Highlights
- •There is a need for new studies in stroke cases that are quite chronic.
- •It may be beneficial to support subjective evaluations used in stroke rehabilitation with objective evaluations such as electrophysiological measurements.
- •The robotic rehabilitation system has some advantages, such as providing high repetitive activities, compared to the traditional rehabilitation approaches.
- •In stroke rehabilitation, it should be aimed to transfer the gains obtained after the treatment to daily life.
Objective
To investigate the effect of electromyography (EMG)-driven robotic therapy on the
recovery of the hand in a stroke case lasting 9 years.
Case
An 18-year-old patient with hemiparesis due to the ischemic lesion was admitted to
our clinic with hand impairment. Fifteen sessions (5 weeks x 3 times) of robotic rehabilitation
were applied with the Hand of Hope. Average EMG (mV) of flexor digitorum superficialis
(FDS) muscle, average force (N) and the rate of force development (RFD)(N/s) were also assessed before and after the treatment following the 5th and 10th sessions
and at the end of treatment. Also, Fugl-Meyer Assessment of Upper Extremity Scale
(FMU-UE), Motor Activity Log (MAL), Canadian Occupational Performance Score (COPM)
and Visual Analog Scale (VAS) were used for assessment before and after the treatment.
Results
The average EMG measured from FDS increased from 0.093-0.133 mV. The average force
and average RFD increased from 45.6-97.7 and from 135.6-172.6 respectively. While
affected and/or unaffected side force ratio increased dramatically from 54%-82%, the
FMA-UE score increased from 56-59. The MAL quality of use score increased from 3.93-4.13.
Performance and satisfaction scores of COPM changed from 5.25-7.25 and 4.5-8.25 respectively.
VAS score for fatigue changed from 6 to 4.
Discussion
The improvement achieved 9 years later with 15 sessions of rehabilitation suggests
that improvement may be possible for chronic stroke patients.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Hand TherapyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Stroke survivors talk while doing: development of a therapeutic framework for continued rehabilitation of hand function post stroke.J Hand Ther. 2013; 26: 124-131
- A clinical study of motor imagery-based brain-computer interface for upper limb robotic rehabilitation.in: Engineering in Medicine and Biology Society. 2009. EMBC 2009. Annual International Conference of the IEEE. IEEE, 2009: 5981-5984
- An EMG-driven exoskeleton hand robotic training device on chronic stroke subjects: task training system for stroke rehabilitation.in: Rehabilitation Robotics (ICORR), 2011 IEEE International Conference on. IEEE, 2011: 1-5
- Arm training induced brain plasticity in stroke studied with serial positron emission tomography.Neuroimage. 2001; 13: 1146-1154
- Improving hand function in chronic stroke.Arch Neurol. 2002; 59: 1278-1282
- Effectiveness of commercial video gaming on fine motor control in chronic stroke within community-level rehabilitation.Disabil Rehabil. 2015; 37: 2184-2191
- Effects of robotic therapy on motor impairment and recovery in chronic stroke.Arch Phys Med Rehabil. 2003; 84: 477-482
- Robotic therapy for chronic motor impairments after stroke: Follow-up results.Arch Phys Med Rehabil. 2004; 85: 1106-1111
- Effects of robot-assisted upper limb rehabilitation on daily function and real-world arm activity in patients with chronic stroke: a randomized controlled trial.Clinical Rehabilitation. 2012; 26: 111-120
- Hands-off assistive robotics for post-stroke arm rehabilitation.in: In9th International Conference on Rehabilitation Robotics, 2005. ICORR 2005. IEEE, 2005: 21-24 (28)
- Robotic-assisted rehabilitation of the upper limb after acute stroke.Arch Phys Med Rehabil. 2007; 88: 142-149
- Kommu S.S. Rehabilitation Robotics. I-Tech Education and Publishing, Vienna2007
- The CARE guidelines: consensus-based clinical case reporting guideline development.J Med Case Rep. 2013; 7: 223
