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

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.

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

Journal of Healthcare Engineering ◽

10.1155/2020/8810867 ◽

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.

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Effects of robot-assisted therapy on upper extremity function and activities of daily living in hemiplegic patients: A single-blinded, randomized, controlled trial

Technology and Health Care ◽

10.3233/thc-181336 ◽

2018 ◽

Vol 26 (4) ◽

pp. 659-666 ◽

Cited By ~ 1

Author(s):

Min-Jae Lee ◽

Jung-Hoon Lee ◽

Sun-Min Lee

Keyword(s):

Randomized Controlled Trial ◽

Activities Of Daily Living ◽

Upper Extremity ◽

Daily Living ◽

Controlled Trial ◽

Robot Assisted ◽

Randomized Controlled ◽

Extremity Function ◽

Upper Extremity Function

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Robot-Assisted Therapy and Constraint-Induced Movement Therapy for Motor Recovery in Stroke: Results From a Randomized Clinical Trial

Frontiers in Neurorobotics ◽

10.3389/fnbot.2021.684019 ◽

2021 ◽

Vol 15 ◽

Author(s):

Thais Tavares Terranova ◽

Marcel Simis ◽

Artur César Aquino Santos ◽

Fábio Marcon Alfieri ◽

Marta Imamura ◽

...

Keyword(s):

Clinical Trial ◽

Activities Of Daily Living ◽

Randomized Clinical Trial ◽

Upper Limb ◽

Daily Living ◽

Movement Therapy ◽

Rehabilitation Program ◽

Motor Recovery ◽

Robot Assisted ◽

Constraint Induced Movement Therapy

Background: Stroke is one of the leading causes of adult disability, and up to 80% of stroke survivors undergo upper extremity motor dysfunction. Constraint-Induced Movement Therapy (CIMT) and Robot-Assisted Therapy (RT) are used for upper limb stroke rehabilitation. Although CIMT and RT are different techniques, both are beneficial; however, their results must be compared. The objective is to establish the difference between RT and CIMT after a rehabilitation program for chronic stroke patients.Method: This is a randomized clinical trial, registered at ClinicalTrials.gov (ID number NCT02700061), in which patients with stroke received sessions of RT or CIMT protocol, combined with a conventional rehabilitation program for 12 weeks. The primary outcome was measured by Wolf Motor Function Test (WMFT) and Fugl-Meyer Assessment—Upper Limb (FMA-UL). Activities of daily living were also assessed.Results: Fifty one patients with mild to moderate upper limb impairment were enrolled in this trial, 25 women and 26 men, mean age of 60,02 years old (SD 14,48), with 6 to 36 months after stroke onset. Function significantly improved regardless of the treatment group. However, no statistical difference was found between both groups as p-values of the median change of function measured by WMFT and FMA were 0.293 and 0.187, respectively.Conclusion: This study showed that Robotic Therapy (RT) was not different from Constraint-Induced Movement Therapy (CIMT) regardless of the analyzed variables. There was an overall upper limb function, motor recovery, functionality, and activities of daily living improvement regardless of the interventions. At last, the combination of both techniques should be considered in future studies.

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Virtual Activities of Daily Living for Recovery of Upper Extremity Motor Function

IEEE Transactions on Neural Systems and Rehabilitation Engineering ◽

10.1109/tnsre.2017.2771272 ◽

2018 ◽

Vol 26 (1) ◽

pp. 252-260 ◽

Cited By ~ 13

Author(s):

Richard J. Adams ◽

Matthew D. Lichter ◽

Allison Ellington ◽

Marga White ◽

Kate Armstead ◽

...

Keyword(s):

Activities Of Daily Living ◽

Upper Extremity ◽

Motor Function ◽

Daily Living

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Differing effects of an immersive virtual reality programme on unilateral spatial neglect on activities of daily living

BMJ Case Reports ◽

10.1136/bcr-2017-222860 ◽

2018 ◽

pp. bcr-2017-222860 ◽

Cited By ~ 2

Author(s):

Kazuhiro Yasuda ◽

Daisuke Muroi ◽

Mizuki Hirano ◽

Kenta Saichi ◽

Hiroyasu Iwata

Keyword(s):

Virtual Reality ◽

Activities Of Daily Living ◽

Daily Living ◽

Spatial Neglect ◽

Immersive Virtual Reality ◽

Unilateral Spatial Neglect

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Effects of short-term upper limb robot-assisted therapy on the rehabilitation of sub-acute stroke patients

Technology and Health Care ◽

10.3233/thc-202127 ◽

2020 ◽

pp. 1-9

Author(s):

Shangrong Jiang ◽

Hong You ◽

Weijing Zhao ◽

Min Zhang

Keyword(s):

Activities Of Daily Living ◽

Acute Stroke ◽

Motor Function ◽

Upper Limb ◽

Daily Living ◽

Muscle Tone ◽

Stroke Patients ◽

Robot Assisted ◽

Short Term ◽

Significant Difference

BACKGROUND: Robot-assisted therapy (RT) has become a promising stroke rehabilitation intervention. OBJECTIVE: To examine the effects of short-term upper limb RT on the rehabilitation of sub-acute stroke patients. METHODS: Subjects were randomly assigned to the RT group (n= 23) or conventional rehabilitation (CR) group (n= 22). All subjects received conventional rehabilitation therapy for 30 minutes twice a day, for 2 weeks. In addition, the RT group received RT for 30 minutes twice a day, for 2 weeks. The outcomes before treatment (T0) and at 2 weeks (T1) and 1 month follow-up (T2) were evaluated in the patients using the upper limb motor function test of the Fugl-Meyer assessment (FMA) the Motricity Index (MI), the Modified Ashworth Scale (MAS), the Functional Independence Measure (FIM), and the Barthel Index (BI). RESULTS: There were significant improvements in motor function scales (P< 0.001 for FMA and MI) and activities of daily living (P< 0.001 for FIM and BI) but without muscle tone (MAS, P> 0.05) in the RT and CR groups. Compared to the CR group, the RT group showed improvements in motor function and activities of daily living (P< 0.05 for FMA, MI, FIM, BI) at T1 and T2. There was no significant difference between the two groups in muscle tone (MAS, P> 0.05). CONCLUSIONS: RT may be a useful tool for sub-acute stroke patients’ rehabilitation.

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