A comparison of functional and impairment-based robotic training in severe to moderate chronic stroke: a pilot study.
OBJECTIVE
To compare the outcome of training the functional movement of transport of the arm and grasping an object with the alternative of training the transport of the arm in isolation.


METHODS
Pretest-posttest comparison.


METHODS
Rehabilitation hospitals, outpatient care.


METHODS
Volunteer sample of forty-seven persons with persistent hemiparesis from a single, unilateral stroke within the past one to five years.


METHODS
Robotic therapy 3 x/week for 6 weeks for the paretic upper limb consisted of either a) sensorimotor, active-assistive impairment-based exercise during repetitive planar reaching tasks, or b) a "free-hand" approach, in which the robot assisted subjects employing the sensorimotor active-assistive exercise to transport the hand to a series of targets, where it stopped to allow the person to interact with actual objects (functional approach 1), or c) transport and manipulation, in which the robot assisted subjects employing active-assistive exercise during repetitive planar reaching tasks while grasping a simulated object and releasing it at the target or followed by grasp and release of a simulated object (functional approach 2).


METHODS
Fugl-Meyer Assessment.


RESULTS
All three groups improved from pre- to post-treatment with the sensorimotor impairment based approach demonstrating the best outcome of the three approaches.


CONCLUSIONS
Short-term, goal-directed robotic therapy can significantly improve motor abilities of the exercised limb segments in persons with chronic stroke, but contrary to expectation, training both the transport of the arm and manipulation of an object (functionally-based approaches) did not confer any advantage over training solely transport of the arm (impairment-based approach).
Krebs
Hermano Igo
HI
Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA. hikrebs@mit.edu
Mernoff
Stephen
S
Fasoli
Susan E
SE
Hughes
Richard
R
Stein
Joel
J
Hogan
Neville
N
D000328:Adult; D000368:Aged; D001132:Arm; D002908:Chronic Disease; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D018737:Hand Strength; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology; D010291:Paresis / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D020127:Recovery of Function / Q000502:physiology; D012371:Robotics; D020521:Stroke / Q000150:complications / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome