Araştırma Makalesi
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Can additional robotic therapy after stroke improve upper extremity function, pain, anxiety, and quality of life?

Yıl 2025, Cilt: 12 Sayı: 2, 69 - 78, 01.08.2025
https://doi.org/10.15437/jetr.1432655

Öz

Purpose: The aim of the study is to investigate the effects of upper limb robotic rehabilitation combined
with conventional treatment on upper limb functions, pain, anxiety, and quality of life in individuals with
stroke.
Methods: Twenty-eight individuals with stroke who were voluntary to participate were included in the
study. The Individuals were randomized into 14 intervention groups (45 min/1 session/week robotic, 45
min/4 sessions/week conventional rehabilitation) and 14 control groups (45 min/4 sessions/week
conventional rehabilitation) and received therapy for six weeks. The participants’ upper limb functions
were assessed by Fugl-Meyer Upper Extremity Scale, their pain level were assessed by Visual Analog
Scale, their anxiety levels were assessed by Beck Anxiety Inventory, and their quality of life was
assessed by Stroke-Specific Quality of Life Scale.
Results: When the pre-treatment and six-week post-treatment data were compared, no significant
difference was found between the groups in terms of upper limb function, pain, anxiety and quality of life
(p>0.05). However, when both groups were evaluated within themselves, a significant improvement was
observed in upper limb functions and pain levels (p<0.05).
Conclusion: In individuals with stroke, it has been observed that one weekly session of robotic
rehabilitation added to conventional treatment has similar effects to conventional rehabilitation alone.
Applying one session per week to reduce the cost burden of paid robotic rehabilitation did not provide
any additional benefit. We recommend that future studies determine the number of sessions accordingly.