- Interobserver agreement for the assessment of handicap in stroke patients.Stroke. 1988; 19: 604-607
- Hand of Hope (HOH) Therapy Device, Instructions for Use. Sha Tin, Hong Kong.Manuel. 2018;
- The Fugl-Meyer assessment of motor recovery after stroke: a critical review of its measurement properties.Neurorehabil Neural Repair. 2002; 16: 232-240
- Motor activity log (mal) manual.UAB Training for CI Therapy. 2011; 1: 18
- Clinimetric properties of the motor activity log for the assessment of arm use in hemiparetic patients.Stroke. 2004; 35: 1410-1414
- The Canadian occupational performance measure: an outcome measure for occupational therapy.Can J Occup Ther. 1990; 57: 82-87
- Validity of the Canadian occupational performance measure.Occup Ther Int. 1997; 4: 231-249
- Clinical utility of the Canadian occupational performance measure-Swedish version.Can J Occup Ther. 2002; 69: 40-48
- Validity and reliability of a scale to assess fatigue.Psychiatry Res. 1991; 36: 291-298
- Defining and measuring fatigue.Image J Nurs Sch. 1999; 31: 45-50
- Graphic representation of pain.Pain. 1976; 2: 175-184
- The use of robots in stroke rehabilitation: a narrative review.Neurorehabilitation. 2018; 43: 99-110
- An intention driven hand functions task training robotic system.in: Engineering in Medicine and Biology Society (EMBC), 2010 Annual International Conference of the IEEE. IEEE, 2010: 3406-3409
- Effects of intensive arm training with the rehabilitation robot ARMin II in chronic stroke patients: four single-cases.J Neuroeng Rehabil. 2009; 6: 46
- Strength training improves upper-limb function in individuals with stroke: a meta-analysis.Stroke. 2010; 41: 136-140
- Unilateral wrist extension training after stroke improves strength and neural plasticity in both arms.Exp Brain Res. 2018; 236: 2009-2021
- Does hand robotic rehabilitation improve motor function by rebalancing interhemispheric connectivity after chronic stroke? Encouraging data from a randomised-clinical-trial.Neurophysiol Clin. 2019; 130: 767-780
- Portable neurorobotics for the severely affected arm in chronic stroke: a case study.J Neurol Phys Ther. 2011; 35: 41-46
- Predicting clinically significant changes in motor and functional outcomes after robot-assisted stroke rehabilitation.Arch Phys Med Rehabil. 2014; 95: 316-321
- Physiological and methodological aspects of rate of force development assessment in human skeletal muscle.Clin Physiol Funct Imaging. 2018; 38: 743-762
JHT Read for Credit
Quiz: # 926
Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to JHTReadforCredit.com. There is only one best answer for each question.
- # 1.The study design is
- a.RCTs
- b.qualitative
- c.case series
- d.case study
- a.
- # 2.Outcome measures included
- a.NCV of both median and ulnar nerves
- b.Semmes Weinstein monofilaments for sensibility
- c.RFD (N/s) & EMG (mV)
- d.JAMAR dynamometry
- a.
- # 3.The intervention consisted of _________ sessions
- a.15
- b.20
- c.10
- d.25
- a.
- # 4.The patient's chief complaint prior to use of the robotic device was
- a.limited ROM
- b.limited function
- c.limited sensibility
- d.pain
- a.
- # 5.While the results of the robotic intervention were positive and encouraging, the device is not being presented as “ready for routine clinical use”
- a.not true
- b.true
- a.
When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.
Article info
Publication history
Published online: April 27, 2021
Accepted:
April 22,
2021
Received in revised form:
January 30,
2021
Received:
July 29,
2020
Footnotes
Declaration of competing interest: The authors of this study report no conflicts of interest. They do not have any financial or personal relationship with any persons or organizations that may inappropriately influence (bias) this work. Rehab-Robotics Company did not involve in this study design, data collection or interpretation of the data.
Funding: This research did not receive any specific grant.
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
