Comparison of Robotics, Functional Electrical Stimulation, and Motor Learning Methods for Treatment of Persistent Upper Extremity Dysfunction After Stroke: A Randomized Controlled Trial

Jessica McCabe; Michelle Monkiewicz; John P Holcomb; Svetlana Pundik; Janis J. Daly

doi:10.1016/j.apmr.2014.10.022

Comparison of Robotics, Functional Electrical Stimulation, and Motor Learning Methods for Treatment of Persistent Upper Extremity Dysfunction After Stroke: A Randomized Controlled Trial

Jessica McCabe
, Michelle Monkiewicz
, John P Holcomb
, Svetlana Pundik
, Janis J. Daly

Louis Stokes Cleveland Department of Veterans Affairs Medical Center

Research output: Contribution to journal › Article › peer-review

Abstract

<p> <h3 id="x-x-x-x-x-x-x-sectitle0015"> Objective </h3> <p id="x-x-x-x-x-x-x-abspara0010"> To compare response to upper-limb treatment using robotics plus motor learning (ML) versus functional electrical stimulation (FES) plus ML versus ML alone, according to a measure of complex functional everyday tasks for chronic, severely impaired stroke survivors. <h3 id="x-x-x-x-x-x-x-sectitle0020"> Design </h3> <p id="x-x-x-x-x-x-x-abspara0015"> Single-blind, randomized trial. <h3 id="x-x-x-x-x-x-x-sectitle0025"> Setting </h3> <p id="x-x-x-x-x-x-x-abspara0020"> Medical center. <h3 id="x-x-x-x-x-x-x-sectitle0030"> Participants </h3> <p id="x-x-x-x-x-x-x-abspara0025"> Enrolled subjects (N=39) were >1 year post single stroke (attrition rate=10%; 35 completed the study). <h3 id="x-x-x-x-x-x-x-sectitle0035"> Interventions </h3> <p id="x-x-x-x-x-x-x-abspara0030"> All groups received treatment 5d/wk for 5h/d (60 sessions), with unique treatment as follows: ML alone (n=11) (5h/d partial- and whole-task practice of complex functional tasks), robotics plus ML (n=12) (3.5h/d of ML and 1.5h/d of shoulder/elbow robotics), and FES plus ML (n=12) (3.5h/d of ML and 1.5h/d of FES wrist/hand coordination training). <h3 id="x-x-x-x-x-x-x-sectitle0040"> Main Outcome Measures </h3> <p id="x-x-x-x-x-x-x-abspara0035"> Primary measure: Arm Motor Ability Test (AMAT), with 13 complex functional tasks; secondary measure: upper-limb Fugl-Meyer coordination scale (FM). <h3 id="x-x-x-x-x-x-x-sectitle0045"> Results </h3> <p id="x-x-x-x-x-x-x-abspara0040"> There was no significant difference found in treatment response across groups (AMAT: <em> P </em> ≥.584; FM coordination: <em> P </em> ≥.590). All 3 treatment groups demonstrated clinically and statistically significant improvement in response to treatment (AMAT and FM coordination: <em> P </em> ≤.009). A group treatment paradigm of 1:3 (therapist/patient) ratio proved feasible for provision of the intensive treatment. No adverse effects. <h3 id="x-x-x-x-x-x-x-sectitle0050"> Conclusions </h3> <p id="x-x-x-x-x-x-x-abspara0045"> Severely impaired stroke survivors with persistent (>1y) upper-extremity dysfunction can make clinically and statistically significant gains in coordination and functional task performance in response to robotics plus ML, FES plus ML, and ML alone in an intensive and long-duration intervention; no group differences were found. Additional studies are warranted to determine the effectiveness of these methods in the clinical setting. </p> </p> </p> </p> </p> </p> </p> </p></p>

Original language	American English
Journal	Archives of Physical Medicine and Rehabilitation
Volume	96
DOIs	https://doi.org/10.1016/j.apmr.2014.10.022
State	Published - Jun 1 2015