Kaynakça

  • Langhorne P, Bernhardt J, Kwakkel G. Stroke rehabilitation. Lancet. 2011;377:1693-1702.
  • Sveen U, Bautz-Holter E, Sødring KM, et al. Association between impairments, self-care ability and social activities 1 year after stroke. Disabil. Rehabil. 1999;21:372-377.
  • Demirkaya Ş, Vural O. Serebral kan akımı ve serebral metabolizma. In: Balkan S. (edt). Serebrovasküler Hastalıklar. 2. baskı. Ankara: Güneş Kitapevi; 2005. 15-27.
  • Özocak O, Gündüz Başçıl S, Gölgeli A. Egzersiz ve Nöroplastisite. Düzce Üniversitesi Sağlık Bilim Enstitüsü Derg. 2019;9:31-38.
  • Miller EL, Murray L, Richards L et al. Comprehensive overview of nursing and interdisciplinary rehabilitation care of the stroke patient: A scientific statement from the American Heart Association. Stroke. 2010;41:2402-2448.
  • Naess H, Lunde L, Brogger J. The effects of fatigue, pain, and depression on quality of life in ischemic stroke patients: The Bergen Stroke Study. Vasc. Health Risk Manag. 2012;8:407-413.
  • Hoang CL, Salle JY, Mandigout S, et al. Physical factors associated with fatigue after stroke: An exploratory study. Top. Stroke Rehabil. 2012;19:369-376.
  • Pendlebury ST, Rothwell PM. Prevalence, incidence, and factors associated with pre-stroke and post-stroke dementia: a systematic review and meta-analysis. Lancet Neurol. 2009;8:1006-1018.
  • Vercelli S, Ferriero G, Bravini E, et al. A simple orthosis solves a problem in a patient with a dystonic finger after stroke. J Hand Ther. 2017;30:113-115.
  • Hüseyinsinoğlu EB. Kısıtlayıcı Zorunlu Hareket Tedavisi: Bilmediklerimiz. TFD Nöroloji̇k Fi̇zyoterapi̇ Grubu Bülteni. 2016:2(1):1-7.
  • Mehrholz J, Pohl M, Platz T, et al. Electromechanical and robot-assisted arm training for improving activities of daily living, arm function, and arm muscle strength after stroke. Cochrane Database Syst Rev. 2018;9(9):CD006876.
  • Taveggia G, Borboni A, Salvi L, et al. Efficacy of robot-assisted rehabilitation for the functional recovery of the upper limb in post-stroke patients: A randomized controlled study. Eur J Phys Rehabil. Med. 2016;52:767-773.
  • Lanningham-Foster L, Foster RC, McCrady SK, et al. Activity promoting games and increased energy expenditure. J Pediatr. 2010;154:819-823.
  • Mustafaoğlu R, Yıldız A, Kesiktaş FN. İnmeli hastalarda robot destekli üst ekstremite eğitiminin el fonksiyonu ve yaşam kalitesi üzerine etkisi. Osmangazi Tıp Dergisi. 2021;43:224-233.
  • Gladstone DJ, Danells CJ, Black SE. The fugl-meyer assessment of motor recovery after stroke: a critical review of its measurement properties. Neurorehabil. Neural Repair 2002;16:232-240.
  • Boonstra AM, Preuper HRS, Balk GA, et al. Cut-off points for mild, moderate, and severe pain on the visual analogue scale for pain in patients with chronic musculoskeletal pain. Pain. 2014;155:2545-2550.
  • Ulusoy M, Sahin NH, Erkmen H. Turkish version of the Beck Anxiety Inventory: Psychometric properties. J Cogn Psychother An Int Q. 1998;12:163-172.
  • Eyigör S. İnmeli hastalarda genel rehabilitasyon prensipleri, yaşam kalitesi ve son durum deǧerlendirmesi. Turk J Phys Med Rehab. 2007:53 Suppl 1;19-25.
  • Timmermans, AAA, Lemmens RJM, Monfrance M, et al. Effects of task-oriented robot training on arm function, activity, and quality of life in chronic stroke patients: A randomized controlled trial. J Neuroeng Rehabil. 2014;11:1-11.
  • Sale P, Franceschini M, Mazzoleni S, et al. Effects of upper limb robot-assisted therapy on motor recovery in subacute stroke patients. J Neuroeng Rehabil. 2014;11:104.
  • Cho KH, Hong M-R, Song W-K. Upper limb robotic rehabilitation for chronic stroke survivors: a single-group preliminary study. J Phys Ther Sci. 2018;30:580-583.
  • Fazekas G, Horvath M, Troznai T, et al. Robot-mediated upper limb physiotherapy for patients with spastic hemiparesis: A preliminary study. J Rehabil Med. 2007;39:580-582.
  • Tomić, TJD, Savić AM, Vidaković AS, et al. ArmAssist robotic system versus matched conventional therapy for poststroke upper limb rehabilitation: A randomized clinical trial. Biomed Res Int. 2017;2017:7659893.
  • Raffaeli W, Arnaudo E. Pain as a disease: An overview. J Pain Res. 2017;10:2003-2008.
  • Serrezuela RR, Quezada MT, Zayas MH, et al. Robotic therapy for the hemiplegic shoulder pain: A pilot study. J Neuroeng Rehabil. 2002;17:1-12.
  • Kim MG; Lee SA, Park EJ, et al. Elastic dynamic sling on subluxation of hemiplegic shoulder in patients with subacute stroke: a multicenter randomized controlled trial. Int J Environ Res Public Health. 2022;19(16):9975.
  • Masiero S, Armani M, Ferlini G, et al. Randomized trial of a robotic assistive device for the upper extremity during early inpatient stroke rehabilitation. Neurorehabil Neural Repair. 2014;28:377-386.
  • Chien WT, Chong YY, Tse MK, et al. Robot-assisted therapy for upper-limb rehabilitation in subacute stroke patients: A systematic review and meta-analysis. Brain Behav. 2020;10(8):e01742.
  • Harrison M, Ryan T, Gardiner C, et al. Psychological and emotional needs, assessment, and support post-stroke: A multi-perspective qualitative study. Top Stroke Rehabil. 2017;24:119-125.
  • Bornheim S, Croisier JL, Maquet P, et al. Transcranial direct current stimulation associated with physical-therapy in acute stroke patients - A randomized, triple blind, sham-controlled study. Brain Stimul. 2020;13:329-336.
  • Tang WK, Lau CG, Mok V, et al. Impact of anxiety on health-related quality of life after stroke: A cross-sectional study. Arch Phys Med Rehabil. 2013;94:2535-2541.
  • Rafsten L, Danielsson A, Sunnerhagen KS. Anxiety after stroke: A systematic review and meta-analysis. J Rehabil Med. 2018;50:769-778.
  • Cumming TB, Churilov L, Collier J, et al. Early mobilization and quality of life after stroke: Findings from AVERT. Neurology. 2019;93:E717-E728.
  • Lo Buono V, Corallo F, Bramanti Pet al. Coping strategies and health-related quality of life after stroke. J Health Psychol. 2017;22:16-28.
  • Armagan, O. Post stroke aphasia and quality of life. Turkish J Cerebrovasc Dis. 2011;17:89-94.
  • Yoo DH, Kim SY. Effects of upper limb robot-assisted therapy in the rehabilitation of stroke patients. J Phys Ther Sci. 2015;27:677-679.
  • Lum PS, Burgar CG, Shor PC, et al. Robot-assisted movement training compared with conventional therapy techniques for the rehabilitation of upper-limb motor function after stroke. Arch Phys Med Rehabil. 2002;83:952-959.
  • Germanotta M, Cruciani A, Pecchioli C, et al. Reliability, validity and discriminant ability of the instrumental indices provided by a novel planar robotic device for upper limb rehabilitation. J Neuroeng Rehabil. 2018;15:39.

