Effects of Combined Robot-assisted Therapy With Mirror Priming in Stroke Patients

Kokeellinen: Robotic training with mirror therapy

20 minutes mirror therapy followed by 40 minutes robotic-assisted training

Käyttäytyminen: Robotic training with mirror therapy

Participants will receive 18 intervention sessions for about 6 consecutive weeks in a clinical setting (1 hour per session, 3 sessions per week). For each intervention session, participants will first receive 20 minutes mirror therapy followed by 40 minutes robotic-assisted training (robotic-assisted training includes 10 minutes active/passive training mode and 30 minutes robot-participant interactive training mode).

Huijausvertailija: Robotic-assisted training

20 minutes sham mirror therapy followed by 40 minutes robotic-assisted training

Käyttäytyminen: Robotic-assisted training

The training procedure will be the same as the robotic-assisted training with mirror therapy group except that sham mirror therapy will be provided in the first 20 minutes in the intervention session.

Muuta aktiivisen liikealueen (AROM) pisteitä

Potilas suorittaa harjoituksen liikuttaakseen niveltä ilman apua niveltä ympäröiville lihaksille.

Muuta modifioidun Ashworth-asteikon (MAS) pisteitä

MAS on 6 pisteen järjestysasteikko, joka mittaa lihasten spastisuutta potilailla, joilla on aivovaurioita. Korkeampi pistemäärä tarkoittaa korkeampaa lihasjännettä. Tutkijat arvioivat UE-lihasten MAS-pisteet, mukaan lukien hauislihakset, triceps, ranteen koukistajat ja ojentajalihakset sekä sormen koukistajat ja ojentajalihakset. Aivohalvauspotilaiden MAS-tutkimuksen validiteetti ja luotettavuus todettiin riittäväksi hyvään.

Muuta lääketieteellisen tutkimusneuvoston asteikon (MRC) pisteitä

MRC on järjestysasteikko, joka arvioi lihasvoimaa. Kunkin lihaksen pisteytys vaihtelee välillä 0-5, korkeampi pistemäärä tarkoittaa vahvempaa lihasta. MRC:n luotettavuus kaikissa lihasryhmissä oli hyvä tai erinomainen aivohalvauspotilailla.

Mini-Mental State Exam (MMSE) -pisteiden muuttaminen

Mini-Mental State Examination (MMSE) on yleisimmin käytetty kognitiivisen toiminnan psykometrinen seulontaarviointi. MMSE:tä käytetään potilaiden kognitiivisten heikentymien seulomiseen, kognitiivisen toiminnan muutosten seuraamiseen ajan myötä ja usein terapeuttisten aineiden vaikutusten arvioimiseen kognitiiviseen toimintaan. MMSE:n kokonaispistemäärä vaihteli 0–30. Korkeammat arvot edustavat parempaa kognitiivista toimintaa.

Muuta aivohalvauksen itsetehokkuuskyselyn (SSEQ) pisteitä

Stroke Self-Efficacy Questionnaire (SSEQ), kyselylomake, joka on kehitetty mittaamaan tärkeimpiä aivohalvauspopulaatioon liittyviä itsetehokkuutta ja itsehallintaa. Se sisältää 13 kohdetta, jotka on arvioitu asteikolla 0–10, ja korkeammat pisteet osoittavat suurempaa itsetehokkuutta. Kyselylomake sisältää joukon asiaankuuluvia toiminnallisia tehtäviä, kuten kävelyä, sängyssä olonsa mukavuutta sekä joitain itsehallintatehtäviä.

Muuta Daily Living Self-Efficacy Scale (DLSES) -tuloksia

DLSES on suunniteltu mittaamaan itsetehokkuutta psykososiaalisessa toiminnassa ja itsetehokkuutta päivittäisissä toimissa fyysisen vamman tasosta riippumatta.

Muuta toiminnallisten kykyjen luottamusasteikon (FACS) pisteitä

Functional Abilities Confidence Scale (FACS) on suunniteltu mittaamaan potilaan itsetehokkuutta tai itseluottamusta eri liikkeissä tai asennoissa.

