FYI. For your doctor to implement.
Effect of Rehabilitation Robot Training on Cognitive Function in Stroke Patients : A Systematic Review and Meta-analysis
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Advances in Engineering Technology Research ICACTIC 2023
ISSN:2790-1688 Volume-6-(2023)
Effect of Rehabilitation Robot Training on Cognitive Function in
Stroke Patients : A Systematic Review and Meta-analysis
Wenzhan Xie1,a,*, Jiaqian Yan1,b, Mingxun Zhang2,c, and Yihan Chen1,d
1School of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, China;
2 College of Chinese medicine, Shandong University of Traditional Chinese Medicine, China.
az577741395@163.com, b19859026699@163.com, czmx181080@163.com,
d13676371605@163.com
Abstract. Objective: Post-stroke cognitive impairment is one of the major dysfunction after stroke,
which can lead to a variety of negative health outcomes. This study aims to evaluate the effects of
rehabilitation robotic therapy in post-stroke cognitive impairment patients.
Methods: As of December 2022, PubMed, Embase, Web of Science, Cochrane Library, and China
National Knowledge Infrastructure were searched through electronic databases. Eligibility criteria
RCTs evaluate RCTs of rehabilitation robots on treatment events in patients with cognitive
impairment after stroke, compared to control groups.
Results: Eight studies were included (n = 431). When combined with routine cognitive training
efficacy, rehabilitation robot intervention observably reduced MOCA scores, MBI scores and FMA
score. Furthermore, the FIM scores and MMSE scores were also better than the control groups.
Rehabilitation robots training can improve the cognitive function of stroke patients and is an
effective means of stroke rehabilitation.
Keywords: Cognitive Rehabilitation, Stroke, Robotics, Meta-Analysis.
1. Introduction
Post-stroke cognitive impairment is a clinical syndrome characterized by cognitive impairment
that occurs after stroke and lasts for 3-6 months. It is one of the major functional disorders after
stroke. Statistically, three quarters of stroke survivors show cognitive impairment, with an incidence
of up to 80 percent [1]. Cognitive dysfunction includes executive force, memory, visual-spatial, and
emotional defects associated with depressive / anxiety issues. Post-stroke cognitive impairment
makes patients unable to well cooperate with rehabilitation training, hinders the progress of
functional recovery, effects the ability of daily life activities, reduces the living quality and survival
time of patients, significantly adds the pressure of family and social and economic burden of, and
has a negative impact on rehabilitation strategies.
Traditional rehabilitation therapy only carries out routine cognitive training, which consumes a
considerable amount of manpower and material resources, and the training process is relatively
simple and lack of interest. It relies on the skills and professional knowledge of therapists, and has
few active participation of patients, which makes the effect of rehabilitation training is not ideal.
Currently, increasing evidence highlights the possible impact of robotic rehabilitation on functional
recovery in neurology patients. At present, the rehabilitation robot has been gradually applied in
clinical rehabilitation, studies have shown that rehabilitation robot can combine task orientation and
virtual reality technology, with high intensity, high repetition, rich environment stimulation
characteristics, can provide personalized auxiliary support, to insure that the patients in the right
way to complete the task needed to keep power, is an important supplement of cognitive
rehabilitation training.Previous meta-analysis studies have involved only rehabilitation robots being
useful in improving motor function, daily living ability, but no clear study suggests its role in
enhancing cognitive skills. Therefore, we strictly included the experiment by standardized screening
and demonstrated the conclusion by comparing the scores of five aspects. This article aimed to
assess the impact of rehabilitation robot therapy in post-stroke cognitive impairment patients byAdvances in Engineering Technology Research ICACTIC 2023
ISSN:2790-1688 Volume-6-(2023)
Effect of Rehabilitation Robot Training on Cognitive Function in
Stroke Patients : A Systematic Review and Meta-analysis
Wenzhan Xie1,a,*, Jiaqian Yan1,b, Mingxun Zhang2,c, and Yihan Chen1,d
1School of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, China;
2 College of Chinese medicine, Shandong University of Traditional Chinese Medicine, China.
az577741395@163.com, b19859026699@163.com, czmx181080@163.com,
d13676371605@163.com
Abstract. Objective: Post-stroke cognitive impairment is one of the major dysfunction after stroke,
which can lead to a variety of negative health outcomes. This study aims to evaluate the effects of
rehabilitation robotic therapy in post-stroke cognitive impairment patients.
Methods: As of December 2022, PubMed, Embase, Web of Science, Cochrane Library, and China
National Knowledge Infrastructure were searched through electronic databases. Eligibility criteria
RCTs evaluate RCTs of rehabilitation robots on treatment events in patients with cognitive
impairment after stroke, compared to control groups.
Results: Eight studies were included (n = 431). When combined with routine cognitive training
efficacy, rehabilitation robot intervention observably reduced MOCA scores, MBI scores and FMA
score. Furthermore, the FIM scores and MMSE scores were also better than the control groups.
Rehabilitation robots training can improve the cognitive function of stroke patients and is an
effective means of stroke rehabilitation.
Keywords: Cognitive Rehabilitation, Stroke, Robotics, Meta-Analysis.
1. Introduction
Post-stroke cognitive impairment is a clinical syndrome characterized by cognitive impairment
that occurs after stroke and lasts for 3-6 months. It is one of the major functional disorders after
stroke. Statistically, three quarters of stroke survivors show cognitive impairment, with an incidence
of up to 80 percent [1]. Cognitive dysfunction includes executive force, memory, visual-spatial, and
emotional defects associated with depressive / anxiety issues. Post-stroke cognitive impairment
makes patients unable to well cooperate with rehabilitation training, hinders the progress of
functional recovery, effects the ability of daily life activities, reduces the living quality and survival
time of patients, significantly adds the pressure of family and social and economic burden of, and
has a negative impact on rehabilitation strategies.
Traditional rehabilitation therapy only carries out routine cognitive training, which consumes a
considerable amount of manpower and material resources, and the training process is relatively
simple and lack of interest. It relies on the skills and professional knowledge of therapists, and has
few active participation of patients, which makes the effect of rehabilitation training is not ideal.
Currently, increasing evidence highlights the possible impact of robotic rehabilitation on functional
recovery in neurology patients. At present, the rehabilitation robot has been gradually applied in
clinical rehabilitation, studies have shown that rehabilitation robot can combine task orientation and
virtual reality technology, with high intensity, high repetition, rich environment stimulation
characteristics, can provide personalized auxiliary support, to insure that the patients in the right
way to complete the task needed to keep power, is an important supplement of cognitive
rehabilitation training.Previous meta-analysis studies have involved only rehabilitation robots being
useful in improving motor function, daily living ability, but no clear study suggests its role in
enhancing cognitive skills. Therefore, we strictly included the experiment by standardized screening
and demonstrated the conclusion by comparing the scores of five aspects. This article aimed to
meta-analysis.
5. Discussion
Post-stroke cognitive impairment is one of the major dysfunction after stroke [8]. The advantage
of this study is the introduction of multiple outcome scores, including five aspects: MOCA, MBI,
FIM, MMSE, and FMA, which can show practical improvements in subfields including attention,
memory, and executive function, making the findings more comprehensive and credible. We
addressed studies with less heterogeneity by using fixed-effects models and sensitivity analyses.
The MOCA, MBI, FIM, MMSE, and FMA scores in the rehabilitation robot groups were all
dramatically improved compared with the conventional cognitive training groups. At the same time,
after the intervention, the scores of both groups were dramatically improved compared with those
before the intervention. It suggests that the routine homework training, whether combined with
conventional cognitive training or rehabilitation robot training, can improve the cognitive function
of stroke patients, Improve their ability to live in their daily activities. However, the training effect
of rehabilitation robot training combined with conventional operation therapy is more significant.
This result did not significantly differ in cognitive function in patients with different cultural levels.
The results are identical to the conclusion of several scholars [5, 11]. Cognitive impairment is
mainly manifested as structural and visual spatial function, memory, execution force, timing and
orientation force, attention disorder, etc., and patients can have one or more symptoms. Patients
with cognitive dysfunction are often difficult to pay attention, training is missing the point, unable
to well understand and implement the goals and treatment plans set by the therapist, and unable to
apply the sports skills learned to daily life. The virtual scene training of the rehabilitation robot
makes the patients get rid of the boredom of the routine operation treatment, mobilize the
enthusiasm of the patients, and make the patients more actively participate in the daily training. It
can give patients rich sound and light dynamic stimulation, attract patients' attention, and the
computer system can also compare the patient training effect immediately [12]. Through repetitive
training, it can effectively enhance sensory and motor information input, improve attention, increase
patients' training interest and enthusiasm, accelerate the recovery of damaged brain function and,
promote the recovery of cognitive function. It can effectively promote the improvement of attention
in the cognitive function of PSCI patients, so as to improve their cognitive function and promote the
improvement of ADL.
In the past few years, robotic therapy aims to improve exercise performance and ADL, although
cognitive disorder is usually overlooked or its treatment is independent of exercise injuries [13].
Cognitive therapy is critical in subjects with frequent concurrent cognitive and exercise disorders,
such as stroke patients. Indeed, as observed in several studies [14], the limited shift in limb motor
improvement of limb mobility, such as ADL, may be because of a lack of attention to coexisting
cognitive impairment. Aprile et al. (2020) show that rehabilitation robot training has made
tremendous strides in multiple domains of cognitive dysfunction after stroke [6].In addition, the
visual feedback, auditory feedback, situational feedback and reward and punishment feedback
generated during the training process of the rehabilitation robot form a rich environmental stimulus.
Abundant environmental stimuli can activate gene expression associated with cellular remodeling,
promote axonal elongation and the establishment of new synaptic connections, and increase
neuroplasticity in. Dendritic spines are an important region for synaptic remodeling. Studies in rats
show that enriched environmental stimuli can increase the number of dendritic spines and synapses,
increase the number of neuronal stem cells and neuroblasts in rats, and promote the migration of
proliferating cells to the area of cerebral infarction. Rich environmental stimulation can promote the
regeneration of neurons and processes in rats, accelerate the remodeling of neural network, transfer
functional brain regions, and promote the reorganization of brain function.
