Feasibility and efficacy of a robotic device for hand rehabilitation in hemiplegic stroke patients: a randomized pilot controlled study

Abstract

Objective:

The purpose of the study was to evaluate the feasibility and efficacy of robot-assisted hand rehabilitation in improving arm function abilities in sub-acute hemiplegic patients.

Design:

Randomized controlled pilot study.

Setting:

Inpatient rehabilitation centers.

Participants:

Thirty hemiplegic stroke patients (Ashworth spasticity index <3) were recruited and randomly divided into a Treatment group (TG) and Control group (CG).

Interventions:

Patients in the TG received intensive hand training with Gloreha, a hand rehabilitation glove that provides computer-controlled, repetitive, passive mobilization of the fingers, with multisensory feedback. Patients in the CG received the same amount of time in terms of conventional hand rehabilitation.

Main outcome measures:

Hand motor function (Motricity Index, MI), fine manual dexterity (Nine Hole Peg Test, NHPT) and strength (Grip and Pinch test) were measured at baseline and after rehabilitation, and the differences, (Δ) mean(standard deviation), compared between groups.

Results

Twenty-seven patients concluded the program: 14 in the TG and 13 in the CG. None of the patients refused the device and only one adverse event of rheumatoid arthritis reactivation was reported. Baseline data did not differ significantly between the two groups. In TG, ΔMI 23(16.4), ΔNHPT 0.16(0.16), ΔGRIP 0.27(0.23) and ΔPINCH 0.07(0.07) were significantly greater than in CG, ΔMI 5.2(9.2), ΔNHPT 0.02(0.07), ΔGRIP 0.03(0.06) and ΔPINCH 0.02(0.03)] (p=0.002, p=0.009, p=0.003 and p=0.038, respectively).

Conclusions:

Gloreha Professional is feasible and effective in recovering fine manual dexterity and strength and reducing arm disability in sub-acute hemiplegic patients.

Keywords

Stroke rehabilitation hand robotics

Get full access to this article

View all access options for this article.

References

Pollock

Farmer

Brady

. Interventions for improving upper limb function after stroke. Cochrane Database Syst Rev 2014;11:CD010820.

Tsu

Abrams

Byl

. Post stroke Upper Limb Recovery. Semin Neurol 2014;34:485–495.

Knecht

Hesse

Oster

. Rehabilitation after stroke. Dtsch Arztebl Int 2011;108:600–606.

Kwakkel

Kollen

van der Grond

. Probability of regaining dexterity in the flaccid upper limb: impact of severity of paresis and time since onset in acute stroke. Stroke 2003;34:2181–2186.

Coupar

Pollock

Rowe

. Predictors of upper limb recovery after stroke: a systematic review and meta-analysis. Clin Rehabil 2012; 26:291–313.

National Institute for Health and Care Excellence. CG162. Stroke rehabilitation: long-term rehabilitation after stroke. London: NICE, 2013.

Wolf

Winstein

Miller

. Retention of upper limb function in stroke survivors who have received constraint-induced movement therapy: the EXCITE randomised trial. Lancet Neurol 2008;7:33–40.

Hayward

Brauer

. Dose of arm activity training during acute and subacute rehabilitation post stroke: A systematic review of the literature. Clinical Rehabil 2015;29:1234–1243.

Guarino

Richards

. Robot-assisted therapy for long-term upper-limb impairment after stroke. N Engl J Med 2010;362:1772–1783.

10.

Buschfort

Brocke

Hess

. Arm studio to intensify the upper limb rehabilitation after stroke: concept, acceptance, utilization and preliminary clinical results. J Rehabil Med 2010;42:310–314.

11.

Masiero

Poli

Rosati

. The value of robotic systems in stroke rehabilitation Expert Rev Med Devices Early online 2014;1–12.

12.

Maciejasz

Eschweiler

Hahn

. A survey on robotic devices for upper limb rehabilitation. J Neuroeng Rehabil 2014;11:3.

13.

Balasubramanian

Klein

Burdet

. Robot-assisted rehabilitation of hand function. Curr Opin Neurol 2010;23:661–670.

14.

Lum

Godfrey

Brokaw

. Robotic approaches for rehabilitation of hand function after stroke. Am J Phys Med Rehabil 2012; 91(Suppl 3): S242–S254.

15.

Mehrholz

Platz

Kugler

. Electromechanical and robot-assisted arm training for improving arm function and activities of daily living after stroke. Stroke 2009;40:e392–e393.

16.

