Reaching exercise for chronic paretic upper extremity after stroke using a novel rehabilitation robot with arm-weight support and concomitant electrical stimulation and vibration: before-and-after feasibility trial

Abstract Background Our group developed a rehabilitation robot to assist with repetitive, active reaching movement of a paretic upper extremity. The robot is equipped with a servo motor-controlled arm-weight support and works in conjunction with neuromuscular electrical stimulation and vibratory sti...

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Main Authors: Yumeko Amano, Tomokazu Noma, Seiji Etoh, Ryuji Miyata, Kentaro Kawamura, Megumi Shimodozono
Format: Article
Language:English
Published: BMC 2020-05-01
Series:BioMedical Engineering OnLine
Subjects:
Online Access:http://link.springer.com/article/10.1186/s12938-020-00774-3
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author Yumeko Amano
Tomokazu Noma
Seiji Etoh
Ryuji Miyata
Kentaro Kawamura
Megumi Shimodozono
author_facet Yumeko Amano
Tomokazu Noma
Seiji Etoh
Ryuji Miyata
Kentaro Kawamura
Megumi Shimodozono
author_sort Yumeko Amano
collection DOAJ
description Abstract Background Our group developed a rehabilitation robot to assist with repetitive, active reaching movement of a paretic upper extremity. The robot is equipped with a servo motor-controlled arm-weight support and works in conjunction with neuromuscular electrical stimulation and vibratory stimulation to facilitate agonist-muscle contraction. In this before-and-after pilot study, we assessed the feasibility of applying the robot to improve motor control and function of the hemiparetic upper extremity in patients who suffered chronic stroke. Methods We enrolled 6 patients with chronic stroke and hemiparesis who, while sitting and without assistance, could reach 10 cm both sagitally and vertically (from a starting position located 10 cm forward from the patient’s navel level) with the affected upper extremity. The patients were assigned to receive reaching exercise intervention with the robot (Yaskawa Electric Co., Ltd. Fukuoka, Japan) for 2 weeks at 15 min/day in addition to regular occupational therapy for 40 min/day. Outcomes assessed before and after 2 weeks of intervention included the upper extremity component of the Fugl-Meyer Assessment (UE-FMA), the Action Research Arm Test (ARAT), and, during reaching movement, kinematic analysis. Results None of the patients experienced adverse events. The mean score of UE-FMA increased from 44.8 [SD 14.4] to 48.0 [SD 14.4] (p = 0.026, r = 0.91), and both the shoulder–elbow and wrist–hand scores increased after 2-week intervention. An increase was also observed in ARAT score, from mean 29.8 [SD 16.3] to 36.2 [SD 18.1] (p = 0.042, r = 0.83). Kinematic analysis during the reaching movement revealed a significant increase in active range of motion (AROM) at the elbow, and movement time tended to decrease. Furthermore, trajectory length for the wrist (“hand path”) and the acromion (“trunk compensatory movement”) showed a decreasing trend. Conclusions This robot-assisted modality is feasible and our preliminary findings suggest it improved motor control and motor function of the hemiparetic upper extremity in patients with chronic stroke. Training with this robot might induce greater AROM for the elbow and decrease compensatory trunk movement, thus contributing to movement efficacy and efficiency. Trial registration UMIN Clinical Trial Registry, as UMIN000018132, on June 30, 2015. https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000020398
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spelling doaj.art-b8edc85e79124df3af77358ad57aae5e2022-12-22T01:18:13ZengBMCBioMedical Engineering OnLine1475-925X2020-05-0119111910.1186/s12938-020-00774-3Reaching exercise for chronic paretic upper extremity after stroke using a novel rehabilitation robot with arm-weight support and concomitant electrical stimulation and vibration: before-and-after feasibility trialYumeko Amano0Tomokazu Noma1Seiji Etoh2Ryuji Miyata3Kentaro Kawamura4Megumi Shimodozono5Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental SciencesKagoshima University Hospital Kirishima Rehabilitation CenterDepartment of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental SciencesDepartment of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental SciencesDepartment of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental SciencesDepartment of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental