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

Figures & data

Figure 1. Illustration of the study design.

Notes: Baseline (BL) assessment: active and passive ROM, MMAS and CAHAI-9. T1/3/5: performed at the beginning of the intervention week; passive ROM and MMAS. T2/4/6: performed at the last day of the intervention week; active and passive ROM, MMAS, CAHAI-9 and questionnaire. CAHAI-9 = Chedoke McMaster Arm and Hand Activity Inventory (nine item version), MMAS = Modified Modified Ashworth Scale, ROM = Range of Motion, T1/3/5 = Measurement events at the beginning of intervention week T2/4/6 = Measurement events at the end of intervention week.

Figure 2. Illustration of the therapy setting.

Table 1. Patient characteristics

Patient	Sex	Age (y)	Diagnosis	Time post-stroke (months)	Side affected	Therapies per week (outpatient)	RAT modes	CAHAI-pre	CAHAI-post
1	M	55	Hemorrhagic	26	L	PT, OT, RM, MTT, MT	PM, G,ADL	47	52
2	M	59	Ischemic	13	L	None	PM, ADL, G	47	51
3	F	63	Hemorrhagic	46	L	PT	ADL, PM, G	18	23
4	M	59	Ischemic	0.75	R	PT, OT, WT, BG, MTT	PM, G, ADL	62	63
5	M	68	Hemorrhagic	38	R	PT	G, ADL, PM	21	24
6	M	58	Hemorrhagic	63	L	PT	PM,G, ADL	19	22
7	F	75	Ischemic	61	R	PT, OT	G, ADL, PM	37	39

Notes: ADL = Activities of daily living, CAHAI-pre = Chedoke McMaster Arm and Hand Activity Inventory (version with nine items) assessed at Baseline, CAHAI-post = Chedoke McMaster Arm and Hand Activity Inventory (version with nine items) assessed at the last measurement event after three intervention weeks, F = female, G = Games, M = male, L = left, PM = passive mobilisation, R = right, RAT = Robot-assisted training for week 1,2, and 3, y = years. If not otherwise indicated the therapies per week occurred once: BG = Balance group, MT = music therapy, MTT = medical training therapy, OT = occupational therapy, PT = physiotherapy, RM = reflex zone massage, WT = water therapy.

Table 2. Patients’ Modified Modified Ashworth Scale scores

		Pre PM	Post PM	Pre GA	Post GA	Pre ADL	Post ADL	Pre overall	Post overall
Elbow flexor muscles	P1	1.5	2	2	2	2	2	1.5	2
	P2	1	1	1	0	1	1	1	0
	P3	1.5	2	1.5	1	1	1	1.5	2
	P4	1	1	1	0	0	1	1	1
	P5	1.5	1	1	1	1	1	1	1
	P6	1.5	1	1	1	1	1	1.5	1
	P7	1	1	1	1	1	1	1	1
	p	1.00		0.10		0.32		0.71
Elbow extensor muscles	P1	1.5	2	2	1	1	2	1.5	2
	P2	0	1	0	1	1	0	0	1
	P3	1	1	1	1	1	1	1	1
	P4	0	0	0	0	0	0	0	0
	P5	0	0	0	0	0	0	0	0
	P6	1.5	1	1	1	1	2	1.5	2
	P7	0.5	1	1	0	0.5	0	0.5	0
	p	0.26		0.56		0.71		0.26
Mm. pronatores	P1	0.5	1	1	1	1	1	0.5	1
	P2	0	0	0	0	0	0	0	0
	P3	0.5	1	1	0	0.5	1	1	1
	P4	0	0	0	0	0	0	0	0
	P5	1	1	1	1	0.5	1	0.5	1
	P6	1	1	1	1	1	1	1	1
	P7	0	0	0	0	0	0	0	0
	p	0.16		0.32		0.16		0.16
Wrist flexor muscles	P1	0.5	0	0	1	0.5	0	0.5	0
	P2	0	0	0	0	0	0	0	0
	P3	2	2	1.5	1	1	2	1.5	2
	P4	0	0	0	0	0	0	0	0
	P5	2	1	1.5	1	1	2	1	1
	P6	1.5	1	1.5	1	1	1	1.5	1
	P7	1	2	2	2	1.5	1	1.5	2
	p	0.58		0.71		0.46		1.00
Finger flexor muscles	P1	1	1	1	1	1	1	1	1
	P2	0	0	0	0	0	0	0	0
	P3	2	2	2	1	1.5	2	2	2
	P4	0	0	0	0	0	0	0	0
	P5	2	2	2	2	2	2	2	2
	P6	2	2	2	1	1.5	2	2	2
	P7	2	1	1	1	2	2	2	1
	p	0.32		0.16		0.16		0.32

Notes: P = patients, p = p-value, pre/post PM = pre/post passive mobilisation mode, pre/post GA = pre/post games mode, pre/post ADL = pre/post Activity of daily living mode, pre/post overall = pre/post three week intervention.

