Effects of task-oriented robot training on arm function, activity, and quality of life in chronic stroke patients: a randomized controlled trial

BackgroundOver fifty percent of stroke patients experience chronic arm hand performance problems, compromising independence in daily life activities and quality of life. Task-oriented training may improve arm hand performance after stroke, whereby augmented therapy may lead to a better treatment outcome. Technology-supported training holds opportunities for increasing training intensity. However, the effects of robot-supported task-oriented training with real life objects in stroke patients are not known to date. The aim of the present study was to investigate the effectiveness and added value of the Haptic Master robot combined with task-oriented arm hand training in chronic stroke patients.MethodsIn a single-blind randomized controlled trial, 22 chronic stroke patients were randomly allocated to receive either task-oriented robot-assisted arm-hand training (experimental group) or task-oriented non-robotic arm-hand training (control group). For training, the T-TOAT (Technology-supported Task-Oriented Arm Training) method was applied. Training was provided during 8 weeks, 4 times/week, 2× 30 min/day.ResultsA significant improvement after training on the Action Research Arm Test (ARAT) was demonstrated in the experimental group (p = 0.008). Results were maintained until 6 months after cessation of the training. On the perceived performance measure (Motor Activity Log (MAL)), both, the experimental and control group improved significantly after training (control group p = 0.008; experimental group p = 0.013). The improvements on MAL in both groups were maintained until 6 months after cessation of the training. With regard to quality of life, only in the control group a significant improvement after training was found (EuroQol-5D p = 0.015, SF-36 physical p = 0.01). However, the improvement on SF-36 in the control group was not maintained (p = 0.012). No between-group differences could be demonstrated on any of the outcome measures.ConclusionArm hand performance improved in chronic stroke patients, after eight weeks of task oriented training. The use of a Haptic Master robot in support of task-oriented arm training did not show additional value over the video-instructed task-oriented exercises in highly functional stroke patients.Clinical trial registration informationCurrent Controlled Trials ISRCTN82787126

[1]  J. E. Brazier,et al.  Using the SF-36 and Euroqol on an elderly population , 1996, Quality of Life Research.

[2]  Etienne Burdet,et al.  Guest Editorial Motor Skill Learning and Neuro-Rehabilitation , 2012, EMBC 2012.

[3]  A. Prevo,et al.  The long-term outcome of arm function after stroke: results of a follow-up study. , 1999, Disability and rehabilitation.

[4]  P. Clark,et al.  Factors Influencing Stroke Survivors' Quality of Life During Subacute Recovery , 2005, Stroke.

[5]  T. Platz,et al.  Electromechanical and robot-assisted arm training for improving generic activities of daily living, arm function, and arm muscle strength after stroke. , 2012, The Cochrane database of systematic reviews.

[6]  Subashan Perera,et al.  Persisting Consequences of Stroke Measured by the Stroke Impact Scale , 2002, Stroke.

[7]  Robert Riener,et al.  Robot-aided neurorehabilitation of the upper extremities , 2005, Medical and Biological Engineering and Computing.

[8]  P. Langhorne,et al.  Motor recovery after stroke: a systematic review , 2009, The Lancet Neurology.

[9]  H. Krebs,et al.  Effects of Robot-Assisted Therapy on Upper Limb Recovery After Stroke: A Systematic Review , 2008, Neurorehabilitation and neural repair.

[10]  A. Timmermans,et al.  Influence of Task-Oriented Training Content on Skilled Arm-Hand Performance in Stroke: A Systematic Review , 2010, Neurorehabilitation and neural repair.

[11]  Frank I. Katch,et al.  Exercise Physiology: Energy, Nutrition, and Human Performance , 2006 .

[12]  I. Hsueh,et al.  Inter-rater reliability and validity of the action research arm test in stroke patients. , 1998, Age and ageing.

