Robotic Assisted Upper Limb Training Post Stroke: A Randomized Control Trial Using Combinatory Approach Toward Reducing Workforce Demands
Post stroke upper limb rehabilitation is a challenging problem with poor outcomes as 40% of survivors have functionally useless upper limbs. Robot-aided therapy (RAT) is a potential method to alleviate the effort of intensive, task-specific, repetitive upper limb exercises for both patients and ther...
| Main Authors: | , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2021-06-01
|
| Series: | Frontiers in Neurology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2021.622014/full |
| _version_ | 1819155776429621248 |
|---|---|
| author | Aamani Budhota Aamani Budhota Karen S. G. Chua Asif Hussain Simone Kager Adèle Cherpin Sara Contu Deshmukh Vishwanath Christopher W. K. Kuah Chwee Yin Ng Lester H. L. Yam Yong Joo Loh Deshan Kumar Rajeswaran Liming Xiang Etienne Burdet Domenico Campolo |
| author_facet | Aamani Budhota Aamani Budhota Karen S. G. Chua Asif Hussain Simone Kager Adèle Cherpin Sara Contu Deshmukh Vishwanath Christopher W. K. Kuah Chwee Yin Ng Lester H. L. Yam Yong Joo Loh Deshan Kumar Rajeswaran Liming Xiang Etienne Burdet Domenico Campolo |
| author_sort | Aamani Budhota |
| collection | DOAJ |
| description | Post stroke upper limb rehabilitation is a challenging problem with poor outcomes as 40% of survivors have functionally useless upper limbs. Robot-aided therapy (RAT) is a potential method to alleviate the effort of intensive, task-specific, repetitive upper limb exercises for both patients and therapists. The present study aims to investigate how a time matched combinatory training scheme that incorporates conventional and RAT, using H-Man, compares with conventional training toward reducing workforce demands. In a randomized control trial (NCT02188628, www.clinicaltrials.gov), 44 subacute to chronic stroke survivors with first-ever clinical stroke and predominant arm motor function deficits were recruited and randomized into two groups of 22 subjects: Robotic Therapy (RT) and Conventional Therapy (CT). Both groups received 18 sessions of 90 min; three sessions per week over 6 weeks. In each session, participants of the CT group received 90 min of 1:1 therapist-supervised conventional therapy while participants of the RT group underwent combinatory training which consisted of 60 min of minimally-supervised H-Man therapy followed by 30 min of conventional therapy. The clinical outcomes [Fugl-Meyer (FMA), Action Research Arm Test and, Grip Strength] and the quantitative measures (smoothness, time efficiency, and task error, derived from two robotic assessment tasks) were independently evaluated prior to therapy intervention (week 0), at mid-training (week 3), at the end of training (week 6), and post therapy (week 12 and 24). Significant differences within group were observed at the end of training for all clinical scales compared with baseline [mean and standard deviation of FMA score changes between baseline and week 6; RT: Δ4.41 (3.46) and CT: Δ3.0 (4.0); p < 0.01]. FMA gains were retained 18 weeks post-training [week 24; RT: Δ5.38 (4.67) and week 24 CT: Δ4.50 (5.35); p < 0.01]. The RT group clinical scores improved similarly when compared to CT group with no significant inter-group at all time points although the conventional therapy time was reduced to one third in RT group. There were no training-related adverse side effects. In conclusion, time matched combinatory training incorporating H-Man RAT produced similar outcomes compared to conventional therapy alone. Hence, this study supports a combinatory approach to improve motor function in post-stroke arm paresis.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT02188628. |
| first_indexed | 2024-12-22T15:42:21Z |
| format | Article |
| id | doaj.art-056e7b1f30ee4f438ceb67cdc131db80 |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-12-22T15:42:21Z |
