Robot-Assisted Therapy for stroke patients
Evidences are needed for the effect of the new technologies on the rehabilitation of stroke patients who suffered from long term motor deficits especially of the upper limbs.
In this multicenter, randomized, controlled trial involving 127 patients with moderate-to-severe upper-limb impairment 6 months or more after a stroke, the authors randomly assigned 49 patients to receive intensive robot-assisted therapy, 50 to receive intensive comparison therapy, and 28 to receive usual care (New Eng J Med. on line publication on 16th April 2010 to coincide with the meeting of the American Academy of Neurology).
Therapy consisted of 36 1-hour sessions over a period of 12 weeks. The primary outcome was a change in motor function, as measured on the Fugl-Meyer Assessment of Sensorimotor Recovery after Stroke, at 12 weeks. Secondary outcomes were scores on the Wolf Motor Function Test and the Stroke Impact Scale. Secondary analyses assessed the treatment effect at 36 weeks.
The study showed that at 12 weeks, the mean Fugl-Meyer score for patients receiving robot-assisted therapy was better than that for patients receiving usual care and worse than that for patients receiving intensive comparison therapy, but the differences were not significant. The results on the Stroke Impact Scale were significantly better for patients receiving robot-assisted therapy than for those receiving usual care.
The study concluded that in patients with long-term upper-limb deficits after stroke, robot-assisted therapy did not significantly improve motor function at 12 weeks, as compared with usual care or intensive therapy. In secondary analyses, robot-assisted therapy improved outcomes over 36 weeks as compared with usual care but not with intensive therapy.
In his editorial ( www.nejm.org, April 16, 2010), Steven Cramer mentioned that these results challenge us to better stratify patients with long-term disabilities after stroke. He went to say that such studies ‘reinforce the theory that the adult brain has the capacity for clinically relevant plasticity even in the chronic phase after a stroke. The future holds great hope for the development of brain-repair protocols to greatly reduce the degree of disability after stroke’.