SciencesAbstract Background Our group developed a rehabilitation robot to assist with repetitive, active reaching movement of a paretic upper extremity. The robot is equipped with a servo motor-controlled arm-weight support and works in conjunction with neuromuscular electrical stimulation and vibratory stimulation to facilitate agonist-muscle contraction. In this before-and-after pilot study, we assessed the feasibility of applying the robot to improve motor control and function of the hemiparetic upper extremity in patients who suffered chronic stroke. Methods We enrolled 6 patients with chronic stroke and hemiparesis who, while sitting and without assistance, could reach 10 cm both sagitally and vertically (from a starting position located 10 cm forward from the patient’s navel level) with the affected upper extremity. The patients were assigned to receive reaching exercise intervention with the robot (Yaskawa Electric Co., Ltd. Fukuoka, Japan) for 2 weeks at 15 min/day in addition to regular occupational therapy for 40 min/day. Outcomes assessed before and after 2 weeks of intervention included the upper extremity component of the Fugl-Meyer Assessment (UE-FMA), the Action Research Arm Test (ARAT), and, during reaching movement, kinematic analysis. Results None of the patients experienced adverse events. The mean score of UE-FMA increased from 44.8 [SD 14.4] to 48.0 [SD 14.4] (p = 0.026, r = 0.91), and both the shoulder–elbow and wrist–hand scores increased after 2-week intervention. An increase was also observed in ARAT score, from mean 29.8 [SD 16.3] to 36.2 [SD 18.1] (p = 0.042, r = 0.83). Kinematic analysis during the reaching movement revealed a significant increase in active range of motion (AROM) at the elbow, and movement time tended to decrease. Furthermore, trajectory length for the wrist (“hand path”) and the acromion (“trunk compensatory movement”) showed a decreasing trend. Conclusions This robot-assisted modality is feasible and our preliminary findings suggest it improved motor control and motor function of the hemiparetic upper extremity in patients with chronic stroke. Training with this robot might induce greater AROM for the elbow and decrease compensatory trunk movement, thus contributing to movement efficacy and efficiency. Trial registration UMIN Clinical Trial Registry, as UMIN000018132, on June 30, 2015. https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000020398http://link.springer.com/article/10.1186/s12938-020-00774-3StrokeRehabilitationRoboticsReachingHemiparesisElectric stimulation
spellingShingle Yumeko Amano
Tomokazu Noma
Seiji Etoh
Ryuji Miyata
Kentaro Kawamura
Megumi Shimodozono
Reaching exercise for chronic paretic upper extremity after stroke using a novel rehabilitation robot with arm-weight support and concomitant electrical stimulation and vibration: before-and-after feasibility trial
BioMedical Engineering OnLine
Stroke
Rehabilitation
Robotics
Reaching
Hemiparesis
Electric stimulation
title Reaching exercise for chronic paretic upper extremity after stroke using a novel rehabilitation robot with arm-weight support and concomitant electrical stimulation and vibration: before-and-after feasibility trial
title_full Reaching exercise for chronic paretic upper extremity after stroke using a novel rehabilitation robot with arm-weight support and concomitant electrical stimulation and vibration: before-and-after feasibility trial
title_fullStr Reaching exercise for chronic paretic upper extremity after stroke using a novel rehabilitation robot with arm-weight support and concomitant electrical stimulation and vibration: before-and-after feasibility trial
title_full_unstemmed Reaching exercise for chronic paretic upper extremity after stroke using a novel rehabilitation robot with arm-weight support and concomitant electrical stimulation and vibration: before-and-after feasibility trial
title_short Reaching exercise for chronic paretic upper extremity after stroke using a novel rehabilitation robot with arm-weight support and concomitant electrical stimulation and vibration: before-and-after feasibility trial
title_sort reaching exercise for chronic paretic upper extremity after stroke using a novel rehabilitation robot with arm weight support and concomitant electrical stimulation and vibration before and after feasibility trial
topic Stroke
Rehabilitation
Robotics
Reaching
Hemiparesis
Electric stimulation
url http://link.springer.com/article/10.1186/s12938-020-00774-3
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