Efficacy of robot-assisted fingers training in chronic stroke survivors: a pilot randomized-controlled trial

BackgroundWhile constraint-induced movement therapy (CIMT) is one of the most promising techniques for upper limb rehabilitation after stroke, it requires high residual function to start with. Robotic device, on the other hand, can provide intention-driven assistance and is proven capable to complement conventional therapy. However, with many robotic devices focus on more proximal joints like shoulder and elbow, recovery of hand and fingers functions have become a challenge. Here we propose the use of robotic device to assist hand and fingers functions training and we aim to evaluate the potential efficacy of intention-driven robot-assisted fingers training.MethodsParticipants (6 to 24 months post-stroke) were randomly assigned into two groups: robot-assisted (robot) and non-assisted (control) fingers training groups. Each participant underwent 20-session training. Action Research Arm Test (ARAT) was used as the primary outcome measure, while, Wolf Motor Function Test (WMFT) score, its functional tasks (WMFT-FT) sub-score, Fugl-Meyer Assessment (FMA), its shoulder and elbow (FMA-SE) sub-score, and finger individuation index (FII) served as secondary outcome measures.ResultsNineteen patients completed the 20-session training (Trial Registration: HKClinicalTrials.com HKCTR-1554); eighteen of them came back for a 6-month follow-up. Significant improvements (p < 0.05) were found in the clinical scores for both robot and control group after training. However, only robot group maintained the significant difference in the ARAT and FMA-SE six months after the training. The WMFT-FT score and time post-training improvements of robot group were significantly better than those of the control group.ConclusionsThis study showed the potential efficacy of robot-assisted fingers training for hand and fingers rehabilitation and its feasibility to facilitate early rehabilitation for a wider population of stroke survivors; and hence, can be used to complement CIMT.

[1]  C. Dolea,et al.  World Health Organization , 1949, International Organization.

[2]  A. Fugl-Meyer,et al.  The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance. , 1975, Scandinavian journal of rehabilitation medicine.

[3]  E. Taub.  Movement In Nonhuman Primates Deprived Of Somatosensory Feedback , 1976, Exercise and sport sciences reviews.

[4]  P. Celnik,et al.  Stroke Rehabilitation. , 2015, Physical medicine and rehabilitation clinics of North America.

[5]  T. Olsen,et al.  Recovery of upper extremity function in stroke patients: the Copenhagen Stroke Study. , 1994, Archives of physical medicine and rehabilitation.

[6]  N. Miller,et al.  An operant approach to rehabilitation medicine: overcoming learned nonuse by shaping. , 1994, Journal of the experimental analysis of behavior.

[7]  E. Taub,et al.  Constraint-induced movement therapy: A new approach to treatment in physical rehabilitation. , 1998 .

[8]  G. Kwakkel,et al.  Intensity of leg and arm training after primary middle-cerebral-artery stroke: a randomised trial , 1999, The Lancet.

[9]  E. Taub,et al.  The reliability of the wolf motor function test for assessing upper extremity function after stroke. , 2001, Archives of physical medicine and rehabilitation.

[10]  S. Wolf,et al.  Assessing Wolf Motor Function Test as Outcome Measure for Research in Patients After Stroke , 2001, Stroke.

[11]  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.

[12]  I. Hsueh,et al.  The Action Research Arm Test: is it necessary for patients being tested to sit at a standardized table? , 2002, Clinical rehabilitation.

[13]  T. Elbert,et al.  New treatments in neurorehabiliation founded on basic research , 2002, Nature Reviews Neuroscience.

[14]  A. G. Feldman,et al.  Interjoint coordination dynamics during reaching in stroke , 2003, Experimental Brain Research.

[15]  M. Latash,et al.  The effects of stroke and age on finger interaction in multi-finger force production tasks , 2003, Clinical Neurophysiology.

[16]  G. Kwakkel,et al.  Probability of regaining dexterity in the flaccid upper limb: impact of severity of paresis and time since onset in acute stroke. , 2003, Stroke.

[17]  R. D'Agostino,et al.  The influence of gender and age on disability following ischemic stroke: the Framingham study. , 2003, Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association.

[18]  D. Nowak,et al.  Grip force control during object manipulation in cerebral stroke , 2003, Clinical Neurophysiology.

[19]  B. Dobkin.  Strategies for stroke rehabilitation , 2004, The Lancet Neurology.

[20]  T. Platz,et al.  Reliability and validity of arm function assessment with standardized guidelines for the Fugl-Meyer Test, Action Research Arm Test and Box and Block Test: a multicentre study , 2005, Clinical rehabilitation.

