Robot-assisted upper-limb therapy in acute rehabilitation setting following stroke: Department of Veterans Affairs multisite clinical trial

摘要

This randomized, controlled, multisite Department of Veterans Affairs clinical trial assessed robotassisted (RA) upperlimb therapy with the Mirror Image Movement Enabler (MIME) in the acute stroke rehabilitation setting. Hemiparetic subjects (n = 54) received RA therapy using MIME for either up to 15 hours (lowdose) or 30 hours (highdose) or received up to 15 hours of additional conventional therapy in addition to usual care (control). The primary outcome measure was the FuglMeyer Assessment (FMA). The secondary outcome measures were the Functional Independence Measure (FIM), Wolf Motor Function Test, Motor Power, and Ashworth scores at intake, discharge, and 6month followup. Mean duration of study treatment was 8.6, 15.8, and 9.4 hours for the lowdose, highdose, and control groups, respectively. Gains in the primary outcome measure were not significantly different between groups at followup. Significant correlations were found at discharge between FMA gains and the dose and intensity of RA. Intensity also correlated with FMA gain at 6 months. The highdose group had greater FIM gains than controls at discharge and greater tone but no difference in FIM changes compared with lowdose subjects at 6 months. As used during acute rehabilitation, motorcontrol changes at followup were no less with MIME than with additional conventional therapy. Intensity of training with MIME was positively correlated with motorcontrol gains.