Abstract
Background.
Robot-assisted therapy provides high-intensity arm rehabilitation that
can significantly reduce stroke-related upper extremity (UE) deficits.
Motor improvement has been shown at the joints trained, but
generalization to real-world function has not been profound.
Objective.
To investigate the efficacy of robot-assisted therapy combined with
therapist-assisted task training versus robot-assisted therapy alone on
motor outcomes and use in participants with moderate to severe chronic
stroke-related arm disability.
Methods. This was a single-blind
randomized controlled trial of two 12-week robot-assisted interventions;
45 participants were stratified by Fugl-Meyer (FMA) impairment (mean 21
± 1.36) to 60 minutes of robot therapy (RT; n = 22) or 45 minutes of RT
combined with 15 minutes therapist-assisted transition-to-task training
(TTT; n = 23). The primary outcome was the mean FMA change at week 12
using a linear mixed-model analysis. A subanalysis included the Wolf
Motor Function Test (WMFT) and Stroke Impact Scale (SIS), with
significance P <.05.
Results. There was no significant
12-week difference in FMA change between groups, and mean FMA gains were
2.87 ± 0.70 and 4.81 ± 0.68 for RT and TTT, respectively. TTT had
greater 12-week secondary outcome improvements in the log WMFT (−0.52 ±
0.06 vs −0.18 ± 0.06; P = .01) and SIS hand (20.52 ± 2.94 vs 8.27 ± 3.03; P = .03).
Conclusion.
Chronic UE motor deficits are responsive to intensive robot-assisted
therapy of 45 or 60 minutes per session duration. The replacement of
part of the robotic training with nonrobotic tasks did not reduce
treatment effect and may benefit stroke-affected hand use and motor task
performance.
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