Comparative Efficacy of Proximal- and Distal-Emphasized Robot-Assisted Therapy on Upper Extremity Motor Recovery in Chronic Stroke: A Pilot Kinematic Study

Autor: Tsai Yu Shih, 施采瑜
Rok vydání: 2015
Druh dokumentu: 學位論文 ; thesis
Popis: 103
Introduction Stroke is the major cause of long-term disabilities. Most of the stroke survivors have motor impairment on upper extremity (UE). To optimize UE motor function and recovery is an important issue. Robot-assisted therapy (RT) is one of the useful therapeutic approaches to facilitate UE motor recovery. However, there is limited evidence available on the treatment effects of RT focus on the proximal part of UE versus distal part of UE. In addition, the generalizability of motor gains from the targeted segment to the untreated segment was still under debate. Thus, the purposes of this pilot study were (1) to compare the treatment effects of proximal RT versus distal RT on UE motor control and UE motor function; and (2) to examine the generalizability of targeted segment to the untreated segment after proximal RT and distal RT. Methods A total of 19 subjects were recruited in this study to receive proximal RT (P-IMT) or distal RT (D-IMT) intervention for 18 to 20 sessions in 4 to 5 weeks. The primary outcome measures were the variables of kinematic analysis. Two reaching tasks were assessed at within and beyond arm’s length distance. The secondary outcome measures were the Fugl-Meyer motor assessment (FMA-UE), the Wolf Motor Function Test (WMFT), the Box and Block Test (BBT) and the accelerometers. The potential adverse effects were also monitored. The Mann-Whitney U test was used to compare treatment effects between the 2 groups, and the Wilcoxon sign rank test was used to examine within-group changes. Results There were 10 participants recruited in the P-IMT group, and 9 participants recruited in the D-IMT group. For the kinematics analysis, in the within arm’s length reaching task, the P-IMT group had significant differences in index peak velocity (p = 0.05, r = 0.79). The reaction time was significantly decreased in the D-IMT group (p = 0.02, r = 0.89) after intervention. In addition, the D-IMT group had significantly more improvement on the reaction time than the P-IMT group (p &;lt; 0.01, r = 0.61). The P-IMT group had significant difference in maximal shoulder flexion (p = 0.02, r = 0.73) and maximal elbow extension (p = 0.02, r = 0.73) over time. The P-IMT group had significantly better improvement on maximum elbow extension than the D-IMT group (p = 0.02, r = 0.54). Both 2 groups had significantly increased trunk peal velocity (P-IMT: p > 0.01, r = 0.79; D-IMT: p = 0.02, r = 0.77). In the beyond arm’s length reaching task, the D-IMT group significant increased the reaction time (p = 0.02, r = 0.79). The D-IMT group also had significantly more improvement on the reaction time than the P-IMT group (p &;lt; 0.01, r = 0.59). The P-IMT group had significant increase in maximum elbow flexion (p = 0.02, r = 0.76) after intervention. The P-IMT group had significantly better improvement on maximum elbow extension than the D-IMT group (p = 0.05, r = 0.46). The P-IMT group has significant change in maximum trunk flexion (p = 0.02, r = 0.76) over time. For secondary outcomes, both groups have significant improvements on the FMA-UE, WMFT, and BBT over time, but there were no significant differences between groups. The results of accelerometers showed that the P-IMT group had significantly greater improvements on caloric consumption than the D-IMT group (p = 0.04, r = 0.54). Conclusion The findings of this pilot study suggest that the proximal RT intervention have more benefits on improving joint angle coordination and reducing trunk compensation. The distal RT intervention can promote better pre-planning ability of UE motor control. Both groups are prominent interventions to enhance UE motor function assessed by clinical scales. The generalization of motor gains into the untrained segment was demonstrated in the both groups, but the effects are small. The study findings need to be confirmed in the further large-scale studies.
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