Impact of initial flexor synergy pattern scores on improving upper extremity function in stroke patients treated with adjunct robotic rehabilitation: A randomized clinical trial

ABSTRACT

Background: Robot-assisted rehabilitation is an appealing strategy for patients after stroke, as it generates repetitive movements in a consistent, precise, and automated manner.

Objective: To identify patients who will benefit most from robotic rehabilitation for upper extremity (UE) hemiparesis.

Methods:We used data from our previous randomized clinical trial comparing 6 weeks of robotic therapy (ReoGeo system) plus standard therapy (n=30) with self-guided therapy plus standard therapy (n=26) for sub-acute phase rehabilitation in adults with mild to moderate UE hemiparesis. The outcome measures were three Fugl-Meyer (FMA) motor scores: total UE score, proximal UE score, and UE flexor synergy score. Based on pre-therapy UE flexor synergy scores, participants were categorized into mild (10–12 points), moderate (6–9 points), and severe (0–5 points) impairment classes.

Results: In the robotic group, all outcome measures improved after therapy in patients with moderate or severe impairment. In the self-guided therapy, most outcomes did not improve, regardless of the impairment class. When changes from pre- to post-therapy were compared between robotic and self-guided groups, most outcomes were similar in all impairment classes. However, robotic therapy was associated with greater improvement in UE flexor synergy than self-guided therapy in patients with moderate impairment (2.3±1.3 vs. -0.1±2.8, P=0.027).

Conclusions: Post-strokerobot-assisted rehabilitation, as an adjunct to standard rehabilitation therapy, improved UE function in patients with moderate or severe pre-therapy UE flexor synergy impairment. Adjunct robotic therapy produced greater improvement in UE flexor synergy motor function than adjunct self-guided rehabilitation in patients with moderate pre-therapy impairment.

KEYWORDS:

• Stroke
• upper extremity
• hemiplegia
• adjunct robotic therapy
• rehabilitation

Acknowledgments

We would like to thank all of the clinicians and researchers involved in this study. We would also like to thank BioScience Writers for their professional writing assistance.

Author contribution statements

TT and KT contributed equally in designing the study, as well as writing and reviewing the manuscript. KH and KD contributed to reviewing the manuscript.

Additional information

Funding

This work was supported by Teijin Pharma Ltd, Tokyo, Japan.