Chronic stroke survivors achieve comparable outcomes following virtual task specific repetitive training guided by a wearable robotic orthosis (UL-EXO7) and actual task specific repetitive training guided by a physical therapist.

Survivors post stroke commonly have upper limb impairments. Patients can drive neural reorganization, brain recovery and return of function with task specific repetitive training (TSRT). Fifteen community independent stroke survivors (25-75 years, >6 months post stroke, Upper Limb Fugl Meyer [ULFM] scores 16-39) participated in this randomized feasibility study to compare outcomes of upper limb TSRT guided by a robotic orthosis (bilateral or unilateral) or a physical therapist. After 6 weeks of training (18 h), across all subjects, there were significant improvements in depression, flexibility, strength, tone, pain and voluntary movement (ULFM) (p < 0.05; effect sizes 0.49-3.53). Each training group significantly improved ULFM scores and range of motion without significant group differences. Virtual or actual TSRT performed with a robotic orthosis or a physical therapist significantly reduced arm impairments around the shoulder and elbow without significant gains in fine motor hand control, activities of daily living or independence.

[1]  L. Jongbloed Prediction of function after stroke: a critical review. , 1986, Stroke.

[2]  Jeffrey D. Riley,et al.  Neuroplasticity and brain repair after stroke , 2008, Current opinion in neurology.

[3]  Antonio Frisoli,et al.  Robotic assisted rehabilitation in Virtual Reality with the L-EXOS. , 2009, Studies in health technology and informatics.

[4]  S. Fung,et al.  Functional outcomes : The development of a new instrument to monitor the effectiveness of physical therapy , 1997 .

[5]  Paolo Bonato,et al.  Advances in wearable technology for rehabilitation. , 2009, Studies in health technology and informatics.

[6]  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.

[7]  C. Aring,et al.  A CRITICAL REVIEW , 1939, Journal of neurology and psychiatry.

[8]  P. Verschure,et al.  The rehabilitation gaming system: a review. , 2009, Studies in health technology and informatics.

[9]  Ching-yi Wu,et al.  Constraint-Induced Therapy Versus Dose-Matched Control Intervention to Improve Motor Ability, Basic/Extended Daily Functions, and Quality of Life in Stroke , 2009, Neurorehabilitation and neural repair.

[10]  D. Mozaffarian,et al.  Heart disease and stroke statistics--2012 update: a report from the American Heart Association. , 2012, Circulation.

[11]  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.

[12]  Ching-yi Wu,et al.  Effects of Constraint-Induced Therapy Versus Bilateral Arm Training on Motor Performance, Daily Functions, and Quality of Life in Stroke Survivors , 2009, Neurorehabilitation and neural repair.

[13]  J. P. Miller,et al.  Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: the EXCITE randomized clinical trial. , 2006, JAMA.

[14]  J. Kleim,et al.  Motor training induces experience-specific patterns of plasticity across motor cortex and spinal cord. , 2006, Journal of applied physiology.

[15]  Richard W. Bohannon,et al.  Interrater reliability of a modified Ashworth scale of muscle spasticity. , 1987, Physical therapy.

[16]  John T Chibnall,et al.  Comparison of the Saint Louis University mental status examination and the mini-mental state examination for detecting dementia and mild neurocognitive disorder--a pilot study. , 2006, The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry.

[17]  Maureen K. Holden,et al.  Virtual Environments for Motor Rehabilitation: Review , 2005, Cyberpsychology Behav. Soc. Netw..

[18]  D. Reinkensmeyer Robotic assistance for upper extremity training after stroke. , 2009, Studies in health technology and informatics.

[19]  Hilla Peretz,et al.  Ju n 20 03 Schrödinger ’ s Cat : The rules of engagement , 2003 .

[20]  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.

[21]  Roland G. Henry,et al.  Resting state alpha-band functional connectivity and recovery after stroke , 2012, Experimental Neurology.

[22]  S. Studenski,et al.  Measuring Stroke Impact with SIS: Construct Validity of SIS Telephone Administration , 2006, Quality of Life Research.

[23]  N. Hogan,et al.  Robotic devices as therapeutic and diagnostic tools for stroke recovery. , 2009, Archives of neurology.

[24]  N. Hogan,et al.  A working model of stroke recovery from rehabilitation robotics practitioners , 2009, Journal of NeuroEngineering and Rehabilitation.

[25]  Joel C. Perry,et al.  Isotropy of an upper limb exoskeleton and the kinematics and dynamics of the human arm , 2009 .

[26]  P. Duncan,et al.  Measurement of Motor Recovery After Stroke: Outcome Assessment and Sample Size Requirements , 1992, Stroke.

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

[28]  G. Morel,et al.  Constraining Upper Limb Synergies of Hemiparetic Patients Using a Robotic Exoskeleton in the Perspective of Neuro-Rehabilitation , 2012, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

[29]  V. Mathiowetz,et al.  Adult norms for the Box and Block Test of manual dexterity. , 1985, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[30]  T. Murphy,et al.  Plasticity during stroke recovery: from synapse to behaviour , 2009, Nature Reviews Neuroscience.

[31]  E. Taub,et al.  A Placebo-Controlled Trial of Constraint-Induced Movement Therapy for Upper Extremity After Stroke , 2006, Stroke.

[32]  Daniel M. Corcos,et al.  Comparison of Bilateral and Unilateral Training for Upper Extremity Hemiparesis in Stroke , 2009, Neurorehabilitation and neural repair.

