Robotic-assisted therapy with bilateral practice improves task and motor performance in the upper extremities of chronic stroke patients: A randomised controlled trial.
activities of daily living
computer assisted
occupational therapy
stroke
therapy
Journal
Australian occupational therapy journal
ISSN: 1440-1630
Titre abrégé: Aust Occup Ther J
Pays: Australia
ID NLM: 15420200R
Informations de publication
Date de publication:
10 2019
10 2019
Historique:
received:
27
11
2017
revised:
15
04
2019
accepted:
16
06
2019
pubmed:
19
7
2019
medline:
4
9
2020
entrez:
19
7
2019
Statut:
ppublish
Résumé
Task-specific repetitive training, a usual care in occupational therapy practice, and robotic-aided rehabilitation with bilateral practice are used to improve upper limb motor and task performance. The difference in effects of two strategies requires exploration. This study compared the impact of robotic-assisted therapy with bilateral practice (RTBP) and usual task-specific training facilitated by therapists on task and motor performance for stroke survivors. Forty-three community-dwelling stroke survivors (20 males; 23 females; 53.3 ± 13.1 years; post-stroke duration 14.2 ± 10.9 months) were randomised into RTBP and usual care. All participants received a 10-minute per-protocol sensorimotor stimulation session prior to interventions as part of usual care. Primary outcome was different in the amount of use (AOU) and quality of movement (QOM) on the Motor Activity Log (MAL) scale at endpoint. Secondary outcomes were AOU and QOM scores at follow-up, and pre-post and follow-up score differences on the Fugl-Meyer Assessment (FMA) and surface electromyography (sEMG). Friedman and Mann-Whitney U tests were used to calculate difference. There were no baseline differences between groups. Both conditions demonstrated significant within-group improvements in AOU-MAL and FMA scores following treatment (P < 0.05) and improvements in FMA scores at follow-up (P < 0.05). The training-induced improvement in AOU (30.0%) following treatment was greater than the minimal detectable change (16.8%) in the RTBP group. RTBP demonstrated better outcomes in FMA wrist score (P = 0.003) and sEMG of wrist extensor (P = 0.043) following treatment and in AOU (P < 0.001), FMA total score (P = 0.006), FMA wrist score (P < 0.001) and sEMG of wrist extensor (P = 0.017) at follow-up compared to the control group. Control group boost more beneficial effects on FMA hand score (P = 0.049) following treatment. RTBP demonstrated superior upper limb motor and task performance outcomes compared to therapists-facilitated task training when both were preceded by a 10-minute sensorimotor stimulation session. ClinicalTrials.gov Identifier: NCT03847103.
Sections du résumé
BACKGROUND/AIM
Task-specific repetitive training, a usual care in occupational therapy practice, and robotic-aided rehabilitation with bilateral practice are used to improve upper limb motor and task performance. The difference in effects of two strategies requires exploration. This study compared the impact of robotic-assisted therapy with bilateral practice (RTBP) and usual task-specific training facilitated by therapists on task and motor performance for stroke survivors.
METHODS
Forty-three community-dwelling stroke survivors (20 males; 23 females; 53.3 ± 13.1 years; post-stroke duration 14.2 ± 10.9 months) were randomised into RTBP and usual care. All participants received a 10-minute per-protocol sensorimotor stimulation session prior to interventions as part of usual care. Primary outcome was different in the amount of use (AOU) and quality of movement (QOM) on the Motor Activity Log (MAL) scale at endpoint. Secondary outcomes were AOU and QOM scores at follow-up, and pre-post and follow-up score differences on the Fugl-Meyer Assessment (FMA) and surface electromyography (sEMG). Friedman and Mann-Whitney U tests were used to calculate difference.
