Stéphanie Dehem1, Maxime Gilliaux2, Gaëtan Stoquart3, Christine Detrembleur4, Géraldine Jacquemin5, Sara Palumbo6, Anne Frederick7, Thierry Lejeune3. 1. Université catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Avenue Mounier 53, B-1200 Brussels, Belgium; Université catholique de Louvain, Louvain Bionics, B-1348 Louvain-la-Neuve, Belgium. Electronic address: stephanie.dehem@uclouvain.be. 2. Université catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Avenue Mounier 53, B-1200 Brussels, Belgium; Université catholique de Louvain, Louvain Bionics, B-1348 Louvain-la-Neuve, Belgium; Institut de Formation en Masso-Kinésithérapie La Musse, Allée Louis Martin, CS 20119, 27180 Saint-Sébastien-de-Morsent, France; Hôpital La Musse, Allée Louis Martin, CS 20119, 27180 Saint-Sébastien-de-Morsent, France. 3. Université catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Avenue Mounier 53, B-1200 Brussels, Belgium; Université catholique de Louvain, Louvain Bionics, B-1348 Louvain-la-Neuve, Belgium; Cliniques universitaires Saint-Luc, Service de médecine physique et réadaptation, Avenue Hippocrate 10, B-1200 Brussels, Belgium. 4. Université catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Avenue Mounier 53, B-1200 Brussels, Belgium; Université catholique de Louvain, Louvain Bionics, B-1348 Louvain-la-Neuve, Belgium. 5. Centre Hospitalier Valida, Service de médecine physique et réadaptation, Avenue Josse Goffin 180, B-1082 Brussels, Belgium; Université de Montréal, Institut de Réadaptation Gingras-Lindsay de Montreal, Montreal, Canada. 6. Centre Hospitalier Valida, Service de médecine physique et réadaptation, Avenue Josse Goffin 180, B-1082 Brussels, Belgium. 7. Centre Hospitalier Neurologique William Lennox, Service de neurologie, Allée de Clerlande 6, B1340 Ottignies, Belgium.
Abstract
BACKGROUND:Upper-limb robotic-assisted therapy (RAT) is promising for stroke rehabilitation, particularly in the early phase. When RAT is provided as partial substitution of conventional therapy, it is expected to be at least as effective or might be more effective than conventional therapy. Assessments have usually been restricted to the first 2 domains of the International classification of functioning, disability and health (ICF). OBJECTIVE: This was a pragmatic, multicentric, single-blind, randomized controlled trial to evaluate the effectiveness of upper-limb RAT used as partial substitution to conventional therapy in the early phase of stroke rehabilitation, following the 3 ICF domains. METHODS: We randomized 45 patients with acute stroke into 2 groups (conventional therapy, n=22, and RAT, n=23). Both interventions were dose-matched regarding treatment duration and lasted 9 weeks. The conventional therapy group followed a standard rehabilitation. In the RAT group, 4 sessions of conventional therapy (25%) were substituted by RAT each week. RAT consisted of moving the paretic upper limb along a reference trajectory while the robot provided assistance as needed. A blinded assessor evaluated participants before, just after the intervention and 6 months post-stroke, according to the ICF domains UL motor impairments, activity limitations, and social participation restriction. RESULTS: In total, 28 individuals were assessed after the intervention. The following were more improved in the RAT than conventional therapy group at 6 months post-stroke: gross manual dexterity (Box and Block test +7.7 blocks; P=0.02), upper-limb ability during functional tasks (Wolf Motor Function test +12%; P=0.02) and patient social participation (Stroke Impact Scale +18%; P=0.01). Participants' abilities to perform manual activities and activities of daily living improved similarly in both groups. CONCLUSION: For the same duration of daily rehabilitation, RAT combined with conventional therapy during the early rehabilitation phase after stroke is more effective than conventional therapy alone to improve gross manual dexterity, upper-limb ability during functional tasks and patient social participation.
RCT Entities:
BACKGROUND: Upper-limb robotic-assisted therapy (RAT) is promising for stroke rehabilitation, particularly in the early phase. When RAT is provided as partial substitution of conventional therapy, it is expected to be at least as effective or might be more effective than conventional therapy. Assessments have usually been restricted to the first 2 domains of the International classification of functioning, disability and health (ICF). OBJECTIVE: This was a pragmatic, multicentric, single-blind, randomized controlled trial to evaluate the effectiveness of upper-limb RAT used as partial substitution to conventional therapy in the early phase of stroke rehabilitation, following the 3 ICF domains. METHODS: We randomized 45 patients with acute stroke into 2 groups (conventional therapy, n=22, and RAT, n=23). Both interventions were dose-matched regarding treatment duration and lasted 9 weeks. The conventional therapy group followed a standard rehabilitation. In the RAT group, 4 sessions of conventional therapy (25%) were substituted by RAT each week. RAT consisted of moving the paretic upper limb along a reference trajectory while the robot provided assistance as needed. A blinded assessor evaluated participants before, just after the intervention and 6 months post-stroke, according to the ICF domains UL motor impairments, activity limitations, and social participation restriction. RESULTS: In total, 28 individuals were assessed after the intervention. The following were more improved in the RAT than conventional therapy group at 6 months post-stroke: gross manual dexterity (Box and Block test +7.7 blocks; P=0.02), upper-limb ability during functional tasks (Wolf Motor Function test +12%; P=0.02) and patientsocial participation (Stroke Impact Scale +18%; P=0.01). Participants' abilities to perform manual activities and activities of daily living improved similarly in both groups. CONCLUSION: For the same duration of daily rehabilitation, RAT combined with conventional therapy during the early rehabilitation phase after stroke is more effective than conventional therapy alone to improve gross manual dexterity, upper-limb ability during functional tasks and patientsocial participation.
Authors: Fernanda M R M Ferreira; Maria Emília A Chaves; Vinícius C Oliveira; Jordana S R Martins; Claysson B S Vimieiro; Adriana M V N Van Petten Journal: Occup Ther Int Date: 2021-07-31 Impact factor: 1.448
Authors: Alma S Merians; Gerard G Fluet; Qinyin Qiu; Mathew Yarossi; Jigna Patel; Ashley J Mont; Soha Saleh; Karen J Nolan; A M Barrett; Eugene Tunik; Sergei V Adamovich Journal: Front Neurol Date: 2020-11-26 Impact factor: 4.003