Article

Robot-assisted movement training can help individuals with stroke
reduce arm and hand impairment, but robot therapy is typically only about as
effective as conventional therapy. Refining the way that robots assist during
training may make them more effective than conventional therapy. Here, the
authors measured the therapeutic effect of a robot that required individuals with
a stroke to achieve virtual tasks in three dimensions against gravity. DESIGN:
The robot continuously estimated how much assistance patients needed to perform
the tasks and provided slightly less assistance than needed to reduce patient
slacking. Individuals with a chronic stroke (n = 26; baseline upper limb
Fugl-Meyer score, 23 +/- 8) were randomized into two groups
and underwent 24
one-hour training sessions over 2 mos. One group received the assist-as-needed
robot training and the other received conventional tabletop therapy with the
supervision of a physical therapist. RESULTS: Training helped both groups
significantly reduce their motor impairment, as measured by the primary outcome
measure, the Fugl-Meyer score, but the improvement was small (3.0 +/- 4.9 points
for robot therapy vs. 0.9 +/- 1.7 for conventional therapy).
There was a trend
for greater reduction for the robot-trained group (P = 0.07). The robot group
largely sustained this gain at the 3-mo follow-up.
The robot-trained group also
experienced significant improvements in Box and Blocks score and hand grip
strength, whereas the control group did not, but these improvements were not
sustained at follow-up. In addition, the robot-trained group showed a trend
toward greater improvement in sensory function, as measured by the Nottingham
Sensory Test (P = 0.06). CONCLUSIONS: These results suggest that in patients with
chronic stroke and moderate-severe deficits, assisting in three-dimensional
virtual tasks with an assist-as-needed controller may make robotic training more
effective than conventional tabletop training.

Langue : ANGLAIS