Clinimetric Properties of the Motor Activity Log for the Assessment of Arm Use in Hemiparetic Patients Robot-assisted therapy for long-term upper-limb impairment after stroke. Computerized Arm Training Improves the Motor Control of the Severely Affected Arm After Stroke: A Single-Blinded Randomized Trial in Two Centers Probability of regaining dexterity in the flaccid upper limb: impact of severity of paresis and time since onset in acute stroke. Robot-assisted upper-limb therapy in acute rehabilitation setting following stroke: Department of Veterans Affairs multisite clinical trial. Effects of upper limb robot-assisted therapy on motor recovery in subacute stroke patients Robot-assisted movement training compared with conventional therapy techniques for the rehabilitation of upper-limb motor function after stroke. Upper-limb robot-assisted therapy in rehabilitation of acute stroke patients: focused review and results of new randomized controlled trial. Effects of robotic therapy on motor impairment and recovery in chronic stroke. Who May Benefit From Armeo Power Treatment? A Neurophysiological Approach to Predict Neurorehabilitation Outcomes. Effects of robot-assisted upper limb rehabilitation on daily function and real-world arm activity in patients with chronic stroke: a randomized controlled trial Effects of Treatment Intensity in Upper Limb Robot-Assisted Therapy for Chronic Stroke Intensive Sensorimotor Arm Training Mediated by Therapist or Robot Improves Hemiparesis in Patients With Chronic Stroke Time Course of Trunk, Arm, Leg, and Functional Recovery After Ischemic Stroke Three-dimensional, task-specific robot therapy of the arm after stroke: a multicentre, parallel-group randomised trial Robotic Therapy Provides a Stimulus for Upper Limb Motor Recovery After Stroke That Is Complementary to and Distinct From Conventional Therapy Robotic-assisted rehabilitation of the upper limb after acute stroke. A Randomized Controlled Trial of Gravity-Supported, Computer-Enhanced Arm Exercise for Individuals With Severe Hemiparesis
Background and Purpose — The Motor Activity Log ( MAL ) is a semistructured interview for hemiparetic stroke patients to assess the use of their paretic arm and h and ( amount of use [ AOU ] ) and quality of movement [ QOM ] ) during activities of daily living . Scores range from 0 to 5 . The following clinimetric properties of the MAL were quantified : internal consistency ( Cronbach α ) , test – retest agreement ( Bl and and Altman method ) , cross-sectional construct validity ( correlation between AOU and QOM and with the Action Research Arm [ ARA ] test ) , longitudinal construct validity ( correlation of change on the MAL during the intervention with a global change rating [ GCR ] and with change on the ARA ) , and responsiveness ( effect size ) . Methods — Two baseline measurements 2 weeks apart and 1 follow-up measurement immediately after 2 weeks of intensive exercise therapy either with or without immobilization of the unimpaired arm ( forced use ) were performed in 56 chronic stroke patients . Results — Internal consistency was high ( AOU : α=0.88 ; QOM : α=0.91 ) . The limits of agreement were −0.70 to 0.85 and −0.61 to 0.71 for AOU and QOM , respectively . The correlation with the ARA score ( Spearman ρ ) was 0.63 ( AOU and QOM ) . However , the improvement on the MAL during the intervention was only weakly related to the GCR and to the improvement on the ARA , Spearman ρ was between 0.16 and 0.22 . The responsiveness ratio was 1.9 ( AOU ) and 2.0 ( QOM ) . Conclusion — The MAL is internally consistent and relatively stable in chronic stroke patients not undergoing an intervention . The cross-sectional construct validity of the MAL is reasonable , but the results raise doubt about its longitudinal construct validity BACKGROUND Effective rehabilitative therapies are needed for patients with long-term deficits after stroke . METHODS In this multicenter , r and omized , controlled trial involving 127 patients with moderate-to-severe upper-limb impairment 6 months or more after a stroke , we r and omly assigned 49 patients to receive intensive robot-assisted therapy  , 50 to receive intensive comparison therapy , and 28 to receive usual care . Therapy consisted of 36 1-hour sessions over a period of 12 weeks . The primary outcome was