http://nnr.sagepub.com/content/early/2016/09/03/1545968316666957.abstract?&
- Janne M. Veerbeek, PhD1,2,3⇑
- Anneli C. Langbroek-Amersfoort, MSc4
- Erwin E. H. van Wegen, PhD1,2,3
- Carel G. M. Meskers, PhD, MD1,2,3,5
- Gert Kwakkel, PhD1,2,3,5,6
- 1MOVE Research Institute Amsterdam, VU University Amsterdam, Amsterdam, the Netherlands
- 2Neuroscience Campus Amsterdam, Amsterdam, the Netherlands
- 3VU University Medical Center, Amsterdam, the Netherlands
- 4Centrum voor Fysiotherapie, Eerstelijns Centrum Beatrixpark, Ede, the Netherlands
- 5Northwestern University, Evanston, IL, USA
- 6Amsterdam Rehabilitation Research Center, Reade, Amsterdam, the Netherlands
- Janne M. Veerbeek, Department of Rehabilitation Medicine, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, the Netherlands. Email: j.veerbeek@vumc.nl
Abstract
Background. Robot technology for poststroke rehabilitation is developing rapidly. A number of new randomized controlled trials (RCTs)
have investigated the effects of robot-assisted therapy for the paretic upper limb (RT-UL).
Objective.
To systematically review the effects of poststroke RT-UL on measures of
motor control of the paretic arm, muscle strength
and tone, upper limb capacity, and basic activities
of daily living (ADL) in comparison with nonrobotic treatment.
Methods.
Relevant RCTs were identified in electronic searches. Meta-analyses
were performed for measures of motor control (eg, Fugl-Meyer
Assessment of the arm; FMA arm), muscle strength
and tone, upper limb capacity, and basic ADL. Subgroup analyses were
applied
for the number of joints involved, robot type,
timing poststroke, and treatment contrast.
Results. Forty-four
RCTs (N = 1362) were included. No serious adverse events were reported.
Meta-analyses of 38 trials (N = 1206)
showed significant but small improvements in motor
control (~2 points FMA arm) and muscle strength of the paretic arm and
a negative effect on muscle tone. No effects were
found for upper limb capacity and basic ADL. Shoulder/elbow robotics
showed
small but significant effects on motor control and
muscle strength, while elbow/wrist robotics had small but significant
effects
on motor control.
Conclusions. RT-UL
allows patients to increase the number of repetitions and hence
intensity of practice poststroke, and appears to be
a safe therapy. Effects on motor control are small
and specific to the joints targeted by RT-UL, whereas no generalization
is found to improvements in upper limb capacity.
The impact of RT-UL started in the first weeks poststroke remains
unclear.
These limited findings could mainly be related to
poor understanding of robot-induced motor learning as well as inadequate
designing of RT-UL trials, by not applying an
appropriate selection of stroke patients with a potential to recovery at
baseline
as well as the lack of fixed timing of baseline
assessments and using an insufficient treatment contrast early
poststroke.
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