According to a new study featured in the journal Clinical Rehabilitation, published by SAGE, robot-assisted therapy had considerable benefits for patients with a weaker arm following a stroke.
The investigation authors, Keh-chung Lin, Yu-wei Hsieh, Wan-wen Liao – National Taiwan University, Ching-yi Wu – Chang Gung University, and Wan-ying Chang, Department of Physical Medicine and Rehabilitation, Taipei Hospital, researched how robot-assisted therapy helps enhance arm function after a stroke. 20 patients were enrolled in the investigation comparing robot-assisted therapy together with functional training against an active control treatment group.
Due to cognitive deficits, stroke patients often have difficulties transferring motor skills learned in therapy to their daily living environment. Researchers included real-world arm activity in the investigation by getting patients to wear accelerometers on both arms daily as they went about their normal routines.
One of the major discoveries of the investigation was that robot-assisted therapy, when incorporated with functional task training, helps functional arm use and improves bimanual arm activity in daily life. Following a stroke, patients usually have weakness on one side of the upper body (hemiparesis), which can increase the difficulty in everyday life. Robotic rehabilitation is becoming increasingly more accessible, and shows promise for improving traditional post-stroke interventions. As they never tire, robots can provide immense and intensive training in a consistent manner without fatigue, and can be programmed precisely to tailor each patient’s needs.
The robots provide sensorimotor feedback through visual and auditory feedback during training sessions, to help patient’s motor learning. Although arm motor function and muscle strength have shown to improve when robot-assisted therapy was used in rehabilitation, previous investigations indicated that these improvements did not carry through to the patient’s daily lives. A few explanations for this may include a need for improved measurement scales for patients real life daily functions, in addition to the fact several people compensate by using their non-impaired arm instead. This study addressed those issues, by measuring both arms and following patients with the accelerometers at home.
Accelerometers are appropriate tools to measure real-world arm activity in stroke patients, when used together with traditional clinical measurements; it can improve holistic understanding of a patient’s life performance.
The portable accelerometers can be easily worn like a wristwatch on each arm, and by measuring the acceleration of body movements; they give objective data about physical activity. Researchers now have the accurate information they need to verify the intensity and amount of physical activity the patients really do in their daily life.
Throughout the investigation, both groups had intensive training by certified occupational therapists for 90 to 105 minutes per session, five days a week for four weeks, while all other routine interdisciplinary stroke rehabilitation continued as usual. In the control group, therapy was designed to match the robot-assisted therapy in the amount of therapy hours, and these participants served as a dose-matched comparison group. Based on neurodevelopmental techniques and contemporary rehabilitative models, like task-oriented training and motor learning theory, occupational therapists created activities for the group.
In the robot-assisted therapy group the mean ratio change was 0.047± 0.047, beating the 0.007 ± 0.026 ratio of the control group. Compared to the control group the robot-assisted therapy group also handled more daily tasks with their impaired arm.
Keh-chung Lin explained,
“In this study of rehabilitation approaches for patients with mild-to-moderate upper limb impairment six months after a stroke, we found significantly greater benefits of robot-assisted therapy compared with the active control group on the amount and quality of functional arm activity for the hemiplegic hand in the living environment.
Moreover, robot-assisted therapy had superior benefits on improving bimanual arm activity.”
To make the most of robots for stroke patients rehabilitation in the future, larger investigations together with follow up research to see whether these improvements are lasting are the next steps.
Written by Grace Rattue