Robotic Therapy Can Improve Arm and Shoulder Mobility After Stroke

Allison Gandey

February 17, 2011

February 17, 2011 (Los Angeles, California) — Combining standard rehabilitation with robotic therapy can increase shoulder and arm function in stroke patients, a new clinical trial shows.

ReoGo offers 5 preprogrammed movements

Patients using robotic therapy had marked improvement in 2 measures of upper-extremity function — the Fugl-Meyer flexor synergy score and the shoulder, elbow, forearm score.

"Robotic therapy can be an effective clinical tool for improving upper-extremity function during subacute rehabilitation," lead investigator Kayoko Takahashi, ScD, OTR, from Kitasato University in Kanagawa, Japan, told reporters attending a news conference here at the International Stroke Conference. "These effects are more remarkable in moderately severe hemiplegia."

Investigators are evaluating the usefulness of a robotic device known as ReoGo, which is designed to assist patients with repeated movements targeting the upper extremities. The system, developed by Motorika, is being promoted by Teijin Pharma.

Dr. Kayoko Takahashi

The trial involved 60 stroke survivors with paralysis on 1 side of the body treated at 6 rehabilitation centers in Japan. All patients received standard rehabilitation therapy from an occupational therapist.

Half of the group received robotic therapy every day for 6 weeks in sessions lasting 40 minutes. The other half spent the same amount of time working on a self-training program performing stretches and passive-to-active exercises.

Patients assigned to the robotic therapy placed or strapped their forearm to a platform that moves in multiple directions on the basis of a preprogrammed exercise plan.

The robotic therapy group showed significant improvement in the Fugl-Meyer flexor synergy score compared with the control group (change, 2.1 ± 2.7 vs -0.1 ± 2.4; P < .01), as well as in the shoulder, elbow, forearm score (change, 4.8 ± 5.0 vs. 1.9 ± 5.5; P < .05).

In the higher-function cohort, there was no significant difference between the 2 groups. However, for the lower-function cohort, robotic therapy significantly improved the shoulder, elbow, forearm score (change, 6.6 ± 5.1 vs 2.2 ± 6.2; P < .05).

The mechanism of action for the proposed benefit is unknown. Dr. Takahashi told Medscape Medical News she believes the repetitive motion is helping to re-educate the brain.

Session moderator Robert Adams, MD, director of the Medical University of South Carolina Stroke Center in Charleston, took a question from reporters about the expense of robotic therapy. "There are higher upfront costs with devices like this," Dr. Adams acknowledged, "but standard occupational therapy can involve many hours and many people and an argument could be made that this approach could become cheaper in the long run."

Dr. Takahashi took additional questions from meeting delegates after her presentation. One delegate raised concerns about the fact that the treatment group was given a machine to work with and the control group was not. Might the presence of the robot have skewed the results? The delegate suggested it could be beneficial to have the placebo group work with a machine as well to balance things out.

Dr. Takahashi said her group would consider this in future trial designs. "Further research using larger groups of patients is necessary."

During the question-and-answer period, David Alexander, MD, Medical Director of Neurologic Rehabilitation at the University of California at Los Angeles, pointed out that not all robotic therapy studies have been as positive as this one. Albert Lo's team reported far less favorable results in May in The New England Journal of Medicine (2010;362:1772-1783).

Dr. Lo is from the Providence Veterans Affairs Medical Center and Brown University in Rhode Island. He found that in patients with long-term upper-limb deficits after stroke, robot-assisted therapy did not significantly improve motor function at 12 weeks compared with usual care or intensive therapy. In secondary analyses, robot-assisted therapy improved outcomes over 36 weeks compared with usual care but not with intensive therapy.

This study was funded by Teijin Pharma. The researchers have disclosed no relevant financial relationships.

American Stroke Association International Stroke Conference. Abstract # LB4. Presented February 10, 2011.

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