Winter

Hunter

Sim

Crome

. Hands-on therapy intervention for upper limb motor dysfunction following stroke. Cochrane Database Syst Rev 2011; 6:CD006609.

17.

www.gloreha.com (accessed July 2015).

18.

Sheean

McGuire

. Spastic Hypertonia and Movement Disorders: Pathophysiology, Clinical Presentation, and Quantification. PM R. 2009;1:827–833.

19.

Granger

Cotter

Hamilton

. Functional assessment: a study of persons after stroke. Arch Phys Med Rehabil 1993;74:133–138.

20.

Lennon

Ashburn

. The Bobath concept in stroke rehabilitation: a focus group study of the experienced physiotherapists’ perspective. Disability and Rehabilitation. 2000; 22: 665–674.

21.

Borboni

Fausti

Mor

. A CPM device for hand rehabilitation. XX Conference AIMETA, Bologna, Italy, 2011.

22.

Downie

Leatham

Rhind

. Studies with pain rating scales. Ann Rehum Dis 1978;37:378–381.

23.

Bohannon

. Motricity index scores are valid indicators of paretic upper extremity strength following stroke. J Phys Ther Sci 1999;11:59–61.

24.

Mathiowetz

Volland

Kashman

. Adult norms for the box and block test of manual dexterity. Am J Occup Ther 1985;39:386–391.

25.

Mathiowetz

Kashman

Volland

. Grip and pinch strengh: normative data for adults. Arch Phys Med Rehabil 1985;66:69–74.

26.

Beaton

Wright

Katz

. Upper Extremity Collaborative Group. Development of the QuickDASH: Comparison of three item-reduction approaches. J Bone Joint Surg Am 2005;87:1038–1046.

27.

Sethi

Davis

McGuirk

. Effect of intense functional task training upon temporal structure of variability of upper extremity post stroke. J Hand Ther 2013;26:132–137.

28.

Thielbar

Lord

Fischer

. Training finger individuation with a mechatronic-virtual reality system leads to improved fine motor control post-stroke. J Neuroeng Rehabil 2014;11:171.

29.

Hwang

Seong

Son

. Individual finger synchronized robot-assisted hand rehabilitation in subacute to chronic stroke: a prospective randomized clinical trial of efficacy. Clin Rehabil 2012;26: 696–704.

30.

Salter

. Continuous passive motion: from origination to research to clinical applications. J Rheumatol 2004;31:2104–5

31.

Tong

Song

A comparison between electromyography-driven robot and passive motion device on wrist rehabilitation for chronic stroke. Neurorehabil Neural Repair. 2009;23:837–46.

32.

Giudice

. Effects of continuous passive motion and elevation on hand edema. Am J Occup Ther 1990;44:914–21.

33.

Dirette

Hinojosa

. Effects of continuous passive motion on the edematous hands of two persons with flaccid hemiplegia. Am J Occup Ther 1994;48:403–9.

34.

Szameitat

Shen

Conforto

. Cortical activation during executed, imagined, observed, and passive wrist movements in healthy volunteers and stroke patients. Neuroimage 2012;62:266–280.

35.

Seitz

Dinse

. A common framework for perceptual learning. Curr. Neurobiol 2007;17:148–153.

36.

Vanoglio

Luisa

Garofali

. Evaluation of the effectiveness of Gloreha (Hand Rehabilitation Glove) on hemiplegic patients. Pilot study. XIII Congress of Italian Society of Neurorehabilitation, Bari, Italy, 2013.

37.

Parrinello

Faletti

Santus

. Use of a continuous passive motion device for hand rehabilitation: clinical trial on neurological patients. 41 National Congress of Italian Society of Medicine and Physical Rehabilitation, Rome, Italy; 2013.

38.

Varalta

Picelli

Fonte

. Effects of contralesional robot-assisted hand training in patients with unilateral spatial neglect following stroke: a case series study. J Neuroeng Rehabil 2014;11:160.

39.

Bassolino

Sandini

Pozzo

. Activating the motor system through action observation: is this an efficient approach in adults and children. Dev Med Child Neurol 2015;57(Suppl 2):42–45.

40.

Knott

Voss

. Proprioceptive neuromuscular facilitation. 2th ed. New York: Harper and Row, 1968.

41.

Rosati

Rodà

Avanzini

Masiero

. On the role of auditory feedback in robot-assisted movement training after stroke: review of the literature. Comput Intell Neurosci 2013:586138.

42.

Aman

Elangovan

Yeh

. The effectiveness of proprioceptive training for improving motor function: a systematic review. Front Hum Neurosci.2015;8:1075.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.81 MB

0.37 MB