Robot-assisted movement training compared with conventional therapy techniques for the rehabilitation of upper-limb motor function after stroke.

OBJECTIVE

To compare the effects of robot-assisted movement training with conventional techniques for the rehabilitation of upper-limb motor function after stroke.

DESIGN

Randomized controlled trial, 6-month follow-up.

SETTING

A Department of Veterans Affairs rehabilitation research and development center.

PARTICIPANTS

Consecutive sample of 27 subjects with chronic hemiparesis (>6mo after cerebrovascular accident) randomly allocated to group.

INTERVENTIONS

All subjects received twenty-four 1-hour sessions over 2 months. Subjects in the robot group practiced shoulder and elbow movements while assisted by a robot manipulator. Subjects in the control group received neurodevelopmental therapy (targeting proximal upper limb function) and 5 minutes of exposure to the robot in each session.

MAIN OUTCOME MEASURES

Fugl-Meyer assessment of motor impairment, FIMtrade mark instrument, and biomechanic measures of strength and reaching kinematics. Clinical evaluations were performed by a therapist blinded to group assignments.

RESULTS

Compared with the control group, the robot group had larger improvements in the proximal movement portion of the Fugl-Meyer test after 1 month of treatment (P<.05) and also after 2 months of treatment (P<.05). The robot group had larger gains in strength (P<.02) and larger increases in reach extent (P<.01) after 2 months of treatment. At the 6-month follow-up, the groups no longer differed in terms of the Fugl-Meyer test (P>.30); however, the robot group had larger improvements in the FIM (P<.04).

CONCLUSIONS

Compared with conventional treatment, robot-assisted movements had advantages in terms of clinical and biomechanical measures. Further research into the use of robotic manipulation for motor rehabilitation is justified.