Robot-assisted reaching exercise promotes arm movement recovery in chronic hemiparetic stroke: a randomized controlled pilot study MIME robotic device for upper-limb neurorehabilitation in subacute stroke subjects: A follow-up study. Repetitive bilateral arm training and motor cortex activation in chronic stroke: a randomized controlled trial. Repetitive Bilateral Arm Training With Rhythmic Auditory Cueing Improves Motor Function in Chronic Hemiparetic Stroke Classification of Subtype of Acute Ischemic Stroke: Definitions for Use in a Multicenter Clinical Trial Computerized Arm Training Improves the Motor Control of the Severely Affected Arm After Stroke: A Single-Blinded Randomized Trial in Two Centers Comparison of Two Techniques of Robot-Aided Upper Limb Exercise Training After Stroke Automated Constraint-Induced Therapy Extension (AutoCITE) for movement deficits after stroke. Response to upper-limb robotics and functional neuromuscular stimulation following stroke. Probability of regaining dexterity in the flaccid upper limb: impact of severity of paresis and time since onset in acute stroke. PEDro: A Database of Randomised Controlled Trials in Physiotherapy Robot-aided neurorehabilitation. Robot-assisted movement training compared with conventional therapy techniques for the rehabilitation of upper-limb motor function after stroke. Effects of robotic therapy on motor impairment and recovery in chronic stroke. Robot training enhanced motor outcome in patients with stroke maintained over 3 years Intensive Sensorimotor Arm Training Mediated by Therapist or Robot Improves Hemiparesis in Patients With Chronic Stroke Evidence for improved muscle activation patterns after retraining of reaching movements with the MIME robotic system in subjects with post-stroke hemiparesis Does Shorter Rehabilitation Limit Potential Recovery Poststroke? Robot-mediated upper limb physiotherapy for patients with spastic hemiparesis: a preliminary study. A novel approach to stroke rehabilitation Paretic Upper-Limb Strength Best Explains Arm Activity in People With Stroke Recovery of upper extremity function in stroke patients: the Copenhagen Stroke Study. Robotic-assisted rehabilitation of the upper limb after acute stroke.
Background and purpose Providing active assistance to complete desired arm movements is a common technique in upper extremity rehabilitation after stroke . Such active assistance may improve recovery by affecting somatosensory input , motor planning , spasticity or soft tissue properties , but it is labor intensive and has not been vali date d in controlled trials . The purpose of this study was to investigate the effects of robotically administered active-assistive exercise and compare those with free reaching voluntary exercise in improving arm movement ability after chronic stroke . Methods Nineteen individuals at least one year post-stroke were r and omized into one of two groups . One group performed 24 sessions of active-assistive reaching exercise with a simple robotic device , while a second group performed a task-matched amount of unassisted reaching . The main outcome measures were range and speed of supported arm movement , range , straightness and smoothness of unsupported reaching , and the Rancho Los Amigos Functional Test of Upper Extremity Function . Results and discussion There were significant improvements with training for range of motion and velocity of supported reaching , straightness of unsupported reaching , and functional movement ability . These improvements were not significantly different between the two training groups . The group that performed unassisted reaching exercise improved the smoothness of their reaching movements more than the robot-assisted group . Conclusion Improvements with both forms of exercise confirmed that repeated , task-related voluntary activation of the damaged motor system is a key stimulus to motor recovery following chronic stroke . Robotically assisting in reaching successfully improved arm movement ability , although it did not provide any detectable , additional value beyond the movement practice that occurred concurrently with it . The inability to detect any additional value of robot-assisted reaching may have been due to this pilot study 's limited sample size , the specific diagnoses of the participants , or the inclusion of only individuals with chronic stroke This study presents results from a r and omized controlled clinical trial of the Mirror Image Movement Enabler ( MIME ) robotic device for shoulder and elbow neurorehabilitation in subacute stroke patients , including data on the use of its bilateral training mode . MIME incorporates a PUMA 560 robot ( Staubli Unimation Inc , Duncan , South Carolina ) that applies forces to the paretic limb during unilateral and bilateral movements in three dimensions . Robot-assisted treatment ( bilateral , unilateral , and combined bilateral and unilateral ) was compared with conventional therapy . Similar to a previous study in chronic stroke , combined unilateral and bilateral robotic training had advantages compared with conventional therapy , producing larger improvements on a motor impairment scale and a measure of abnormal synergies . However , gains in all treatment groups were equivalent at the 6-month follow-up . Combined unilateral and bilateral training yielded functional gains that were similar to the gains from equivalent doses of unilateral-only robotic training , although