Original articleEffects of Robot-Aided Bilateral Force-Induced Isokinetic Arm Training Combined With Conventional Rehabilitation on Arm Motor Function in Patients With Chronic Stroke
Section snippets
Participants
We recruited 20 subjects (12 men, 8 women) from the outpatient rehabilitation service to participate in this study. Eighteen subjects were right-handed. The patients were between ages 36 to 80 years (mean ± standard deviation [SD], 57.1±14.0y) and had unilateral lesions (cortical, n=14; subcortical, n=6; left hemisphere, n=9; right hemisphere, n=11) identified by neuroimaging done at least 6 months before the pretest (mean, 35.4±36.6mo). The subjects’ Fugl-Meyer Assessment (FMA) scores for
Results
Table 1 shows the affected arm motor scores at pretest, post-test, and retention test measures. There was significant within-subject effect in FMA (F=15.09, P<.001). Multiple comparison tests revealed that both the post-test and retention test scores were higher than the pretest scores (reflecting about a 3-point increase) and there was no significant difference between post-test and retention test scores. The FAT and MAS scores did not show significant differences across the pretest,
Discussion
Our findings demonstrate that motor recovery in a paretic upper limb might be enhanced with an 8-week, robot-aided training program using the BFIAMT. These major recovery components comprised increasing paretic upper-limb grip strength, push and pull strengths, motor function, and reaching control. Muscle tone and FAT scores did not show significant changes across the pre-test, post-test, and retention test scores.
Bilateral arm movement would enhance interhemispheric motor cortex disinhibition
Conclusions
This study suggests that conventional rehabilitation, combined with 24 sessions of robot-aided therapy in the form of BFIAMT training over an 8-week period, may be beneficial for chronic stroke patients in recovering paretic upper-limb strength and motor control ability. It may provide an alternative therapy for the upper-limb rehabilitation of the stroke population in both clinical and community situations. Future study with randomized controlled trials is required to assess its effectiveness.
References (59)
- et al.
Recovery of upper extremity function in stroke patients: The Copenhagen stroke study
Arch Phys Med Rehabil
(1994) - et al.
Fine motor control in adults with and without chronic hemiparesis: baseline comparison to nondisabled adults and effects of bilateral arm training
Arch Phys Med Rehabil
(2004) - et al.
Robot-assisted movement training compared with conventional therapy techniques for the rehabilitation of upper-limb motor function after stroke
Arch Phys Med Rehabil
(2002) - et al.
Effects of robotic therapy on motor impairment and recovery in chronic stroke
Arch Phys Med Rehabil
(2003) - et al.
Dynamic muscle strength training in stroke patients: effects on knee extension torque, electromyographic activity, and motor function
Arch Phys Med Rehabil
(1995) - et al.
Isokinetic strength training of the hemiparetic knee: effects on function and spasticity
Arch Phys Med Rehabil
(1997) - et al.
Alterations in reaching after stroke and their relation to movement direction and impairment severity
Arch Phys Med Rehabil
(2002) - et al.
Kinematical measure for spastic reaching in children with cerebral palsy
Clin Biomech (Bristol, Avon)
(2005) - et al.
Parkinsonism reduces coordination of fingers, wrist, and arm in fine motor control
Exp Neurol
(1997) - et al.
Rehabilitation of reaching after stroke: task-related training versus progressive resistive exercise
Arch Phys Med Rehabil
(2004)
Change of facilitation during voluntary bilateral hand activation after stroke
J Neurol Sci
Arm and leg paresis as outcome predictors in stroke rehabilitation
Stroke
Outcome following occlusion of the middle cerebral artery
Acta Neurol Scand
Reorganization of movement representations in primary motor cortex following focal ischemic infarcts in adult squirrel monkeys
J Neurophysiol
Neural substrates for the effects of rehabilitative training on motor recovery after ischemic infarct
Science
Use-dependent alterations of movement representations in primary motor cortex of adult squirrel monkeys
J Neurosci
Treatment-induced cortical reorganization after stroke in humans
Stroke
Repetitive bilateral arm training and motor cortex activation in chronic stroke: a randomized controlled trial
JAMA
Functional MRI evidence of cortical reorganization in upper-limb stroke hemiplegia treated with constraint-induced movement therapy
Am J Phys Med Rehabil
Increased cortical representation of the fingers of the left hand in string players
Science
Representational cortex in musiciansPlastic alterations in response to musical practice
Ann N Y Acad Sci
Can simultaneous bilateral movement involve the undamaged hemisphere in reconstruction of neural networks damaged by stroke?
Disabil Rehabil
Repetitive bilateral arm training with rhythmic auditory cueing improves motor function in chronic hemiparetic stroke
Stroke
Neurophysiological and behavioural adaptations to a bilateral training intervention in individuals following stroke
Clin Rehabil
Distribution of muscle strength impairments following stroke
Clin Rehabil
Impaired regulation of force and firing pattern of single motor units in patients with spasticity
J Neurol Neurosurg Psychiatry
Characteristics of motor unit discharge in subjects with hemiparesis
Muscle Nerve
Motor variables correlated with the hand-to-mouth maneuver in stroke patients
Arch Phys Med Rehabil
Maximal grip force in chronic stroke subjects and its relationship to global upper extremity function
Clin Rehabil
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Supported by the National Science Council, Taiwan, ROC (grant no. NSC 92-2320-B-037-033).
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.