Stroke Clinical Trial
Official title:
Is the Rehabilitation Robotic a Safe and Effective Choice for Stroke Patients?
The effectiveness of robotic over conventional therapy is arguable and the best therapy strategy is still not clear. Basing on the existing evidence on motor learning and practice-induced neuroplasticity, the investigators plan to use an exoskeleton robotic hand to enhance the rehabilitation volume in the subacute stage of stroke patients. The robotic system allows intensive and customized training of hand and finger movements. The aim of this study is (1) to establish whether robot assisted therapy provides any additional motor recovery for the hand when administered during the subacute stage in a Chinese adult population diagnosed with stroke; (2) to evaluate the feasibility and efficacy of robot-assisted hand rehabilitation in improving arm function abilities in subacute hemiplegic patients.
Introduction The number of incident strokes, prevalent stroke survivors, disability-adjusted
life-years (DALYs) lost due to stroke, and stroke-related deaths is increasing in the word
(1). Stroke is the most common cause of complex disability in Taiwan (2). After the acute
phase of stroke, many patients are left with impairment of upper-limb movement (hemiparesis)
because of the hand weakness and abnormal contractions. Motor recovery of the hand is the
slowest and most difficult, leading to limited hand activities and occupational disability.
Therefore, facilitating motor recovery of hand after stroke is crucial in stroke
rehabilitation.
The mechanisms of recovery after stroke are multifactorial and the effect of rehabilitation
programs is complex (3). Activity-dependent neural plasticity of the cortical maps adjacent
to the lesion probably occurs, particularly during the acute period after stroke (4). In
order to stimulate such plasticity, many new rehabilitation methods, including rehabilitation
robots, have been developed according to the principles of motor learning (5). Robotic
systems can provide repetitive, reproducible, interactive forms of physical therapy that can
be quantified (6). The advantages of using robots in neuromotor rehabilitation includes
favoring attention and reducing the effort of the patient during training (7), boosting
motivation and adherence to treatment (8), as well as help in multi-sensory and sensorimotor
integration (9). Some results are very promising, showing that robot-assisted therapy is safe
and well tolerated and that it has a positive impact on muscle strength and function in the
paretic arm (10-12). However, the quality of these evidence is still controversial and
inconclusive. The effectiveness of robotic over conventional therapy is arguable and the best
therapy strategy is still not clear. Furthermore, there is little understanding of the
neurological mechanisms involved in functional recovery of the hand (13). In this study, the
investigators hypothesize that the robot based assistance would outperform conventional
therapy during the subacute stage of stroke.
Study objective
1. To establish whether robot assisted therapy provides any additional motor recovery for
the hand when administered during the subacute stage in a Chinese adult population
diagnosed with stroke.
2. To evaluate the feasibility and efficacy of robot-assisted hand rehabilitation in
improving arm function abilities in subacute hemiplegic patients.
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