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Neurorehabil Neural Repair. 2017 Feb;31(2):107-121. doi: 10.1177/1545968316666957. Epub 2016 Sep 24.

Effects of Robot-Assisted Therapy for the Upper Limb After Stroke.

Author information

1
1 MOVE Research Institute Amsterdam, VU University Amsterdam, Amsterdam, the Netherlands.
2
2 Neuroscience Campus Amsterdam, Amsterdam, the Netherlands.
3
3 VU University Medical Center, Amsterdam, the Netherlands.
4
4 Centrum voor Fysiotherapie, Eerstelijns Centrum Beatrixpark, Ede, the Netherlands.
5
5 Northwestern University, Evanston, IL, USA.
6
6 Amsterdam Rehabilitation Research Center, Reade, Amsterdam, the Netherlands.

Abstract

BACKGROUND:

Robot technology for poststroke rehabilitation is developing rapidly. A number of new randomized controlled trials (RCTs) have investigated the effects of robot-assisted therapy for the paretic upper limb (RT-UL).

OBJECTIVE:

To systematically review the effects of poststroke RT-UL on measures of motor control of the paretic arm, muscle strength and tone, upper limb capacity, and basic activities of daily living (ADL) in comparison with nonrobotic treatment.

METHODS:

Relevant RCTs were identified in electronic searches. Meta-analyses were performed for measures of motor control (eg, Fugl-Meyer Assessment of the arm; FMA arm), muscle strength and tone, upper limb capacity, and basic ADL. Subgroup analyses were applied for the number of joints involved, robot type, timing poststroke, and treatment contrast.

RESULTS:

Forty-four RCTs (N = 1362) were included. No serious adverse events were reported. Meta-analyses of 38 trials (N = 1206) showed significant but small improvements in motor control (~2 points FMA arm) and muscle strength of the paretic arm and a negative effect on muscle tone. No effects were found for upper limb capacity and basic ADL. Shoulder/elbow robotics showed small but significant effects on motor control and muscle strength, while elbow/wrist robotics had small but significant effects on motor control.

CONCLUSIONS:

RT-UL allows patients to increase the number of repetitions and hence intensity of practice poststroke, and appears to be a safe therapy. Effects on motor control are small and specific to the joints targeted by RT-UL, whereas no generalization is found to improvements in upper limb capacity. The impact of RT-UL started in the first weeks poststroke remains unclear. These limited findings could mainly be related to poor understanding of robot-induced motor learning as well as inadequate designing of RT-UL trials, by not applying an appropriate selection of stroke patients with a potential to recovery at baseline as well as the lack of fixed timing of baseline assessments and using an insufficient treatment contrast early poststroke.

KEYWORDS:

activities of daily living; meta-analysis; review; robotics; stroke; upper extremity

PMID:
27597165
DOI:
10.1177/1545968316666957
[Indexed for MEDLINE]

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