RESULTS
There were no baseline differences between groups. Both conditions demonstrated significant within-group improvements in AOU-MAL and FMA scores following treatment (P < 0.05) and improvements in FMA scores at follow-up (P < 0.05). The training-induced improvement in AOU (30.0%) following treatment was greater than the minimal detectable change (16.8%) in the RTBP group. RTBP demonstrated better outcomes in FMA wrist score (P = 0.003) and sEMG of wrist extensor (P = 0.043) following treatment and in AOU (P < 0.001), FMA total score (P = 0.006), FMA wrist score (P < 0.001) and sEMG of wrist extensor (P = 0.017) at follow-up compared to the control group. Control group boost more beneficial effects on FMA hand score (P = 0.049) following treatment.
CONCLUSIONS
RTBP demonstrated superior upper limb motor and task performance outcomes compared to therapists-facilitated task training when both were preceded by a 10-minute sensorimotor stimulation session.
CLINICAL TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT03847103.
Identifiants
pubmed: 31317553
doi: 10.1111/1440-1630.12602
doi:
Banques de données
ClinicalTrials.gov
['NCT03847103']
Types de publication
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
637-647Subventions
Organisme : Chi Mei Medical Center
Pays : International
Organisme : National Cheng Kung University
ID : CMNCKU10304
Pays : International
Organisme : Medical Device Innovation Center
Pays : International
Informations de copyright
© 2019 Occupational Therapy Australia.
Références
Angelova, S., Ribagin, S., Raikova, R. & Veneva, I. (2018). Power frequency spectrum analysis of surface EMG signals of upper limb muscles during elbow flexion - A comparison between healthy subjects and stroke survivors. Journal of Electromyography & Kinesiology, 38, 7-16. https://doi.org/10.1016/j.jelekin.2017.10.013
Birkenmeier, R. L., Prager, E. M. & Lang, C. E. (2010). Translating animal doses of task-specific training to people with chronic stroke in 1-hour therapy sessions: a proof-of-concept study. Neurorehabil Neural Repair, 24, 620-635. https://doi.org/10.1177/1545968310361957
Chen, S., Wolf, S. L., Zhang, Q., Thompson, P. A. & Winstein, C. J. (2012). Minimal detectable change of the actual amount of use test and the motor activity log: the EXCITE Trial. Neurorehabil Neural Repair, 26, 507-514. https://doi.org/10.1177/1545968311425048
Dobkin, B. H. (2007). Confounders in rehabilitation trials of task-oriented training: lessons from the designs of the EXCITE and SCILT multicenter trials. Neurorehabil Neural Repair, 21, 3-13. https://doi.org/10.1177/1545968306297329
Foti, C., Laurini, A., Tiberti, S., Carli, G., Tsarpela, O., Adamidis, K., et al (2012). Leg extension test, sEMG and vibratory stimuli to assess functional recovery following knee joint surgery. Muscles, Ligaments and Tendons Journal, 2, 127-132.
Gandolfi, M., Formaggio, E., Geroin, C., Storti, S. F., Boscolo Galazzo, I., Bortolami, M., et al (2018). Quantification of Upper Limb Motor Recovery and EEG Power Changes after Robot-Assisted Bilateral Arm Training in Chronic Stroke Patients: A Prospective Pilot Study. Neural Plasticity, 2018, 8105480. https://doi.org/10.1155/2018/8105480
Gassert, R. & Dietz, V. (2018). Rehabilitation robots for the treatment of sensorimotor deficits: a neurophysiological perspective. J Neuroeng Rehabil, 15, 46. https://doi.org/10.1186/s12984-018-0383-x
Gialanella, B., Santoro, R. & Ferlucci, C. (2013). Predicting outcome after stroke: the role of basic activities of daily living predicting outcome after stroke. Eur J Phys Rehabil Med, 49, 629-637.