a change in motor function , as measured on the Fugl-Meyer Assessment of Sensorimotor Recovery after Stroke , at 12 weeks . Secondary outcomes were scores on the Wolf Motor Function Test and the Stroke Impact Scale . Secondary analyses assessed the treatment effect at 36 weeks . RESULTS At 12 weeks , the mean Fugl-Meyer score for patients receiving robot-assisted therapy was better than that for patients receiving usual care ( difference , 2.17 points ; 95 % confidence interval [ CI ] , -0.23 to 4.58 ) and worse than that for patients receiving intensive comparison therapy ( difference , -0.14 points ; 95 % CI , -2.94 to 2.65 ) , but the differences were not significant . The results on the Stroke Impact Scale were significantly better for patients receiving robot-assisted therapy than for those receiving usual care ( difference , 7.64 points ; 95 % CI , 2.03 to 13.24 ) . No other treatment comparisons were significant at 12 weeks . Secondary analyses showed that at 36 weeks , robot-assisted therapy significantly improved the Fugl-Meyer score ( difference , 2.88 points ; 95 % CI , 0.57 to 5.18 ) and the time on the Wolf Motor Function Test ( difference , -8.10 seconds ; 95 % CI , -13.61 to -2.60 ) as compared with usual care but not with intensive therapy . No serious adverse events were reported . CONCLUSIONS In patients with long-term upper-limb deficits after stroke , robot-assisted therapy did not significantly improve motor function at 12 weeks , as compared with usual care or intensive therapy . In secondary analyses , robot-assisted therapy improved outcomes over 36 weeks as compared with usual care but not with intensive therapy . ( Clinical Trials.gov number , NCT00372411 . Background and Purpose — To compare a computerized arm trainer ( AT ) , allowing repetitive practice of passive and active bilateral forearm and wrist movement cycle , and electromyography-initiated electrical stimulation ( ES ) of the paretic wrist extensor in severely affected subacute stroke patients . Method — A total of 44 patients , 4 to 8 weeks after stroke causing severe arm paresis ( Fugl – Meyer Motor Score [ FM , 0 to 66 ] < 18 ) , were r and omly assigned to either  AT or ES . All patients practice d 20 minutes every workday for 6 weeks . AT patients performed 800 repetitions per session with the robot and ES patients performed 60 to 80 wrist extensions per session . The primary outcome measure was the blindly assessed FM ( 0 to 66 ) , and the secondary measures were the upper limb muscle power ( Medical Research Council [ MRC ] sum , 0 to 45 ) and muscle tone ( Ashworth score sum , 0 to 25 ) , assessed at the beginning and end of treatment and at 3-month follow-up . Results — The AT group had a higher Barthel Index score at baseline , but the groups were otherwise homogenous . As expected , FM and MRC sum scores improved overtime in both groups but significantly more in the robot AT group . The initial Barthel Index score had no influence . In the robot AT group , FM score was 15 points higher at study end and 13 points higher at 3-month follow-up than the control ES group . MRC sum score was 15 points higher at study end and at 3-month follow-up compared with the control ES group . Muscle tone remained unchanged , and no side effects occurred . Conclusion — The computerized active arm training produced a superior improvement in upper limb motor control and power compared with ES in severely affected stroke patients . This is probably attributable to the greater number of repetitions and the bilateral approach BACKGROUND AND PURPOSE To improve the accuracy of early postonset prediction of motor recovery in the flaccid hemiplegic arm , the effects of change in motor function over time on the accuracy of prediction were evaluated , and a prediction model for the probability of regaining dexterity at 6 months was developed . METHODS In 102 stroke patients , dexterity and paresis were measured with the  Action Research Arm Test , Motricity Index , and Fugl-Meyer motor evaluation .  