the combined group had more hypertonia and less movement out of synergy at baseline . Robot-assisted treatment gains exceeded those expected from spontaneous recovery . These results are discussed in light of the need for further device development and continued clinical trials CONTEXT Reorganization in central motor networks occurs during early recovery from hemiparetic stroke . In chronic stroke survivors , specific rehabilitation therapy can improve upper extremity function . OBJECTIVE To test the hypothesis that in patients who have chronic motor impairment following stroke , specific rehabilitation therapy that improves arm function is associated with reorganization of cortical networks . DESIGN , SETTING , AND PATIENTS A r and omized controlled clinical trial conducted in a US ambulatory rehabilitation program with 21 patients ( median [ IQR ] , 50.3 [ 34.8 - 77.3 ] months after unilateral stroke ) . Data were collected between 2001 and 2004 . INTERVENTIONS Patients were r and omly assigned to bilateral arm training with rhythmic auditory cueing ( BATRAC ) ( n = 9 ) or st and ardized dose-matched therapeutic exercises ( DMTE ) ( n = 12 ) . Both were conducted for 1 hour , 3 times a week , for 6 weeks . MAIN OUTCOME MEASURES Within 2 weeks before and after the intervention , brain activation during elbow movement assessed by functional magnetic resonance imaging ( fMRI ) and functional outcome assessed using arm function scores . RESULTS Patients in the BATRAC group but not in the DMTE group increased hemispheric activation during paretic arm movement ( P = .03 ) . Changes in activation were observed in the contralesional cerebrum and ipsilesional cerebellum ( P = .009 ) . BATRAC was associated with significant increases in activation in pre central ( P<.001 ) and post central gyri ( P = .03 ) and the cerebellum ( P<.001 ) , although 3 BATRAC patients showed no fMRI changes . Considering all patients , there were no differences in functional outcome between groups . When only BATRAC patients with fMRI response were included ( n = 6 ) , BATRAC improved arm function more than DMTE did ( P = .02 ) . CONCLUSIONS These preliminary findings suggest that BATRAC induces reorganization in contralesional motor networks and provide biological plausibility for repetitive bilateral training as a potential therapy for upper extremity rehabilitation in hemiparetic stroke Background and Purpose Chronic upper extremity hemiparesis is a leading cause of functional disability after stroke . We investigated the hypothesis that bilateral arm training with rhythmic auditory cueing ( BATRAC ) will improve motor function in the hemiparetic arm of stroke patients . Methods In this single group pilot study we determined the effects of 6 weeks of BATRAC on 14 patients with chronic hemiparetic stroke ( median time after stroke , 30 months ) immediately after training and at 2 months after training . Four 5-minute periods per session ( 3 times per week ) of BATRAC were performed with the use of a custom- design ed arm training machine . Results The patients showed significant and potentially durable increases in the following : Fugl-Meyer Upper Extremity Motor Performance Test of impairment ( P < 0.0004 ) , Wolf Motor Function Test ( performance time measure , P < 0.02 ) , and University of Maryl and Arm Question naire for Stroke measuring daily use of the hemiparetic arm ( P < 0.002 ) . Isometric strength improved in elbow flexion ( P < 0.05 ) and wrist flexion ( P < 0.02 ) for the paretic arm and in elbow flexion ( P < 0.02 ) and wrist extension ( P < 0.02 ) for the nonparetic arm . Active range of motion improved for paretic-side shoulder extension ( P < 0.01 ) , wrist flexion ( P < 0.004 ) , and thumb opposition ( P < 0.002 ) , and passive range of motion improved for paretic wrist flexion ( P < 0.03 ) . Conclusions Six weeks of BATRAC improves functional motor performance of the paretic upper extremity as well as a few changes in isometric strength and range of motion . These benefits are largely sustained at 8 weeks after training cessation Background and Purpose The etiology of ischemic stroke affects prognosis , outcome , and management . Trials of therapies for patients with acute stroke should include measurements of responses as influenced by subtype of ischemic stroke . A system for categorization of subtypes of ischemic stroke mainly based on etiology has been developed for the Trial of Org 10172 in Acute Stroke Treatment ( TOAST ) . Methods A classification of subtypes was prepared using clinical features and the results of ancillary diagnostic studies . “ Possible ” and “ probable ” diagnoses can be made based on the physician 's certainty of diagnosis . The usefulness and interrater agreement of the classification were tested by two neurologists who had not participated in the writing of the criteria . The neurologists independently used the TOAST classification system in their bedside evaluation of 20 patients , first based only on clinical features and then after review ing the results of diagnostic tests . Results The TOAST classification denotes five subtypes of ischemic stroke : 1 ) large-artery atherosclerosis , 2 ) cardioembolism , 3 ) small-vessel occlusion , 4 ) stroke of other determined etiology , and 5 ) stroke of undetermined etiology . Using this rating system , interphysician agreement was very high . The two physicians disagreed in only one patient . They were both able to reach