What did your doctor and hospital do with this information from 3 years ago? NOTHING? Then you don't have a functioning stroke hospital.
Comparative effects of EMG-driven robot-assisted therapy versus task-oriented training on motor and daily function in patients with stroke: a randomized cross-over trial
Journal of NeuroEngineering and Rehabilitation volume 19, Article number: 6 (2022)
Abstract
Background
Robot-assisted hand training has shown positive effects on promoting neuromuscular control. Since both robot-assisted therapy and task-oriented training are often used in post-stroke rehabilitation, we raised the question of whether two interventions engender differential effects in different domains.
Methods
The study was conducted using a randomized, two-period crossover design. Twenty-four chronic stroke survivors received a 12-session robot-assisted intervention followed by a 12-session task-oriented intervention or vice versa. A 1-month washout period between each intervention was implemented. Outcome measures were evaluated before the intervention, after the first 12-session intervention, and after the second 12-session intervention. Clinical assessments included Fugl-Meyer Assessment for Upper Extremity, Wolf Motor Function Test, Action Research Arm Test and Motor Activity Log.
Results
Our findings suggested that EMG-driven robot-assisted therapy was as effective as task-oriented training in terms of improving upper limbs functional performance in activity domain, and robot-assisted therapy was more effective in improving movement duration during functional tasks. Task-oriented training showed better improvement in body function domain and activity and participation domain, especially in improving spontaneous use of affected arm during daily activities.
Conclusions
Both intervention protocol had their own advantages in different domains, and robot-assisted therapy may save manpower and be considered as an alternative intervention to task-oriented training. Combining the two approaches could yield results greater than either alone, which awaits further study.
Trial registration: ClinicalTrials.gov Identifier: NCT03624153. Registered on 9th August 2018, https://clinicaltrials.gov/ct2/show/NCT03624153.
Background
Upper limbs dysfunction is a common sequela of stroke. Dysfunction in upper limbs is a combination of muscle weakness, poor dexterity, incoordination, sensory loss and abnormal motor synergies, which impairs the performance of activities of daily living (ADLs). Hand function accounted for most of delicate movements in daily activities [1, 2] and deficits in hand movements seriously influence performance of a variety of daily tasks. A decline in functional independence after stroke not only leads to the deterioration in quality of life, but also places heavy pressure on caregivers. Thus, restoration of upper limbs function is identified as a top priority for stroke patients, ranked by stroke patients, caregivers and medical professionals [3, 4].
Restoration of motor function after stroke requires intense and massed practice for desired motor skills [3, 5, 6]. Among several contemporary approaches, robot-assisted therapy has gained acceptance in upper limbs rehabilitation [6,7,8]. Robot-assisted therapy provides patients with intense, repetitive practice and precise motion guidance which could promote neuromuscular control and reverse learned nonuse phenomenon [9]. Many rehabilitation robots for the upper limbs are available in the market and there is an increasing trend of using exoskeleton robots [10, 11]. Exoskeleton robots are wearable devices with joints and links which correspond to those of the human body [12]. The advantage of exoskeleton robots is that they provide precise control over multiple joints and allow training at selective joints. Control strategy is a major aspect that enables the robot to provide assisted movement [13]. During active-assisted training mode, the robot detects the patient’s intention to move through the sensor and trigger the assisted movement that allow the patient’s hand actively interacts with the robot. The sensors that integrated into the robots can be classified into physical sensors and bioelectrical sensors [14]. Physical sensors such as torque sensors and position sensors are the most used sensors in rehabilitation robots for the upper limbs [15]. However, physical sensors require some degree of volitional movement to trigger, and those devices might not benefit patients who are unable to generate sufficient force to trigger robots. In contrast to physical sensors, bioelectrical sensors such as electromyography (EMG) sensors can detect patients’ voluntary muscle activation in real time and triggered the robot-assisted movement, which could be beneficial in a broader range of patients. The aim of this study was to examine the therapeutic effects of robot-assisted therapy in neurorehabilitation using an EMG-driven exoskeleton hand robot.
EMG-driven hand robot has shown to increase voluntary motor control, decrease muscle spasticity and improve upper limbs motor function [16,17,18], but there were limited studies mainly compared the effects between EMG-driven robot-assisted therapy and task-oriented training in patients with stroke. Task-oriented training is a client-centered and functional-based intervention, which has demonstrated effectiveness on motor recovery after stroke [19] and been commonly incorporated into routine practice in occupational therapy for stroke rehabilitation [20, 21]. In this study, we intended to examine whether EMG-driven robot-assisted therapy and task-oriented training engenders differential effects in different domains.
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