Kim Grace J, Taub Michael, Creelman Carly, Cahalan Christine, O'Dell Michael W, Stein Joel
Grace J. Kim, PhD, OTR/L, is Assistant Professor, Department of Occupational Therapy, New York University, New York. At the time of this study, she was Senior Occupational Therapist, Department of Rehabilitation Medicine, New York Presbyterian Hospital-Weill Cornell Medical Center, New York;
Michael Taub, MS, was Research Assistant, Department of Physical Medicine and Rehabilitation, Weill Cornell Medicine, New York, at the time of this study.
Am J Occup Ther. 2019 Jul/Aug;73(4):7304345040p1-7304345040p9. doi: 10.5014/ajot.2019.030908.
Effective treatment of the affected hand after stroke is crucial for improved functional independence and recovery.
To determine the feasibility and clinical utility of an electromyography-triggered hand robot.
Single-group repeated-measures design. Participants completed training 3×/wk for 6 wk. Feasibility data included participant feedback, adverse events, and compliance rates. Upper extremity outcomes were collected at baseline, discharge, and 6-wk follow-up.
Outpatient clinic.
Twelve stroke survivors at least 6 mo poststroke living in the community.
Eighteen sessions of intensive robotic hand therapy over 6 wk. Each 60-min treatment session was personalized to match the participant's ability.
Arm Motor Ability Test (AMAT), Stroke Impact Scale Hand subscale (SIS-H), Stroke Upper Limb Capacity Scale (SULCS), Fugl-Meyer Assessment, Box and Block Test, and dynamometer.
All participants completed the training phase. Mild skin pinching or rubbing at dorsal proximal interphalangeal joint and proximal arm fatigue were the most common adverse events. Improvements in raw scores were achieved from baseline to discharge for all outcome measures, except the SULCS. Participants significantly improved from baseline to discharge on the AMAT and the SIS-H, and improvements were maintained at 6-wk follow-up.
Robotic hand training was feasible, safe, and well tolerated. Participants reported and demonstrated improvements in functional use of the affected arm. Thirty percent of participants achieved clinically significant improvements on the AMAT. We recommend further study of the device in a larger study using the AMAT as a primary outcome measure.
It is feasible and safe to implement a robotic hand training protocol for people with moderate to severe arm impairment in an outpatient setting. Robotic training may provide a viable option for this group to actively participate in intensive training of the distal hand.
中风后对患手进行有效治疗对于提高功能独立性和恢复至关重要。
确定肌电图触发的手部机器人的可行性和临床效用。
单组重复测量设计。参与者每周进行3次训练，共6周。可行性数据包括参与者反馈、不良事件和依从率。在基线、出院时和6周随访时收集上肢结果。
门诊诊所。
12名中风后至少6个月的社区中风幸存者。
在6周内进行18次强化机器人手部治疗。每次60分钟的治疗课程都根据参与者的能力进行个性化定制。
手臂运动能力测试（AMAT）、中风影响量表手部子量表（SIS-H）、中风上肢能力量表（SULCS）、Fugl-Meyer评估、箱块测试和握力计。
所有参与者均完成训练阶段。最常见的不良事件是近端指间关节背侧轻度皮肤挤压或摩擦以及近端手臂疲劳。除SULCS外，所有结果指标从基线到出院时原始分数均有所改善。参与者在AMAT和SIS-H上从基线到出院时显著改善，且在6周随访时仍保持改善。
机器人手部训练可行、安全且耐受性良好。参与者报告并证明患臂功能使用有所改善。30%的参与者在AMAT上取得了临床上显著的改善。我们建议在一项以AMAT作为主要结果指标的更大规模研究中进一步研究该设备。
在门诊环境中为中度至重度手臂损伤患者实施机器人手部训练方案是可行且安全的。机器人训练可能为该群体积极参与远端手部强化训练提供一个可行的选择。