For model development , 23 c and i date determinants were selected . Logistic regression analysis was used for prognostic factors and model development . RESULTS At 6 months , some dexterity in the paretic arm was found in 38 % , and complete functional recovery was seen in 11.6 % of the patients . Total anterior circulation infa rcts , right hemisphere strokes , homonymous hemianopia , visual gaze deficit , visual inattention , and paresis were statistically significant related to a poor arm function . Motricity Index leg scores of at least 25 points in the first week and Fugl-Meyer arm scores of 11 points in the second week increasing to 19 points in the fourth week raised the probability of developing some dexterity ( Action Research Arm Test > or=10 points ) from 74 % ( positive predictive value [ PPV ] , 0.74 ; 95 % confidence interval [ CI ] , 0.63 to 0.86 ) to 94 % ( PPV , 0.83 ; 95 % CI , 0.76 to 0.91 ) at 6 months . No change in probabilities of prediction dexterity was found after 4 weeks . CONCLUSIONS Based on the Fugl-Meyer scores of the flaccid arm , optimal prediction of arm function outcome at 6 months can be made within 4 weeks after onset . Lack of voluntary motor control of the leg in the first week with no emergence of arm synergies at 4 weeks is associated with poor outcome at 6 months This r and omized , controlled , multisite Department of Veterans Affairs clinical trial assessed robot-assisted ( RA ) upper-limb therapy with the Mirror Image Movement Enabler ( MIME ) in the acute stroke rehabilitation setting . Hemiparetic subjects ( n = 54 ) received RA therapy using MIME for either up to 15 hours ( low-dose ) or 30 hours ( high-dose ) or received up to 15 hours of additional conventional therapy in addition to usual care ( control ) . The primary outcome measure was the Fugl-Meyer Assessment ( FMA ) . The secondary outcome measures were the Functional Independence Measure ( FIM ) , Wolf Motor Function Test , Motor Power , and Ashworth scores at intake , discharge , and 6-month follow-up . Mean duration of study treatment was 8.6 , 15.8 , and 9.4 hours for the low-dose , high-dose , and control groups , respectively . Gains in the primary outcome measure were not significantly different between groups at follow-up . Significant correlations were found at discharge between FMA gains and the dose and intensity of RA . Intensity also correlated with FMA gain at 6 months . The high-dose group had greater FIM gains than controls at discharge and greater tone but no difference in FIM changes compared with low-dose subjects at 6 months . As used during acute rehabilitation , motor-control changes at follow-up were no less with MIME than with additional conventional therapy . Intensity of training with MIME was positively correlated with motor-control gains Background and purpose There is little evidence available on the use of robot-assisted therapy in subacute stroke patients . A r and omized controlled trial was carried out to evaluate the short-time efficacy of intensive robot-assisted therapy compared to usual physical therapy performed in the early phase after stroke onset . Methods Fifty-three subacute stroke patients at their first-ever stroke were enrolled 30 ± 7 days after the acute event and r and omized into two groups , both exposed to st and ard therapy . Additional 30 sessions of robot-assisted therapy were provided to the Experimental Group . Additional 30 sessions of usual therapy were provided to the Control Group . The following impairment evaluations were performed at the beginning ( T0 ) , after 15 sessions ( T1 ) , and at the end of the treatment ( T2 ) : Fugl-Meyer Assessment Scale ( FM ) , Modified Ashworth Scale-Shoulder ( MAS-S ) , Modified Ashworth Scale-Elbow ( MAS-E ) , Total Passive Range of Motion-Shoulder/Elbow ( pROM ) , and Motricity Index ( MI ) . Results Evidence of significant improvements in MAS-S ( p = 0.004 ) , MAS-E ( p = 0.018 ) and pROM ( p < 0.0001 ) was found in the Experimental Group . Significant improvement was demonstrated in both Experimental and Control Group in FM ( EG : p < 0.0001 , CG : p < 0.0001 ) and MI ( EG : p < 0.0001 , CG : p < 0.0001 ) , with an higher improvement in the Experimental Group . Conclusions Robot-assisted upper limb rehabilitation treatment can contribute to increasing motor recovery in subacute stroke patients . Focusing on the early phase of stroke recovery has a high potential impact in clinical practice OBJECTIVE To compare the effects of robot-assisted movement training with conventional techniques for the rehabilitation of upper-limb motor function after stroke . DESIGN