Three Ways to Improve Arm Function in the Chronic Phase After Stroke by Robotic Priming Combined With Mirror Therapy, Arm Training, and Movement-Oriented Therapy

Yi-Chun Li; Keh-Chung Lin; Chia-Ling Chen; Grace Yao; Ya-Ju Chang; Ya-Yun Lee; Chien-Ting Liu; Wen-Shiang Chen

doi:10.1016/j.apmr.2023.02.015

Three Ways to Improve Arm Function in the Chronic Phase After Stroke by Robotic Priming Combined With Mirror Therapy, Arm Training, and Movement-Oriented Therapy

Arch Phys Med Rehabil. 2023 Aug;104(8):1195-1202. doi: 10.1016/j.apmr.2023.02.015. Epub 2023 Mar 16.

Authors

Yi-Chun Li¹, Keh-Chung Lin², Chia-Ling Chen³, Grace Yao⁴, Ya-Ju Chang⁵, Ya-Yun Lee⁶, Chien-Ting Liu⁷, Wen-Shiang Chen⁸

Affiliations

¹ Department of Occupational Therapy, College of Medicine, I-Shou University, Kaohsiung, Taiwan.
² School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: kehchunglin@ntu.edu.tw.
³ Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Graduate Institute of Early Intervention, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
⁴ Department of Psychology, National Taiwan University, Taipei, Taiwan.
⁵ Neuroscience Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan.
⁶ School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.
⁷ Department of Physical Medicine and Rehabilitation, Da Chien General Hospital, Miaoli, Taiwan.
⁸ Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital & National Taiwan University College of Medicine, Taipei City, Taiwan.

PMID: 36933609
DOI: 10.1016/j.apmr.2023.02.015

Abstract

Objective: To examine the effects of bilateral robotic priming combined with mirror therapy (R-mirr) vs bilateral robotic priming combined with bilateral arm training (R-bilat), relative to the control approach of bilateral robotic priming combined with movement-oriented training (R-mov) in patients with stroke.

Design: A single-blind, preliminary, randomized controlled trial.

Setting: Four outpatient rehabilitation settings.

Participants: Outpatients with stroke and mild to moderate motor impairment (N=63).

Interventions: Patients received 6 weeks of clinic-based R-mirr, R-bilat, or R-mov for 90 min/d, 3 d/wk, plus a transfer package at home for 5 d/wk.

Main outcome measures: Fugl-Meyer Assessment Upper Extremity subscale (FMA-UE), ABILHAND, and Stroke Impact Scale v3.0 scores before, immediately after, and 3 months after treatment as well as lateral pinch strength and accelerometry before and immediately after treatment.

Results: The posttest results favored R-mirr over R-bilat and R-mov on the FMA-UE score (P<.05). Follow-up analysis revealed that significant improvement in FMA-UE score was retained at the 3-month follow-up in the R-mirr over R-bilat or R-mov (P<.05). Significant improvements were not observed in the R-mirr over R-bilat and R-mov on other outcomes.

Conclusions: Between-group differences were only detected for the primary outcome, FMA-UE. R-mirr was more effective at enhancing upper limb motor improvement, and the effect has the potential to be maintained at 3 months of follow-up.

Keywords: Exercise Movement Techniques; Mirror therapy; Rehabilitation; Repetition Priming; Robotics; Stroke.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Arm
Humans
Mirror Movement Therapy
Recovery of Function
Robotic Surgical Procedures*
Single-Blind Method
Stroke Rehabilitation*
Stroke*
Treatment Outcome
Upper Extremity