İnme sonrası ilave bir robotik terapi üst ekstremite fonksiyonları, ağrı, anksiyete ve yaşam kalitesini iyileştirebilir mi?

Yıl 2025, Cilt: 12 Sayı: 2, 69 - 78, 01.08.2025
https://doi.org/10.15437/jetr.1432655

Öz

Amaç: Çalışmanın amacı, inmeli bireylerde konvansiyonel tedaviye ek olarak verilen üst ekstremite
robotik rehabilitasyonun üst ekstremite fonksiyonları, ağrı, anksiyete ve yaşam kalitesi üzerine etkisini
araştırmaktır.
Yöntem: 28 inmeli birey gönüllü olarak dahil edildi. Bireyler; 14 kişi müdahale grubu (45 dk/1seans/hafta
robotik, 45 dk/4 seans/hafta konvansiyonel rehabilitasyon) ve 14 kişi kontrol grubu (45 dk/4 seans/hafta
konvansiyonel rehabilitasyon) olarak randomize edilerek altı hafta boyunca terapiye alındı. Çalışmamıza
dahil edilen bireylerin üst ekstremite fonksiyonları Fugl-Meyer Ölçeği ile, ağrı düzeyleri Visual Analog
Skala ile, anksiyete düzeyleri Beck Anksiyete Ölçeği ile, yaşam kaliteleri İnmeye Özgü Yaşam Kalitesi
Ölçeği ile değerlendirildi.
Bulgular: Tedavi öncesi ve altı hafta sonrası veriler karşılaştırıldığında gruplar arasında; üst ekstremite
fonksiyonları, ağrı, anksiyete ve yaşam kalitesi arasında anlamlı bir fark bulunmadı (p>0,05). Fakat her
iki grup da kendi içerisinde değerlendirildiğinde; üst ekstremite fonksiyonları ve ağrı düzeylerinde anlamlı
bir iyileşme görüldü (p<0,05).
Sonuç: İnmeli bireylerde, konvansiyonel tedaviye eklenen haftalık bir seanslık robotik rehabilitasyonun,
tek başına konvansiyonel rehabilitasyonla benzer etkiler gösterdiği görülmüştür. Ücretli olan robotik
rehabilitasyonun maliyet yükünü azaltmak amacıyla haftada bir seans uygulanması ek bir fayda
sağlamamıştır. İleriki çalışmaların seans sayılarını bu doğrultuda belirlemelerini önermekteyiz.

