Robot-Assisted Therapy for Improving Muscle Functions and Daily Life Activities in Patients with Stroke:The Effects of Treatment Intensity
Date Issued
2010
Date
2010
Author(s)
Liao, Wan-Wen
Abstract
Background: Robot-assisted therapy is a brand-new neuro-rehabilitation technique. Randomized controlled trials that investigated the effects of robot-assisted therapy (RAT) in stroke survivors have accumulated in recent years, but the optimal dose of treatment intensity, treatment frequency and protocol still not be established. Besides, Previous systematic review showed that benefits of RAT for enhancing daily functions were less conclusive.
Purpose: To compare the treatment effects of different intensity robot-assisted therapy and dose-matched usual rehabilitation on motor functions, muscle functions, daily functions and quality of life in stroke survivors with moderate to severe paresis. This study also explored changes in daily functions and patient-reported, health-related quality of life associated with robot-assisted therapy combined with functional task training.
Design and Setting: A single-blind, multisite, randomized controlled trial was conducted.
Participants: Twenty individuals who were six months post-stroke participated.
Intervention: Stroke survivors participated in one of the three groups: (1) high intensity robot-assisted therapy; (2) low intensity robot-assisted therapy; (3) dose-matched usual rehabilitation. Both robot-assisted therapy groups combined with 15 to 20 minutes of functional task training in each session. All participants engaged in 90 to 105 minutes of training in each session, 5 times a week for 4 weeks.
Measurements: Primary outcome measures were Fugl-Meyer Motor Scale of the upper extremity, Modified Ashworth Scale and Medical Research Council. Secondary outcome measures were Motor Activity Log, Nottingham Extended ADL scale, Stroke Impact scale and Accelerometer.
Results:
High intensity robot-assisted therapy group not only had significant greater increase in rating of Fugl-Meyer Motor scale than dose-matched usual rehabilitation group, but also in Medical research council. Stroke patients in robot-assisted therapy groups improved affected arm-use and quality of movements in their daily routines. Furthermore, the results of accelerometers showed the declining of learned-use phenomenon in participants of robot-assisted therapy group. However, the dose-matched usual rehabilitation group showed little evidence of increasing affected hand use. Surprisingly, both robot-assisted therapy groups reported improvements in IADL and quality of life, especially in the physical functions of Stroke Impact scale. Stroke survivors in low intensity robot-assisted therapy group enhanced more in social participation than other groups. In order to monitor potential adverse effects, we adopted the Multidimensional Fatigue Symptom Inventory (general). Among the three groups, high intensity robot-assisted therapy and dose-matched usual rehabilitation group demonstrated an increasing tendency in fatigue symptoms after undergone interventions. On the contrary, participants receiving low intensity robot-assisted therapy felt fatigue being relieved and much more energetic than before.
Conclusion: Robot-assisted therapy combined with functional task training, in comparison with dose-matched usual rehabilitation, improved more on motor functions, muscle functions, daily functions and quality of life. Training intensity could be an important factor of efficacy, especially in the domains of motor and muscle functions. However, this may not be a crucial factor that related to patient-perceived quality of life. High intensity training may induce muscle fatigue, resulting in decreased self-perceived welling. In contrast, a just enough intensity of robot-assisted therapy not only could improve motor and muscle functions but also quality of life.
Subjects
robot-assisted therapy
stroke
intensity
accelerometer
daily life activities
Type
thesis
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