Brain Neurorehabil.  2014 Sep;7(2):111-117. 10.12786/bn.2014.7.2.111.

Effects of Robot-assisted Arm Training in Patients with Subacute Stroke

• Joo MC
• Park HI
• Noh SE
• Kim JH
• Kim HJ
• Jang CH

• KMID: 1797644
• DOI: http://doi.org/10.12786/bn.2014.7.2.111

Abstract

OBJECTIVE
To investigate the effects of robot-assisted arm training on motor and functional recovery of upper limb in patients with subacute stroke. METHOD: Thirty one subacute stroke patients were randomly divided into 2 groups. Robot-assisted arm training group received robot-assisted therapy using Armeo(R)Spring (Hocoma Inc., Zurich, Switzerland) for thirty minutes per day and five times every week during four weeks while control group received conventional arm training with same duration and frequency as robotic group. Outcome measures were used manual muscle test (MMT) for motor strength, Fugl-Meyer assessment (FMA), Manual function test (MFT) for arm function, Korean-modified Barthel index (K-MBI) for activities of daily living, Korean-mini mental state examination (K-MMSE) and Computerized Neuro-Cognitive Function test software-40 (CNT-40) for cognitive function. All recruited patients underwent these evaluations before and after four weeks robot-assisted arm training.
RESULTS
Robot-assisted training on upper limb after subacute stroke showed improvement on motor strength, arm function, and activities of daily living. But change values in terms of MMT, FMA, MFT, K-MBI exhibited a no statistically significant difference compared with conventional group (p>0.05).
CONCLUSION
In patients with upper limb deficits after subacute stroke, Robot-assisted arm training was considered to facilitate motor and functional recovery of upper limb. But robot-assisted arm training did not significantly improve motor and arm function at 4 weeks compared with conventional arm training group. Further research is required about the comparison of conventional rehabilitation therapy group and the questions about the duration, severity of stroke.

Keyword

subacute stroke; robot; upper limb; rehabilitation

MeSH Terms

Activities of Daily Living
Arm*
Humans
Outcome Assessment (Health Care)
Rehabilitation
Stroke*
Upper Extremity

Figure

• 

  Fig. 1 Armeo®Spring robot.

Reference

1. Skilbeck CE, Wade DT, Hewer RL, Wood VA. Recovery after stroke. J Neurol Neurosurg Psychiatry. 1983; 46:5–8.

2. Geddes JM, Fear J, Tennant A, Pickering A, Hillman M, Chamberlain MA. Prevalence of self reported stroke in a population in northern England. J Epidemiol Community Health. 1996; 50:140–143.

3. Gowland C, Stratford P, Ward M, Moreland J, Torresin W, Van Hullenaar S, Sanford J, Barreca S, Vanspall B, Plews N. Measuring physical impairment and disability with the Chedoke-McMaster Stroke Assessment. Stroke. 1993; 24:58–63.

4. Twitchell TE. The restoration of motor function following hemiplegia in man. Brain. 1951; 74(4):443–480.

5. Bobath B. Observations on adult hemiplegia and suggestions for treatment. Physiotherapy. 1959; 45:279–289.

6. Flanagan EM. Methods for facilitation and inhibition of motor activity. Am J Phys Med. 1967; 46:1006–1011.

7. Basmajian JV, Gowland CA, Finlayson MA, Hall AL, Swanson LR, Stratford PW, Trotter JE, Brandstater ME. Stroke treatment: comparison of integrated behavioral-physical therapy vs traditional physical therapy programs. Arch Phys Med Rehabil. 1987; 68:267–272.

8. Basmajian JV, Gowland C, Brandstater ME, Swanson L, Trotter J. EMG feedback treatment of upper limb in hemiplegic stroke patients: a pilot study. Arch Phys Med Rehabil. 1982; 63:613–616.

9. Dickstein R, Hocherman S, Pillar T, Shaham R. Stroke rehabilitation. Three exercise therapy approaches. Phys Ther. 1986; 66:1233–1238.

10. Lord JP, Hall K. Neuromuscular reeducation versus traditional programs for stroke rehabilitation. Arch Phys Med Rehabil. 1986; 67:88–91.

11. Stern PH, McDowell F, Miller JM, Robinson M. Effects of facilitation exercise techniques in stroke rehabilitation. Arch Phys Med Rehabil. 1970; 51:526–531.

12. Wagenaar RC, Meijer OG, van Wieringen PC, Kuik DJ, Hazenberg GJ, Lindeboom J, Wichers F, Rijswijk H. The functional recovery of stroke: a comparison between neuro-developmental treatment and the Brunnstrom method. Scand J Rehabil Med. 1990; 22(1):1–8.

13. Bütefisch C, Hummelsheim H, Denzler P, Mauritz KH. Repetitive training of isolated movements improves the outcome of motor rehabilitation of the centrally paretic hand. J Neurol Sci. 1995; 130:59–68.

14. Blanton S, Wolf SL. An application of upper-extremity constraint-induced movement therapy in a patient with subacute stroke. Phys Ther. 1999; 79:847–853.

15. Chae J, Yu D. A critical review of neuromuscular electrical stimulation for treatment of motor dysfunction in hemiplegia. Assist Technol. 2000; 12(1):33–49.

16. X-angli C, Yiqi Z, Cuipeng Z, Xiaohua F. Design of an upper limb rehabilitation robot based on medical therapy. Procedia Engineering. 2011; 15:688–692.

