Robotic Assisted Upper Limb Training Post Stroke: A Randomized Control Trial Using Combinatory Approach Toward Reducing Workforce Demands.

Autor:	Budhota A; Interdisciplinary Graduate School, Nanyang Technological University, Singapore, Singapore.; Robotic Research Center, Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore., Chua KSG; Centre for Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore., Hussain A; Robotic Research Center, Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore., Kager S; NUS Graduate School for Integrative Sciences and Engineering, National University of Singapore, Singapore, Singapore., Cherpin A; Robotic Research Center, Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore., Contu S; Robotic Research Center, Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore., Vishwanath D; Centre for Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore., Kuah CWK; Centre for Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore., Ng CY; Centre for Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore., Yam LHL; Centre for Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore., Loh YJ; Centre for Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore., Rajeswaran DK; Centre for Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore., Xiang L; School of Physical and Mathematical Sciences, Nanyang Technological University, Singapore, Singapore., Burdet E; Department of Bioengineering, Imperial College of Science, Technology and Medicine, London, United Kingdom., Campolo D; Robotic Research Center, Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore.
Jazyk:	angličtina
Zdroj:	Frontiers in neurology [Front Neurol] 2021 Jun 02; Vol. 12, pp. 622014. Date of Electronic Publication: 2021 Jun 02 (Print Publication: 2021).
DOI:	10.3389/fneur.2021.622014
Abstrakt:	Post stroke upper limb rehabilitation is a challenging problem with poor outcomes as 40% of survivors have functionally useless upper limbs. Robot-aided therapy (RAT) is a potential method to alleviate the effort of intensive, task-specific, repetitive upper limb exercises for both patients and therapists. The present study aims to investigate how a time matched combinatory training scheme that incorporates conventional and RAT, using H-Man, compares with conventional training toward reducing workforce demands. In a randomized control trial (NCT02188628, www.clinicaltrials.gov), 44 subacute to chronic stroke survivors with first-ever clinical stroke and predominant arm motor function deficits were recruited and randomized into two groups of 22 subjects: Robotic Therapy (RT) and Conventional Therapy (CT). Both groups received 18 sessions of 90 min; three sessions per week over 6 weeks. In each session, participants of the CT group received 90 min of 1:1 therapist-supervised conventional therapy while participants of the RT group underwent combinatory training which consisted of 60 min of minimally-supervised H-Man therapy followed by 30 min of conventional therapy. The clinical outcomes [Fugl-Meyer (FMA), Action Research Arm Test and, Grip Strength] and the quantitative measures (smoothness, time efficiency, and task error, derived from two robotic assessment tasks) were independently evaluated prior to therapy intervention (week 0), at mid-training (week 3), at the end of training (week 6), and post therapy (week 12 and 24). Significant differences within group were observed at the end of training for all clinical scales compared with baseline [mean and standard deviation of FMA score changes between baseline and week 6; RT: Δ4.41 (3.46) and CT: Δ3.0 (4.0); p < 0.01]. FMA gains were retained 18 weeks post-training [week 24; RT: Δ5.38 (4.67) and week 24 CT: Δ4.50 (5.35); p < 0.01]. The RT group clinical scores improved similarly when compared to CT group with no significant inter-group at all time points although the conventional therapy time was reduced to one third in RT group. There were no training-related adverse side effects. In conclusion, time matched combinatory training incorporating H-Man RAT produced similar outcomes compared to conventional therapy alone. Hence, this study supports a combinatory approach to improve motor function in post-stroke arm paresis. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT02188628. Competing Interests: AH and DC hold equity positions in ARTICARES Pte. Ltd., a company that manufactures the type of technology used under license from Nanyang Technological University, Singapore. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2021 Budhota, Chua, Hussain, Kager, Cherpin, Contu, Vishwanath, Kuah, Ng, Yam, Loh, Rajeswaran, Xiang, Burdet and Campolo.)
Databáze:	MEDLINE
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