[13]  P Sandercock,et al.  Qualitative comparison of the reliability of health status assessments with the EuroQol and SF-36 questionnaires after stroke. United Kingdom Collaborators in the International Stroke Trial. , 1998, Stroke.

[14]  Ryanne J. M. Lemmens,et al.  Valid and reliable instruments for arm-hand assessment at ICF activity level in persons with hemiplegia: a systematic review , 2012, BMC Neurology.

[15]  A. Timmermans,et al.  Arm and hand skills: Training preferences after stroke , 2009, Disability and rehabilitation.

[16]  W. Rymer,et al.  Robot-assisted reaching exercise promotes arm movement recovery in chronic hemiparetic stroke: a randomized controlled pilot study , 2006, Journal of NeuroEngineering and Rehabilitation.

[17]  Sarah J. Housman,et al.  A Randomized Controlled Trial of Gravity-Supported, Computer-Enhanced Arm Exercise for Individuals With Severe Hemiparesis , 2009, Neurorehabilitation and neural repair.

[18]  Maarten J. IJzerman,et al.  Systematic review of the effect of robot-aided therapy on recovery of the hemiparetic arm after stroke. , 2006, Journal of rehabilitation research and development.

[19]  E Burdet,et al.  Motor skill learning and neuro-rehabilitation. , 2012, IEEE transactions on neural systems and rehabilitation engineering.

[20]  L. Gauthier,et al.  The Bells Test: A quantitative and qualitative test for visual neglect. , 1989 .

[21]  C. Mathers,et al.  Stroke incidence and prevalence in Europe: a review of available data , 2006, European journal of neurology.

[22]  M. Weatherall,et al.  Is goal planning in rehabilitation effective? A systematic review , 2006, Clinical rehabilitation.

[23]  Ann Johansson,et al.  Activities of daily living among St Petersburg women after mild stroke. , 2007, Occupational therapy international.

[24]  S. Ferber,et al.  How to Assess Spatial Neglect - Line Bisection or Cancellation Tasks? , 2001, Journal of clinical and experimental neuropsychology.

[25]  M.J. Johnson,et al.  Development of ADLER: The Activities of Daily Living Exercise Robot , 2006, The First IEEE/RAS-EMBS International Conference on Biomedical Robotics and Biomechatronics, 2006. BioRob 2006..

[26]  G. Kwakkel.  Impact of intensity of practice after stroke: issues for consideration. , 2012, Disability and rehabilitation.

[27]  Jean-Bernard Martens,et al.  Rehabilitation of handwriting skills in stroke patients using interactive games: a pilot study , 2009, CHI Extended Abstracts.

[28]  E. Taub,et al.  Automated Constraint-Induced Therapy Extension (AutoCITE) for movement deficits after stroke. , 2004, Journal of rehabilitation research and development.

[29]  K. J. Miller,et al.  Goal-directed training: linking theories of treatment to clinical practice for improved functional activities in daily life , 2007, Clinical rehabilitation.

[30]  P. Feys,et al.  The Armeo Spring as training tool to improve upper limb functionality in multiple sclerosis: a pilot study , 2011, Journal of NeuroEngineering and Rehabilitation.

[31]  N. Aaronson,et al.  Translation, validation, and norming of the Dutch language version of the SF-36 Health Survey in community and chronic disease populations. , 1998, Journal of clinical epidemiology.

[32]  E. Taub,et al.  A telerehabilitation approach to delivery of constraint-induced movement therapy. , 2006, Journal of rehabilitation research and development.

[33]  Peter Hagoort,et al.  De Akense Afasie Test , 1991 .

[34]  W. Taylor,et al.  Toward a cognitive-affective model of goal-setting in rehabilitation: is self-regulation theory a key step? , 2004, Disability and rehabilitation.

[35]  Annick A.A. Timmermans,et al.  T-TOAT: A method of task-oriented arm training for stroke patients suitable for implementation of exercises in rehabilitation technology , 2009, 2009 IEEE International Conference on Rehabilitation Robotics.

