Robot-Assisted Therapy May Not Improve Motor Function After Stroke
Robot-Assisted Therapy May Not Improve Motor Function After Stroke
Lo AC, Guarino PD, Richards LG, et al
N Engl J Med. 2010;362:1772-83
Patients with long-term deficits after stroke need effective rehabilitation. Of 127 study participants with moderate to severe upper-limb impairment ≥6 months after stroke, 49 were randomly assigned to receive intensive robot-assisted therapy, 50 to receive intensive comparison therapy, and 28 to receive usual care. The therapy groups received 36 one-hour sessions given over 12 weeks. Change in motor function at 12 weeks was the main study endpoint, as determined with the Fugl-Meyer Assessment of Sensorimotor Recovery after Stroke.
Differences among groups in mean Fugl-Meyer score were not significant at 12 weeks, but results on the Stroke Impact Scale were significantly better in participants receiving robot-assisted therapy than in those receiving usual care (difference, 7.64 points; 95% confidence interval, 2.03-13.24 points). At 12 weeks, no other treatment comparisons were significant, but in secondary analyses at 36 weeks, robot-assisted therapy significantly improved the Fugl-Meyer score and the time on the Wolf Motor Function Test as compared with usual care but not with intensive therapy. Robot-assisted therapy was not associated with any serious adverse events.
Limitations of this study include the fact that most (98%) of participants were men, lack of blinding in study-group assignments, involvement in rehabilitative therapy in nearly one quarter of the patients at baseline, and average time from index stroke to randomization approximately 2 years longer in the usual-care group than in the 2 active-therapy groups. Nonetheless, this otherwise well-designed study failed to prove the hypothesis that robot-assisted therapy would significantly improve motor function at 12 weeks, as compared with usual care or intensive therapy, in patients with long-term upper-limb deficits after stroke.
As noted in an accompanying editorial by Steven C. Cramer, MD, from the University of California, Irvine, there still remains an "enormous" potential for robotic therapy after stroke. The present study did not assess the ability of robotic devices to provide therapy in different functional modes. However, building on the results from this study should allow better design of trials of repair-based therapies for patients with stroke; these therapies drive maximum brain plasticity and yield optimal behavioral gains when they are shaped by training and experience.
Potential advantages of robot-assisted therapy include consistency, precision, reproducibility, and lack of fatigability. Through a computer interface, robotic devices can offer brain-stimulation treatment or provide simultaneous cognitive training.
Robot-Assisted Therapy for Long-term Upper-Limb Impairment After Stroke
Lo AC, Guarino PD, Richards LG, et al
N Engl J Med. 2010;362:1772-83
Summary
Patients with long-term deficits after stroke need effective rehabilitation. Of 127 study participants with moderate to severe upper-limb impairment ≥6 months after stroke, 49 were randomly assigned to receive intensive robot-assisted therapy, 50 to receive intensive comparison therapy, and 28 to receive usual care. The therapy groups received 36 one-hour sessions given over 12 weeks. Change in motor function at 12 weeks was the main study endpoint, as determined with the Fugl-Meyer Assessment of Sensorimotor Recovery after Stroke.
Differences among groups in mean Fugl-Meyer score were not significant at 12 weeks, but results on the Stroke Impact Scale were significantly better in participants receiving robot-assisted therapy than in those receiving usual care (difference, 7.64 points; 95% confidence interval, 2.03-13.24 points). At 12 weeks, no other treatment comparisons were significant, but in secondary analyses at 36 weeks, robot-assisted therapy significantly improved the Fugl-Meyer score and the time on the Wolf Motor Function Test as compared with usual care but not with intensive therapy. Robot-assisted therapy was not associated with any serious adverse events.
Viewpoint
Limitations of this study include the fact that most (98%) of participants were men, lack of blinding in study-group assignments, involvement in rehabilitative therapy in nearly one quarter of the patients at baseline, and average time from index stroke to randomization approximately 2 years longer in the usual-care group than in the 2 active-therapy groups. Nonetheless, this otherwise well-designed study failed to prove the hypothesis that robot-assisted therapy would significantly improve motor function at 12 weeks, as compared with usual care or intensive therapy, in patients with long-term upper-limb deficits after stroke.
As noted in an accompanying editorial by Steven C. Cramer, MD, from the University of California, Irvine, there still remains an "enormous" potential for robotic therapy after stroke. The present study did not assess the ability of robotic devices to provide therapy in different functional modes. However, building on the results from this study should allow better design of trials of repair-based therapies for patients with stroke; these therapies drive maximum brain plasticity and yield optimal behavioral gains when they are shaped by training and experience.
Potential advantages of robot-assisted therapy include consistency, precision, reproducibility, and lack of fatigability. Through a computer interface, robotic devices can offer brain-stimulation treatment or provide simultaneous cognitive training.
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