Furthermore, our study currently has the following limitations. First, the study time is not long,
and its long-term efficacy needs to be improved in subsequent studies. For future studies, studies
planning more participants and long-term follow-up to draw conclusions probably appropriate.
Second, the virtual scene training is not immersive, and the training effect is not ideal. If further
improvement can be achieved, it is not only more conducive to functional improvement, but also
has a better patient training experience. Furthermore, future experiments should improve the
standardized reporting of robot-assisted rehabilitation, encourage randomized controlled trials to
follow the STRICTA guidelines, and rigorously design large-scale RCTs to fully meet the standard
for reporting interventions included in the guidelines for clinical trials of rehabilitation robots.
6. Conclusion
Based on our study, rehabilitation robot training can improve the cognitive function of stroke
patients and promote the improvement of daily living ability, which is an effective means of stroke
rehabilitation
Post-stroke cognitive impairment is one of the major dysfunction after stroke [8]. The advantage
of this study is the introduction of multiple outcome scores, including five aspects: MOCA, MBI,
FIM, MMSE, and FMA, which can show practical improvements in subfields including attention,
memory, and executive function, making the findings more comprehensive and credible. We
addressed studies with less heterogeneity by using fixed-effects models and sensitivity analyses.
The MOCA, MBI, FIM, MMSE, and FMA scores in the rehabilitation robot groups were all
dramatically improved compared with the conventional cognitive training groups. At the same time,
after the intervention, the scores of both groups were dramatically improved compared with those
before the intervention. It suggests that the routine homework training, whether combined with
conventional cognitive training or rehabilitation robot training, can improve the cognitive function
of stroke patients, Improve their ability to live in their daily activities. However, the training effect
of rehabilitation robot training combined with conventional operation therapy is more significant.
This result did not significantly differ in cognitive function in patients with different cultural levels.
The results are identical to the conclusion of several scholars [5, 11]. Cognitive impairment is
mainly manifested as structural and visual spatial function, memory, execution force, timing and
orientation force, attention disorder, etc., and patients can have one or more symptoms. Patients
with cognitive dysfunction are often difficult to pay attention, training is missing the point, unable
to well understand and implement the goals and treatment plans set by the therapist, and unable to
apply the sports skills learned to daily life. The virtual scene training of the rehabilitation robot
makes the patients get rid of the boredom of the routine operation treatment, mobilize the
enthusiasm of the patients, and make the patients more actively participate in the daily training. It
can give patients rich sound and light dynamic stimulation, attract patients' attention, and the
computer system can also compare the patient training effect immediately [12]. Through repetitive
training, it can effectively enhance sensory and motor information input, improve attention, increase
patients' training interest and enthusiasm, accelerate the recovery of damaged brain function and,
promote the recovery of cognitive function. It can effectively promote the improvement of attention
in the cognitive function of PSCI patients, so as to improve their cognitive function and promote the
improvement of ADL.
In the past few years, robotic therapy aims to improve exercise performance and ADL, although
cognitive disorder is usually overlooked or its treatment is independent of exercise injuries [13].
Cognitive therapy is critical in subjects with frequent concurrent cognitive and exercise disorders,
such as stroke patients. Indeed, as observed in several studies [14], the limited shift in limb motor
improvement of limb mobility, such as ADL, may be because of a lack of attention to coexisting
cognitive impairment. Aprile et al. (2020) show that rehabilitation robot training has made
tremendous strides in multiple domains of cognitive dysfunction after stroke [6].In addition, the
visual feedback, auditory feedback, situational feedback and reward and punishment feedback
generated during the training process of the rehabilitation robot form a rich environmental stimulus.
Abundant environmental stimuli can activate gene expression associated with cellular remodeling,
promote axonal elongation and the establishment of new synaptic connections, and increase
neuroplasticity in. Dendritic spines are an important region for synaptic remodeling. Studies in rats
show that enriched environmental stimuli can increase the number of dendritic spines and synapses,
increase the number of neuronal stem cells and neuroblasts in rats, and promote the migration of
proliferating cells to the area of cerebral infarction. Rich environmental stimulation can promote the
regeneration of neurons and processes in rats, accelerate the remodeling of neural network, transfer
functional brain regions, and promote the reorganization of brain function.
Furthermore, our study currently has the following limitations. First, the study time is not long,
and its long-term efficacy needs to be improved in subsequent studies. For future studies, studies
planning more participants and long-term follow-up to draw conclusions probably appropriate.
Second, the virtual scene training is not immersive, and the training effect is not ideal. If further
improvement can be achieved, it is not only more conducive to functional improvement, but also
has a better patient training experience. Furthermore, future experiments should improve the
standardized reporting of robot-assisted rehabilitation, encourage randomized controlled trials to
follow the STRICTA guidelines, and rigorously design large-scale RCTs to fully meet the standard
for reporting interventions included in the guidelines for clinical trials of rehabilitation robots.
6. Conclusion
Based on our study, rehabilitation robot training can improve the cognitive function of stroke
patients and promote the improvement of daily living ability, which is an effective means of stroke
rehabilitation
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