Ma Di, Li Xin, Xu Quan, Yang Fei, Feng Yutong, Wang Wenxu, Huang Jian-Jia, Pei Yu-Cheng, Pan Yu
Department of Rehabilitation Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Taoyuan City, Taiwan.
Front Neurol. 2022 Jul 6;13:884261. doi: 10.3389/fneur.2022.884261. eCollection 2022.
A randomized controlled pilot study.
Bimanual therapy (BMT) is an effective neurorehabilitation therapy for the upper limb, but its application to the distal upper limb is limited due to methodological difficulties. Therefore, we applied an exoskeleton hand to perform robot-assisted task-oriented bimanual training (RBMT) in patients with stroke.
To characterize the effectiveness of RBMT in patients with hemiplegic stroke with upper limb motor impairment.
A total of 19 patients with subacute stroke (1-6 months from onset) were randomized and allocated to RBMT and conventional therapy (CT) groups. The RBMT and CT groups received 90 min of training/day (RBMT: 60 min RBMT + 30 min CT; CT: 60 min CT for hand functional training + 30 min regular CT), 5 days/week, for 4 weeks (20 sessions during the experimental period).
Clinical assessments, including the Fugl-Meyer assessment of the upper extremity (FMA-UE), action research arm test (ARAT), and wolf motor arm function test (WMFT), were conducted before and after the intervention.
Within-group analysis showed a significant improvement in the FMA-UE and WMFT in both the CT and RBMT groups. A significant improvement in the Fugl-Meyer assessment (FMA) of the wrist and hand for the distal part in the RBMT group occurred earlier than that in the CT group. A significant improvement in WMFT time was found in both groups, but the WMFT functional ability assessment was only found in the RBMT group. No significant improvements in ARAT assessment were observed in either the CT or RBMT groups. Compared with CT, significant improvements were found in terms of the proportion of minimally clinically important differences after RBMT in FMA-UE (χ = 4.34, = 0.037). No adverse events were reported by any of the participants across all sessions.
This study is the first to apply RBMT to the distal part of the upper limb. Both RBMT and CT are effective in improving the upper limb function in patients with subacute stroke. RBMT shows superior potential efficacy in facilitating recovery of the distal part of upper extremity (UE) motor function in the early stage. Future randomized control studies with a large sample size and follow-up assessments are needed to validate the present conclusions.
一项随机对照试验性研究。
双手疗法（BMT）是一种有效的上肢神经康复疗法，但由于方法上的困难，其在远端上肢的应用受到限制。因此，我们应用外骨骼手对中风患者进行机器人辅助的任务导向性双手训练（RBMT）。
描述RBMT对伴有上肢运动功能障碍的偏瘫中风患者的疗效。
总共19例亚急性中风患者（发病1 - 6个月）被随机分配到RBMT组和传统疗法（CT）组。RBMT组和CT组每天接受90分钟训练（RBMT组：60分钟RBMT + 30分钟CT；CT组：60分钟手部功能训练CT + 30分钟常规CT），每周5天，共4周（实验期内20次训练）。
在干预前后进行临床评估，包括上肢Fugl - Meyer评估（FMA - UE）、动作研究臂试验（ARAT）和Wolf运动臂功能测试（WMFT）。
组内分析显示，CT组和RBMT组的FMA - UE和WMFT均有显著改善。RBMT组手腕和手部远端部分的Fugl - Meyer评估（FMA）的显著改善比CT组出现得更早。两组的WMFT时间均有显著改善，但WMFT功能能力评估仅在RBMT组中发现。CT组和RBMT组的ARAT评估均未观察到显著改善。与CT组相比，RBMT组在FMA - UE中达到最小临床重要差异比例方面有显著改善（χ = 4.34， = 0.037）。所有参与者在所有训练过程中均未报告不良事件。
本研究首次将RBMT应用于上肢远端部分。RBMT和CT在改善亚急性中风患者的上肢功能方面均有效。RBMT在促进上肢（UE）运动功能远端部分早期恢复方面显示出更好的潜在疗效。未来需要进行大样本量的随机对照研究及随访评估来验证本结论。
