Effects of Combining Proximal and Distal Robot-Assisted Therapy With Intensive Functional Task Practice on Real-World Upper-Limb Functions in Patients With Chronic Stroke: A Case Series
Date Issued
2016
Date
2016
Author(s)
Chen, Po-Ting
Abstract
Introduction: Robot-assisted therapy (RT) has become an innovative rehabilitation approach. RT has been known for its high intensity, high accuracy, labor saving, and task-directedness. However, previous studies revealed that RT is more effective on motor abilities, but less on motor functions than intensive functional task practice. Moreover, few studies have studied the effects of proximal- vs. distal-emphasized RT. Comparison of the 2 devices of InMotion interactive therapy system (ie, InMotion Arm 2.0 and InMotion Wrist 3.0) may improve our knowledge about their relative effects and inform clinical practice of motor rehabilitation based on RT. Objectives: This case series study compared the effects of proximal-emphasized RT (P-IMT), distal-emphasized RT (D-IMT), and control treatment (CT) combined with intensive functional task practice on real-world arm activities and functional outcomes. In addition, this study also examined the effects of these two modes of InMotion on motor impairment, including muscle tone and muscle power, and motor control strategies. Methods: This case series study was a cluster randomized controlled trial with pretest and posttest assessments. Participants received one of P-IMT, D-IMT, or CT intervention for 20 sessions (90 minutes per day, 5 days per week for 4 weeks). Outcome measures included the upper-extremity subscale of Fugl-Meyer Assessment (FMA-UE), Modified Ashworth Scale (MAS), Medical Research Council Scale (MRC), Wolf Motor Function Test (WMFT), Motor Activity Log (MAL), ABILHAND Questionnaire, Functional Independence Measure (FIM), Stroke Impact Scale (SIS), kinematic variables, and wrist accelerometers. Moreover, self-reported pain was monitored by using the Visual Analogue Scale (VAS) immediately after intervention. Results: There were 6 participants recruited in P-IMT group; 4 participants recruited in D-IMT group; 3 participants recruited in CT group. In clinical outcomes, from the perspective of relative change in FMA-UE, 3 participants in P-IMT group reached minimal clinically important difference (MCID); 3 participants in D-IMT group reached MCID; 1 participant in CT group reached MCID. In FMA-UE proximal subscale, 4 participants in P-IMT group reached MCID; 3 participants in D-IMT group reached MCID; 1 participant in CT group reached MCID. In FMA-UE distal subscale, 2 participants in P-IMT group reached MCID; 3 participants in D-IMT group reached MCID; 1 participant in CT group reached MCID. In WMFT-QOM, 2 participants in P-IMT group reached MCID; 2 participants in D-IMT group reached MCID; 1 participant in CT group reached MCID. In WMFT-TIME, 3 participants in P-IMT group reached MCID; 4 participants in D-IMT group reached MCID. In SIS physical functions subscale, 3 participants in P-IMT group reached MCID; 2 participants in D-IMT group reached MCID; 2 participants in CT group reached MCID. In kinematic variables, P-IMT group showed favorable outcomes in reaction time, movement time (MT), motor unit (MU), and normalized total displacement (NTD) of endpoint control; MT and NTD of trunk compensation. D-IMT group showed favorable outcomes in reaction time, peak velocity (PV), and percentage of index peak velocity (PPV) of endpoint control; PV of trunk compensation, and joint coordination. In accelerometric measures, both P-IMT and D-IMT groups showed favorable outcomes in vector magnitude counts, energy expenditure and using amount of activity in lifestyle to moderate level. In adverse effects monitoring, no serious adverse effect occurred during the period of intervention. Conclusion: This study supports the positive effects of P-IMT or D-IMT combined with intensive functional task practice on motor abilities, motor functions, and QOL in patients with chronic stroke. Moreover, P-IMT revealed superiority on proximal and gross movement of upper extremity, while D-IMT revealed superiority on distal and dexterous movement of upper extremity. In addition, generalizing effects emerged during intervention (D-IMT might have more generalizing effects than P-IMT). Due to the small sample size, the conclusion should be interpreted cautiously. Further studies are needed to expand the sample size and further validate the findings of this study.
Subjects
InMotion
Robot-assisted therapy
Stroke
Rehabilitation
Comparative efficacy research
Type
thesis
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