Movement therapy improves functional outcomes in stroke survivors
MedWire News: Nine months of robot-assisted movement therapy improves physical function in patients with chronic stroke, show findings published in the New England Journal of Medicine.
Neither robot-assisted nor intensive therapy improved patients’ function on the Fugl-Meyer scale over that achieved with usual care after 12 weeks, which was the primary endpoint of the trial. But both therapies were superior to usual care at 36 weeks.
“One of the purposes of this study was to upend the conventional dogma that stroke victims can’t recover physiologic function,” commented lead investigator Albert Lo (Providence Veterans Affairs Medical Center, Rhode Island, USA).
The team enrolled 127 patients who had persistent moderate-to-severe upper-limb functional impairment at 6 months or more after a stroke. Active treatment was given during 36 sessions lasting 1 hour each over a period of 12 weeks.
Co-investigator George Wittenberg (University of Maryland School of Medicine, Baltimore, USA) described robot-assisted therapy as “‘power steering’ for the arms – just enough assistance to allow people to move.”
At 12 weeks, the average Fugl-Meyer scores of the 49 patients assigned to robot-assisted therapy had improved a nonsignificant 2.17 points over those of the 28 patients given usual care, after accounting for baseline scores and comorbidities. Their scores were a nonsignificant 0.14 points worse than scores of the 50 patients assigned to intensive therapy (assisted stretching, arm exercises, functional reaching tasks, etc).
In a secondary analysis of function after 36 weeks, robot-assisted therapy was associated with a 2.88-point improvement in Fugl-Meyer scores compared with usual care. But robot-assisted therapy was no better than intensive therapy for improving patients’ functional outcomes, with scores 0.58 points lower on average.
Editorialist Steven Cramer (University of California, Irvine, USA) said that “movement training, at the heart of the current study, stands on its own as a means of improving behavior in the stroke-injured brain.”
He added that the findings “reinforce the theory that the adult brain has the capacity for clinically relevant plasticity even in the chronic phase after a stroke. The future holds great hope for the development of brain-repair protocols to greatly reduce the degree of disability after stroke.”
Despite the failure of robot-assisted therapy to outperform standard intensive therapy in the current trial, Cramer said that “in the bigger picture, the potential for robotic therapy after stroke remains enormous.”
He said: “Robots work in a consistent and precise manner and over long periods without fatigue. They can modulate timing, content, and intensity of training in reproducible ways, with a reduced need for human oversight.”
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By Eleanor McDermid