title: Sequencing bilateral robot-assisted arm therapy and constraint-induced therapy improves reach to press and trunk kinematics in patients with stroke.
abstract: BACKGROUND
  The combination of robot-assisted therapy (RT) and a modified form of constraint-induced therapy (mCIT) shows promise for improving motor function of patients with stroke. However, whether the changes of motor control strategies are concomitant with the improvements in motor function after combination of RT and mCIT (RT + mCIT) is unclear. This study investigated the effects of the sequential combination of RT + mCIT compared with RT alone on the strategies of motor control measured by kinematic analysis and on motor function and daily performance measured by clinical scales.
  
  
  METHODS
  The study enrolled 34 patients with chronic stroke. The data were derived from part of a single-blinded randomized controlled trial. Participants in the RT + mCIT and RT groups received 20 therapy sessions (90 to 105 min/day, 5 days for 4 weeks). Patients in the RT + mCIT group received 10 RT sessions for first 2 weeks and 10 mCIT sessions for the next 2 weeks. The Bi-Manu-Track was used in RT sessions to provide bilateral practice of wrist and forearm movements. The primary outcome was kinematic variables in a task of reaching to press a desk bell. Secondary outcomes included scores on the Wolf Motor Function Test, Functional Independence Measure, and Nottingham Extended Activities of Daily Living. All outcome measures were administered before and after intervention.
  
  
  RESULTS
  RT + mCIT and RT demonstrated different benefits on motor control strategies. RT + mCIT uniquely improved motor control strategies by reducing shoulder abduction, increasing elbow extension, and decreasing trunk compensatory movement during the reaching task. Motor function and quality of the affected limb was improved, and patients achieved greater independence in instrumental activities of daily living. Force generation at movement initiation was improved in the patients who received RT.
  
  
  CONCLUSIONS
  A combination of RT and mCIT could be an effective approach to improve stroke rehabilitation outcomes, achieving better motor control strategies, motor function, and functional independence of instrumental activities of daily living.
  
  
  BACKGROUND
  ClinicalTrials.gov. NCT01727648.
authors.affiliation: Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, and Healthy Aging Research Center, Chang Gung University, 259 Wenhua 1st Rd, Taoyuan, Taiwan.
authors.forename: Yu-wei
authors.initials: YW
authors.lastname: Hsieh
authors.affiliation: School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Rong-jiuan
authors.initials: RJ
authors.lastname: Liing
authors.affiliation: 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.
authors.forename: Keh-chung
authors.initials: KC
authors.lastname: Lin
authors.affiliation: Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, and Healthy Aging Research Center, Chang Gung University, 259 Wenhua 1st Rd, Taoyuan, Taiwan. cywu@mail.cgu.edu.tw.
authors.forename: Ching-yi
authors.identifier: http://orcid.org/0000-0003-4726-2916
authors.initials: CY
authors.lastname: Wu
authors.affiliation: Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.
authors.forename: Tsan-hon
authors.initials: TH
authors.lastname: Liou
authors.affiliation: Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.
authors.forename: Jui-chi
authors.initials: JC
authors.lastname: Lin
authors.affiliation: Department of Rehabilitation, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung, Taiwan.
authors.forename: Jen-wen
authors.initials: JW
authors.lastname: Hung
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D001696:Biomechanical Phenomena; D003131:Combined Modality Therapy / Q000379:methods*; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009068:Movement; D012371:Robotics / Q000379:methods*; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome
keywords: Constraint-induced; Robotic rehabilitation; Sequential combination therapy; Stroke; Upper extremity