Immediate effects of different upper limb robot-assisted training modes in patients after stroke: A case series

Abstract

Purpose: This case series investigated immediate effects of three different robot-assisted training (RAT) modes post stroke. Methods: A repeated measures descriptive case series design was applied. Patients after stroke (sub‐acute or chronic) received 4x30min RAT for 3 weeks. Every week, a different randomly selected RAT-mode was applied: passive mobilisation, games, or activities of daily living (ADL). Outcome measures were bilateral upper limb function evaluated with the Chedoke McMaster Arm and Hand Activity Inventory (CAHAI‐9), muscle tone investigated with the Modified Modified Ashworth Scale (MMAS), and active and passive range of motion measured with a goniometer (aROM, pROM). Assessments were conducted by a blinded examiner at baseline, before and after each intervention week. Patients qualitatively evaluated RAT. There was no control on the patients receiving other therapies or treatments during the study period. For statistical analyses the Wilcoxon signed-rank test was used. Results: In total, seven patients participated (2 females, 5 males, mean±SD: age 62.4±6.9; time since stroke 35.4±23.6 months, except for 1 sub-acute patient). CAHAI-9 scores changed: 35.9±17.1 at baseline to 39.4±16.6 after RAT, with a significant improvement after ADL-mode (p=0.028). Patients reported larger ROM, less muscle tone, increased upper limb motor function, and no adverse events. Conclusions: An overall improvement in upper limb function was found in all cases. Despite the significant improvement after the ADL-mode, it remains recommended to include all three RAT modes. RAT did subjectively but not objectively influence muscle tone and ROM.