| publishDate | 2021-06-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-056e7b1f30ee4f438ceb67cdc131db802022-12-21T18:21:06ZengFrontiers Media S.A.Frontiers in Neurology1664-22952021-06-011210.3389/fneur.2021.622014622014Robotic Assisted Upper Limb Training Post Stroke: A Randomized Control Trial Using Combinatory Approach Toward Reducing Workforce DemandsAamani Budhota0Aamani Budhota1Karen S. G. Chua2Asif Hussain3Simone Kager4Adèle Cherpin5Sara Contu6Deshmukh Vishwanath7Christopher W. K. Kuah8Chwee Yin Ng9Lester H. L. Yam10Yong Joo Loh11Deshan Kumar Rajeswaran12Liming Xiang13Etienne Burdet14Domenico Campolo15Interdisciplinary Graduate School, Nanyang Technological University, Singapore, SingaporeRobotic Research Center, Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, SingaporeCentre for Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital Rehabilitation Centre, Singapore, SingaporeRobotic Research Center, Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, SingaporeNUS Graduate School for Integrative Sciences and Engineering, National University of Singapore, Singapore, SingaporeRobotic Research Center, Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, SingaporeRobotic Research Center, Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, SingaporeCentre for Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital Rehabilitation Centre, Singapore, SingaporeCentre for Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital Rehabilitation Centre, Singapore, SingaporeCentre for Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital Rehabilitation Centre, Singapore, SingaporeCentre for Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital Rehabilitation Centre, Singapore, SingaporeCentre for Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital Rehabilitation Centre, Singapore, SingaporeCentre for Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital Rehabilitation Centre, Singapore, SingaporeSchool of Physical and Mathematical Sciences, Nanyang Technological University, Singapore, SingaporeDepartment of Bioengineering, Imperial College of Science, Technology and Medicine, London, United KingdomRobotic Research Center, Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, SingaporePost stroke upper limb rehabilitation is a challenging problem with poor outcomes as 40% of survivors have functionally useless upper limbs. Robot-aided therapy (RAT) is a potential method to alleviate the effort of intensive, task-specific, repetitive upper limb exercises for both patients and therapists. The present study aims to investigate how a time matched combinatory training scheme that incorporates conventional and RAT, using H-Man, compares with conventional training toward reducing workforce demands. In a randomized control trial (NCT02188628, www.clinicaltrials.gov), 44 subacute to chronic stroke survivors with first-ever clinical stroke and predominant arm motor function deficits were recruited and randomized into two groups of 22 subjects: Robotic Therapy (RT) and Conventional Therapy (CT). Both groups received 18 sessions of 90 min; three sessions per week over 6 weeks. In each session, participants of the CT group received 90 min of 1:1 therapist-supervised conventional therapy while participants of the RT group underwent combinatory training which consisted of 60 min of minimally-supervised H-Man therapy followed by 30 min of conventional therapy. The clinical outcomes [Fugl-Meyer (FMA), Action Research Arm Test and, Grip Strength] and the quantitative measures (smoothness, time efficiency, and task error, derived from two robotic assessment tasks) were independently evaluated prior to therapy intervention (week 0), at mid-training (week 3), at the end of training (week 6), and post therapy (week 12 and 24). Significant differences within group were observed at the end of training for all clinical scales compared with baseline [mean and standard deviation of FMA score changes between baseline and week 6; RT: Δ4.41 (3.46) and CT: Δ3.0 (4.0); p < 0.01]. FMA gains were retained 18 weeks post-training [week 24; RT: Δ5.38 (4.67) and week 24 CT: Δ4.50 (5.35); p < 0.01]. The RT group clinical scores improved similarly when compared to CT group with no significant inter-group at all time points although the conventional therapy time was reduced to one third in RT group. There were no training-related adverse side effects. In conclusion, time matched combinatory training incorporating H-Man RAT produced similar outcomes compared to conventional therapy alone. Hence, this study supports a combinatory approach to improve motor function in post-stroke arm paresis.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT02188628.https://www.frontiersin.org/articles/10.3389/fneur.2021.622014/fullrobotic rehabilitationassessmentupper limbrandomized control trialstroke |