a specific etiologic diagnosis in 11 patients , whereas the cause of stroke was not determined in nine . Conclusions The TOAST stroke subtype classification system is easy to use and has good interobserver agreement . This system should allow investigators to report responses to treatment among important subgroups of patients with ischemic stroke . Clinical trials testing treatments for acute ischemic stroke should include similar methods to diagnose subtypes of stroke 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 Stein J , Krebs HI , Frontera WR , Fasoli SE , Hughes R , Hogan N : Comparison of two techniques of robot-aided upper limb exercise training after stroke . Am J Phys Med Rehabil 2004;83:720–728 . Objective : This study examined whether incorporating progressive resistive training into robot-aided exercise training provides incremental benefits over active-assisted robot-aided exercise for the upper limb after stroke . Design : A total of 47 individuals at least 1 yr poststroke were enrolled in this 6-wk training protocol . Paretic upper limb motor abilities were evaluated using clinical measures and a robot-based assessment to determine eligibility for robot-aided progressive resistive training at study entry . Subjects capable of participating in resistance training were r and omized to receive either active-assisted robot-aided exercises or robot-aided progressive resistance training . Subjects who were incapable of participating in resistance training underwent active-assisted robotic therapy and were again screened for eligibility after 3 wks of robotic therapy . Those subjects capable of participating in resistance training at 3 wks were then r and omized to receive either robot-aided resistance training or to continue with robot-aided active-assisted training . Results : One subject withdrew due to unrelated medical issues , and data for the remaining 46 subjects were analyzed . Subjects in all groups showed improvement in measures of motor control ( mean increase in Fugl-Meyer of 3.3 ; 95 % confidence interval , 2.2–4.4 ) and maximal force ( mean increase in maximal force of 3.5 N , P = 0.027 ) over the course of robot-aided exercise training . No differences in outcome measures were observed between the resistance training groups and the matched active-assisted training groups . Subjects ’ ability to perform the robotic task at the time of group assignment predicted the magnitude of the gain in motor control . Conclusion : The incorporation of robot-aided progressive resistance exercises into a program of robot-aided exercise did not favorably or negatively affect the gains in motor control or strength associated with this training , though interpretation of these results is limited by sample size . Individuals with better motor control at baseline experienced greater increases in motor control with robotic training We report progress in the development of AutoCITE , a workstation that delivers the task practice component of upper-limb Constraint-Induced Movement therapy and that can potentially be used in the clinic or the home without the need for one-on-one supervision from a therapist . AutoCITE incorporates a computer and eight task devices arranged on a modified cabinet . Task performance is automatically recorded , and several types of feedback are provided . In preliminary testing , nine chronic stroke subjects with mild to moderate motor deficits practice d with AutoCITE for 3 h each weekday for 2 weeks . Subjects wore a padded mitt on the less-affected h and for a target of 90 % of their waking hours . In terms of effect sizes , gains were large and significant on the Motor Activity Log , and moderate to large on the Wolf Motor Function Test . These gains were comparable to the gains of a matched group of 12 subjects who received st and ard Constraint-Induced Movement therapy Twelve moderately to severely involved chronic stroke survivors ( > 12 mo ) were r and omized to one of two treatments : robotics and motor learning ( ROB-ML ) or functional neuromuscular stimulation and motor learning ( FNS-ML ) . Treatment was 5 h/d , 5 d/wk for 12 wk . ROB-ML group had 1.5 h per session devoted to robotics shoulder and elbow ( S/E ) training . FNS-ML had 1.5 h per session devoted to functional neuromuscular stimulation ( surface electrodes ) for wrist and h and ( W/H ) flexors/extensors . The primary outcome measure was the functional measure Arm Motor Ability Test ( AMAT ) . Secondary measures were AMAT-S/E and AMAT-W/H , Fugl-Meyer ( FM ) upper-limb coordination , and the motor control measures of target accuracy ( TA ) and smoothness of movement ( SM ) .  ROB-ML produced significant gains in AMAT , AMAT-S/E , FM upper-limb coordination , TA , and SM .  