Gladstone, D. J., Danells, C. J. & Black, S. E. (2002). The fugl-meyer assessment of motor recovery after stroke: a critical review of its measurement properties. Neurorehabil Neural Repair, 16, 232-240. https://doi.org/10.1177/154596802401105171
Hoonhorst, M. H., Nijland, R. H., Van Den Berg, J. S., Emmelot, C. H., Kollen, B. J. & Kwakkel, G. (2015). How Do Fugl-Meyer Arm Motor Scores Relate to Dexterity According to the Action Research Arm Test at 6 Months Poststroke? Archives of Physical Medicine and Rehabilitation, 96, 1845-1849. https://doi.org/10.1016/j.apmr.2015.06.009
Jolliffe, L., Lannin, N. A., Cadilhac, D. A. & Hoffmann, T. (2018). Systematic review of clinical practice guidelines to identify recommendations for rehabilitation after stroke and other acquired brain injuries. British Medical Journal Open, 8, e018791. https://doi.org/10.1136/bmjopen-2017-018791
Karlsson, S. & Gerdle, B. (2001). Mean frequency and signal amplitude of the surface EMG of the quadriceps muscles increase with increasing torque-a study using the continuous wavelet transform. Journal of Electromyography & Kinesiology, 11, 131-140. https://doi.org/10.1016/S1050-6411(00)00046-8
Lang, C. E., Bland, M. D., Bailey, R. R., Schaefer, S. Y. & Birkenmeier, R. L. (2013). Assessment of upper extremity impairment, function, and activity after stroke: foundations for clinical decision making. Journal of Hand Therapy, 26 (2), 104-115. https://doi.org/10.1016/j.jht.2012.06.005
Lee, M. J., Lee, J. H., Koo, H. M. & Lee, S. M. (2017). Effectiveness of Bilateral Arm Training for Improving Extremity Function and Activities of Daily Living Performance in Hemiplegic Patients. Journal of Stroke and Cerebrovascular Diseases, 26, 1020-1025. https://doi.org/10.1016/j.jstrokecerebrovasdis.2016.12.008
Liao, W. W., Wu, C. Y., Hsieh, Y. W., Lin, K. C. & Chang, W. Y. (2012). Effects of robot-assisted upper limb rehabilitation on daily function and real-world arm activity in patients with chronic stroke: a randomized controlled trial. Clin Rehabil, 26, 111-120. https://doi.org/10.1177/0269215511416383
Lin, K. C., Chen, Y. A., Chen, C. L., Wu, C. Y. & Chang, Y. F. (2010). The effects of bilateral arm training on motor control and functional performance in chronic stroke: a randomized controlled study. Neurorehabil Neural Repair, 24, 42-51. https://doi.org/10.1177/1545968309345268
Lohse, K. R., Lang, C. E. & Boyd, L. A. (2014). Is more better? Using metadata to explore dose-response relationships in stroke rehabilitation. Stroke, 45, 2053-2058. https://doi.org/10.1161/STROKEAHA.114.004695
Mchugh, G. & Swain, I. D. (2014). A comparison between reported therapy staffing levels and the department of health therapy staffing guidelines for stroke rehabilitation: a national survey. BMC Health Serv Res, 14, 216. https://doi.org/10.1186/1472-6963-14-216
Mehrholz, J., Pohl, M., Platz, T., Kugler, J. & Elsner, B. (2018). Electromechanical and robot-assisted arm training for improving activities of daily living, arm function, and arm muscle strength after stroke. Cochrane Database Systematic Review, 9, CD006876. https://doi.org/10.1002/14651858.CD006876.pub5
Metcalfe, A. B. & Lawes, N. (1998). A modern interpretation of the Rood Approach. Physical Therapy Reviews, 3, 195-212. https://doi.org/10.1179/ptr.1998.3.4.195
Page, S. J., Hade, E. & Persch, A. (2015). Psychometrics of the wrist stability and hand mobility subscales of the Fugl-Meyer assessment in moderately impaired stroke. Physical Therapy, 95, 103-108. https://doi.org/10.2522/ptj.20130235