[33]  J.C. Perry,et al.  Upper-Limb Powered Exoskeleton Design , 2007, IEEE/ASME Transactions on Mechatronics.

[34]  N. Hogan,et al.  A comparison of functional and impairment-based robotic training in severe to moderate chronic stroke: a pilot study. , 2008, NeuroRehabilitation.

[35]  R W Bohannon,et al.  Stopwatch for Measuring Thumb-Movement Time , 1995, Perceptual and motor skills.

[36]  Mark D. Huffman,et al.  Heart disease and stroke statistics--2013 update: a report from the American Heart Association. , 2013, Circulation.

[37]  N. Byl,et al.  Functional Outcomes Can Vary by Dose: Learning-Based Sensorimotor Training for Patients Stable Poststroke , 2008, Neurorehabilitation and neural repair.

[38]  Ching-yi Wu,et al.  The Effects of Bilateral Arm Training on Motor Control and Functional Performance in Chronic Stroke: A Randomized Controlled Study , 2010, Neurorehabilitation and neural repair.

[39]  C. Burgar,et al.  Robot-assisted movement training compared with conventional therapy techniques for the rehabilitation of upper-limb motor function after stroke. , 2002, Archives of physical medicine and rehabilitation.

[40]  Antonio Frisoli,et al.  A new force-feedback arm exoskeleton for haptic interaction in virtual environments , 2005, First Joint Eurohaptics Conference and Symposium on Haptic Interfaces for Virtual Environment and Teleoperator Systems. World Haptics Conference.

[41]  Grant D. Huang,et al.  An Economic Analysis of Robot-Assisted Therapy for Long-Term Upper-Limb Impairment After Stroke , 2011, Stroke.

[42]  R. Rosenthal Meta-analytic procedures for social research , 1984 .

[43]  S. Embretson,et al.  The stroke impact scale version 2.0. Evaluation of reliability, validity, and sensitivity to change. , 1999, Stroke.

[44]  Jeffery J. Summers,et al.  Bilateral and unilateral movement training on upper limb function in chronic stroke patients: A TMS study , 2007, Journal of the Neurological Sciences.

[45]  W. Rymer,et al.  Robot-assisted movement training for the stroke-impaired arm: Does it matter what the robot does? , 2006, Journal of rehabilitation research and development.

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

[47]  R. Tong,et al.  Bilateral Upper Limb Training With Functional Electric Stimulation in Patients With Chronic Stroke , 2009, Neurorehabilitation and Neural Repair.

[48]  Jose L Pons,et al.  Introduction to Wearable Robotics , 2008 .

[49]  M. Muhlenhaupt Measurement of Joint Motion: A Guide to Goniometry , 1986 .

[50]  Moshe Brand,et al.  Redundancy resolution of a human arm for controlling a seven DOF wearable robotic system , 2011, 2011 Annual International Conference of the IEEE Engineering in Medicine and Biology Society.

[51]  Peter Sandercock,et al.  Evidence-based practice for stroke , 2009, The Lancet Neurology.

[52]  Alan Buckingham,et al.  Statistical Update , 1996, The Bulletin of the Ecological Society of America.

[53]  J. Kleim,et al.  Principles of experience-dependent neural plasticity: implications for rehabilitation after brain damage. , 2008, Journal of speech, language, and hearing research : JSLHR.

[54]  Hermano I Krebs,et al.  Multicenter Randomized Trial of Robot-Assisted Rehabilitation for Chronic Stroke: Methods and Entry Characteristics for VA ROBOTICS , 2009, Neurorehabilitation and neural repair.

[55]  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.

[56]  G. Kwakkel,et al.  The impact of physical therapy on functional outcomes after stroke: what's the evidence? , 2004, Clinical rehabilitation.

[57]  Bruce R. Rosen,et al.  Connectivity alterations assessed by combining fMRI and MR-compatible hand robots in chronic stroke , 2009, NeuroImage.

[58]  D. Mozaffarian,et al.  Heart disease and stroke statistics--2010 update: a report from the American Heart Association. , 2010, Circulation.

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

[60]  M. Levin,et al.  What Do Motor “Recovery” and “Compensation” Mean in Patients Following Stroke? , 2009, Neurorehabilitation and neural repair.

[61]  L. A. Marascuilo,et al.  Nonparametric and Distribution-Free Methods for the Social Sciences , 1977 .

[62]  Jeffery J. Summers,et al.  Neural plasticity and bilateral movements: A rehabilitation approach for chronic stroke , 2005, Progress in Neurobiology.

[63]  A. Beck,et al.  An inventory for measuring depression. , 1961, Archives of general psychiatry.

[64]  Valerie Hill,et al.  Portable upper extremity robotics is as efficacious as upper extremity rehabilitative therapy: a randomized controlled pilot trial , 2013, Clinical rehabilitation.

[65]  R. Nudo,et al.  Neural Substrates for the Effects of Rehabilitative Training on Motor Recovery After Ischemic Infarct , 1996, Science.

[66]  Michelle J. Johnson,et al.  Advances in upper limb stroke rehabilitation: a technology push , 2011, Medical & Biological Engineering & Computing.

[67]  Hyunchul Kim,et al.  Kinematic Data Analysis for Post-Stroke Patients Following Bilateral Versus Unilateral Rehabilitation With an Upper Limb Wearable Robotic System , 2013, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

[68]  H. Hricak,et al.  Evidence-based medicine. , 1997, Singapore medical journal.

[69]  K. Furie,et al.  Heart disease and stroke statistics--2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. , 2007, Circulation.