Table 3. Patients’ passive ROM scores

		Patient 1	Patient 2	Patient 3	Patient 4	Patient 5	Patient 6	Patient 7	Mean	p-value
SH flex	PM	5.0	4.2	3.3	0	−8.3	10.0	−1.7	1.8	0.35
	GA	11.7	0	9.2	0	6.7	1.7	8.3	5.4	0.04^*
	ADL	−5.0	0	5.0	0	−1.7	1.7	5.0	0.7	0.69
	OV	8.3	2.5	15.8	0	10.0	15.0	11.7	9.1	0.03^*
SH abd	PM	19.2	−1.7	5.0	−1.7	−3.3	6.7	−8.3	2.3	0.74
	GA	1.7	3.3	2.5	8.3	8.3	−8.3	6.7	3.2	0.13
	ADL	0	6.7	3.3	3.3	−10.8	0	0.8	0.5	0.50
	OV	24.2	−1.7	12.5	15.0	10.8	8.3	5.8	10.7	0.03^*
SH ex	PM	−0.8	16.7	−10.0	6.7	−10.0	0.8	5.0	1.2	0.87
	GA	8.4	3.3	5.0	−1.7	6.7	0	1.7	3.3	0.06 T
	ADL	1.7	8.3	6.7	0	9.2	5.0	6.7	5.4	0.03^*
	OV	5.8	20.0	3.3	10.0	5.8	0.8	10.0	8.0	0.02^*
ELB flex	PM	−1.7	19.2	6.7	0	3.3	4.2	3.3	5.0	0.05^*
	GA	0	8.3	0	1.7	10.0	−5.0	5.0	2.9	0.18
	ADL	−3.3	11.7	3.3	8.3	6.7	0	0.8	3.9	0.09
	OV	−5.0	15.8	11.7	8.3	6.7	4.2	9.2	7.3	0.04^*
ELB ex	PM	5.0	0	0	3.3	0	0	0	1.2	0.18
	GA	0	1.7	6.7	−1.7	0	0	3.3	1.4	0.20
	ADL	0	3.3	1.7	0	0	0	0	0.7	0.18
	OV	6.7	0	3.3	3.3	0	0	6.7	2.9	0.07 T
PRO	PM	10.0	8.3	−3.3	1.7	1.7	−1.7	−8.3	1.2	0.73
	GA	3.3	0	3.3	1.7	0	−1.7	0	1.0	0.20
	ADL	0	10.	1.7	0	0.8	−1.7	9.2	2.8	0.18
	OV	10.0	8.3	3.3	1.7	0.8	−1.7	9.2	4.5	0.05 T
SUP	PM	12.5	15.8	−6.7	1.7	8.3	9.2	−1.7	5.6	0.13
	GA	10.0	−1.67	4.2	3.3	13.3	15.0	0	6.3	0.05^*
	ADL	21.7	26.7	−3.3	8.3	13.3	−1.7	5.8	10.1	0.06 T
	OV	15.8	30.8	2.5	6.7	10.0	2.5	9.2	11.1	0.02^*
WRIST palm	PM	1.7	−3.3	6.7	8.3	0	−2.8	−5.0	0.8	0.75
	GA	8.3	1.7	−2.5	−1.7	−6.7	3.3	−1.7	0.1	1.00
	ADL	−3.3	0	−5.0	8.3	9.2	0	3.3	1.8	0.50
	OV	−1.7	13.3	9.2	15.0	9.2	8.8	−1.7	7.5	0.06 T
WRIST dors	PM	5.8	5.8	6.7	3.3	3.3	15.8	0	5.8	0.03^*
	GA	13.3	6.7	−7.5	1.7	18.3	−5.0	5.0	4.6	0.3
	ADL	13.3	1.7	−6.7	5.0	−9.2	3.3	0	1.1	0.75
	OV	20.8	19.2	25.8	23.3	4.2	14.2	15.0	17.5	0.02^*

Notes: PM = passive mobilisation mode, GA = games mode, ADL = activities of daily living mode, OV = overall ROM change, SH flex = shoulder flexion, SH abd = shoulder abduction, SH ex = shoulder external rotation, ELB flex = elbow flexion, ELB ex = elbow extension, PRO = pronation, SUP = supination, WRIST palm = wrist palmarflexion, WRIST dors = wrist dorsiflexion.

