A novel approach to stroke rehabilitation

TLDR

The study tested whether robotic sensorimotor training of the affected upper limb improves motor outcomes in stroke patients. Fifty‑six stroke patients with hemiparesis or hemiplegia were randomized to receive ≥25 h of robotic sensorimotor training or device exposure while continuing standard rehabilitation, and motor outcomes were evaluated pre‑ and post‑treatment by masked raters using the Fugl‑Meyer, Motor Status, Motor Power, and Functional Independence measures. Robotic training led to significant improvements in shoulder and elbow motor power and status, enhanced functional independence, but did not generalize to wrist and hand function.

Abstract

<b><i>Objective:</i></b> 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. <b><i>Methods:</i></b> Fifty-six patients with stroke and hemiparesis or hemiplegia received standard poststroke multidisciplinary rehabilitation, and were randomly 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. <b><i>Result:</i></b> 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, <i>p</i> &lt; 0.001; Motor Status score, <i>p</i> &lt; 0.01) that did not generalize to untrained wrist and hand. The robot-treated group also demonstrated significantly improved functional outcome (Functional Independence Measurement–Motor, <i>p</i> &lt; 0.01). <b><i>Conclusion:</i></b> 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 standard multidisciplinary rehabilitation, robotics provides novel therapeutic strategies that focus on impairment reduction and improved motor performance.