Sequencing bilateral robot-assisted arm therapy and constraint-induced therapy improves reach to press and trunk kinematics in patients with stroke

Yu-wei Hsieh, Rong-jiuan Liing, Keh-chung Lin, Ching-yi Wu, Tsan-hon Liou, Jui-chi Lin, Jen-wen Hung, Yu-wei Hsieh, Rong-jiuan Liing, Keh-chung Lin, Ching-yi Wu, Tsan-hon Liou, Jui-chi Lin, Jen-wen Hung

Abstract

Background: The combination of robot-assisted therapy (RT) and a modified form of constraint-induced therapy (mCIT) shows promise for improving motor function of patients with stroke. However, whether the changes of motor control strategies are concomitant with the improvements in motor function after combination of RT and mCIT (RT + mCIT) is unclear. This study investigated the effects of the sequential combination of RT + mCIT compared with RT alone on the strategies of motor control measured by kinematic analysis and on motor function and daily performance measured by clinical scales.

Methods: The study enrolled 34 patients with chronic stroke. The data were derived from part of a single-blinded randomized controlled trial. Participants in the RT + mCIT and RT groups received 20 therapy sessions (90 to 105 min/day, 5 days for 4 weeks). Patients in the RT + mCIT group received 10 RT sessions for first 2 weeks and 10 mCIT sessions for the next 2 weeks. The Bi-Manu-Track was used in RT sessions to provide bilateral practice of wrist and forearm movements. The primary outcome was kinematic variables in a task of reaching to press a desk bell. Secondary outcomes included scores on the Wolf Motor Function Test, Functional Independence Measure, and Nottingham Extended Activities of Daily Living. All outcome measures were administered before and after intervention.

Results: RT + mCIT and RT demonstrated different benefits on motor control strategies. RT + mCIT uniquely improved motor control strategies by reducing shoulder abduction, increasing elbow extension, and decreasing trunk compensatory movement during the reaching task. Motor function and quality of the affected limb was improved, and patients achieved greater independence in instrumental activities of daily living. Force generation at movement initiation was improved in the patients who received RT.

Conclusion: A combination of RT and mCIT could be an effective approach to improve stroke rehabilitation outcomes, achieving better motor control strategies, motor function, and functional independence of instrumental activities of daily living.

Trial registration: ClinicalTrials.gov. NCT01727648.

Keywords: Constraint-induced; Robotic rehabilitation; Sequential combination therapy; Stroke; Upper extremity.

Figures

Fig. 1
Fig. 1
Graphic representation of the angular strategy variables: (a) shoulder flexion (ShFlex) in the sagittal plane and elbow extension (ElbExt) in the sagittal plane; (b) shoulder abduction (ShAbd) in the frontal plane; and (c) trunk flexion in sagittal (TrunkFlex) plane

References

    1. Roger VL, Go AS, Lloyd-Jones DM, Adams RJ, Berry JD, Brown TM, et al. Heart disease and stroke statistics--2011 update: a report from the American Heart Association. Circulation. 2011;123:e18–209. doi: 10.1161/CIR.0b013e3182009701.
    1. Kwakkel G, Kollen BJ, Wagenaar RC. Therapy impact on functional recovery in stroke rehabilitation: a critical review of the literature. Physiotherapy. 1999;85:377–91. doi: 10.1016/S0031-9406(05)67198-2.
    1. Alt Murphy M, Willen C, Sunnerhagen KS. Kinematic variables quantifying upper-extremity performance after stroke during reaching and drinking from a glass. Neurorehabil Neural Repair. 2011;25:71–80. doi: 10.1177/1545968310370748.
    1. Broeks JG, Lankhorst GJ, Rumping K, Prevo AJ. The long-term outcome of arm function after stroke: results of a follow-up study. Disabil Rehabil. 1999;21:357–64. doi: 10.1080/096382899297459.
    1. Lai SM, Studenski S, Duncan PW, Perera S. Persisting consequences of stroke measured by the Stroke Impact Scale. Stroke. 2002;33:1840–4. doi: 10.1161/01.STR.0000019289.15440.F2.
    1. Fasoli SE, Krebs HI, Stein J, Frontera WR, Hogan N. Effects of robotic therapy on motor impairment and recovery in chronic stroke. Arch Phys Med Rehabil. 2003;84:477–82. doi: 10.1053/apmr.2003.50110.
    1. Brewer BR, McDowell SK, Worthen-Chaudhari LC. Poststroke upper extremity rehabilitation: a review of robotic systems and clinical results. Top Stroke Rehabil. 2007;14:22–44. doi: 10.1310/tsr1406-22.
    1. Kwakkel G, Kollen BJ, Krebs HI. Effects of robot-assisted therapy on upper limb recovery after stroke: a systematic review. Neurorehabil Neural Repair. 2008;22:111–21. doi: 10.1177/1545968307305457.
    1. Langhorne P, Coupar F, Pollock A. Motor recovery after stroke: a systematic review. Lancet Neurol. 2009;8:741–54. doi: 10.1016/S1474-4422(09)70150-4.
    1. Nordin N, Xie SQ, Wunsche B. Assessment of movement quality in robot- assisted upper limb rehabilitation after stroke: a review. J Neuroeng Rehabil. 2014;11:137. doi: 10.1186/1743-0003-11-137.
    1. Wu CY, Yang CL, Chuang LL, Lin KC, Chen HC, Chen MD, et al. Effect of therapist-based versus robot-assisted bilateral arm training on motor control, functional performance, and quality of life after chronic stroke: a clinical trial. Phys Ther. 2012;92:1006–16. doi: 10.2522/ptj.20110282.
    1. Kahn LE, Zygman ML, Rymer WZ, Reinkensmeyer DJ. Robot-assisted reaching exercise promotes arm movement recovery in chronic hemiparetic stroke: a randomized controlled pilot study. J Neuroeng Rehabil. 2006;3:12. doi: 10.1186/1743-0003-3-12.
    1. Chang JJ, Tung WL, Wu WL, Huang MH, Su FC. Effects of robot-aided bilateral force-induced isokinetic arm training combined with conventional rehabilitation on arm motor function in patients with chronic stroke. Arch Phys Med Rehabil. 2007;88:1332–8. doi: 10.1016/j.apmr.2007.07.016.
    1. Norouzi-Gheidari N, Archambault PS, Fung J. Effects of robot-assisted therapy on stroke rehabilitation in upper limbs: systematic review and meta-analysis of the literature. J Rehabil Res Dev. 2012;49:479–96. doi: 10.1682/JRRD.2010.10.0210.
    1. Mehrholz J, Hadrich A, Platz T, Kugler J, Pohl M. Electromechanical and robot-assisted arm training for improving generic activities of daily living, arm function, and arm muscle strength after stroke. Cochrane Database Syst Rev. 2012;6
    1. Chang WH, Kim YH. Robot-assisted therapy in stroke rehabilitation. J Stroke. 2013;15:174–81. doi: 10.5853/jos.2013.15.3.174.
    1. Mehrholz J, Pohl M, Platz T, Kugler J, Elsner B. Electromechanical and robot-assisted arm training for improving activities of daily living, arm function, and arm muscle strength after stroke. Cochrane Database Syst Rev. 2015;11
    1. Taub E, Miller NE, Novack TA, Cook EW, 3rd, Fleming WC, Nepomuceno CS, et al. Technique to improve chronic motor deficit after stroke. Arch Phys Med Rehabil. 1993;74:347–54.
    1. Kwakkel G, Veerbeek JM, van Wegen EE, Wolf SL. Constraint-induced movement therapy after stroke. Lancet Neurol. 2015;14:224–34. doi: 10.1016/S1474-4422(14)70160-7.
    1. Fleet A, Page SJ, MacKay-Lyons M, Boe SG. Modified constraint-induced movement therapy for upper extremity recovery post stroke: what is the evidence? Top Stroke Rehabil. 2014;21:319–31. doi: 10.1310/tsr2104-319.
    1. Taub E, Uswatte G, Mark VW, Morris DM, Barman J, Bowman MH, et al. Method for enhancing real-world use of a more affected arm in chronic stroke: transfer package of constraint-induced movement therapy. Stroke. 2013;44:1383–8. doi: 10.1161/STROKEAHA.111.000559.
    1. Dettmers C, Teske U, Hamzei F, Uswatte G, Taub E, Weiller C. Distributed form of constraint-induced movement therapy improves functional outcome and quality of life after stroke. Arch Phys Med Rehabil. 2005;86:204–9. doi: 10.1016/j.apmr.2004.05.007.
    1. Page SJ, Levine P, Leonard A, Szaflarski JP, Kissela BM. Modified constraint-induced therapy in chronic stroke: results of a single-blinded randomized controlled trial. Phys Ther. 2008;88:333–40. doi: 10.2522/ptj.20060029.
    1. Stevenson T, Thalman L, Christie H, Poluha W. Constraint-induced movement therapy compared to dose-matched interventions for upper-limb dysfunction in adult survivors of stroke: a systematic review with meta-analysis. Physiother Can. 2012;64:397–413. doi: 10.3138/ptc.2011-24.
    1. Thrane G, Friborg O, Anke A, Indredavik B. A meta-analysis of constraint-induced movement therapy after stroke. J Rehabil Med. 2014;46:833–42. doi: 10.2340/16501977-1859.
    1. Hesse S, Waldner A, Mehrholz J, Tomelleri C, Pohl M, Werner C. Combined transcranial direct current stimulation and robot-assisted arm training in subacute stroke patients: an exploratory, randomized multicenter trial. Neurorehabil Neural Repair. 2011;25:838–46. doi: 10.1177/1545968311413906.
    1. Brokaw EB, Nichols D, Holley RJ, Lum PS. Robotic therapy provides a stimulus for upper limb motor recovery after stroke that is complementary to and distinct from conventional therapy. Neurorehabil Neural Repair. 2014;28:367–76. doi: 10.1177/1545968313510974.
    1. Kutner NG, Zhang R, Butler AJ, Wolf SL, Alberts JL. Quality-of-life change associated with robotic-assisted therapy to improve hand motor function in patients with subacute stroke: a randomized clinical trial. Phys Ther. 2010;90:493–504. doi: 10.2522/ptj.20090160.
    1. Hsieh YW, Lin KC, Horng YS, Wu CY, Wu TC, Ku FL. Sequential combination of robot-assisted therapy and constraint-induced therapy in stroke rehabilitation: a randomized controlled trial. J Neurol. 2014;261:1037–45. doi: 10.1007/s00415-014-7345-4.
    1. Nowak DA. The impact of stroke on the performance of grasping: usefulness of kinetic and kinematic motion analysis. Neurosci Biobehav Rev. 2008;32:1439–50. doi: 10.1016/j.neubiorev.2008.05.021.
    1. Levin MF, Kleim JA, Wolf SL. What do motor "recovery" and "compensation" mean in patients following stroke? Neurorehabil Neural Repair. 2009;23:313–9. doi: 10.1177/1545968308328727.
    1. van Dokkum L, Hauret I, Mottet D, Froger J, Metrot J, Laffont I. The contribution of kinematics in the assessment of upper limb motor recovery early after stroke. Neurorehabil Neural Repair. 2014;28:4–12. doi: 10.1177/1545968313498514.
    1. Fugl-Meyer AR, Jaasko L, Leyman I, Olsson S, Steglind S. The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance. Scand J Rehabil Med. 1975;7:13–31.
    1. Taub E, Uswatte G, Bowman MH, Mark VW, Delgado A, Bryson C, et al. Constraint-induced movement therapy combined with conventional neurorehabilitation techniques in chronic stroke patients with plegic hands: a case series. Arch Phys Med Rehabil. 2013;94:86–94. doi: 10.1016/j.apmr.2012.07.029.