| spellingShingle | Aamani Budhota Aamani Budhota Karen S. G. Chua Asif Hussain Simone Kager Adèle Cherpin Sara Contu Deshmukh Vishwanath Christopher W. K. Kuah Chwee Yin Ng Lester H. L. Yam Yong Joo Loh Deshan Kumar Rajeswaran Liming Xiang Etienne Burdet Domenico Campolo Robotic Assisted Upper Limb Training Post Stroke: A Randomized Control Trial Using Combinatory Approach Toward Reducing Workforce Demands Frontiers in Neurology robotic rehabilitation assessment upper limb randomized control trial stroke |
| title | Robotic Assisted Upper Limb Training Post Stroke: A Randomized Control Trial Using Combinatory Approach Toward Reducing Workforce Demands |
| title_full | Robotic Assisted Upper Limb Training Post Stroke: A Randomized Control Trial Using Combinatory Approach Toward Reducing Workforce Demands |
| title_fullStr | Robotic Assisted Upper Limb Training Post Stroke: A Randomized Control Trial Using Combinatory Approach Toward Reducing Workforce Demands |
| title_full_unstemmed | Robotic Assisted Upper Limb Training Post Stroke: A Randomized Control Trial Using Combinatory Approach Toward Reducing Workforce Demands |
| title_short | Robotic Assisted Upper Limb Training Post Stroke: A Randomized Control Trial Using Combinatory Approach Toward Reducing Workforce Demands |
| title_sort | robotic assisted upper limb training post stroke a randomized control trial using combinatory approach toward reducing workforce demands |
| topic | robotic rehabilitation assessment upper limb randomized control trial stroke |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2021.622014/full |
| work_keys_str_mv | AT aamanibudhota roboticassistedupperlimbtrainingpoststrokearandomizedcontroltrialusingcombinatoryapproachtowardreducingworkforcedemands AT aamanibudhota roboticassistedupperlimbtrainingpoststrokearandomizedcontroltrialusingcombinatoryapproachtowardreducingworkforcedemands AT karensgchua roboticassistedupperlimbtrainingpoststrokearandomizedcontroltrialusingcombinatoryapproachtowardreducingworkforcedemands AT asifhussain roboticassistedupperlimbtrainingpoststrokearandomizedcontroltrialusingcombinatoryapproachtowardreducingworkforcedemands AT simonekager roboticassistedupperlimbtrainingpoststrokearandomizedcontroltrialusingcombinatoryapproachtowardreducingworkforcedemands AT adelecherpin roboticassistedupperlimbtrainingpoststrokearandomizedcontroltrialusingcombinatoryapproachtowardreducingworkforcedemands AT saracontu roboticassistedupperlimbtrainingpoststrokearandomizedcontroltrialusingcombinatoryapproachtowardreducingworkforcedemands AT deshmukhvishwanath roboticassistedupperlimbtrainingpoststrokearandomizedcontroltrialusingcombinatoryapproachtowardreducingworkforcedemands AT christopherwkkuah roboticassistedupperlimbtrainingpoststrokearandomizedcontroltrialusingcombinatoryapproachtowardreducingworkforcedemands AT chweeyinng roboticassistedupperlimbtrainingpoststrokearandomizedcontroltrialusingcombinatoryapproachtowardreducingworkforcedemands AT lesterhlyam roboticassistedupperlimbtrainingpoststrokearandomizedcontroltrialusingcombinatoryapproachtowardreducingworkforcedemands AT yongjooloh roboticassistedupperlimbtrainingpoststrokearandomizedcontroltrialusingcombinatoryapproachtowardreducingworkforcedemands AT deshankumarrajeswaran roboticassistedupperlimbtrainingpoststrokearandomizedcontroltrialusingcombinatoryapproachtowardreducingworkforcedemands AT limingxiang roboticassistedupperlimbtrainingpoststrokearandomizedcontroltrialusingcombinatoryapproachtowardreducingworkforcedemands AT etienneburdet roboticassistedupperlimbtrainingpoststrokearandomizedcontroltrialusingcombinatoryapproachtowardreducingworkforcedemands AT domenicocampolo roboticassistedupperlimbtrainingpoststrokearandomizedcontroltrialusingcombinatoryapproachtowardreducingworkforcedemands |