difference (SMD) were set as noninferiority margin. Results. Thirty-five trials with 2241 participants met inclusion criteria. The effect size for arm motor impairment, capacity, activities of daily living, and social participation were 0.763 (WMD, 95% CI: 0.404 to 1.123), 0.109 (SMD, 95% CI: −0.066 to 0.284), 0.049 (SMD, 95% CI: −0.055 to 0.17), and −0.061 (SMD, 95% CI: −0.196 to 0.075), respectively. Conclusion. This systematic review and meta-analysis demonstrated that robot-assisted training was slightly superior in motor impairment recovery and noninferior to therapist-mediated training in improving arm capacity, activities of daily living, and social participation, which supported the use of RAT in clinical practice.

scholarly journals Robot-Assisted Arm Training in Stroke Individuals With Unilateral Spatial Neglect: A Pilot Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Ze-Jian Chen ◽  
Ming-Hui Gu ◽  
Chang He ◽  
Cai-Hua Xiong ◽  
Jiang Xu ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Activities Of Daily Living ◽  
Upper Extremity ◽  
Outcome Measures ◽  
Motor Function ◽  
Social Participation ◽  
Daily Living ◽  
Spatial Neglect ◽  
Robot Assisted ◽  
Unilateral Spatial Neglect

Background: Robot-assisted arm training (RAT) is an innovative exercise-based therapy that provides highly intensive, adaptive, and task-specific training, yet its effects for stroke individuals with unilateral spatial neglect remain to be explored. The study was aimed to investigate the effects of RAT on unilateral spatial neglect, arm motor function, activities of daily living, and social participation after stroke.Methods: In a pilot randomized controlled trial, individuals with unilateral spatial neglect after right hemisphere stroke were equally allocated to intervention group and control group, 45-min training daily, 5 days/week, for 4 weeks. Outcome measures included the Behavioral Inattention Test-conventional section (BIT-C), Catherine Bergego Scale (CBS), Fugl-Meyer Assessment for Upper Extremity (FMA-UE), Modified Barthel Index (MBI), and World Health Organization Disability Assessment Schedule Version 2.0 (WHODAS 2.0).Results: From November 2018 to February 2021, 20 stroke patients (mean age 47.40 ± 8.47) were enrolled in the study. Robot-assisted arm training was feasible and safe for individuals with unilateral spatial neglect. Both groups had significant improvements in all outcome measures. Participants assigned to RAT therapy had significantly greater improvements in BIT-C (difference, 7.70; 95% CI, 0.55–14.85, P = 0.04), FMA-UE (difference, 5.10; 95% CI, 1.52–8.68, P = 0.01), and WHODAS 2.0 (difference, −7.30; 95% CI, −12.50 to −2.10, P = 0.01). However, the change scores on CBS and MBI demonstrated no significance between the groups.Conclusion: Our findings provide preliminary support for introducing robot-assisted arm training to remediate unilateral spatial neglect after stroke. The training program focusing on neglect of contralateral space and affected upper extremity may be effective in neglect symptoms, motor function recovery, and social participation, while not generalizing into improvements in activities of daily living.Clinical Trial Registration: Chinese Clinical Trial Registry (http://www.chictr.org.cn/) on 17 October 2019, identifier: ChiCTR1900026656.

scholarly journals Effects of Virtual Reality-Based Intervention on Cognition, Motor Function, Mood, and Activities of Daily Living in Patients With Chronic Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Vol 13 ◽  
Author(s):  
Yong Gao ◽  
Lu Ma ◽  
Changsheng Lin ◽  
Shizhe Zhu ◽  
Lingling Yao ◽  
...  
Keyword(s):  
Systematic Review ◽  
Virtual Reality ◽  
Activities Of Daily Living ◽  
Motor Function ◽  
Daily Living ◽  
Meta Analysis ◽  
Chronic Stroke ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Global Cognition