R and omized controlled trial , 6-month follow-up . SETTING A Department of Veterans Affairs rehabilitation research and development center . PARTICIPANTS Consecutive sample of 27 subjects with chronic hemiparesis ( > 6mo after cerebrovascular accident ) r and omly allocated to group . INTERVENTIONS All subjects received twenty-four 1-hour sessions over 2 months . Subjects in the robot group practice d shoulder and elbow movements while assisted by a robot manipulator . Subjects in the control group received neurodevelopmental therapy ( targeting proximal upper limb function ) and 5 minutes of exposure to the robot in each session . MAIN OUTCOME MEASURES Fugl-Meyer assessment of motor impairment , FIMtrade mark instrument , and biomechanic measures of strength and reaching kinematics . Clinical evaluations were performed by a therapist blinded to group assignments . RESULTS Compared with the control group , the robot group had larger improvements in the proximal movement portion of the Fugl-Meyer test after 1 month of treatment ( P<.05 ) and also after 2 months of treatment ( P<.05 ) . The robot group had larger gains in strength ( P<.02 ) and larger increases in reach extent ( P<.01 ) after 2 months of treatment . At the 6-month follow-up , the groups no longer differed in terms of the Fugl-Meyer test ( P>.30 ) ; however , the robot group had larger improvements in the FIM ( P<.04 ) . CONCLUSIONS Compared with conventional treatment , robot-assisted movements had advantages in terms of clinical and biomechanical measures . Further research into the use of robotic manipulation for motor rehabilitation is justified The successful motor rehabilitation of stroke patients requires early intensive and task-specific therapy . A recent Cochrane Review , although based on a limited number of r and omized controlled trials ( RCTs ) , showed that early robotic training of the upper limb ( i.e. , during acute or subacute phase ) can enhance motor learning and improve functional abilities more than chronic-phase training . In this article , a new subacute-phase RCT with the Neuro-Rehabilitation-roBot ( NeReBot ) is presented . While in our first study we used the NeReBot in addition to conventional therapy , in this new trial we used the same device in substitution of st and ard proximal upper-limb rehabilitation . With this protocol , robot patients achieved similar reductions in motor impairment and enhancements in paretic upper-limb function to those gained by patients in a control group . By analyzing these results and those of previous studies , we hypothesize a new robotic protocol for acute and subacute stroke patients based on both treatment modalities ( in addition and in substitution ) OBJECTIVE To examine whether robotic therapy can reduce motor impairment and enhance recovery of the hemiparetic arm in persons with chronic stroke . DESIGN Pre-posttest design . SETTING Rehabilitation hospital , outpatient care . PARTICIPANTS Volunteer sample of 20 persons diagnosed with a single , unilateral stroke within the past 1 to 5 years , with persistent hemiparesis . INTERVENTIONS Robotic therapy was provided 3 times weekly for 6 weeks . Subjects able to reach robot targets were r and omly assigned to sensorimotor or progressive-resistive robotic therapy groups . Robotic therapy consisted of goal -directed , planar reaching tasks to exercise the hemiparetic shoulder and elbow . MAIN OUTCOME MEASURES The Modified Ashworth Scale , Fugl-Meyer test of upper-extremity function , Motor Status Scale ( MSS ) score , and Medical Research Council motor power score . RESULTS Evaluations by a single blinded therapist revealed statistically significant gains from admission to discharge ( P<.05 ) on the Fugl-Meyer test , MSS score , and motor power score . Secondary analyses revealed group differences : the progressive-resistive therapy group experienced nonspecific improvements on wrist and h and MSS scores that were not observed in the sensorimotor group . CONCLUSIONS Robotic therapy may complement other treatment approaches by reducing motor impairment in persons with moderate to severe chronic impairments BACKGROUND The Armeo Power , a rehabilitation exoskeleton that allows early treatment of motor disabilities , provides intelligent arm support in a large 3-dimensional work space , thus