Immediate effects of different upper limb robot-assisted training modes in patients after stroke: A case series

Abstract

Purpose: This case series investigated immediate effects of three different robot-assisted training (RAT) modes post stroke. Methods: A repeated measures descriptive case series design was applied. Patients after stroke (sub‐acute or chronic) received 4 × 30 min RAT for 3 weeks. Every week, a different randomly selected RAT-mode was applied: passive mobilisation, games, or activities of daily living (ADL). Outcome measures were bilateral upper limb function evaluated with the Chedoke McMaster Arm and Hand Activity Inventory (CAHAI‐9), muscle tone investigated with the Modified Modified Ashworth Scale (MMAS), and active and passive range of motion measured with a goniometer (aROM, pROM). Assessments were conducted by a blinded examiner at baseline, before and after each intervention week. Patients qualitatively evaluated RAT. There was no control on the patients receiving other therapies or treatments during the study period. For statistical analyses the Wilcoxon signed-rank test was used. Results: In total, seven patients participated (2 females, 5 males, mean ± SD: age 62.4 ± 6.9; time since stroke 35.4 ± 23.6 months, except for 1 sub-acute patient). CAHAI-9 scores changed: 35.9 ± 17.1 at baseline to 39.4 ± 16.6 after RAT, with a significant improvement after ADL-mode (p = 0.028). Patients reported larger ROM, less muscle tone, increased upper limb motor function, and no adverse events. Conclusions: An overall improvement in upper limb function was found in all cases. Despite the significant improvement after the ADL-mode, it remains recommended to include all three RAT modes. RAT did subjectively but not objectively influence muscle tone and ROM.

Keywords:

• upper limb motor function
• robot-assisted training
• stroke
• activities of daily living

Public Interest Statement

The World Health Organisation states that every 6 s, someone’s quality of life will forever be changed—they will permanently be physically disabled due to stroke. Recovery of motor and sensory function is essential for activities of daily living (ADL) and the independence of the patient. Recently there has been more attention for technology-based treatment methods, such as robot-assisted training (RAT). In our study patients after stroke (sub‐acute or chronic) received 4 × 30 min RAT for 3 weeks. Every week, a different RAT-mode was applied: passive mobilisation, games, or ADL. In total, two females and five males participated (age 62.4 ± 6.9; time since stroke 35.4 ± 23.6 months) in the study. Each of them showed important functional improvements in particular after the ADL training mode. Patients reported larger ROM, less muscle tone, increased upper limb motor function, and no adverse events. It is recommended to include all three RAT modes in the training.

Competing Interests

The authors declare no competing interest.

Acknowledgements

We would like to thank Andrea Henneke for her advice and support regarding the robot-assisted training. We are grateful to all patients, who kindly participated in our study.

Notes

The work was presented at the Swiss National Physiotherapy Conference, Bern, Switzerland, June 2014 and the World Congress of the World Confederation of Physical Therapy, Singapore, May 2015.

Additional information

Funding

Funding. The authors received no direct funding for this research.

Notes on contributors

Corina Schuster-Amft

Dr Corina Schuster-Amft is a physiotherapist especially trained in neurological rehabilitation. She is the head of the Research Department at the Reha Rheinfelden in Switzerland. The team includes experts from the therapeutic disciplines, sports and movement scientists, and psychologist. The research of the department focusses on technology-based rehabilitation treatment options, e.g. robot-assisted training, virtual reality-based training, or wearable technology and cognitive assessments to evaluate the stroke recovery process. Furthermore, the team is interested in the technique of motor imagery as a treatment option, and devices and assessments to evaluate postural control.