title: Robot training for hand motor recovery in subacute stroke patients: A randomized controlled trial.
abstract: BACKGROUND
  Evidence of superiority of robot training for the hand over classical therapies in stroke patients remains controversial. During the subacute stage, hand training is likely to be the most useful.
  
  
  OBJECTIVE
  To establish whether robot active assisted therapies provides any additional motor recovery for the hand when administered during the subacute stage (<4 months from event) in a Mexican adult population diagnosed with stroke.
  
  
  OBJECTIVE
  Compared to classical occupational therapy, robot based therapies for hand recovery will show significant differences at subacute stages.
  
  
  METHODS
  A randomized clinical trial.
  
  
  METHODS
  A between subjects randomized controlled trial was carried out on subacute stroke patients (n = 17) comparing robot active assisted therapy (RT) with a classical occupational therapy (OT). Both groups received 40 sessions ensuring at least 300 repetitions per session. Treatment duration was (mean ± std) 2.18 ± 1.25 months for the control group and 2.44 ± 0.88 months for the study group. The primary outcome was motor dexterity changes assessed with the Fugl-Meyer (FMA) and the Motricity Index (MI).
  
  
  RESULTS
  Both groups (OT: n = 8; RT: n = 9) exhibited significant improvements over time (Non-parametric Cliff's delta-within effect sizes: dwOT-FMA = 0.5, dwOT-MI = 0.5, dwRT-FMA = 1, dwRT-MI = 1). Regarding differences between the therapies; the Fugl-Meyer score indicated a significant advantage for the hand training with the robot (FMA hand: WRS: W = 8, p <0.01), whilst the Motricity index suggested a greater improvement (size effect) in hand prehension for RT with respect to OT but failed to reach significance (MI prehension: W = 17.5, p = 0.080). No harm occurred.
  
  
  CONCLUSIONS
  Robotic therapies may be useful during the subacute stages of stroke - both endpoints (FM hand and MI prehension) showed the expected trend with bigger effect size for the robotic intervention. Additional benefit of the robotic therapy over the control therapy was only significant when the difference was measured with FM, demanding further investigation with larger samples. Implications of this study are important for decision making during therapy administration and resource allocation.
authors: National Institute for Astrophysics, Optics and Electronics (INAOE), Puebla, Mexico. Electronic address: f.orihuela-espina@ccc.inaoep.mx.
authors: Felipe
authors: F
authors: Orihuela-Espina
authors: National Institute of Neurology and Neurosurgery (INNN), Mexico City, Mexico.
authors: Giovana Femat
authors: GF
authors: Roldán
authors: National Institute of Neurology and Neurosurgery (INNN), Mexico City, Mexico.
authors: Israel
authors: I
authors: Sánchez-Villavicencio
authors: National Institute of Neurology and Neurosurgery (INNN), Mexico City, Mexico.
authors: Lorena
authors: L
authors: Palafox
authors: National Autonomous University of Mexico (UNAM), Mexico City, Mexico.
authors: Ronald
authors: R
authors: Leder
authors: National Institute for Astrophysics, Optics and Electronics (INAOE), Puebla, Mexico.
authors: Luis Enrique
authors: LE
authors: Sucar
authors: National Institute of Neurology and Neurosurgery (INNN), Mexico City, Mexico.
authors: Jorge
authors: J
authors: Hernández-Franco
mesh_terms: D004185:Disability Evaluation; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006225:Hand / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009048:Motor Skills / Q000502:physiology*; D020127:Recovery of Function / Q000502:physiology*; D012371:Robotics; D020521:Stroke / Q000503:physiopathology; D000071939:Stroke Rehabilitation
keywords: Motor training; Robotic rehabilitation; Stroke; Subacute