Keywords

Electric stimulation; FES; Randomized controlled trial
Rehabilitation; Robotics; Stroke; Upper extremity

Disciplines

Mathematics
Rehabilitation and Therapy

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Comparison of Robotics Functional Electrical Stimulation and MoFinal published version, 1.21 MBLicense: CC BY

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Comparison of Robotics, Functional Electrical Stimulation, and Motor Learning Methods for Treatment of Persistent Upper Extremity Dysfunction After Stroke: A Randomized Controlled Trial. / McCabe, Jessica; Monkiewicz, Michelle; Holcomb, John P et al.
In: Archives of Physical Medicine and Rehabilitation, Vol. 96, 01.06.2015.

Research output: Contribution to journal › Article › peer-review

@article{cb4efa5c35f34a808eaf669b59c065f8,

title = "Comparison of Robotics, Functional Electrical Stimulation, and Motor Learning Methods for Treatment of Persistent Upper Extremity Dysfunction After Stroke: A Randomized Controlled Trial",

abstract = " Objective To compare response to upper-limb treatment using robotics plus motor learning (ML) versus functional electrical stimulation (FES) plus ML versus ML alone, according to a measure of complex functional everyday tasks for chronic, severely impaired stroke survivors. Design Single-blind, randomized trial. Setting Medical center. Participants Enrolled subjects (N=39) were >1 year post single stroke (attrition rate=10\%; 35 completed the study). Interventions All groups received treatment 5d/wk for 5h/d (60 sessions), with unique treatment as follows: ML alone (n=11) (5h/d partial- and whole-task practice of complex functional tasks), robotics plus ML (n=12) (3.5h/d of ML and 1.5h/d of shoulder/elbow robotics), and FES plus ML (n=12) (3.5h/d of ML and 1.5h/d of FES wrist/hand coordination training). Main Outcome Measures Primary measure: Arm Motor Ability Test (AMAT), with 13 complex functional tasks; secondary measure: upper-limb Fugl-Meyer coordination scale (FM). Results There was no significant difference found in treatment response across groups (AMAT: P \≥.584; FM coordination: P \≥.590). All 3 treatment groups demonstrated clinically and statistically significant improvement in response to treatment (AMAT and FM coordination: P \≤.009). A group treatment paradigm of 1:3 (therapist/patient) ratio proved feasible for provision of the intensive treatment. No adverse effects. Conclusions Severely impaired stroke survivors with persistent (>1y) upper-extremity dysfunction can make clinically and statistically significant gains in coordination and functional task performance in response to robotics plus ML, FES plus ML, and ML alone in an intensive and long-duration intervention; no group differences were found. Additional studies are warranted to determine the effectiveness of these methods in the clinical setting. ",

keywords = "Electric stimulation; FES; Randomized controlled trial, Rehabilitation; Robotics; Stroke; Upper extremity",

author = "Jessica McCabe and Michelle Monkiewicz and Holcomb, \{John P\} and Svetlana Pundik and Daly, \{Janis J.\}",

year = "2015",

month = jun,

day = "1",

doi = "10.1016/j.apmr.2014.10.022",

language = "American English",

volume = "96",

journal = "Archives of Physical Medicine and Rehabilitation",

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TY - JOUR

T1 - Comparison of Robotics, Functional Electrical Stimulation, and Motor Learning Methods for Treatment of Persistent Upper Extremity Dysfunction After Stroke: A Randomized Controlled Trial

AU - McCabe, Jessica

AU - Monkiewicz, Michelle

AU - Holcomb, John P

AU - Pundik, Svetlana

AU - Daly, Janis J.