Change scores of Fugl-Myer Assessment (FMA)

The UE-FMA subscale will be used to assess the sensorimotor impairment level of UE in patients after stroke. The UE-FMA contains 33 movements with a score range from 0 to 66. A higher UE-FMA score indicates less impairment of the paretic limb. The validity and reliability of FMA is good to excellent.

Change scores of grip and pinch power(Jamar hand dynamometer)

The Jamar hand dynamometer is the most widely cited in the literature and accepted as the gold standard by which other dynamometers are evaluated. Excellent concurrent validity of the Jamar hand dynamometer is reported. The Jamar hand dynamometer measure the grip-strength. The norm of healthy male aged 18 to 75 years is from 64.8 lb to 121.8 lb, while the norm of healthy female aged 18 to 75 years is from 41.5 lb to 78.7 lb. Higher value represent a greater grip-strength.

Change scores of MyotonPro

Investigators will use the MyotonPRO device to evaluate the viscoelastic properties of UE muscles.

Change scores of pressure pain threshold

The Commander Algometer (JTECH Medical, USA) is designed for easy handling and fine resolution to identify clinically significant pain sensitivity changes. The Commander Algometer provides a convenient, efficient, objective pain evaluation tool for treatment planning, progress evaluation and case management. The measured pressure thresholds/tolerances and trigger point tenderness will be reported by patients.

Change scores of Revised Nottingham Sensory Assessment (RNSA)

Changes in sensation before and after intervention will be measured with rNSA. Tactile sensation,proprioception, and stereognosis will be assessed with various sensory modalities. The rNSA is scored based on a 3-point ordinal scale (0-2) with a higher score indicates better sensation. The psychometric properties of rNSA have been established in patients with stroke.

Change scores of Wolf Motor Function Test (WMFT)

The Wolf Motor Function Test evaluates upper extremity motor function via 15 function-based tasks and 2 strength-based tasks. The Wolf Motor Function Test -time evaluates the time required to complete the function-based tasks, and the Wolf Motor Function Test -quality assesses functional ability on a 6-point ordinal scale. A lower Wolf Motor Function Test -time performance indicates faster movement, whereas a higher Wolf Motor Function Test -quality score suggests better quality of movement. The psychometric properties of Wolf Motor Function Test have been established in stroke patients.

Change scores of Jamar hand dynamometer

The Jamar hand dynamometer is the most widely cited in the literature and accepted as the gold standard by which other dynamometers are evaluated. Excellent concurrent validity of the Jamar hand dynamometer is reported. The Jamar hand dynamometer measure the grip-strength. The norm of healthy male aged 18 to 75 years is from 64.8 lb to 121.8 lb, while the norm of healthy female aged 18 to 75 years is from 41.5 lb to 78.7 lb. Higher value represent a greater grip-strength.

Change scores of Motor Activity Log (MAL)

The Motor Activity Log evaluates the amount of use (AOU) and quality of movement (QOM) of the affected hand in completing 30 common daily tasks. Scoring of each task ranges from 0 to 5, with higher scores indicating more use or better movement quality. The responsiveness, validity, and reliability have been established in stroke patients.

Change scores of Nottingham Extended Activities of Daily Living Scale (NEADL)

The NEADL is a self-report scale that measures instrumental activities of daily living. It evaluates 4 areas of daily living, including mobility, kitchen, domestic, and leisure activities. The total score is 0-66, and a higher score indicates better daily functional ability. The psychometric properties of NEADL have been well established.

Change scores of Stroke Impact Scale (SIS)

The SIS 3.0 will be used to evaluate health-related quality of life for patients with stroke. The SIS assesses eight domains (strength, hand function, ADL/IADL, mobility, communication, emotion, memory and thinking, and participation/role function) with 59 test items.

Kinematic Analysis

The movements of the arm and trunk will be captured by a 7-camera motion analysis system during unilateral and bilateral reaching tasks. Kinematic variables, such as reaction time, movement time, peak velocity, path length during the tasks can assess a patient's motor function in daily activities after intervention.