Robot-Assisted Bimanual Training Improves Hand Function in Patients With Subacute Stroke: A Randomized Controlled Pilot Study

Di Ma; Xin Li; Quan Xu; Fei Yang; Yutong Feng; Wenxu Wang; Jian-Jia Huang; Yu-Cheng Pei; Yu Pan

doi:10.3389/fneur.2022.884261

Robot-Assisted Bimanual Training Improves Hand Function in Patients With Subacute Stroke: A Randomized Controlled Pilot Study

Front Neurol. 2022 Jul 6:13:884261. doi: 10.3389/fneur.2022.884261. eCollection 2022.

Authors

Di Ma¹, Xin Li¹, Quan Xu¹, Fei Yang¹, Yutong Feng¹, Wenxu Wang¹, Jian-Jia Huang^{2

3

4}, Yu-Cheng Pei^{2

5

3

4}, Yu Pan¹

Affiliations

¹ Department of Rehabilitation Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
² Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Taoyuan City, Taiwan.
³ Graduate School of Science Design Program in Innovation for Smart Medicine, Chang Gung University, Taoyuan, Taiwan.
⁴ Center of Vascularized Tissue Allograft, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
⁵ School of Medicine, Chang Gung University, Taoyuan, Taiwan.

Abstract

Study design: A randomized controlled pilot study.

Background: Bimanual therapy (BMT) is an effective neurorehabilitation therapy for the upper limb, but its application to the distal upper limb is limited due to methodological difficulties. Therefore, we applied an exoskeleton hand to perform robot-assisted task-oriented bimanual training (RBMT) in patients with stroke.

Objective: To characterize the effectiveness of RBMT in patients with hemiplegic stroke with upper limb motor impairment.

Interventions: A total of 19 patients with subacute stroke (1-6 months from onset) were randomized and allocated to RBMT and conventional therapy (CT) groups. The RBMT and CT groups received 90 min of training/day (RBMT: 60 min RBMT + 30 min CT; CT: 60 min CT for hand functional training + 30 min regular CT), 5 days/week, for 4 weeks (20 sessions during the experimental period).

Assessments: Clinical assessments, including the Fugl-Meyer assessment of the upper extremity (FMA-UE), action research arm test (ARAT), and wolf motor arm function test (WMFT), were conducted before and after the intervention.

Results: Within-group analysis showed a significant improvement in the FMA-UE and WMFT in both the CT and RBMT groups. A significant improvement in the Fugl-Meyer assessment (FMA) of the wrist and hand for the distal part in the RBMT group occurred earlier than that in the CT group. A significant improvement in WMFT time was found in both groups, but the WMFT functional ability assessment was only found in the RBMT group. No significant improvements in ARAT assessment were observed in either the CT or RBMT groups. Compared with CT, significant improvements were found in terms of the proportion of minimally clinically important differences after RBMT in FMA-UE (χ² = 4.34, p = 0.037). No adverse events were reported by any of the participants across all sessions.

Conclusions: This study is the first to apply RBMT to the distal part of the upper limb. Both RBMT and CT are effective in improving the upper limb function in patients with subacute stroke. RBMT shows superior potential efficacy in facilitating recovery of the distal part of upper extremity (UE) motor function in the early stage. Future randomized control studies with a large sample size and follow-up assessments are needed to validate the present conclusions.

Keywords: exoskeleton; hand function; neurorehabilitation; robot-assisted bimanual task-oriented therapy; stroke.