Distal versus proximal-an investigation on different supportive strategies by robots for upper limb rehabilitation after stroke: a randomized controlled trial

Nothing here even suggests they have an objective starting point. Thus none of this is repeatable research and you can't make any conclusions from this.

The Fugl-Meyer upper extremity scale has no objective distinction for changes in ability and thus would be useless as a measurement tool. 

Using the Action Research Arm Test for validation is not useful, it is subjective.

The Modified Ashworth Scale is way too subjective to be of any use in knowing if improvements are occurring.  

 

Distal versus proximal-an investigation on different supportive strategies by robots for upper limb rehabilitation after stroke: a randomized controlled trial

• Qiuyang QIAN,
• Chingyi Nam,
• Ziqi Guo,
• Yanhuan Huang,
• Xiaoling HuEmail authorView ORCID ID profile,
• Stephanie C. Ng,
• Yongping Zheng and
• Waisang Poon

Journal of NeuroEngineering and Rehabilitation201916:64

https://doi.org/10.1186/s12984-019-0537-5

©  The Author(s). 2019

• Received: 21 September 2018
• Accepted: 16 May 2019
• Published: 3 June 2019

Abstract

Background

Different mechanical supporting strategies to the joints in the upper extremity (UE) may lead to varied rehabilitative effects after stroke. This study compared the rehabilitation effectiveness achieved by electromyography (EMG)-driven neuromuscular electrical stimulation (NMES)-robotic systems when supporting to the distal fingers and to the proximal (wrist-elbow) joints.

Methods

Thirty subjects with chronic stroke were randomly assigned to receive motor trainings with NMES-robotic support to the finger joints (hand group, n = 15) and with support to the wrist-elbow joints (sleeve group, n = 15). The training effects were evaluated by the clinical scores of Fugl-Meyer Assessment (FMA), Action Research Arm Test (ARAT), and Modified Ashworth Scale (MAS) before and after the trainings, as well as 3 months later. The cross-session EMG monitoring of EMG activation level and co-contraction index (CI) were also applied to investigate the recovery progress of muscle activations and muscle coordination patterns through the training sessions.

Results

Significant improvements (P < 0.05) in FMA full score, FMA shoulder/elbow (FMA-SE) and ARAT scores were found in both groups, whereas significant improvements (P < 0.05) in FMA wrist/hand (FMA-WH) and MAS scores were only observed in the hand group. Significant decrease of EMG activation levels (P < 0.05) of UE flexors was observed in both groups. Significant decrease in CI values (P < 0.05) was observed in both groups in the muscle pairs of biceps brachii and triceps brachii (BIC&TRI) and the wrist-finger flexors (flexor carpi radialis-flexor digitorum) and TRI (FCR-FD&TRI). The EMG activation levels and CIs of the hand group exhibited faster reductions across the training sessions than the sleeve group (P < 0.05).

Conclusions

Robotic supports to either the distal fingers or the proximal elbow-wrist could achieve motor improvements in UE. The robotic support directly to the distal fingers was more effective than to the proximal parts in improving finger motor functions and in releasing muscle spasticity in the whole UE.

Clinical trial registration

ClinicalTrials.gov, identifier NCT02117089; date of registration: April 10, 2014. https://clinicaltrials.gov/ct2/show/NCT02117089