* p = significant (p ≤ 0.05).

T = trend (0.05 < p < 0.07).

Table 4. Patients’ active ROM scores

		Patient 1	Patient 2	Patient 3	Patient 4	Patient 5	Patient 6	Patient 7	Mean	p-value
SH flex	PM	23.3	8.3	–	5.0	−6.7	3.3	−16.7	2.8	0.60
	GA	−3.3	−5.0	21.7	0	10.	15.0	23.3	8.8	0.12
	ADL	5.0	3.3	20.0	0	−5.0	−16.7	5.0	1.7	0.60
	OV	25.0	6.7	–	5.0	−1.7	1.7	11.7	8.1	0.08
SH abd	PM	20.0	−1.7	–	−1.7	−6.7	18.3	−6.7	3.6	0.92
	GA	−6.7	6.7	11.7	11.7	15.0	−1.7	18.3	7.7	0.03*
	ADL	−1.7	−5.0	6.7	6.7	6.7	−6.7	5.0	1.7	0.31
	OV	11.7	0	–	16.7	15.0	10.0	16.7	11.7	0.04*
SH exo	PM	3.3	15.0	–	6.7	0	0	3.3	4.7	0.07
	GA	0	−5.0	−28.3	3.3	0	11.7	−5.0	−3.3	0.50
	ADL	8.3	11.7	11.7	−1.7	0	1.7	3.3	5.0	0.08
	OV	11.7	21.7	–	8.3	0	13.3	1.7	9.5	0.04*
ELB flex	PM	1.7	25.0	–	0	5.0	13.3	−3.3	7.0	0.14
	GA	−1.7	−6.7	−20.0	1.7	−5.0	10.0	0	−3.1	0.40
	ADL	0	−5.0	20.0	6.7	13.3	6.7	6.7	6.9	0.05*
	OV	0	13.3	–	8.3	13.3	30.0	3.3	11.4	0.04*
ELB ex	PM	−3.3	−1.7	–	0	−3.4	−15.0	−3.3	−4.5	0.04*
	GA	−5.0	0	15.0	0	1.7	5.0	6.7	3.3	0.18
	ADL	−1.7	0	5.0	3.3	1.7	8.3	3.3	2.9	0.08
	OV	−10.0	−1.7	–	3.3	0	−1.7	6.7	−0.6	0.89
PRO	PM	20.0	3.3	–	3.3	0	0	−5.0	3.6	0.47
	GA	0	−1.7	1.7	0	0	0	5.0	0.7	0.42
	ADL	1.7	5.0	8.3	1.7	16.7	0	6.7	5.7	0.03*
	OV	21.7	6.7	–	5.0	16.7	0	6.7	9.5	0.05*
SUP	PM	1.7	20.0	–	1.7	−1.7	26.7	−16.7	5.3	0.40
	GA	10.0	−1.7	0	−1.7	−3.3	−8.3	13.3	1.2	0.92
	ADL	−6.7	11.7	0	5.0	−3.3	−15.0	15.0	1.0	0.83
	OV	5.0	30.0	–	5.0	−8.3	3.3	11.7	7.8	0.17
WRIST palm	PM	−5.0	3.3	–	0	−26.7	−20.0	−25.0	−12.2	0.08
	GA	11.7	8.3	26.7	8.3	15.0	1.7	15.0	12.4	0.02*
	ADL	−8.3	5.0	−13.3	1.7	31.7	8.3	3.3	4.1	0.50
	OV	−1.7	16.7	–	10.0	20.0	−10.0	−6.7	4.7	0.40
WRIST dors	PM	−3.3	1.7	–	0	−3.3	0	0	−0.8	0.29
	GA	8.3	0	−21.7	10.0	3.3	−8.3	5.0	−0.5	0.75
	ADL	−15.0	5.0	21.7	5.0	0	−18.3	10.0	1.2	0.75
	OV	−10.0	6.7	–	15.0	0	−26.7	15.0	0	0.90

Notes: PM = passive mobilisation mode, GA = games mode, ADL = activities of daily living mode, OV = overall ROM change, SH flex = shoulder flexion, SH abd = shoulder abduction, SH EX = shoulder external rotation, ELB flex = elbow flexion, ELB ex = elbow extension, PRO = pronation; SUP = supination, WRIST palm = wrist palmarflexion, WRIST dors = wrist dorsiflexion.

^* p = significant (p ≤ 0.05).

T = trend (0.05 < p < 0.07).

Figure 3. Changes in CAHAI-9 scores for all patients.

Notes: ADL=Activities of daily living, CAHAI-9 = Chedoke McMaster Arm and Hand Activity Inventory (nine item version).