Patten, C., Lexell, J. & Brown, H. E. (2004). Weakness and strength training in persons with poststroke hemiplegia: rationale, method, and efficacy. Journal of Rehabilitation Research and Development, 41, 293-312. https://doi.org/10.1682/JRRD.2004.03.0293
Pezzotti, P., Scalmana, S., Mastromattei, A., Di Lallo, D., Progetto Alzheimer Working Group. (2008). The accuracy of the MMSE in detecting cognitive impairment when administered by general practitioners: a prospective observational study. BMC Fam Pract, 9, 29. https://doi.org/10.1186/1471-2296-9-29
Pollock, A., Farmer, S. E., Brady, M. C., Langhorne, P., Mead, G. E., Mehrholz, J. & et al (2014). Interventions for improving upper limb function after stroke. Cochrane Database Systematic Review, CD010820, https://doi.org/10.1002/14651858.CD010820.pub2
Reinkensmeyer, D. J., Wolbrecht, E. T., Chan, V., Chou, C., Cramer, S. C. & Bobrow, J. E. (2012). Comparison of three-dimensional, assist-as-needed robotic arm/hand movement training provided with Pneu-WREX to conventional tabletop therapy after chronic stroke. American Journal of Physical Medicine & Rehabilitation, 91, S232-241. https://doi.org/10.1097/PHM.0b013e31826bce79
Roberts, T. J. & Gabaldon, A. M. (2008). Interpreting muscle function from EMG: lessons learned from direct measurements of muscle force. Integrative and Comparative Biology, 48, 312-320. https://doi.org/10.1093/icb/icn056
Smith, A. L. & Staines, W. R. (2006). Cortical adaptations and motor performance improvements associated with short-term bimanual training. Brain Research, 1071, 165-174. https://doi.org/10.1016/j.brainres.2005.11.084
Stinear, C. M., Barber, P. A., Coxon, J. P., Fleming, M. K. & Byblow, W. D. (2008). Priming the motor system enhances the effects of upper limb therapy in chronic stroke. Brain, 131, 1381-1390. https://doi.org/10.1093/brain/awn051
Stoykov, M. E., Lewis, G. N. & Corcos, D. M. (2009). Comparison of bilateral and unilateral training for upper extremity hemiparesis in stroke. Neurorehabil Neural Repair, 23, 945-953. https://doi.org/10.1177/1545968309338190
Turner, D. L., Ramos-Murguialday, A., Birbaumer, N., Hoffmann, U. & Luft, A. (2013). Neurophysiology of robot-mediated training and therapy: a perspective for future use in clinical populations. Front Neurol, 4, 184. https://doi.org/10.3389/fneur.2013.00184
Wagner, J. M., Rhodes, J. A. & Patten, C. (2008). Reproducibility and minimal detectable change of three-dimensional kinematic analysis of reaching tasks in people with hemiparesis after stroke. Physical Therapy, 88, 652-663. https://doi.org/10.2522/ptj.20070255
Wilkins, K. B., Owen, M., Ingo, C., Carmona, C., Dewald, J. P. A. & Yao, J. (2017). Neural Plasticity in Moderate to Severe Chronic Stroke Following a Device-Assisted Task-Specific Arm/Hand Intervention. Front Neurol, 8, 284. https://doi.org/10.3389/fneur.2017.00284
Winstein, C. J., Stein, J., Arena, R., Bates, B., Cherney, L. R., Cramer, S. C., et al (2016). Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke, 47, e98-e169. https://doi.org/10.1161/STR.0000000000000098
Wu, C. Y., Yang, C. L., Chen, M. D., Lin, K. C. & Wu, L. L. (2013). Unilateral versus bilateral robot-assisted rehabilitation on arm-trunk control and functions post stroke: a randomized controlled trial. J Neuroeng Rehabil, 10, 35. https://doi.org/10.1186/1743-0003-10-35
Zwecker, M., Levenkrohn, S., Fleisig, Y., Zeilig, G., Ohry, A. & Adunsky, A. (2002). Mini-Mental State Examination, cognitive FIM instrument, and the Loewenstein Occupational Therapy Cognitive Assessment: relation to functional outcome of stroke patients. Archives of Physical Medicine and Rehabilitation, 83, 342-345. https://doi.org/10.1053/apmr.2002.29641