Robot training for hand motor recovery in subacute stroke patients: A randomized controlled trial
Por:
Orihuela-Espina, Felipe, Femat Roldan, Giovana, Sanchez-Villavicencio, Israel, Palafox, Lorena, Leder, Ronald, Enrique Sucar, Luis, Hernandez-Franco, Jorge
Publicada:
1 ene 2016
Resumen:
Background: Evidence of superiority of robot training for the hand over
classical therapies in stroke patients remains controversial. During the
subacute stage, hand training is likely to be the most useful.
Aim: To establish whether robot active assisted therapies provides any
additional motor recovery for the hand when administered during the
subacute stage (<4 months from event) in a Mexican adult population
diagnosed with stroke.
Hypothesis: Compared to classical occupational therapy, robot based
therapies for hand recovery will show significant differences at
subacute stages.
Trial design: A randomized clinical trial.
Methods: A between subjects randomized controlled trial was carried out
on subacute stroke patients (n = 17) comparing robot active assisted
therapy (RT) with a classical occupational therapy (OT). Both groups
received 40 sessions ensuring at least 300 repetitions per session.
Treatment duration was (mean std) 2.18 +/- 1.25 months for the control
group and 2.44 +/- 0.88 months for the study group. The primary outcome
was motor dexterity changes assessed with the Fugl-Meyer (FMA) and the
Motricity Index (MI).
Results: Both groups (OT: n = 8; RT: n = 9) exhibited significant
improvements over time (Non parametric Cliffs delta -within effect
sizes: dw(oT-FMA) = 0.5, dw(OT-M)I = 0.5, dw(RT-FMA) = 1, dw(RT-MI) =
1). Regarding differences between the therapies; the Fugl-Meyer score
indicated a significant advantage for the hand training with the robot
(FMA hand: WRS: W = 8, p <0.01), whilst the Motricity index suggested a
greater improvement (size effect) in hand prehension for RT with respect
to OT but failed to reach significance (MI prehension: W = 17.5, p =
0.080). No harm occurred.
Conclusions: Robotic therapies may be useful during the subacute stages
of stroke both endpoints (FM hand and MI prehension) showed the expected
trend with bigger effect size for the robotic intervention. Additional
benefit of the robotic therapy over the control therapy was only
significant when the difference was measured with FM, demanding further
investigation with larger samples. Implications of this study are
important for decision making during therapy administration and resource
allocation. (C) 2016 Hanley & Belfus, an imprint of Elsevier Inc. All
rights reserved.
Filiaciones:
Orihuela-Espina, Felipe:
Natl Inst Astrophys Opt & Elect INAOE, Puebla, Mexico
Femat Roldan, Giovana:
Natl Inst Neurol & Neurosurg, Mexico City, DF, Mexico
Sanchez-Villavicencio, Israel:
Natl Inst Neurol & Neurosurg, Mexico City, DF, Mexico
Palafox, Lorena:
Natl Inst Neurol & Neurosurg, Mexico City, DF, Mexico
Leder, Ronald:
Univ Nacl Autonoma Mexico, Mexico City 04510, DF, Mexico
Enrique Sucar, Luis:
Natl Inst Astrophys Opt & Elect INAOE, Puebla, Mexico
Hernandez-Franco, Jorge:
Natl Inst Neurol & Neurosurg, Mexico City, DF, Mexico
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