Effects of Intensive Arm Training With an Electromechanical Orthosis in Chronic Stroke Patients: A Preliminary Study

Araújo, Rodrigo Cappato de; Lúcio, Fábio; Rocha, Daniel Neves; Sono, Tálita Saemi Payossim; Pinotti, Marcos

doi:10.1016/j.apmr.2011.05.021

Cited by 17 publications

(18 citation statements)

References 37 publications

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“…Thirty-five studies evaluated motor control using three different instruments. Of these 35 studies, 33 (94.2%)[ 15 , 16 , 18 – 27 , 35 – 38 , 40 – 41 , 44 – 59 ] used the Fugl Meyer (FM), two studies (5.7%)[ 34 , 42 ] used the Chedoke McMaster Stroke Assessment (CMSA). Fourteen studies[ 15 – 17 , 20 , 25 , 26 , 38 , 40 , 43 , 46 , 48 , 50 , 51 , 55 ] evaluated spasticity using the Modified Ashworth Scale (MAS).…”

Section: Resultsmentioning

confidence: 99%

Effectiveness of robot therapy on body function and structure in people with limited upper limb function: A systematic review and meta-analysis

Ferreira¹,

Chaves²,

Oliveira³

et al. 2018

PLoS ONE

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Robot-Assisted Therapy (RT) is an innovative approach to neurological rehabilitation that uses intensive, repetitive, interactive, and individualized practice. This systematic review aimed to investigate the effectiveness of RT on the body function and structure of people with upper limb impairments (PROSPERO registration: CRD42017054982). A search strategy conducted on seven databases identified randomized controlled studies. Methodological quality was assessed using the PEDro scale. When possible, the data were pooled, the strength of evidence was assessed using the GRADE system, and the effect sizes were assessed using Cohen coefficient. Subgroup analyses investigated the impact on the estimated effects of the following parameters: methodological quality; portion of the assessed upper limb; duration of stroke; and intervention dose and duration. Thirty-eight studies involving 1174 participants were included. Pooled estimates revealed small effects of RT on motor control and medium effects on strength compared with other intervention (OI) at a short-term follow-up. Standardized differences in means were as follows: 0.3 (95% CI 0.1 to 0.4) and 0.5 (95% CI 0.2 to 0.8). Effects at other time points and on other investigated outcomes related to body function and structure were not found (p>0.05). The strength of the current evidence was usually low quality. Subgroup analyses suggested that the methodological quality, and duration and dose of RT may influence the estimated effects. In conclusion, RT has small effects on motor control and medium effects on strength in people with limited upper limb function. Poor methodological quality, and lower treatment dose and duration may impact negatively the estimated effects.

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Section: Resultsmentioning

confidence: 99%

Effectiveness of robot therapy on body function and structure in people with limited upper limb function: A systematic review and meta-analysis

Ferreira¹,

Chaves²,

Oliveira³

et al. 2018

PLoS ONE

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“…Another explanation for the finding of no difference in the neural correlates of response to FST and MPT in the present trial is that previous studies were undertaken with smaller sample sizes, e.g., n = 13 ( 113 ), n = 12 ( 114 ), n = 14 ( 115 ), and n = 23 ( 116 ), thus increasing the chances of false positive findings. These compare with the sample sizes in the present trial for the MRI variables, n = 38, and the TMS variables, n = 55.…”

Section: Discussionmentioning

confidence: 62%

“…These compare with the sample sizes in the present trial for the MRI variables, n = 38, and the TMS variables, n = 55. In addition, the earlier studies have potential risk of bias respecting: randomisation process ( 113 – 115 ); observer-blind assessments ( 113 , 114 ); selective recruitment ( 114 , 115 ); and from results emanating from a post hoc analysis of an RCT ( 116 ). However, there may be genuine associations which are too subtle to identify with the available sample sizes in this trial.…”

