Dose-Response Relationship of Robot-Assisted Stroke Motor Rehabilitation: The Impact of Initial Motor Status

In the 10.5 years since HAS YOUR STROKE HOSPITAL DONE ONE DAMN THING WITH THIS? NO? Then you don't have a functioning stroke hospital. Why are you there? 

Dose-Response Relationship of Robot-Assisted Stroke Motor Rehabilitation: The Impact of Initial Motor Status

The Impact of Initial Motor Status

Yu-wei Hsieh,

Ching-yi Wu,

Keh-chung Lin,

Grace Yao,

Kuen-yuh Wu and

Ya-ju Chang

Originally published14 Aug 2012https://doi.org/10.1161/STROKEAHA.112.658807Stroke. 2012;43:2729–2734

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Abstract

Background and Purpose—

The increasing availability of robot-assisted therapy (RT), which provides quantifiable, reproducible, interactive, and intensive practice, holds promise for stroke rehabilitation, but data on its dose–response relation are scanty. This study used 2 different intensities of RT to examine the treatment effects of RT and the effect on outcomes of the severity of initial motor deficits.

Methods—

Fifty-four patients with stroke were randomized to a 4-week intervention of higher-intensity RT, lower-intensity RT, or control treatment. The primary outcome, the Fugl-Meyer Assessment, was administered at baseline, midterm, and posttreatment. Secondary outcomes included the Medical Research Council scale, the Motor Activity Log, and the physical domains of the Stroke Impact Scale.

Results—

The higher-intensity RT group showed significantly greater improvements on the Fugl-Meyer Assessment than the lower-intensity RT and control treatment groups at midterm (P=0.003 and P=0.02) and at posttreatment (P=0.04 and P=0.02). Within-group gains on the secondary outcomes were significant, but the differences among the 3 groups did not reach significance. Recovery rates of the higher-intensity RT group were higher than those of the lower-intensity RT group, particularly on the Fugl-Meyer Assessment. Scatterplots with curve fitting showed that patients with moderate motor deficits gained more improvements than those with severe or mild deficits after the higher-intensity RT.

Conclusions—

This study demonstrated the higher treatment intensity provided by RT was associated with better motor outcome for patients with stroke, which may shape further stroke rehabilitation.

Clinical Trial Registration—

URL: http://clinicaltrials.gov. Unique identifier: NCT00917605.

Introduction

Stroke remains a common cause of acquired adult disability worldwide.^1,2 Motor deficits of the upper limb are often a devastating disability for stroke survivors³ and thus, the search for effective and efficient rehabilitation to promote motor recovery becomes urgent. Robot-assisted therapy (RT) is an innovative approach to stroke rehabilitation that uses intensive, repetitive, interactive, and individualized practice as an optimal strategy to enhance motor learning.^4,5

The optimal dosage for specific rehabilitation regimens to induce improvement is unclear from current evidence.⁶ Because the research suggests that intensive therapy has a positive influence on stroke recovery,^7,8 RT may offer a good way to close the gap between limited rehabilitation resources and a greater amount of therapy.⁹ RT also provides precise and quantifiable control of therapy, allowing better research into treatment dosage.¹⁰ This critical factor—how the intensity of therapy influences the effects of RT—should be addressed to inform the dose–response relation and to seek proper treatment intensity for patients.

Another emerging concern is which intervention is most beneficial for which type of patient under specific circumstances.¹¹ Identifying the factors affecting successful outcomes and the patients most likely to respond to the therapy would be informative for clinical guidelines. Although the initial motor status of patients with stroke is viewed as an important factor that influences recovery,^12,13 whether this factor affects the outcomes of RT remains unknown. We therefore investigated the effects of RT on clinical outcomes in patients with chronic stroke by using higher-intensity and lower-intensity RT relative to a duration-matched control treatment (CT) and also examined whether the initial severity of motor deficits and the treatment intensities of RT interact to influence the primary outcome.

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