Robot therapy benefited movement, function of patients after stroke

Issue: March 2011

International Stroke Conference 2011

Results of a randomized controlled trial have shown that patients with post-stroke hemiplegia had improved voluntary movement and function of the upper extremity when compared with usual self-training.

In the study, patients (n=56) were included if they had stroke in the previous 4 to 8 weeks and hemiplegia with upper extremity Brunnstrom stage 3 to 4. They were randomly assigned to receive either standard therapy plus robotic therapy (Reo Therapy System, Motorika Ltd.; n=30), which assisted repetitive movements of the forearm in multiple directions at a constant level of assistance, or standard therapy plus self-training (n=26). The intervention ran for 6 weeks, 7 days per week, for 40 minutes per day for each therapy.

Using the Fugl-Meyer Assessment (FMA) to determine upper extremity function, the researchers found a statistically significant improvement in the robotic therapy arm compared to control group on the effect of proximal upper extremity movement (+3 FMA points). Results were also similar in the comparison of robotic therapy vs. control on the effect of upper extremity synergy movement (+2 FMA points; P<.01).

Additionally those with a lower class baseline FMA total score of less than 30 points had statistically significant improved outcomes whereas the improvement of those the higher class of at least 30 was not statistically significant.

“What we are suggesting is that robot therapy alone may not be effective, but if you combine it with the regular, standard rehab it will be more effective to recover upper arm function. Robotic therapy can be cost effective as well, but it needs to be prescribed or supervised by occupational or physical therapists,” Kayoko Takahashi, ScD, clinician and research associate, department of occupational therapy, Kitasato University East Hospital, Kanagawa, Japan and investigator on the trial, told Cardiology Today. – by Brian Ellis

For more information:

Takahashi K. Abstract LB4. Presented at: International Stroke Conference 2011. Feb. 9-11, 2011; Los Angeles.

There is already a small market of what are called robotic-assisted devices, mostly for stroke rehab and some for other kinds of uses including spinal cord injuries, where people can be strapped in and walk on a treadmill. This is sort of an equivalent of that, an upper extremity treadmill. What you expect to see happen is more active movement and less passive action provided by the robotic device.

Regarding cost, any cost benefit analysis is premature as this field is just getting started, and the benefits and costs are in active evolution. However, one-on-one therapy is time consuming and “expensive” and it may be less expensive to have the therapist programming and watching the robotic sessions taking place for several people simultaneously because more people can be treated with the same personnel costs. This assumes, of course, that the robotic devices are affordable. It may be far cheaper to program one of these things and run a series of patients through it, for 12 hours a day particularly if the treatment is only for 40 minutes or an hour a day, than it is to have a therapist. I think we are going to have rooms with a number of these devices running 10 to 12 hours per day, supervised by therapists. I think this is going to be huge in the United States.

– Robert J. Adams, MD, MS
Director, Medical University of South Carolina Stroke Center, Charleston