Individual and combined applied robotic hand rehabilitation and conventional rehabilitation for post-stroke hemiplegia: a prospective three-arm randomized study.

BACKGROUND

Conventional rehabilitation (CR) and robotic hand rehabilitation (RR) are effective rehabilitation options for post-stroke hemiplegia. Combining these two rehabilitation protocols may positively affect the results.

AIM

To compare the effectiveness of individual and combined applications of CR and RR on hand and upper extremity function, spasticity, grip and tip pinch strength in the treatment of post-stroke hemiplegia.

DESIGN

A three-arm, prospective randomized controlled trial.

SETTING

Multidisciplinary rehabilitation facility.

POPULATION

Sixty-six patients with post-stroke hemiplegia.

METHODS

Participants were randomized into three groups: RR, CR, and combined conventional and robotic hand rehabilitation (CR-RR). For the RR group, a passive and active finger motion program (40 minutes a day), along with a home-based rehabilitation program, was administered using the robotic device. For the CR group, traditional manual therapy techniques were used to improve activities of daily living and to achieve isometric contractions in weak muscles (60 minutes a day). For the CR-RR group, 60 minutes of conventional rehabilitation was followed by 40 minutes of hand rehabilitation using the robotic device. The patients in all groups were rehabilitated for 1 month, 5 days a week. The Fugl-Meyer Upper Extremity Assessment Scale was used as primary outcome measure for evaluating the upper extremity function. The secondary outcome was evaluated based on hand function, upper extremity and hand motor function, activities of daily living (ADLs), upper extremity spasticity, and hand strength.

RESULTS

CR-RR was significantly more effective than both CR and RR in improving upper extremity function, hand function, and ADLs. The only group that had no effect on upper extremity function was RR. All three rehabilitation protocols were ineffective in treating shoulder adductor and elbow flexor spasticity. While all three protocols effectively reduced spasticity in the wrist, fingers, and thumb flexors, CR was significantly less effective compared to the other groups. Although the CR-RR and RR groups had similar results in reducing wrist and finger flexor spasticity, the CR-RR group was significantly more effective than the RR group in reducing thumb spasticity. CR did not influence grip and tip pinch strength, whereas both CR-RR and RR led to significant improvements.

CONCLUSIONS

RR has no effect on upper extremity functional results. CR has no effect on grip and pinch strength and only a limited effect on wrist, finger, and thumb flexor spasticity. Combining conventional rehabilitation with robotic rehabilitation in the CR-RR protocol yields better results in daily living activities, upper extremity function, hand function, wrist, finger, and thumb flexor spasticity, as well as hand grip and tip pinch strength in post-stroke hemiplegia.

CLINICAL REHABILTATION IMPACT

Concomitant application of RR and CR achieves better outcomes in post-stroke hemiplegia.