FNS-ML produced significant gains in AMAT-W/H and FM upper-limb coordination 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 PEDro is a data base of clinical trials design ed to assist the practice of evidence -based physiotherapy . When complete , it will contain bibliographic details , abstract s and quality assessment scores of all published r and omised controlled trials in physiotherapy . Trials on the data base will be rated on the basis of their method ological quality , so that users of the data base can be guided to those trials which provide the most method ologically sound sources of evidence . The data base has been made freely available on the world wide web , where it can be search ed with a powerful and user-friendly search engine Our goal is to apply robotics and automation technology to assist , enhance , quantify , and document neurorehabilitation . This paper review s a clinical trial involving 20 stroke patients with a prototype robot-aided rehabilitation facility developed at the Massachusetts Institute of Technology , Cambridge , ( MIT ) and tested at Burke Rehabilitation Hospital , White Plains , NY . It also presents our approach to analyze kinematic data collected in the robot-aided assessment procedure . In particular , we present evidence 1 ) that robot-aided therapy does not have adverse effects , 2 ) that patients tolerate the procedure , and 3 ) that peripheral manipulation of the impaired limb may influence brain recovery . These results are based on st and ard clinical assessment procedures . We also present one approach using kinematic data in a robot-aided assessment procedure 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 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 Article abstract In an attempt to improve motor recovery of the upper limb after stroke , we added a robot ( MIT-Manus ) experience that provided additional goal -directed sensorimotor activity to st and ard rehabilitation treatments . The first trial produced a significant decrease in motor impairment in the upper limb for the treated group . In re-evaluating 12 of those 20 patients , nearly 3 years later , robot-trained patients showed further significant decreases in impairment measures of the affected limb . The groups were comparable at the start of the study 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 Previously , we reported that chronic stroke subjects had significant improvements in isometric strength , free reaching extent , and clinical evaluations of function after training in the  mirror-image movement enabler ( MIME ) robotic device . Our primary goal in this analysis was to investigate the hypothesis that the robotic training promoted improved muscle activation patterns . To this end , we examined the interaction forces , kinematics , and electromyograms recorded during training of eight different movement patterns in active-constrained mode . In this mode , the robot constrained the reaching movements to be toward the target , and the movement velocity was proportional to the force produced along the trajectory . Thirteen chronic stroke subjects trained in MIME for 24 1-h sessions over an eight-week period . Work output was significantly increased by week five in all eight movement patterns . Low-level subjects increased their extent of reach , while high-level subjects increased their speed . Directional errors in force production were reduced in six of eight movement patterns . Electromyographic data provided evidence for improved muscle activation patterns in the four movement patterns that started at tabletop level and ended at shoulder level . In contrast , there was no evidence of improved muscle activation patterns in any of the tabletop movements , with increased activation of antagonists in two movement patterns . This dichotomy may have been related to compensation at the shoulder girdle during movements that remained at tabletop level . A simple biomechanical model will be introduced to demonstrate the likelihood of this possibility Objective . To examine retrospectively the recovery of patients engaged in robotic research during a 6- to 7-week course of inpatient rehabilitation . Because timing of the Interim evaluation at 31/2 weeks was comparable to the present length of inpatient stroke rehabilitation , the authors assessed whether significant gains in motor abilities occurred after the time when most stroke patients today are discharged home . Methods . Fifty-six in patients with a single , unilateral stroke were r and omly assigned to a robot therapy or robot exposure group . Therapists blinded to group assignment administered the Fugl-Meyer , Motor Status Score , and MRC motor power test . Results . Significant improvements in upper-limb motor abilities occurred throughout a period approximately twice the present length of stay in inpatient rehabilitation . However , in the latter half of this period , patients who received conventional therapy showed little improvement , whereas patients who received robot training plus conventional therapy continued to improve . Conclusion . Further opportunities for recovery after stroke are possible by extending intensive therapy beyond present inpatient rehabilitation stays OBJECTIVE To investigate the clinical usefulness of the REHAROB Therapeutic System , which provides passive robot-mediated physiotherapy for patients with spastic hemiparesis . DESIGN Controlled , r and omized , preliminary study . PATIENTS AND METHODS Thirty patients with hemiparesis as a consequence of upper motor neurone lesion were divided r and omly into 2 groups : robotic and control . Subjects from both groups received 30 minutes of Bobath therapy sessions on 20 consecutive work days . Members of the robotic group received an additional 30 minutes of robot-mediated therapy on the same days . The clinical status of each patient was assessed before the first session and at the end of the programme . The difference in the scores was statistically evaluated by t-test for dependent variables in case of parametric data and Friedman 's test in case of non-parametric data . RESULTS The majority of the parameters measured