Alexa B Keeling1,2, Mark Piitz2, Jennifer A Semrau1,2,3, Michael D Hill1,2, Stephen H Scott4, Sean P Dukelow5,6. 1. Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada. 2. Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada. 3. Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA. 4. Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada. 5. Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada. spdukelo@ucalgary.ca. 6. Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada. spdukelo@ucalgary.ca.
Abstract
BACKGROUND: Robotic rehabilitation after stroke provides the potential to increase and carefully control dosage of therapy. Only a small number of studies, however, have examined robotic therapy in the first few weeks post-stroke. In this study we designed robotic upper extremity therapy tasks for the bilateral Kinarm Exoskeleton Lab and piloted them in individuals with subacute stroke. Pilot testing was focused mainly on the feasibility of implementing these new tasks, although we recorded a number of standardized outcome measures before and after training. METHODS: Our team developed 9 robotic therapy tasks to incorporate feedback, intensity, challenge, and subject engagement as well as addressing both unimanual and bimanual arm activities. Subacute stroke participants were assigned to a robotic therapy (N = 9) or control group (N = 10) in a matched-group manner. The robotic therapy group completed 1-h of robotic therapy per day for 10 days in addition to standard therapy. The control group participated only in standard of care therapy. Clinical and robotic assessments were completed prior to and following the intervention. Clinical assessments included the Fugl-Meyer Assessment of Upper Extremity (FMA UE), Action Research Arm Test (ARAT) and Functional Independence Measure (FIM). Robotic assessments of upper limb sensorimotor function included a Visually Guided Reaching task and an Arm Position Matching task, among others. Paired sample t-tests were used to compare initial and final robotic therapy scores as well as pre- and post-clinical and robotic assessments. RESULTS: Participants with subacute stroke (39.8 days post-stroke) completed the pilot study. Minimal adverse events occurred during the intervention and adding 1 h of robotic therapy was feasible. Clinical and robotic scores did not significantly differ between groups at baseline. Scores on the FMA UE, ARAT, FIM, and Visually Guided Reaching improved significantly in the robotic therapy group following completion of the robotic intervention. However, only FIM and Arm Position Match improved over the same time in the control group. CONCLUSIONS: The Kinarm therapy tasks have the potential to improve outcomes in subacute stroke. Future studies are necessary to quantify the benefits of this robot-based therapy in a larger cohort. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04201613, Registered 17 December 2019-Retrospectively Registered, https://clinicaltrials.gov/ct2/show/NCT04201613 .
BACKGROUND: Robotic rehabilitation after stroke provides the potential to increase and carefully control dosage of therapy. Only a small number of studies, however, have examined robotic therapy in the first few weeks post-stroke. In this study we designed robotic upper extremity therapy tasks for the bilateral Kinarm Exoskeleton Lab and piloted them in individuals with subacute stroke. Pilot testing was focused mainly on the feasibility of implementing these new tasks, although we recorded a number of standardized outcome measures before and after training. METHODS: Our team developed 9 robotic therapy tasks to incorporate feedback, intensity, challenge, and subject engagement as well as addressing both unimanual and bimanual arm activities. Subacute stroke participants were assigned to a robotic therapy (N = 9) or control group (N = 10) in a matched-group manner. The robotic therapy group completed 1-h of robotic therapy per day for 10 days in addition to standard therapy. The control group participated only in standard of care therapy. Clinical and robotic assessments were completed prior to and following the intervention. Clinical assessments included the Fugl-Meyer Assessment of Upper Extremity (FMA UE), Action Research Arm Test (ARAT) and Functional Independence Measure (FIM). Robotic assessments of upper limb sensorimotor function included a Visually Guided Reaching task and an Arm Position Matching task, among others. Paired sample t-tests were used to compare initial and final robotic therapy scores as well as pre- and post-clinical and robotic assessments. RESULTS:Participants with subacute stroke (39.8 days post-stroke) completed the pilot study. Minimal adverse events occurred during the intervention and adding 1 h of robotic therapy was feasible. Clinical and robotic scores did not significantly differ between groups at baseline. Scores on the FMA UE, ARAT, FIM, and Visually Guided Reaching improved significantly in the robotic therapy group following completion of the robotic intervention. However, only FIM and Arm Position Match improved over the same time in the control group. CONCLUSIONS: The Kinarm therapy tasks have the potential to improve outcomes in subacute stroke. Future studies are necessary to quantify the benefits of this robot-based therapy in a larger cohort. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04201613, Registered 17 December 2019-Retrospectively Registered, https://clinicaltrials.gov/ct2/show/NCT04201613 .
Authors: Charles G Burgar; Peter S Lum; A M Erika Scremin; Susan L Garber; H F Machiel Van der Loos; Deborah Kenney; Peggy Shor Journal: J Rehabil Res Dev Date: 2011
Authors: Cameron S Mang; Tara A Whitten; Madeline S Cosh; Stephen H Scott; J Preston Wiley; Chantel T Debert; Sean P Dukelow; Brian W Benson Journal: J Neurotrauma Date: 2018-09-27 Impact factor: 5.269
Authors: Carolee J Winstein; Dorian K Rose; Sylvia M Tan; Rebecca Lewthwaite; Helena C Chui; Stanley P Azen Journal: Arch Phys Med Rehabil Date: 2004-04 Impact factor: 3.966
Authors: Corina Schuster-Amft; Jan Kool; J Carsten Möller; Raoul Schweinfurther; Markus J Ernst; Leah Reicherzer; Carina Ziller; Martin E Schwab; Simon Wieser; Markus Wirz Journal: Pilot Feasibility Stud Date: 2022-07-05
Authors: Ananda Sidarta; Yu Chin Lim; Russell A Wong; Isaac O Tan; Christopher Wee Keong Kuah; Wei Tech Ang Journal: PLoS One Date: 2022-08-11 Impact factor: 3.752
Authors: Liliane Raess; Rachel L Hawe; Megan Metzler; Ephrem Zewdie; Elizabeth Condliffe; Sean P Dukelow; Adam Kirton Journal: Front Rehabil Sci Date: 2022-02-25