Probability of regaining dexterity in the flaccid upper limb: impact of severity of paresis and time since onset in acute stroke. Robot-aided neurorehabilitation.
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 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
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 generic activities of daily living , arm function , and arm muscle strength in patients after stroke .
We will also assess the acceptability and safety of the therapy .