[36]  M. Woollacott,et al.  Motor Control: Translating Research into Clinical Practice , 2006 .

[37]  R. Teasell,et al.  Assessment of participation outcomes in randomized controlled trials of stroke rehabilitation interventions , 2007, International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation.

[38]  S. Black,et al.  The Fugl-Meyer Assessment of Motor Recovery after Stroke: A Critical Review of Its Measurement Properties , 2002, Neurorehabilitation and neural repair.

[39]  H. Vet,et al.  Clinimetric Properties of the Motor Activity Log for the Assessment of Arm Use in Hemiparetic Patients , 2004, Stroke.

[40]  W. D. McArdle,et al.  Essentials of Exercise Physiology , 1981 .

[41]  E. Heath.  Essentials of Exercise Physiology, 2nd Edition , 2000 .

[42]  M. Ferrarin,et al.  Robot Training of Upper Limb in Multiple Sclerosis: Comparing Protocols With or WithoutManipulative Task Components , 2012, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

[43]  C H Shea,et al.  Composition of practice: influence on the retention of motor skills. , 1991, Research quarterly for exercise and sport.

[44]  J. H. van der Lee,et al.  The intra- and interrater reliability of the action research arm test: a practical test of upper extremity function in patients with stroke. , 2001, Archives of physical medicine and rehabilitation.

[45]  A. Berger.  FUNDAMENTALS OF BIOSTATISTICS , 1969 .

[46]  Olivier Rouaud,et al.  Epidemiology of stroke in Europe: Geographic and environmental differences , 2007, Journal of the Neurological Sciences.

[47]  N. Yozbatiran,et al.  A Standardized Approach to Performing the Action Research Arm Test , 2008, Neurorehabilitation and neural repair.

[48]  Frans C. T. van der Helm,et al.  Influence of haptic guidance in learning a novel visuomotor task , 2009, Journal of Physiology-Paris.

[49]  Grant D. Huang,et al.  Robot-assisted therapy for long-term upper-limb impairment after stroke. , 2010, The New England journal of medicine.

[50]  Peter Langhorne,et al.  Effects of Augmented Exercise Therapy Time After Stroke: A Meta-Analysis , 2004, Stroke.

[51]  Panos Markopoulos,et al.  Motivating arm-hand use for stroke patients by serious games. , 2012, Conference proceedings : ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual Conference.

[52]  Gert Kwakkel Senior Researcher.  Impact of intensity of practice after stroke: Issues for consideration , 2009 .

[53]  P. Langhorne,et al.  Repetitive Task Training for Improving Functional Ability After Stroke , 2009, The Cochrane database of systematic reviews.

[54]  Bruce H Dobkin,et al.  Confounders in Rehabilitation Trials of Task-Oriented Training: Lessons From the Designs of the EXCITE and SCILT Multicenter Trials , 2007, Neurorehabilitation and neural repair.

[55]  M. Folstein,et al.  Population-based norms for the Mini-Mental State Examination by age and educational level. , 1993, JAMA.

[56]  Neville Hogan,et al.  Intensive Sensorimotor Arm Training Mediated by Therapist or Robot Improves Hemiparesis in Patients With Chronic Stroke , 2008, Neurorehabilitation and neural repair.

[57]  A. Timmermans,et al.  Sensor-Based Arm Skill Training in Chronic Stroke Patients: Results on Treatment Outcome, Patient Motivation, and System Usability , 2010, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

[58]  P. Bach-y-Rita,et al.  Reconsidering the motor recovery plateau in stroke rehabilitation. , 2004, Archives of physical medicine and rehabilitation.

[59]  T. Platz,et al.  Electromechanical and robot-assisted arm training for improving arm function and activities of daily living after stroke. , 2008, The Cochrane database of systematic reviews.

[60]  Ralph L. Sacco,et al.  Stroke Outcome in Clinical Trial Patients Deriving From Different Countries , 2009, Stroke.