Background: The efficacy of virtual reality (VR)-based intervention for improving cognition in patients with the chronic stage of stroke is controversial. The aims of this meta-analysis were to evaluate the effect of VR-based training combined with traditional rehabilitation on cognition, motor function, mood, and activities of daily living (ADL) after chronic stroke.Methods: The search was performed in the Cochrane Library (CENTRAL), EBSCO, EMBASE, Medline (OVID), Web of Science databases, PubMed, CINAHL Ovid, and Scopus from inception to May 31, 2021. All included studies were randomized controlled trials (RCTs) examining VR-based intervention combined with traditional rehabilitation for chronic stroke. The main outcomes of this study were cognition, including overall cognition (combined with all cognitive measurement results), global cognition (measured by the Montreal Cognitive Assessment, MoCA, and/or Mini-Mental State Examination, MMSE), and attention/execution. The additional outcomes were motor function, mood, and ADL. Subgroup analyses were conducted to verify the potential factors for heterogeneity.Results: Six RCTs including 209 participants were included for systematic review, and five studies of 177 participants were included in meta-analyses. Main outcome analyses showed large and significant effect size (ES) of VR-based training on overall cognition (g = 0.642; 95% CI = 0.134–1.149; and P = 0.013) and attention/execution (g = 0.695; 95% CI = 0.052–1.339; and P = 0.034). Non-significant result was found for VR-based intervention on global cognition (g = 0.553; 95% CI = −0.273–1.379; and P = 0.189). Additional outcome analyses showed no superiority of VR-based intervention over traditional rehabilitation on motor function and ADL. The ES of VR-based intervention on mood (g = 1.421; 95% CI = 0.448–2.393; and P = 0.004) was large and significant. In the subgroup analysis, large effects for higher daily intensity, higher weekly frequency, or greater dose of VR intervention were found.Conclusion: Our findings indicate that VR-based intervention combined with traditional rehabilitation showed better outcomes for overall cognition, attention/execution, and depressive mood in individuals with chronic stroke. However, VR-based training combined with traditional rehabilitation showed a non-significant effect for global cognition, motor function, and ADL in individuals with chronic stroke.

scholarly journals Home-Based Physical Activity Programs for People With Dementia: Systematic Review and Meta-Analysis

2019 ◽  
Vol 60 (8) ◽  
pp. e600-e608 ◽  
Author(s):  
Sara Isabel Lebre de Almeida ◽  
Madalena Gomes da Silva ◽  
Alda Sofia Pires de Dias Marques
Keyword(s):  
Physical Activity ◽  
Systematic Review ◽  
Activities Of Daily Living ◽  
Daily Living ◽  
Meta Analysis ◽  
Functional Reach ◽  
People With Dementia ◽  
Home Based ◽  
Functional Reach Test

Abstract Background and Objectives Physical activity has the potential to improve health outcomes in people with dementia, namely when living at home. However, the knowledge about home-based physical activity for this population is scarce. Thus, we aim to identify and synthesize the effects of home-based physical activity for people with dementia. Research Design and Methods A systematic review was conducted. Quality of studies was assessed using the Delphi List. Effect sizes (ES) were calculated with MetaXL 2.0. A meta-analysis was conducted for the Mini-Mental Status Examination (MMSE), Neuropsychiatric Inventory (NPI), Cornell Scale for Depression in Dementia, Alzheimer’s Disease Cooperative Study Group Activities of Daily Living Scale (ADCS-ADL), Functional Reach test, Timed Up and Go (TUG) test, Short Physical Performance Battery, Dementia Quality of Life, NPI Caregivers subscale and Zarit Burden Interview (ZBI). Results Sixteen randomized controlled trials were included. Most were of high quality and published after 2015. A large heterogeneity of interventions was found. Meta-analysis showed significant results in MMSE (ES = 0.71, 95% CI 0.43, 0.99), NPI (ES = −0.37, 95% CI −0.57, −0.17), ADCS-ADL (ES = 0.80, 95% CI 0.53, 1.07), Functional Reach test (ES = 2.24, 95% CI 1.80, 2.68), TUG test (ES = −2.40, 95% CI −2.84, −1.96), NPI Caregivers subscale (ES = −0.63, 95% CI −0.94, −0.32), and ZBI (ES = −0.45, 95% CI −0.77, −0.13). Few minor adverse events and high adherence to intervention were found. Discussion and Implications Home-based physical activity seems safe and effective in delaying cognitive function decline and improving changes in behavioral and psychological symptoms of dementia, activities of daily living, health-related physical fitness, and carer’s burden in people with dementia living at home.

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