Background:
Robot-assisted therapy (RT) is an effective approach to promote upper extremity motor recovery in patients with stroke. Previous research showed that severely affected patients were less responsive to RT than those with mild to moderate motor severity. It’s necessary to develop a combined therapy which can expand the optimal treatment effect of RT to all kinds of stroke patients. Neuromuscular electrical stimulation (ES) could be used to supplement RT to improve movement awareness and output.
Purpose:
To compare the effects of RT with ES, dose-matched RT with placebo ES, and conventional rehabilitation (CR) on motor and daily function, and quality of life in patients with chronic stroke.
Methods:
This is a single-blind randomized controlled trial. There were 30 patients with chronic stroke who were randomly assigned to one of the three groups: (1) RT with neuromuscular ES (RT+ES); (2) RT with placebo ES (no stimulations into the electrodes); (3) CR. All participants engaged in 90 to 105 minutes of training in each session, 5 times a week for 4 weeks. Outcome measures were Action Research Arm Test (ARAT) for motor function, accelerometer data of 3-day active level in affected hand for daily function, and Stroke Impact Scale (SIS) for quality of life. Analysis of covariance was used to compare the treatment effects among groups.
Results:
Significant between-group differences favoring the RT+ES group were shown on the grip subtest of ARAT (η2=.614, p <.05,) and the activity of accelerometer (η2=.260, p <.05) while a non-significant trend but large effect favoring RT+ES was observed on total score of ARAT (η2=.192, p=.411). A group effect favoring CR group on activity of daily living subscale of SIS was revealed (η2=.286, p <.05). There were no statistically significant differences on other outcome measures.
Conclusions:
Providing four weeks of RT+ES during chronic stroke appears to produce further improvements on hand grip and active level of affected hand in daily living than providing CR alone. Adding ES to RT could provide additional effect, given that active level of affected hand did not improved in the placebo group. Future study may incorporate more task-oriented practice into RT+ES treatment program to enhance treatment effects on life quality.
Effects of combining robot-assisted therapy with neuromuscular electrical stimulation on motor impairment, motor and daily function, and quality of life in patients with chronic stroke: a double-blinded randomized controlled trial