    1. Hesse S, Werner C, Pohl M, Rueckriem S, Mehrholz J, Lingnau ML. Computerized arm training improves the motor control of the severely affected arm after stroke: a single-blinded randomized trial in two centers. Stroke. 2005;36:1960–6. doi: 10.1161/01.STR.0000177865.37334.ce.
    1. Hsieh YW, Wu CY, Lin KC, Yao G, Wu KY, Chang YJ. Dose–response relationship of robot-assisted stroke motor rehabilitation: the impact of initial motor status. Stroke. 2012;43:2729–34. doi: 10.1161/STROKEAHA.112.658807.
    1. Lin KC, Wu CY, Liu JS, Chen YT, Hsu CJ. Constraint-induced therapy versus dose-matched control intervention to improve motor ability, basic/extended daily functions, and quality of life in stroke. Neurorehabil Neural Repair. 2009;23:160–5. doi: 10.1177/1545968308320642.
    1. Wu CY, Chen CL, Tang SF, Lin KC, Huang YY. Kinematic and clinical analyses of upper-extremity movements after constraint-induced movement therapy in patients with stroke: a randomized controlled trial. Arch Phys Med Rehabil. 2007;88:964–70. doi: 10.1016/j.apmr.2007.05.012.
    1. Morris DM, Taub E, Mark VW. Constraint-induced movement therapy: characterizing the intervention protocol. Eura Medicophys. 2006;42:257–68.
    1. World Health Organization . International classification of functioning, disability and health: ICF. Geneva: World Health Organization; 2001.
    1. DeJong SL, Schaefer SY, Lang CE. Need for speed: better movement quality during faster task performance after stroke. Neurorehabil Neural Repair. 2012;26:362–73. doi: 10.1177/1545968311425926.
    1. Wolf SL, Catlin PA, Ellis M, Archer AL, Morgan B, Piacentino A. Assessing Wolf motor function test as outcome measure for research in patients after stroke. Stroke. 2001;32:1635–9. doi: 10.1161/01.STR.32.7.1635.
    1. Morris DM, Uswatte G, Crago JE, Cook EW, 3rd, Taub E. The reliability of the Wolf motor function test for assessing upper extremity function after stroke. Arch Phys Med Rehabil. 2001;82:750–5. doi: 10.1053/apmr.2001.23183.
    1. Hamilton BB, Granger, CV, Sherwin FS, Zielezny M, Tashman JS. Rehabilitation outcomes: analysis and measurements. In: Fuhrer MJ, editor. A uniform national data system for medical rehabilitation. Baltimore, MD: Brookes; 1987. p. 137–47.
    1. Chau N, Daler S, Andre JM, Patris A. Inter-rater agreement of two functional independence scales: the Functional Independence Measure (FIM) and a subjective uniform continuous scale. Disabil Rehabil. 1994;16:63–71. doi: 10.3109/09638289409166014.
    1. Hamilton BB, Laughlin JA, Fiedler RC, Granger CV. Interrater reliability of the 7-level functional independence measure (FIM) Scand J Rehabil Med. 1994;26:115–9.
    1. Gosman-Hedstrom G, Svensson E. Parallel reliability of the functional independence measure and the Barthel ADL index. Disabil Rehabil. 2000;22:702–15. doi: 10.1080/09638280050191972.
    1. Nouri FM, Lincoln NB. An extended activities of daily living scale for stroke patients. Clin Rehabil. 1987;1:301–5. doi: 10.1177/026921558700100409.
    1. Sveen U, Thommessen B, Bautz-Holter E, Wyller TB, Lakke K. Well-being and instrumental activities of daily living after stroke. Clin Rehabil. 2004;18:267–74. doi: 10.1191/0269215504cr719oa.
    1. Hsueh IP, Huang SL, Chen MH, Jush SD, Hsieh CL. Evaluation of stroke patients with the extended activities of daily living scale in Taiwan. Disabil Rehabil. 2000;22:495–500. doi: 10.1080/096382800413989.
    1. Wu CY, Chuang LL, Lin KC, Horng YS. Responsiveness and validity of two outcome measures of instrumental activities of daily living in stroke survivors receiving rehabilitative therapies. Clin Rehabil. 2011;25:175–83. doi: 10.1177/0269215510385482.