Section: Discussionmentioning

confidence: 99%

Functional Strength Training and Movement Performance Therapy for Upper Limb Recovery Early Poststroke—Efficacy, Neural Correlates, Predictive Markers, and Cost-Effectiveness: FAST-INdiCATE Trial

et al. 2018

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BackgroundVariation in physiological deficits underlying upper limb paresis after stroke could influence how people recover and to which physical therapy they best respond.ObjectivesTo determine whether functional strength training (FST) improves upper limb recovery more than movement performance therapy (MPT). To identify: (a) neural correlates of response and (b) whether pre-intervention neural characteristics predict response.DesignExplanatory investigations within a randomised, controlled, observer-blind, and multicentre trial. Randomisation was computer-generated and concealed by an independent facility until baseline measures were completed. Primary time point was outcome, after the 6-week intervention phase. Follow-up was at 6 months after stroke.ParticipantsWith some voluntary muscle contraction in the paretic upper limb, not full dexterity, when recruited up to 60 days after an anterior cerebral circulation territory stroke.InterventionsConventional physical therapy (CPT) plus either MPT or FST for up to 90 min-a-day, 5 days-a-week for 6 weeks. FST was “hands-off” progressive resistive exercise cemented into functional task training. MPT was “hands-on” sensory/facilitation techniques for smooth and accurate movement.OutcomesThe primary efficacy measure was the Action Research Arm Test (ARAT). Neural measures: fractional anisotropy (FA) corpus callosum midline; asymmetry of corticospinal tracts FA; and resting motor threshold (RMT) of motor-evoked potentials.AnalysisCovariance models tested ARAT change from baseline. At outcome: correlation coefficients assessed relationship between change in ARAT and neural measures; an interaction term assessed whether baseline neural characteristics predicted response.Results288 Participants had: mean age of 72.2 (SD 12.5) years and mean ARAT 25.5 (18.2). For 240 participants with ARAT at baseline and outcome the mean change was 9.70 (11.72) for FST + CPT and 7.90 (9.18) for MPT + CPT, which did not differ statistically (p = 0.298). Correlations between ARAT change scores and baseline neural values were between 0.199, p = 0.320 for MPT + CPT RMT (n = 27) and −0.147, p = 0.385 for asymmetry of corticospinal tracts FA (n = 37). Interaction effects between neural values and ARAT change between baseline and outcome were not statistically significant.ConclusionsThere was no significant difference in upper limb improvement between FST and MPT. Baseline neural measures did not correlate with upper limb recovery or predict therapy response.Trial registrationCurrent Controlled Trials: ISRCT 19090862,

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“…The dynamic orthosis, previously described by Araújo et al [28], consists of an exoskeleton, static orthosis, functional glove, control unit, and electromechanical actuators ( Figure 1).…”

Section: Dynamic Orthosis Devicementioning

confidence: 99%

“…Upon completion of the functional assessment, participants went through a rehabilitation program involving usingthe aforementioned dynamic orthosis associated with functional training. [28]. Training consisted of twenty-four sessions, performed three times a week for eight weeks, with each session lasting for 50 minutes.…”

Section: Rehabilitation Programmentioning

confidence: 99%

The Influence of Dynamic Orthosis Training on Upper Extremity Function after Stroke: A Pilot Study

Araújo

Rocha

Pitangui

et al. 2014

Journal of Healthcare Engineering

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The goal of this study was to assess the use of a dynamic orthosis on upper extremity function in chronic stroke patients. A case series approach was utilized, with provision of a training program (3x/week, 50 minutes/session for 8 weeks) and employment of a dynamic orthosis. Six volunteers with persistent hemiparesis due to a single, unilateral stroke performed task-oriented movements with the aid of a dynamic orthosis. Tests were administered before and after training. Functional capacity was assessed using the TEMPA (Test d'Évaluation des Membres Supérieurs de Personnes Âgées) test. The Wilcoxon test was used for pre-training and post-training comparisons of TEMPA scores. The volunteers showed significant improvement of upper extremity function in the performance of a bilateral task (p = 0.01) and three unilateral tasks (p = 0.04). This pilot study suggests that the dynamic orthosis associated with the performance of functional tasks can have positive outcomes regarding the improvement of functional capacity of upper extremity.

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Effects of Intensive Arm Training With an Electromechanical Orthosis in Chronic Stroke Patients: A Preliminary Study

Cited by 17 publications

References 37 publications

Effectiveness of robot therapy on body function and structure in people with limited upper limb function: A systematic review and meta-analysis

Effectiveness of robot therapy on body function and structure in people with limited upper limb function: A systematic review and meta-analysis

Functional Strength Training and Movement Performance Therapy for Upper Limb Recovery Early Poststroke—Efficacy, Neural Correlates, Predictive Markers, and Cost-Effectiveness: FAST-INdiCATE Trial

The Influence of Dynamic Orthosis Training on Upper Extremity Function after Stroke: A Pilot Study

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