improved in both groups , but modified Ashworth score of shoulder adductors and elbow flexors showed a statistically significant change only in the robotic group . CONCLUSION The results suggest that it could be useful to supplement traditional physiotherapy with this form of robot-mediated therapy . Clinical investigation of a higher number of patients is planned in the near future Objective : In patients with stroke , the authors tested whether additional sensorimotor training of the paralyzed or paretic upper limb delivered by a robotic device enhanced motor outcome . Methods : Fifty-six patients with stroke and hemiparesis or hemiplegia received st and ard poststroke multidisciplinary rehabilitation  , and were r and omly assigned either to receive robotic training ( at least 25 hours ) or exposure to the robotic device without training . Outcomes were assessed by the same masked raters , before treatment began and at the end of treatment , with the upper extremity component of the Fugl-Meyer Motor Assessment , the Motor Status score , the Motor Power score , and Functional Independence Measurement . Result : The robot treatment and control group had comparable clinical characteristics , lesion size , and pretreatment impairment scores . By the end of treatment , the robot-trained group demonstrated improvement in motor outcome for the trained shoulder and elbow ( Motor Power score , p < 0.001 ; Motor Status score , p < 0.01 ) that did not generalize to untrained wrist and h and . The robot-treated group also demonstrated significantly improved functional outcome ( Functional Independence Measurement – Motor , p < 0.01 ) . Conclusion : Robot-delivered quantitative and reproducible sensorimotor training enhanced the motor performance of the exercised shoulder and elbow . The robot-treated group also demonstrated improved functional outcome . When added to st and ard multidisciplinary rehabilitation , robotics provides novel therapeutic strategies that focus on impairment reduction and improved motor performance Background and Purpose The purpose of this study was to determine the relationship among variables of upper-limb impairment , upper-limb performance in activities of daily living ( activity ) , and engagement in life events and roles ( participation ) in people with chronic stroke . Subjects The subjects were 93 community-dwelling individuals with stroke ( ≥1 year ) . Methods This study , which was conducted in a tertiary rehabilitation center , used a cross-sectional design . The main measures of impairment were the Modified Ashworth Scale , h and held dynamometry , sensory testing ( monofilaments ) , and the Brief Pain Inventory .  The main measures of activity were the  Chedoke Arm and H and Activity Inventory ( CAHAI ) and the Motor Activity Log ( MAL ) . The main measure of participation was the Reintegration to Normal Living ( RNL ) Index . Results Paretic upper-limb strength ( force-generating capacity ) ( r=.89 , P<.01 ) , grip strength ( r=.69 , P<.01 ) , and tone ( resistance to passive movement ) ( r=−.80 , P<.01 ) were the impairment variables that were most strongly related to activity . Tone ( r=−.23 , P<.05 ) and CAHAI scores ( r=.22 , P<.05 ) had a significant , but weak , relationship to participation . Upper-limb strength accounted for 87 % of the variance of the CAHAI scores and 78 % of the variance of the MAL scores . In the participation models , tone and CAHAI scores accounted for 5 % of the variance of the RNL Index scores . Discussion and Conclusion Paretic upper-limb strength had the strongest relationship with variables of activity and best explained upper-limb performance in activities of daily living . Grip strength , tone , and sensation also were factors of upper-limb performance in activities of daily living . Increased tone and upper-limb performance in activities of daily living had a weak relationship with participation Time course and degree of recovery of upper extremity ( UE ) function after stroke and the influence of initial UE paresis were studied prospect ively in a community-based population of 421 consecutive stroke patients admitted acutely during a 1-year period .  UE function was assessed weekly , using the Barthel Index subscores for feeding and grooming . UE paresis was assessed by the Sc and inavian Stroke Scale subscores for h and and arm . The best possible UE function was achieved by 80 % of the patients within 3 weeks after stroke onset and by 95 % within 9 weeks ; in patients with mild UE paresis , function was achieved within 3 and 6 weeks , respectively , and in patients with severe UE paresis within 6 and 11 weeks , respectively . Full UE function was achieved by 79 % of patients with mild UE paresis and only by 18 % of patients with severe UE paresis . A valid prognosis of UE function can be made within 3 and 6 weeks in patients with mild and severe UE paresis , respectively . Further recovery of UE function should not be expected after 6 and 11 weeks respectively , in these groups of patients 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 Electromechanical and robot-assisted arm training devices are used in rehabilitation and might help to improve arm function after  stroke .
OBJECTIVES To assess the effectiveness of electromechanical and robot-assisted arm training for improving activities of daily living and arm function and motor strength of patients after stroke , and the acceptability and safety of the therapy .