A novel approach to stroke rehabilitation - Robot-aided sensorimotor stimulation

Objective: In patients with stroke, the authors tested whether additional s ensorimotor training of the paralyzed or paretic upper limb delivered by a robotic device enhanced motor outcome. Methods: Fifty-six patients with str oke and hemiparesis or hemiplegia received standard poststroke multidiscipl inary rehabilitation, and were randomly assigned either to receive robotic training (at least 25 hours) or exposure to the robotic device without trai ning. Outcomes were assessed by the same masked raters, before treatment be gan and at the end of treatment, with the upper extremity component of the Fugl-Meyer Motor Assessment, the Motor Status score, the Motor Power score, and Functional Independence Measurement. Result: The robot treatment and c ontrol group had comparable clinical characteristics, lesion size, and pret reatment impairment scores. By the end of treatment, the robot-trained grou p demonstrated improvement in motor outcome for the trained shoulder and el bow (Motor Power score, p < 0.001; Motor Status score, p < 0.01) that did n ot generalize to untrained wrist and hand. The robot-treated group also dem onstrated significantly improved functional outcome (Functional Independenc e Measurement-Motor, p < 0.01). Conclusion: Robot-delivered quantitative an d reproducible sensorimotor training enhanced the motor performance of the exercised shoulder and elbow. The robot-treated group also demonstrated imp roved functional outcome. When added to standard multidisciplinary rehabili tation, robotics provides novel therapeutic strategies that focus on impair ment reduction and improved motor performance.