Effectiveness of intelligent robotic-assisted training system combined with repetitive facilitative exercise on upper limb motor function after stroke: a randomized controlled trial

Abstract

BACKGROUND: Intelligent robotic-assisted training (IRAT) has been proven to improve upper limb motor function after stroke, but it needs to be combined with other treatment methods to achieve better results. Neuromuscular facilitation manipulation is a common series of therapies for stroke clinical practice, and the Repetitive facilitative exercise (RFE) developed based on it has been widely applied. This study aims to investigate the effectiveness of IRAT combined with RFE on upper limb motor function in stroke patients. METHODS: In this three-arm, single-blind randomized controlled trial, 76 patients with stroke were randomly assigned to the IRAT group (n = 25), the RFE group (n = 26) and the conventional therapy (CT) group (n = 25). The IRAT group received IRAT combined with RFE. The RFE group received only RFE. The CT group received conventional therapy. Interventions were administered five times weekly for four weeks. The primary outcome measure was upper limb motor function, assessed using the Fugl-Meyer assessment for upper extremity (FMA-UE) scale. Assessment instruments included with IRAT system provided additional measures, including kinematic reach range (KRR), active participation proportion (APP), trajectory deviation (TD), and trajectory tracking error (TTE). RESULTS: Demographic properties differences among the three groups were not significant (p > 0.05). At baseline, the groups did not differ significantly (p > 0.05). FMA-UE, KRR and APP increased significantly (p < 0.05) in all groups. TD and TTE decreased significantly (p < 0.05) in all groups. Post-intervention, the IRAT group showed significantly higher FMA-UE, KRR and APP scores compared to the RFE and CT groups. Additionally, TD and TTE were significantly lower in the IRAT group than in the RFE and CT groups. CONCLUSION: IRAT combined with RFE was more effective in improving the upper limb motor function than RFE or CT after stroke. TRIAL REGISTRATION: This study was registered at https://www. CLINICALTRIALS: gov/ (NCT06435624; May 24, 2024).