17. Kahn LE, Zygman ML, Rymer WZ, Reinkensmeyer DJ. Robot-assisted reaching exercise promotes arm movement recovery in chronic hemiparetic stroke: a randomized controlled pilot study. J Neuroeng Rehabil. 2006; 06. 21. 3:12.

18. Lo AC, Guarino PD, Richards LG, Haselkorn JK, Wittenberg GF, Federman DG, Ringer RJ, Wagner TH, Krebs HI, Volpe BT, Bever CT Jr, Bravata DM, Duncan PW, Corn BH, Maffucci AD, Nadeau SE, Conroy SS, Powell JM, Huang GD, Peduzzi P. Robot-assisted therapy for long-term upper-limb impairment after stroke. N Engl J Med. 2010; 362:1772–1783.

19. Lum PS, Burgar CG, Van der Loos M, Shor PC, Majmundar M, Yap R. MIME robotic device for upper-limb neurorehabilitation in subacute stroke subjects: A follow-up study. J Rehabil Res Dev. 2006; 43(5):631–642.

20. Mehrholz J, Platz T, Kugler J, Pohl M. Electromechanical and robot-assisted arm training for improving arm function and activities of daily living after stroke. Cochrane Database Syst Rev. 2008; 10. 8. (4):CD006876.

21. Mehrholz J, Hädrich A, Platz T, Kugler J, Pohl M. Electromechanical and robot-assisted arm training for improving generic activities of daily living, arm function, and arm muscle strength after stroke. Cochrane Database Syst Rev. 2012; 6:CD006876.

22. Sanchez RJ, Reinkensmeyer D, Shah P, Liu J, Rao S, Smith R, Cramer S, Rahman T, Bobrow J. Monitoring functional arm movement for hone based therapy after stroke. In : Proceedings of the 26th international conference of the IEEE ENgineering in Medicine and Biology Society San Francisco; 2004. p. 4787–4790.

23. Sanchez RJ, Liu J, Rao S, Shah P, Smith R, Rahman T, Cramer SC, Bobrow JE, Reinkensmeyer DJ. Automating arm movement training following severe stroke: functional exercises with quantitative feedback in a gravity-reduced environment. IEEE Trans Neural Syst Rehabil Eng. 2006; 14(3):378–389.

24. Kim YH, Shin SH, Park SH, Ko MH. Cognitive assessment for patient with brain injury by computerized nueropsychological test. J Korean Acad Rehabil Med. 2001; 25:209–216.

25. Cauraugh J, Light K, Kim S, Thigpen M, Behrman A. Chronic motor dysfunction after stroke: recovering wrist and finger extension by electromyography-triggered neuromuscular stimulation. Stroke. 2000; 31:1360–1364.

26. Lee YH, Lee YT, Park KH, Kim SH, Jang SM, Kim TH, Lee MY. Effect of EMG-triggered electrical stimulation to improve arm function in patients with chronic hemiplegia. J Korean Acad Rehabil Med. 2003; 27:320–328.

27. Son MO, Kim ES, Park SW, Kim KM, Jang SJ, Oh JK. The Effect of Modified Constraint-induced Movement Therapy for the Stroke Patients in Inpatient Setting. J Korean Acad Rehabil Med. 2007; 31(1):56–62.

28. Reinkensmeyer DJ. Robotic assistance for upper extremity training after stroke. Stud Health Technol Inform. 2009; 145:25–39.

29. Brewer BR, McDowell SK, Worthen-Chaudhari LC. Poststroke upper extremity rehabilitation: A review of robotic systems and clinical results. Top Stroke Rehabil. 2007; 14(6):22–44.

30. Cameirão MS, Badia SB, Duarte E, Frisoli A, Verschure PF. The Combined impact of virtual reality neurorehabilitation and its interfaces on upper extremity functional recovery in patients with chronic stroke. Stroke. 2012; 43(10):2720–2728.

31. Merlo A, Longhi M, Giannotti E, Prati P, Giacobbi M, Ruscelli E, Mancini A, Ottaviani M, Montanari L, Mazzoli D. Upper limb evaluation with robotic exoskeleton. Normative values for indices of accuracy, speed and smothness. NeuroRehabilitation. 2013; 33:523–530.

32. Burgar CG, Lum PS, Scremin AM, Garber SL, Van der Loos HF, Kenney D, Shor P. Robot-assisted upper-limb therapy in acute rehabilitation setting following stroke: Department of Veterans Affairs multisite clinical trial. J Rehabil Res Dev. 2011; 48(4):445–458.

33. Masiero S, Armani M, Rosati G. Upper-limb robot-assisted therapy in rehabilitation of acute stroke patients: focused review and results of new randomized controlled trial. J Rehabil Res Dev. 2011; 48(4):355–366.

34. Lo AC, Guarino PD, Richards LG, Haselkorn JK, Wittenberg GF, Federman DG, Ringer RJ, Wagner TH, Krebs HI, Volpe BT, Bever CT Jr, Bravata DM, Duncan PW, Corn BH, Maffucci AD, Nadeau SE, Conroy SS, Powell JM, Huang GD, Peduzzi P. Robot-assisted therapy for long-term upper-limb impairment after stroke. N Engl J Med. 2010; 362(19):1772–1783.