Lo, Albert C., et al. "Robot-assisted therapy for long-term upper-limb impairment after stroke." New England Journal of Medicine 362.19 (2010): 1772-1783.

January 10, 2022

This is the first large study investigating the effect of robot-assisted therapy for the upper limb in chronic stroke.

The MIT Manus robot and its various extensions were used in this study to investigate the effect of robot-assisted therapy.

The study consisted of three groups:

• Robotic therapy (RT): Shoulder-elbow, antigravity and hand, and wrist trained 3 weeks and then whole UL training in the last three weeks. Followed by 24 weeks of UC. Therapist supervised.

  1 hr/session, 3 session/week, 12 weeks, approx. 1000 movements/session.

• Intense conventional therapy (ICT): Four types of movements/tasks trained with therapist supervision. Duration is matched to RT, and “intensity” is supposed to be matched as well. The frequency of movement was also supposed to be matched!

  (a) Warm-up and assisted stretching, (b) Scapular stabilization, (c) Goal-directed reaching, (d) balancing and supporting with the affected limb.

• Usual car (UC).

Patients with multiple strokes, at least 6 months post-stroke were included. No restriction on other ongoing therapy, and patients had to be severe to moderate on FMA (7 to 38).

Hypothesis: RT will be superior to ICT and UC at 12 and 36 weeks in terms of FMA and WMFT.

Outcomes: FMA, WMFT, Stroke impact scale, and others.

Results:

• No significant difference between RT and UC at 12 weeks, but there was a significant difference at 36 weeks in both FMA and WMFT (time scores).
• No significant difference between RT and ICT at any time point.
• RT continued to increase following 12 weeks of RT, but there was a drop in ICT. This was just a trend in the data.
• Significant differences between RT and UC in terms of SIS at 12 weeks but not at 36 weeks. No difference between RT and ICT in terms of SIS.

Discussion

Broad inclusion criteria so the outcomes can be generalized.