enabling patients to perform intensive , repetitive , and goal -oriented exercises . This device could efficiently induce new connections and facilitate plasticity phenomena potentiation . Knowledge of the potential brain plasticity reservoir after brain damage constitutes a prerequisite for an optimal rehabilitation strategy . OBJECTIVE To identify potential neurophysiologic markers predicting the responsiveness of stroke patients to upper limb robotic treatment . DESIGN Prospect i ve cohort study . SETTING Behavioral and Robotic Neurorehabilitation Laboratory of IRCCS Centro Neurolesi Bonino-Pulejo , Messina , Italy . PATIENTS We enrolled 35 patients who had sustained a first-ever ischemic supratentorial stroke at least 2 months before enrollment and had unilateral hemiplegia . METHODS All patients underwent 40 Armeo Power training sessions that lasted 1 hour each ( ie , 5 times a week for 8 weeks ) . MAIN OUTCOME MEASUREMENTS We assessed the spasticity and motor function of the upper limb by means of the Modified Ashworth scale and Fugl-Meyer assessment , respectively . Moreover , we evaluated the cortical excitability and plasticity potential of the bilateral primary motor areas in response to the repetitive paired associative stimulation paradigm using transcranial magnetic stimulation and Armeo Power kinematic parameters . RESULTS The patients who showed significant repetitive paired associative stimulation aftereffects at baseline exhibited an evident increase of cortical plasticity in the affected hemisphere ( motor evoked potential amplitude increase , P = .03 ) , a decrease of interhemispheric inhibition ( affected hemisphere cortical silent period duration decrease , P = .01 ; unaffected hemisphere cortical silent period duration increase , P = .004 ; repetitive paired associative stimulation aftereffect increase , P = .008 ) . Such findings were paralleled by clinical improvements ( Fugl-Meyer , P = .04 ) and Armeo Power kinematic improvements ( elbow flexion/extension , P = .02 ; shoulder range of movement , P = .002 ) . CONCLUSIONS Our data suggest that use of Armeo Power may improve upper limb motor function recovery as predicted by reshaping of cortical and transcallosal plasticity , according to the baseline cortical excitability . LEVEL OF EVIDENCE IV Objective : To compare the outcome of robot-assisted therapy with dose-matched active control therapy by using accelerometers to study functional recovery in chronic stroke patients . Design : Prospect i ve , r and omized , controlled trial . Setting : Stroke units in three medical centres . Subjects : Twenty patients post stroke for a mean of 22 months . Intervention : Robot-assisted therapy ( n = 10 ) or dose-matched active control therapy ( n = 10 ) . All patients received either of these two therapies for 90–105 minutes each day , 5 days per week , for four weeks . Main measures : Outcome measures included arm activity ratio ( the ratio of mean activity between the impaired and unimpaired arm ) and scores on the Fugl-Meyer Assessment Scale , Functional Independence Measure , Motor Activity Log and ABILH AND question naire . Results : The robot-assisted therapy group significantly increased motor function , hemiplegic arm activity and bilateral arm coordination ( Fugl-Meyer Assessment Scale : 51.20 ± 8.82 , P = 0.002 ; mean arm activity ratio : 0.76 ± 0.10 , P = 0.026 ; ABILH AND question naire : 1.24 ± 0.28 , P = 0.043 ) compared with the dose-matched active control group ( Fugl-Meyer Assessment Scale : 40.90 ± 13.14 ; mean arm movement ratio : 0.69 ± 0.11 ; ABILH AND question naire : 0.95 ± 0.43 ) . Conclusions : Symmetrical and bilateral robotic practice , combined with functional task training , can significantly improve motor function , arm activity , and self-perceived bilateral arm ability in patients late after stroke Background and Objectives . Robot-assisted therapy ( RT ) is a current promising intervention in stroke rehabilitation , but more research is warranted for examining its efficacy and the dose – benefit relation . The authors investigated the effects of higher intensity versus lower intensity RT on movements of forearm pronation – supination and wrist flexion – extension relative to conventional rehabilitation ( CR ) in patients poststroke for a mean of 21 months . Methods . In this pilot study , 18 patients with initial mean Fugl-Meyer Assessment ( FMA ) of 37 to 44 for the upper extremity were r and omized to higher intensity RT , lower intensity RT , or CR intervention for 4 weeks . The dose of the higher intensity RT was twice the number of repetitions in the lower intensity RT . Outcome measures at pretreatment and posttreatment were administered to patients to evaluate beneficial and adverse effects of interventions . Primary outcomes were the FMA and Medical Research Council scale . Results . There were significant differences in motor function ( P = .04 ) and daily performance ( P = .03 ) among the 3 groups . The higher intensity RT group showed better improvement in motor function , muscle strength , performance of daily activities , and bimanual ability than the other 2 groups . The intensive RT intervention did not induce higher levels of an oxidative DNA biomarker . Conclusions . Higher intensity of RT that assists forearm and wrist movements may lead to greater improvement in motor ability and functional performance in stroke patients . A sample size of only 20 to 25 in each arm of a larger r and omized controlled trial is needed to confirm the findings for similar subjects Investigators have demonstrated that a variety of intensive movement training protocol s for persistent upper limb paralysis in patients with chronic stroke ( 6 months or more after stroke ) improve motor outcome . This r and omized controlled study determined in patients with upper limb motor impairment after chronic stroke whether movement therapy delivered by a robot or by a therapist using an intensive training protocol was superior . Robotic training ( n = 11 ) and an intensive movement protocol ( n = 10 ) improved the impairment measures of motor outcome significantly and comparably ; there were no significant changes in disability measures . Motor gains were maintained at the 3-month evaluation after training . These data contribute to the growing awareness that persistent impairments in those with chronic stroke may not reflect exhausted capacity for improvement . These new protocol s , rendered by either therapist or robot , can be st and ardized , tested , and replicated , and potentially will contribute to rational activity-based programs Background . Patterns of recovery provide useful information concerning the potential of physical recovery over time and therefore the setting of realistic goals for rehabilitation programs . Objective . To compare the time course of trunk recovery with the patterns of recovery of arm , leg , and functional ability . Methods . Consecutive stroke patients were recruited in 2 acute neurology wards . Participants were evaluated at 1 week , 1 month , and 3 and 6 months after stroke . Patients were assessed with the Trunk Impairment Scale , Fugl-Meyer arm and leg test , and Barthel Index . Results . Thirty-two patients were included in the study . There were no dropouts . Repeated measures analysis of the recovery patterns of motor and functional performance revealed the most striking improvement for all measures from 1 week to 1 month ( P value between .0021 and < .0001 ) and a significant improvement from 1 month to 3 months after stroke ( P value ranges from .0008 to < .0001 ) . No significant improvement was found between 3 and 6 months after stroke for any of the measures . Statistical analysis revealed no significant difference between time course of trunk , arm , leg , and functional recovery ( P = .2565 ) . No significant differences in level of motor and functional recovery were found at the different time points . Conclusions . Separate analyses of motor and functional recovery patterns after stroke confirm the importance of the first month for recovery . Contrary to common belief , the time course of recovery of the trunk is similar to the recovery of arm , leg , and functional ability BACKGROUND Arm hemiparesis secondary to stroke is common and disabling . We aim ed to assess whether robotic training of an affected arm with ARMin -- an exoskeleton robot that allows task-specific training in three dimensions-reduces motor impairment more effectively than does conventional therapy . METHODS In a prospect i ve , multicentre , parallel-group r and omised trial , we enrolled patients who had had motor impairment