Effects of robotic priming of bilateral arm training, mirror therapy, and impairment-oriented training on sensorimotor and daily functions in patients with chronic stroke: study protocol of a single-blind, randomized controlled trial

Yi-Chen Lee, Yi-Chun Li, Keh-Chung Lin, Grace Yao, Ya-Ju Chang, Ya-Yun Lee, Chien-Ting Liu, Wan-Ling Hsu, Yi-Hsuan Wu, Ho-Ta Chu, Ting-Xuan Liu, Yi-Ping Yeh, Chieh Chang, Yi-Chen Lee, Yi-Chun Li, Keh-Chung Lin, Grace Yao, Ya-Ju Chang, Ya-Yun Lee, Chien-Ting Liu, Wan-Ling Hsu, Yi-Hsuan Wu, Ho-Ta Chu, Ting-Xuan Liu, Yi-Ping Yeh, Chieh Chang

Abstract

Background: Combining robotic therapy (RT) with task-oriented therapy is an emerging strategy to facilitate motor relearning in stroke rehabilitation. This study protocol will compare novel rehabilitation regimens that use bilateral RT as a priming technique to augment two task-oriented therapies: mirror therapy (MT) and bilateral arm training (BAT) with a control intervention: RT combined with impairment-oriented training (IOT).

Methods: This single-blind, randomized, comparative efficacy study will involve 96 participants with chronic stroke. Participants will be randomized into bilateral RT+MT, bilateral RT+BAT, and bilateral RT+IOT groups and receive 18 intervention sessions (90 min/day, 3 d/week for 6 weeks). The outcomes will include the Fugl-Meyer Assessment, Stroke Impact Scale version 3.0, Medical Research Council scale, Revised Nottingham Sensory Assessment, ABILHAND Questionnaire, and accelerometer and will be assessed at baseline, after treatment, and at the 3-month follow-up. Analysis of covariance and the chi-square automatic interaction detector method will be used to examine the comparative efficacy and predictors of outcome, respectively, after bilateral RT+MT, bilateral RT+BAT, and bilateral RT+IOT.

Discussion: The findings are expected to contribute to the research and development of robotic devices, to update the evidence-based protocols in postacute stroke care programs, and to investigate the use of accelerometers for monitoring activity level in real-life situations, which may in turn promote home-based practice by the patients and their caregivers. Directions for further studies and empirical implications for clinical practice will be further discussed in upper-extremity rehabilitation after stroke.

Trial registration: This trial was registered December 12, 2018, at www.

Clinicaltrials: gov ( NCT03773653 ).

Keywords: Bilateral arm training; Bilateral motor priming; Impairment-oriented training; Mirror therapy; Randomized controlled trial; Stroke; Upper extremity rehabilitation.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

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