PY - 2015/6/1

Y1 - 2015/6/1

N2 - Objective To compare response to upper-limb treatment using robotics plus motor learning (ML) versus functional electrical stimulation (FES) plus ML versus ML alone, according to a measure of complex functional everyday tasks for chronic, severely impaired stroke survivors. Design Single-blind, randomized trial. Setting Medical center. Participants Enrolled subjects (N=39) were >1 year post single stroke (attrition rate=10%; 35 completed the study). Interventions All groups received treatment 5d/wk for 5h/d (60 sessions), with unique treatment as follows: ML alone (n=11) (5h/d partial- and whole-task practice of complex functional tasks), robotics plus ML (n=12) (3.5h/d of ML and 1.5h/d of shoulder/elbow robotics), and FES plus ML (n=12) (3.5h/d of ML and 1.5h/d of FES wrist/hand coordination training). Main Outcome Measures Primary measure: Arm Motor Ability Test (AMAT), with 13 complex functional tasks; secondary measure: upper-limb Fugl-Meyer coordination scale (FM). Results There was no significant difference found in treatment response across groups (AMAT: P ≥.584; FM coordination: P ≥.590). All 3 treatment groups demonstrated clinically and statistically significant improvement in response to treatment (AMAT and FM coordination: P ≤.009). A group treatment paradigm of 1:3 (therapist/patient) ratio proved feasible for provision of the intensive treatment. No adverse effects. Conclusions Severely impaired stroke survivors with persistent (>1y) upper-extremity dysfunction can make clinically and statistically significant gains in coordination and functional task performance in response to robotics plus ML, FES plus ML, and ML alone in an intensive and long-duration intervention; no group differences were found. Additional studies are warranted to determine the effectiveness of these methods in the clinical setting.

AB - Objective To compare response to upper-limb treatment using robotics plus motor learning (ML) versus functional electrical stimulation (FES) plus ML versus ML alone, according to a measure of complex functional everyday tasks for chronic, severely impaired stroke survivors. Design Single-blind, randomized trial. Setting Medical center. Participants Enrolled subjects (N=39) were >1 year post single stroke (attrition rate=10%; 35 completed the study). Interventions All groups received treatment 5d/wk for 5h/d (60 sessions), with unique treatment as follows: ML alone (n=11) (5h/d partial- and whole-task practice of complex functional tasks), robotics plus ML (n=12) (3.5h/d of ML and 1.5h/d of shoulder/elbow robotics), and FES plus ML (n=12) (3.5h/d of ML and 1.5h/d of FES wrist/hand coordination training). Main Outcome Measures Primary measure: Arm Motor Ability Test (AMAT), with 13 complex functional tasks; secondary measure: upper-limb Fugl-Meyer coordination scale (FM). Results There was no significant difference found in treatment response across groups (AMAT: P ≥.584; FM coordination: P ≥.590). All 3 treatment groups demonstrated clinically and statistically significant improvement in response to treatment (AMAT and FM coordination: P ≤.009). A group treatment paradigm of 1:3 (therapist/patient) ratio proved feasible for provision of the intensive treatment. No adverse effects. Conclusions Severely impaired stroke survivors with persistent (>1y) upper-extremity dysfunction can make clinically and statistically significant gains in coordination and functional task performance in response to robotics plus ML, FES plus ML, and ML alone in an intensive and long-duration intervention; no group differences were found. Additional studies are warranted to determine the effectiveness of these methods in the clinical setting.

KW - Electric stimulation; FES; Randomized controlled trial

KW - Rehabilitation; Robotics; Stroke; Upper extremity

UR - https://engagedscholarship.csuohio.edu/scimath_facpub/250

U2 - 10.1016/j.apmr.2014.10.022

DO - 10.1016/j.apmr.2014.10.022

M3 - Article

VL - 96

JO - Archives of Physical Medicine and Rehabilitation

JF - Archives of Physical Medicine and Rehabilitation

ER -

Comparison of Robotics, Functional Electrical Stimulation, and Motor Learning Methods for Treatment of Persistent Upper Extremity Dysfunction After Stroke: A Randomized Controlled Trial

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