for more than 6 months and moderate-to-severe arm paresis after a cerebrovascular accident who met our eligibility criteria from four centres in Switzerl and . Eligible patients were r and omly assigned ( 1:1 ) to receive robotic or conventional therapy using a centre-stratified r and omisation procedure . For both groups , therapy was given for at least 45 min three times a week for 8 weeks ( total 24 sessions ) . The primary outcome was change in score on the arm ( upper extremity ) section of the Fugl-Meyer assessment ( FMA-UE ) . Assessors tested patients immediately before therapy , after 4 weeks of therapy , at the end of therapy , and 16 weeks and 34 weeks after start of therapy . Assessors were masked to treatment allocation , but patients , therapists , and data analysts were unmasked . Analyses were by modified intention to treat . This study is registered with Clinical Trials.gov , number NCT00719433 . FINDINGS Between May 4 , 2009 , and Sept 3 , 2012 , 143 individuals were tested for eligibility , of whom 77 were eligible and agreed to participate . 38 patients assigned to robotic therapy and 35 assigned to conventional therapy were included in analyses . Patients assigned to robotic therapy had significantly greater improvements in motor function in the affected arm over the course of the study as measured by FMA-UE than did those assigned to conventional therapy ( F=4.1 , p=0.041 ; mean difference in score 0.78 points , 95 % CI 0.03 - 1.53 ) . No serious adverse events related to the study occurred . INTERPRETATION Neurorehabilitation therapy including task-oriented training with an exoskeleton robot can enhance improvement of motor function in a chronically impaired paretic arm after stroke more effectively than conventional therapy . However , the absolute difference between effects of robotic and conventional therapy in our study was small and of weak significance , which leaves the clinical relevance in question . FUNDING Swiss National Science Foundation and Bangerter-Rhyner Stiftung Background . Individuals with chronic stroke often have long-lasting upper extremity impairments that impede function during activities of daily living . Rehabilitation robotics have shown promise in improving arm function , but current systems do not allow realistic training of activities of daily living . We have incorporated the ARMin III and H and SOME device into a novel robotic therapy modality that provides functional training of reach and grasp tasks . Objective . To compare the effects of equal doses of robotic and conventional therapy in individuals with chronic stroke . Methods . Subjects were r and omized to 12 hours of robotic or conventional therapy and then crossed over to the other therapy type after a 1-month washout period . Twelve moderate to severely impaired individuals with chronic stroke were enrolled , and 10 completed the study . Results . Across the 3-month study period , subjects showed significant improvements in the Fugl-Meyer ( P = .013 ) and Box and Blocks tests ( P = .028 ) . The robotic intervention produced significantly greater improvements in the Action Research Arm Test than conventional therapy ( P = .033 ) . Gains in the Box and Blocks test from conventional therapy were larger than from robotic therapy in subjects who received conventional therapy after robotic therapy ( P = .044 ) . Conclusions . Data suggest that robotic therapy can elicit improvements in arm function that are distinct from conventional therapy and supplements conventional methods to improve outcomes . Results from this pilot study should be confirmed in a larger study OBJECTIVE To investigate whether early therapy with a novel robotic device can reduce motor impairment and enhance functional recovery of poststroke patients with hemiparetic and hemiplegic upper limb . DESIGN A single-blind r and omized controlled trial , with an 8-month follow-up . SETTING Neurologic department and rehabilitation hospital . PARTICIPANTS Thirty-five patients with acute ( < or = 1 wk of onset ) , unilateral , ischemic embolic , or thrombotic stroke . INTERVENTIONS Patients of both groups received the same dose and length per day of st and ard poststroke multidisciplinary rehabilitation . Patients were r and omly assigned to 2 groups . The experimental group ( n=17 ) received