    1. Shumway-cook A, Woollacott MH. Normal reach, grasp, and manipulation. In: Lupash E, editor. Motor control: translating research into clnical practice. 4. Philadelphia: Lippincott Williams & Wilkins; 2012. pp. 552–94.
    1. Wu CY, Lin KC, Chen HC, Chen IH, Hong WH. Effects of modified constraint-induced movement therapy on movement kinematics and daily function in patients with stroke: a kinematic study of motor control mechanisms. Neurorehabil Neural Repair. 2007;21:460–6. doi: 10.1177/1545968307303411.
    1. Flash T, Hogan N. The coordination of arm movements: an experimentally confirmed mathematical model. J Neurosci. 1985;5:1688–703.
    1. Haaland KY, Prestopnik JL, Knight RT, Lee RR. Hemispheric asymmetries for kinematic and positional aspects of reaching. Brain. 2004;127:1145–58. doi: 10.1093/brain/awh133.
    1. Cohen J. Statistical power analysis for the behavior sciences. 2. Hillsdale, NJ: Erlbaum; 1988.
    1. Massie C, Malcolm MP, Greene D, Thaut M. The effects of constraint-induced therapy on kinematic outcomes and compensatory movement patterns: an exploratory study. Arch Phys Med Rehabil. 2009;90:571–9. doi: 10.1016/j.apmr.2008.09.574.
    1. Ellis MD, Sukal-Moulton T, Dewald JP. Progressive shoulder abduction loading is a crucial element of arm rehabilitation in chronic stroke. Neurorehabil Neural Repair. 2009;23:862–9. doi: 10.1177/1545968309332927.
    1. Caimmi M, Carda S, Giovanzana C, Maini ES, Sabatini AM, Smania N, et al. Using kinematic analysis to evaluate constraint-induced movement therapy in chronic stroke patients. Neurorehabil Neural Repair. 2008;22:31–9. doi: 10.1177/1545968307302923.
    1. Lin KC, Wu CY, Wei TH, Lee CY, Liu JS. Effects of modified constraint-induced movement therapy on reach-to-grasp movements and functional performance after chronic stroke: a randomized controlled study. Clin Rehabil. 2007;21:1075–86. doi: 10.1177/0269215507079843.
    1. Beer RF, Given JD, Dewald JP. Task-dependent weakness at the elbow in patients with hemiparesis. Arch Phys Med Rehabil. 1999;80:766–72. doi: 10.1016/S0003-9993(99)90225-3.
    1. Ellis MD, Acosta AM, Yao J, Dewald JP. Position-dependent torque coupling and associated muscle activation in the hemiparetic upper extremity. Exp Brain Res. 2007;176:594–602. doi: 10.1007/s00221-006-0637-x.
    1. Lum PS, Burgar CG, Shor PC, Majmundar M, Van der Loos M. Robot-assisted movement training compared with conventional therapy techniques for the rehabilitation of upper-limb motor function after stroke. Arch Phys Med Rehabil. 2002;83:952–9. doi: 10.1053/apmr.2001.33101.
    1. Wu CY, Chuang LL, Lin KC, Lee SD, Hong WH. Responsiveness, minimal detectable change, and minimal clinically important difference of the Nottingham Extended Activities of Daily Living Scale in patients with improved performance after stroke rehabilitation. Arch Phys Med Rehabil. 2011;92:1281–7. doi: 10.1016/j.apmr.2011.03.008.
    1. Uswatte G, Taub E, Morris D, Light K, Thompson PA. The Motor Activity Log-28: assessing daily use of the hemiparetic arm after stroke. Neurology. 2006;67:1189–94. doi: 10.1212/01.wnl.0000238164.90657.c2.
    1. Takebayashi T, Koyama T, Amano S, Hanada K, Tabusadani M, Hosomi M, et al. A 6-month follow-up after constraint-induced movement therapy with and without transfer package for patients with hemiparesis after stroke: a pilot quasi-randomized controlled trial. Clin Rehabil. 2013;27:418–26. doi: 10.1177/0269215512460779.
    1. Wu G, van der Helm FC, Veeger HE, Makhsous M, Van Roy P, Anglin C, et al. ISB recommendation on definitions of joint coordinate systems of various joints for the reporting of human joint motion--Part II: shoulder, elbow, wrist and hand. J Biomech. 2005;38:981–92. doi: 10.1016/j.jbiomech.2004.05.042.

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