The effect of mirror therapy can be improved by simultaneous robotic assistance

Mareike Schrader, Annette Sterr, Robyn Kettlitz, Anika Wohlmeiner, Rüdiger Buschfort, Christian Dohle, Stephan Bamborschke, Mareike Schrader, Annette Sterr, Robyn Kettlitz, Anika Wohlmeiner, Rüdiger Buschfort, Christian Dohle, Stephan Bamborschke

Abstract

Background: Standard mirror therapy (MT) is a well-established therapy regime for severe arm paresis after acquired brain injury. Bilateral robot-assisted mirror therapy (RMT) could be a solution to provide visual and somatosensory feedback simultaneously.

Objective: The study compares the treatment effects of MT with a version of robot-assisted MT where the affected arm movement was delivered through a robotic glove (RMT).

Methods: This is a parallel, randomized trial, including patients with severe arm paresis after stroke or traumatic brain injury with a Fugl-Meyer subscore hand/finger < 4. Participants received either RMT or MT in individual 30 minute sessions (15 sessions within 5 weeks). Main outcome parameter was the improvement in the Fugl-Meyer Assessment upper extremity (FMA-UE) motor score. Additionally, the Motricity Index (MI) and the FMA-UE sensation test as well as a pain scale were recorded. Furthermore, patients' and therapists' experiences with RMT were captured through qualitative tools.

Results: 24 patients completed the study. Comparison of the FMA-UE motor score difference values between the two groups revealed a significantly greater therapy effect in the RMT group than the MT group (p = 0.006). There were no significant differences for the MI (p = 0.108), the FMA-UE surface sensibility subscore (p = 0.403) as well as the FMA-UE position sense subscore (p = 0.192). In both groups the levels of pain remained stable throughout the intervention. No other adverse effects were observed. The RMT training was well accepted by patients and therapists.

Conclusions: The study provides evidence that bilateral RMT achieves greater treatment benefit on motor function than conventional MT. The use of robotics seems to be a good method to implement passive co-movement in clinical practice. Our study further demonstrates that this form of training can feasibly and effectively be delivered in an inpatient setting.

Keywords: Mirror therapy; acquired brain injury; arm paresis; neurorehabilitation; robotics; somatosensory feedback; stroke.

Figures

Fig. 1
Fig. 1
Study flow chart.
Fig. 2
Fig. 2
(A) Setting of robotic assisted mirror therapy (RMT); (B) Setting of mirror therapy (MT).
Fig. 3
Fig. 3
Median change scores and interquartile range between groups for FMA-UE Motor Function (p = 0.006**) and Motricity Index (p = 0.108), p < 0.05.

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