additional early sensorimotor robotic training , 4 hours a week for 5 weeks ; the control group ( n=18 ) was exposed to the robotic device , 30 minutes a week , twice a week , but the exercises were performed with the unimpaired upper limb . Training by robot consisted of peripheral manipulation of the shoulder and elbow of the impaired limb , correlated with visual stimuli . MAIN OUTCOME MEASURES The Fugl-Meyer Assessment ( FMA ) of upper-extremity function ( shoulder/elbow and coordination and wrist/h and subsections ) to measure each trained limb segment ; the Medical Research Council ( MRC ) score to measure the strength of muscle force during 3 actions : shoulder abduction ( MRC deltoid ) , elbow flexion ( MRC biceps ) , and wrist flexion ( MRC wrist flexors ) ; the FIM instrument and its motor component ; and the Trunk Control Test ( TCT ) and Modified Ashworth Scale ( MAS ) . RESULTS Compared with the patients in the control group , the experimental group showed significant gains in motor impairment and functional recovery of the upper limb after robot therapy , as measured by the MRC deltoid ( P < or = .05 ) and biceps ( P<.05 ) scores , the FMA for the proximal upper arm ( P<.05 ) , the FIM instrument ( P<.05 ) , and the FIM motor score ( P<.01 ) ; these gains were also sustained at the 3- and 8-month follow-up . The FMA and MRC wrist flexor test findings did not differ statistically either at the end of training or at the follow-up sessions . We found no significant differences in MAS and TCT in either group in any of the evaluations . No adverse effects occurred and the robotic approach was very well accepted . CONCLUSIONS Patients who received robotic therapy in addition to conventional therapy showed greater reductions in motor impairment and improvements in functional abilities . Robotic therapy may therefore effectively complement st and ard rehabilitation from the start , by providing therapeutic support for patients with poststroke plegic and paretic upper limb Background / Objective . The authors previously developed a passive instrumented arm orthosis ( Therapy Wilmington Robotic Exoskeleton [ T-WREX ] ) that enables individuals with hemiparesis to exercise the arm by playing computer games in a gravity-supported environment . The purpose of this study was to compare semiautonomous training with T-WREX and conventional semiautonomous exercises that used a tabletop for gravity support . Methods . Twenty-eight chronic stroke survivors with moderate/severe hemiparesis were r and omly assigned to experimental ( T-WREX ) or control ( tabletop exercise ) treatment . A blinded rater assessed arm movement before and after twenty-four 1-hour treatment sessions and at 6-month follow-up . Subjects also rated subjective treatment preferences after a single-session crossover treatment . Results . All subjects significantly improved ( P ≤ .05 ) upper extremity motor control ( Fugl-Meyer ) , active reaching range of motion ( ROM ) , and self-reported quality and amount of arm use ( Motor Activity Log ) . Improvements were sustained at 6 months . The T-WREX group maintained gains on the Fugl-Meyer significantly better than controls at 6 months ( improvement of 3.6 ± 3.9 vs 1.5 ± 2.7 points , mean ± SD ; P = .04 ) . Subjects also reported a preference for T-WREX training . Conclusion . Gravity-supported arm exercise , using the T-WREX or tabletop support , can improve arm movement ability after chronic severe hemiparesis with brief one-on-one assistance from a therapist ( approximately 4 minutes per session ) . The 3-dimensional weight support , instant visual movement feedback , and simple virtual reality software provided by T-WREX were associated with modest sustained gains at 6-month follow-up when compared with the conventional approach
Technology-supported training is emerging as a solution to support therapists in their efforts providing high-intensity , repetitive , and task-specific treatment , in order to enhance the recovery process .
The aim of this review is to assess the effectiveness of different robotic devices ( end-effector and exoskeleton robots ) in comparison with any other type of intervention .
Furthermore , we aim to assess whether or not better improvements are obtained in the sub-acute phase after stroke onset than in the chronic phase .