Janne M Veerbeek1,2,3, Anneli C Langbroek-Amersfoort4, Erwin E H van Wegen1,2,3, Carel G M Meskers1,2,3,5, Gert Kwakkel1,2,3,5,6. 1. 1 MOVE Research Institute Amsterdam, VU University Amsterdam, Amsterdam, the Netherlands. 2. 2 Neuroscience Campus Amsterdam, Amsterdam, the Netherlands. 3. 3 VU University Medical Center, Amsterdam, the Netherlands. 4. 4 Centrum voor Fysiotherapie, Eerstelijns Centrum Beatrixpark, Ede, the Netherlands. 5. 5 Northwestern University, Evanston, IL, USA. 6. 6 Amsterdam Rehabilitation Research Center, Reade, Amsterdam, the Netherlands.
Abstract
BACKGROUND: Robot technology for poststroke rehabilitation is developing rapidly. A number of new randomized controlled trials (RCTs) have investigated the effects of robot-assisted therapy for the paretic upper limb (RT-UL). OBJECTIVE: To systematically review the effects of poststroke RT-UL on measures of motor control of the paretic arm, muscle strength and tone, upper limb capacity, and basic activities of daily living (ADL) in comparison with nonrobotic treatment. METHODS: Relevant RCTs were identified in electronic searches. Meta-analyses were performed for measures of motor control (eg, Fugl-Meyer Assessment of the arm; FMA arm), muscle strength and tone, upper limb capacity, and basic ADL. Subgroup analyses were applied for the number of joints involved, robot type, timing poststroke, and treatment contrast. RESULTS: Forty-four RCTs (N = 1362) were included. No serious adverse events were reported. Meta-analyses of 38 trials (N = 1206) showed significant but small improvements in motor control (~2 points FMA arm) and muscle strength of the paretic arm and a negative effect on muscle tone. No effects were found for upper limb capacity and basic ADL. Shoulder/elbow robotics showed small but significant effects on motor control and muscle strength, while elbow/wrist robotics had small but significant effects on motor control. CONCLUSIONS: RT-UL allows patients to increase the number of repetitions and hence intensity of practice poststroke, and appears to be a safe therapy. Effects on motor control are small and specific to the joints targeted by RT-UL, whereas no generalization is found to improvements in upper limb capacity. The impact of RT-UL started in the first weeks poststroke remains unclear. These limited findings could mainly be related to poor understanding of robot-induced motor learning as well as inadequate designing of RT-UL trials, by not applying an appropriate selection of stroke patients with a potential to recovery at baseline as well as the lack of fixed timing of baseline assessments and using an insufficient treatment contrast early poststroke.
BACKGROUND: Robot technology for poststroke rehabilitation is developing rapidly. A number of new randomized controlled trials (RCTs) have investigated the effects of robot-assisted therapy for the paretic upper limb (RT-UL). OBJECTIVE: To systematically review the effects of poststroke RT-UL on measures of motor control of the paretic arm, muscle strength and tone, upper limb capacity, and basic activities of daily living (ADL) in comparison with nonrobotic treatment. METHODS: Relevant RCTs were identified in electronic searches. Meta-analyses were performed for measures of motor control (eg, Fugl-Meyer Assessment of the arm; FMA arm), muscle strength and tone, upper limb capacity, and basic ADL. Subgroup analyses were applied for the number of joints involved, robot type, timing poststroke, and treatment contrast. RESULTS: Forty-four RCTs (N = 1362) were included. No serious adverse events were reported. Meta-analyses of 38 trials (N = 1206) showed significant but small improvements in motor control (~2 points FMA arm) and muscle strength of the paretic arm and a negative effect on muscle tone. No effects were found for upper limb capacity and basic ADL. Shoulder/elbow robotics showed small but significant effects on motor control and muscle strength, while elbow/wrist robotics had small but significant effects on motor control. CONCLUSIONS: RT-UL allows patients to increase the number of repetitions and hence intensity of practice poststroke, and appears to be a safe therapy. Effects on motor control are small and specific to the joints targeted by RT-UL, whereas no generalization is found to improvements in upper limb capacity. The impact of RT-UL started in the first weeks poststroke remains unclear. These limited findings could mainly be related to poor understanding of robot-induced motor learning as well as inadequate designing of RT-UL trials, by not applying an appropriate selection of strokepatients with a potential to recovery at baseline as well as the lack of fixed timing of baseline assessments and using an insufficient treatment contrast early poststroke.
Authors: Helen Rodgers; Helen Bosomworth; Hermano I Krebs; Frederike van Wijck; Denise Howel; Nina Wilson; Tracy Finch; Natasha Alvarado; Laura Ternent; Cristina Fernandez-Garcia; Lydia Aird; Sreeman Andole; David L Cohen; Jesse Dawson; Gary A Ford; Richard Francis; Steven Hogg; Niall Hughes; Christopher I Price; Duncan L Turner; Luke Vale; Scott Wilkes; Lisa Shaw Journal: Health Technol Assess Date: 2020-10 Impact factor: 4.014
Authors: Michael D Wood; Leif E R Simmatis; Jill A Jacobson; Sean P Dukelow; J Gordon Boyd; Stephen H Scott Journal: Front Hum Neurosci Date: 2021-05-06 Impact factor: 3.169