Background: We evaluated the effectiveness of robot-assisted motion and activity in additional to physiotherapy (PT) and occupational therapy (OT) on stroke patients with hand paralysis. Methods: A randomized controlled trial was conducted. Thirty-two patients, 34.4% female (mean ± SD age: 68.9 ± 11.6 years), with hand paralysis after stroke participated. The experimental group received 30 minutes of passive mobilization of the hand through the robotic device Gloreha (Brescia, Italy), and the control group received an additional 30 minutes of PT and OT for 3 consecutive weeks (3 d/wk) in addition to traditional rehabilitation. Outcomes included the National Institutes of Health Stroke Scale (NIHSS), Modified Ashworth Scale (MAS), Barthel Index (BI), Motricity Index (MI), short version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH), and the visual analog scale (VAS) measurements. All measures were collected at baseline and end of the intervention (3 weeks). Results: A significant effect of time interaction existed for NIHSS, BI, MI, and QuickDASH, after stroke immediately after the interventions (all, P < .001). The experimental group had a greater reduction in pain compared with the control group at the end of the intervention, a reduction of 11.3 mm compared with 3.7 mm, using the 100-mm VAS scale. Conclusions: In the treatment of pain and spasticity in hand paralysis after stroke, robot-assisted mobilization performed in conjunction with traditional PT and OT is as effective as traditional rehabilitation.
Stroke (or cerebrovascular accident) is a sudden ischemic or hemorrhagic episode which causes a disturbed generation and integration of neural commands from the sensorimotor31 areas of the cortex. As a consequence, the ability to selectively activate muscle tissues for performing movement is reduced.26 Sixty percent of those individuals who survive a stroke exhibit a sensorimotor deficit of one or both hands and may benefit from rehabilitation to maximize recovery of the upper extremity.23,25 Restoration of arm and hand motility is essential for the independent performance of daily activities.23,26 A prompt and effective rehabilitation approach is essential28 to obtain recovery of an impaired limb to prevent tendon shortening, spasticity, and pain.2
Recent technologies have facilitated the use of robots as tools to assist patients in the rehabilitation process, thus maximizing patient outcomes.4 Several groups have developed robotic tools for upper limb rehabilitation of the shoulder and elbow.27 These robotic tools assist the patient with carrying out exercise protocols and may help restore upper limb mobility.22,26 The complexity of wrist and finger articulations had delayed the development of dedicated rehabilitation robots until 2003 when the first tool based on continuous passive motion (CPM) was presented followed by several other solutions, with various levels of complexity and functionality.3
A recent review on the mechanisms for motor relearning reported factors such as attention and stimuli (reinforcement) are crucial during learning which indicates that motor relearning can take place with patients with neurological disorders even when only the sensorial passive stimulation is applied.30 In addition, another review reported the benefits of CPM for stretching and upper limb passive mobilization for patients with stroke but that CPM treatment requires further research.40
Among robotic devices, Gloreha (Figure 1),5,10 with its compliant mechanical transmission, may represent an easily applied innovative solution to rehabilitation, because the hand can perform grasp and release activities wearing the device by mean of a flexible and light orthosis. Our objective of this study was to determine the efficacy of robot-assisted motion in addition to traditional physiotherapy (PT) and occupational therapy (OT) compared with additional time spent in PT and OT on stroke patients with hand paralysis on function, motor strength, spasticity, and pain.