Effects of robot therapy on upper body kinematics and arm function in persons post stroke: a pilot randomized controlled trial

Where is the protocol located so survivors can bring it to their stroke medical 'professionals' attention? Top down dissemination of research is a complete fucking failure; bottom up is the way to go!

Effects of robot therapy on upper body kinematics and arm function in persons post stroke: a pilot randomized controlled trial

Ilaria Carpinella 1 , 

Tiziana Lencioni 1* , 

Thomas Bowman 1 , 

Rita Bertoni 1 , 

Andrea Turolla 2 , 

Maurizio Ferrarin 1 and 

Johanna Jonsdottir 1 

Abstract 

Background: 

Robot-based rehabilitation for persons post-stroke may improve arm function and daily-life activities as measured by clinical scales, but its effects on motor strategies during functional tasks are still poorly investigated. This study aimed at assessing the effects of robot-therapy versus arm-specific physiotherapy in persons post-stroke on motor strategies derived from upper body instrumented kinematic analysis, and on arm function measured by clinical scales. 

Methods: 

Forty persons in the sub-acute and chronic stage post-stroke were recruited. This sample included all those subjects, enrolled in a larger bi-center study, who underwent instrumented kinematic analysis and who were randomized in Center 2 into Robot (R_Group) and Control Group (C_Group). R_Group received robot-assisted training. C_ Group received arm-specific treatment delivered by a physiotherapist. Pre- and post-training assessment included clinical scales and instrumented kinematic analysis of arm and trunk during a virtual untrained task simulating the transport of an object onto a shelf. Instrumented outcomes included shoulder/elbow coordination, elbow extension and trunk sagittal compensation. Clinical outcomes included Fugl-Meyer Motor Assessment of Upper Extremity (FM-UE), modified Ashworth Scale (MAS) and Functional Independence Measure (FIM). 

Results: 

R_Group showed larger post-training improvements of shoulder/elbow coordination (Cohen’sd= - 0.81, p = 0.019), elbow extension (Cohen’sd= - 0.71, p = 0.038), and trunk movement (Cohen’sd= - 1.12, p = 0.002). Both groups showed comparable improvements in clinical scales, except proximal muscles MAS that decreased more in R_Group (Cohen’sd= - 0.83, p = 0.018). Ancillary analyses on chronic subjects confirmed these results and revealed larger improvements after robot-therapy in the proximal portion of FM-UE (Cohen’s d = 1.16, p = 0.019). 

Conclusions: 

Robot-assisted rehabilitation was as effective as arm-specific physiotherapy in reducing(NOT RECOVERY!) arm impairment (FM-UE) in persons post-stroke, but it was more effective(If not 100% recovery, IT IS NOT EFFECTIVE!) in improving motor control strategies adopted during an untrained task involving vertical movements not practiced during training. Specifically, robot therapy induced larger improvements of shoulder/elbow coordination and greater reduction of abnormal trunk sagittal movements. The beneficial effects of robot therapy seemed more pronounced in chronic subjects. Future studies on a larger sample should be performed to corroborate present findings. Trial registration: www.ClinicalTrials.gov NCT03530358. Registered 21 May 2018. Retrospectively registered. Keywords: Stroke, Robot therapy, Upper limb, Trunk, Kinematic analysis, Motor strategies