[21]  D. Beevers,et al.  The atlas of heart disease and stroke , 2005, Journal of Human Hypertension.

[22]  S. Sahrmann,et al.  Deficits in grasp versus reach during acute hemiparesis , 2005, Experimental Brain Research.

[23]  Chun-Hou Wang,et al.  Validation of the action research arm test using item response theory in patients after stroke. , 2006, Journal of rehabilitation medicine.

[24]  Gereon R Fink,et al.  Dexterity is impaired at both hands following unilateral subcortical middle cerebral artery stroke , 2007, The European journal of neuroscience.

[25]  H.I. Krebs,et al.  Robot-Aided Neurorehabilitation: A Robot for Wrist Rehabilitation , 2007, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

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

[27]  C. Lang,et al.  Absence of a proximal to distal gradient of motor deficits in the upper extremity early after stroke , 2008, Clinical Neurophysiology.

[28]  Denis Mottet,et al.  Rehabilitation of arm function after stroke. Literature review. , 2009, Annals of physical and rehabilitation medicine.

[29]  Robert Riener,et al.  Effects of Arm Training with the Robotic Device ARMin I in Chronic Stroke: Three Single Cases , 2009, Neurodegenerative Diseases.

[30]  Yuh Jang,et al.  Minimal Detectable Change and Clinically Important Difference of the Wolf Motor Function Test in Stroke Patients , 2009, Neurorehabilitation and neural repair.

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

[32]  M. Chen,et al.  An intention driven hand functions task training robotic system , 2010, 2010 Annual International Conference of the IEEE Engineering in Medicine and Biology.

[33]  Gitendra Uswatte,et al.  The EXCITE Stroke Trial: Comparing Early and Delayed Constraint-Induced Movement Therapy , 2010, Stroke.

[34]  M. Woodbury,et al.  Translating measurement findings into rehabilitation practice: an example using Fugl-Meyer Assessment-Upper Extremity with patients following stroke. , 2011, Journal of rehabilitation research and development.

[35]  K. Y. Tong,et al.  An EMG-driven exoskeleton hand robotic training device on chronic stroke subjects: Task training system for stroke rehabilitation , 2011, 2011 IEEE International Conference on Rehabilitation Robotics.

[36]  P. Langhorne,et al.  Stroke rehabilitation , 2011, The Lancet.

[37]  Xiaoling Hu,et al.  Hand Exoskeleton Robot as a Force Measurement Tool , 2012, BioMed 2012.

[38]  Soo-Jin Lee,et al.  Current hand exoskeleton technologies for rehabilitation and assistive engineering , 2012 .

[39]  S. Page,et al.  Clinically Important Differences for the Upper-Extremity Fugl-Meyer Scale in People With Minimal to Moderate Impairment Due to Chronic Stroke , 2012, Physical Therapy.

[40]  S. Page,et al.  Psychometric properties and administration of the wrist/hand subscales of the Fugl-Meyer Assessment in minimally impaired upper extremity hemiparesis in stroke. , 2012, Archives of physical medicine and rehabilitation.

[41]  S. Leonhardt,et al.  A survey on robotic devices for upper limb rehabilitation , 2014, Journal of NeuroEngineering and Rehabilitation.

[42]  Robert Teasell,et al.  Systematic Review and Meta-Analysis of Constraint-Induced Movement Therapy in the Hemiparetic Upper Extremity More Than Six Months Post Stroke , 2012, Topics in stroke rehabilitation.

[43]  Hyung-Soon Park,et al.  Developing a Multi-Joint Upper Limb Exoskeleton Robot for Diagnosis, Therapy, and Outcome Evaluation in Neurorehabilitation , 2013, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

[44]  E. A. Susanto,et al.  The effects of post-stroke upper-limb training with an electromyography (EMG)-driven hand robot. , 2013, Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology.

[45]  Talicia Tarver,et al.  HEART DISEASE AND STROKE STATISTICS–2014 UPDATE: A REPORT FROM THE AMERICAN HEART ASSOCIATION , 2014 .

[46]  Ching-yi Wu,et al.  Sequential combination of robot-assisted therapy and constraint-induced therapy in stroke rehabilitation: a randomized controlled trial , 2014, Journal of Neurology.

[47]  Jack Parker,et al.  The Effectiveness of Lower-Limb Wearable Technology for Improving Activity and Participation in Adult Stroke Survivors: A Systematic Review , 2016, Journal of medical Internet research.