Unilateral versus bilateral robot-assisted rehabilitation on arm-trunk control and functions post stroke: a randomized controlled trial
Identifieur interne : 001734 ( Main/Merge ); précédent : 001733; suivant : 001735Unilateral versus bilateral robot-assisted rehabilitation on arm-trunk control and functions post stroke: a randomized controlled trial
Auteurs : Ching-Yi Wu [Taïwan] ; Chieh-Ling Yang [Taïwan] ; Ming-De Chen [Taïwan] ; Keh-Chung Lin [Taïwan] ; Li-Ling Wu [Taïwan]Source :
- Journal of NeuroEngineering and Rehabilitation [ 1743-0003 ] ; 2013.
Abstract
Although the effects of robot-assisted arm training after stroke are promising, the relative effects of unilateral (URT) vs. bilateral (BRT) robot-assisted arm training remain uncertain. This study compared the effects of URT vs. BRT on upper extremity (UE) control, trunk compensation, and function in patients with chronic stroke.
This was a single-blinded, randomized controlled trial. The intervention was implemented at 4 hospitals. Fifty-three patients with stroke were randomly assigned to URT, BRT, or control treatment (CT). Each group received UE training for 90 to 105 min/day, 5 days/week, for 4 weeks. The kinematic variables for arm motor control and trunk compensation included normalized movement time, normalized movement units, and the arm-trunk contribution slope in unilateral and bilateral tasks. Motor function and daily function were measured by the Wolf Motor Function Test (WMFT), Motor Activity Log (MAL), and ABILHAND Questionnaire.
The BRT and CT groups elicited significantly larger slope values (i.e., less trunk compensation) at the start of bilateral reaching than the URT group. URT led to significantly better effects on WMFT-Time than BRT. Differences in arm control kinematics and performance on the MAL and ABILHAND among the 3 groups were not significant.
BRT and URT resulted in differential improvements in specific UE/trunk performance in patients with stroke. BRT elicited larger benefits than URT on reducing compensatory trunk movements at the beginning of reaching. In contrast, URT produced better improvements in UE temporal efficiency. These relative effects on movement kinematics, however, did not translate into differential benefits in daily functions.
ClinicalTrials.gov:
Url:
DOI: 10.1186/1743-0003-10-35
PubMed: 23587106
PubMed Central: 3640972
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Medicine, Chang Gung University, Taoyuan</wicri:regionArea><wicri:noRegion>Taoyuan</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="I2">Healthy Ageing Research Center, Chang Gung University, Taoyuan, Taiwan</nlm:aff><country xml:lang="fr">Taïwan</country><wicri:regionArea>Healthy Ageing Research Center, Chang Gung University, Taoyuan</wicri:regionArea><wicri:noRegion>Taoyuan</wicri:noRegion></affiliation></author><author><name sortKey="Yang, Chieh Ling" sort="Yang, Chieh Ling" uniqKey="Yang C" first="Chieh-Ling" last="Yang">Chieh-Ling Yang</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan</nlm:aff><country xml:lang="fr">Taïwan</country><wicri:regionArea>Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan</wicri:regionArea><wicri:noRegion>Taoyuan</wicri:noRegion></affiliation></author><author><name sortKey="Chen, Ming De" sort="Chen, Ming De" uniqKey="Chen M" first="Ming-De" last="Chen">Ming-De Chen</name><affiliation wicri:level="1"><nlm:aff id="I3">Department of Occupational Therapy, Kaohsiung Medical University, Kaohsiung, Taiwan</nlm:aff><country xml:lang="fr">Taïwan</country><wicri:regionArea>Department of Occupational Therapy, Kaohsiung Medical University, Kaohsiung</wicri:regionArea><wicri:noRegion>Kaohsiung</wicri:noRegion></affiliation></author><author><name sortKey="Lin, Keh Chung" sort="Lin, Keh Chung" uniqKey="Lin K" first="Keh-Chung" last="Lin">Keh-Chung Lin</name><affiliation wicri:level="1"><nlm:aff id="I4">School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan</nlm:aff><country xml:lang="fr">Taïwan</country><wicri:regionArea>School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei</wicri:regionArea><wicri:noRegion>Taipei</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="I5">Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan</nlm:aff><country xml:lang="fr">Taïwan</country><wicri:regionArea>Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei</wicri:regionArea><wicri:noRegion>Taipei</wicri:noRegion></affiliation></author><author><name sortKey="Wu, Li Ling" sort="Wu, Li Ling" uniqKey="Wu L" first="Li-Ling" last="Wu">Li-Ling Wu</name><affiliation wicri:level="1"><nlm:aff id="I6">Department of Occupational Therapy, Mackay Memorial Hospital, Taipei, Taiwan</nlm:aff><country xml:lang="fr">Taïwan</country><wicri:regionArea>Department of Occupational Therapy, Mackay Memorial Hospital, Taipei</wicri:regionArea><wicri:noRegion>Taipei</wicri:noRegion></affiliation></author></analytic><series><title level="j">Journal of NeuroEngineering and Rehabilitation</title><idno type="eISSN">1743-0003</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Although the effects of robot-assisted arm training after stroke are promising, the relative effects of unilateral (URT) vs. bilateral (BRT) robot-assisted arm training remain uncertain. This study compared the effects of URT vs. BRT on upper extremity (UE) control, trunk compensation, and function in patients with chronic stroke.</p></sec><sec><title>Method</title><p>This was a single-blinded, randomized controlled trial. The intervention was implemented at 4 hospitals. Fifty-three patients with stroke were randomly assigned to URT, BRT, or control treatment (CT). Each group received UE training for 90 to 105 min/day, 5 days/week, for 4 weeks. The kinematic variables for arm motor control and trunk compensation included normalized movement time, normalized movement units, and the arm-trunk contribution slope in unilateral and bilateral tasks. Motor function and daily function were measured by the Wolf Motor Function Test (WMFT), Motor Activity Log (MAL), and ABILHAND Questionnaire.</p></sec><sec><title>Results</title><p>The BRT and CT groups elicited significantly larger slope values (i.e., less trunk compensation) at the start of bilateral reaching than the URT group. URT led to significantly better effects on WMFT-Time than BRT. Differences in arm control kinematics and performance on the MAL and ABILHAND among the 3 groups were not significant.</p></sec><sec><title>Conclusions</title><p>BRT and URT resulted in differential improvements in specific UE/trunk performance in patients with stroke. BRT elicited larger benefits than URT on reducing compensatory trunk movements at the beginning of reaching. In contrast, URT produced better improvements in UE temporal efficiency. These relative effects on movement kinematics, however, did not translate into differential benefits in daily functions.</p></sec><sec><title>Trial registration</title><p>ClinicalTrials.gov: <ext-link ext-link-type="uri" xlink:href="http://www.clinicaltrials.gov/show/NCT00917605">NCT00917605</ext-link>.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Roger, Vl" uniqKey="Roger V">VL Roger</name></author><author><name sortKey="Go, As" uniqKey="Go A">AS Go</name></author><author><name sortKey="Lloyd Jones, Dm" uniqKey="Lloyd Jones D">DM Lloyd-Jones</name></author><author><name sortKey="Adams, Rj" uniqKey="Adams R">RJ Adams</name></author><author><name sortKey="Berry, Jd" uniqKey="Berry J">JD Berry</name></author><author><name sortKey="Brown, Tm" uniqKey="Brown T">TM Brown</name></author><author><name sortKey="Carnethon, Mr" uniqKey="Carnethon M">MR Carnethon</name></author><author><name sortKey="Dai, S" uniqKey="Dai S">S 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