http://nnr.sagepub.com/content/22/2/111.short?rss=1&ssource=mfr
- Gert Kwakkel, PhD
- Department Rehabilitation Medicine and Research Institute MOVE, VU University Medical Center Amsterdam, The Netherlands, Department Rehabilitation Medicine, Rudolf Magnus Institute of NeuroScience, University Medical Center Utrecht, The Netherlands, g.kwakkel@vumc.nl
- Boudewijn J. Kollen, PhD
- Hermano I. Krebs, PhD
- Mechanical Engineering Department, Massachusetts Institute of Technology, Cambridge, Massachusetts, Department of Neurology and Neuroscience, Burke Institute of Medical Research, Weill Medical College, Cornell University, White Plains, New York, Department of Neurology, University of Maryland, School of Medicine, Baltimore, Maryland
Abstract
Objective. The aim of the study was to present a systematic review of studies that investigate the effects of robot-assisted therapy
on motor and functional recovery in patients with stroke. Methods.
A database of articles published up to October 2006 was compiled using
the following Medline key words: cerebral vascular
accident, cerebral vascular disorders, stroke,
paresis, hemiplegia, upper extremity, arm, and robot. References listed
in
relevant publications were also screened. Studies
that satisfied the following selection criteria were included: (1)
patients
were diagnosed with cerebral vascular accident; (2)
effects of robot-assisted therapy for the upper limb were investigated;
(3) the outcome was measured in terms of motor
and/or functional recovery of the upper paretic limb; and (4) the study
was
a randomized clinical trial (RCT). For each outcome
measure, the estimated effect size (ES) and the summary effect size
(SES)
expressed in standard deviation units (SDU) were
calculated for motor recovery and functional ability (activities of
daily
living [ADLs]) using fixed and random effect
models. Ten studies, involving 218 patients, were included in the
synthesis.
Their methodological quality ranged from 4 to 8 on a
(maximum) 10-point scale. Results. Meta-analysis showed a
nonsignificant heterogeneous SES in terms of upper limb motor recovery.
Sensitivity analysis of studies
involving only shoulder-elbow robotics subsequently
demonstrated a significant homogeneous SES for motor recovery of the
upper
paretic limb. No significant SES was observed for
functional ability (ADL). Conclusion. As a result of marked
heterogeneity in studies between distal and proximal arm robotics, no
overall significant effect in
favor of robot-assisted therapy was found in the
present meta-analysis. However, subsequent sensitivity analysis showed a
significant improvement in upper limb motor
function after stroke for upper arm robotics. No significant improvement
was found
in ADL function. However, the administered ADL
scales in the reviewed studies fail to adequately reflect recovery of
the paretic
upper limb, whereas valid instruments that measure
outcome of dexterity of the paretic arm and hand are mostly absent in
selected
studies. Future research into the effects of
robot-assisted therapy should therefore distinguish between upper and
lower robotics
arm training and concentrate on kinematical
analysis to differentiate between genuine upper limb motor recovery and
functional
recovery due to compensation strategies by proximal
control of the trunk and upper limb.
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