Kaynakça

  • Langhorne P, Bernhardt J, Kwakkel G. Stroke rehabilitation. Lancet. 2011;377:1693-1702.
  • Sveen U, Bautz-Holter E, Sødring KM, et al. Association between impairments, self-care ability and social activities 1 year after stroke. Disabil. Rehabil. 1999;21:372-377.
  • Demirkaya Ş, Vural O. Serebral kan akımı ve serebral metabolizma. In: Balkan S. (edt). Serebrovasküler Hastalıklar. 2. baskı. Ankara: Güneş Kitapevi; 2005. 15-27.
  • Özocak O, Gündüz Başçıl S, Gölgeli A. Egzersiz ve Nöroplastisite. Düzce Üniversitesi Sağlık Bilim Enstitüsü Derg. 2019;9:31-38.
  • Miller EL, Murray L, Richards L et al. Comprehensive overview of nursing and interdisciplinary rehabilitation care of the stroke patient: A scientific statement from the American Heart Association. Stroke. 2010;41:2402-2448.
  • Naess H, Lunde L, Brogger J. The effects of fatigue, pain, and depression on quality of life in ischemic stroke patients: The Bergen Stroke Study. Vasc. Health Risk Manag. 2012;8:407-413.
  • Hoang CL, Salle JY, Mandigout S, et al. Physical factors associated with fatigue after stroke: An exploratory study. Top. Stroke Rehabil. 2012;19:369-376.
  • Pendlebury ST, Rothwell PM. Prevalence, incidence, and factors associated with pre-stroke and post-stroke dementia: a systematic review and meta-analysis. Lancet Neurol. 2009;8:1006-1018.
  • Vercelli S, Ferriero G, Bravini E, et al. A simple orthosis solves a problem in a patient with a dystonic finger after stroke. J Hand Ther. 2017;30:113-115.
  • Hüseyinsinoğlu EB. Kısıtlayıcı Zorunlu Hareket Tedavisi: Bilmediklerimiz. TFD Nöroloji̇k Fi̇zyoterapi̇ Grubu Bülteni. 2016:2(1):1-7.
  • Mehrholz J, Pohl M, Platz T, et al. Electromechanical and robot-assisted arm training for improving activities of daily living, arm function, and arm muscle strength after stroke. Cochrane Database Syst Rev. 2018;9(9):CD006876.
  • Taveggia G, Borboni A, Salvi L, et al. Efficacy of robot-assisted rehabilitation for the functional recovery of the upper limb in post-stroke patients: A randomized controlled study. Eur J Phys Rehabil. Med. 2016;52:767-773.
  • Lanningham-Foster L, Foster RC, McCrady SK, et al. Activity promoting games and increased energy expenditure. J Pediatr. 2010;154:819-823.
  • Mustafaoğlu R, Yıldız A, Kesiktaş FN. İnmeli hastalarda robot destekli üst ekstremite eğitiminin el fonksiyonu ve yaşam kalitesi üzerine etkisi. Osmangazi Tıp Dergisi. 2021;43:224-233.
  • Gladstone DJ, Danells CJ, Black SE. The fugl-meyer assessment of motor recovery after stroke: a critical review of its measurement properties. Neurorehabil. Neural Repair 2002;16:232-240.
  • Boonstra AM, Preuper HRS, Balk GA, et al. Cut-off points for mild, moderate, and severe pain on the visual analogue scale for pain in patients with chronic musculoskeletal pain. Pain. 2014;155:2545-2550.
  • Ulusoy M, Sahin NH, Erkmen H. Turkish version of the Beck Anxiety Inventory: Psychometric properties. J Cogn Psychother An Int Q. 1998;12:163-172.
  • Eyigör S. İnmeli hastalarda genel rehabilitasyon prensipleri, yaşam kalitesi ve son durum deǧerlendirmesi. Turk J Phys Med Rehab. 2007:53 Suppl 1;19-25.
  • Timmermans, AAA, Lemmens RJM, Monfrance M, et al. Effects of task-oriented robot training on arm function, activity, and quality of life in chronic stroke patients: A randomized controlled trial. J Neuroeng Rehabil. 2014;11:1-11.
  • Sale P, Franceschini M, Mazzoleni S, et al. Effects of upper limb robot-assisted therapy on motor recovery in subacute stroke patients. J Neuroeng Rehabil. 2014;11:104.
  • Cho KH, Hong M-R, Song W-K. Upper limb robotic rehabilitation for chronic stroke survivors: a single-group preliminary study. J Phys Ther Sci. 2018;30:580-583.
  • Fazekas G, Horvath M, Troznai T, et al. Robot-mediated upper limb physiotherapy for patients with spastic hemiparesis: A preliminary study. J Rehabil Med. 2007;39:580-582.
  • Tomić, TJD, Savić AM, Vidaković AS, et al. ArmAssist robotic system versus matched conventional therapy for poststroke upper limb rehabilitation: A randomized clinical trial. Biomed Res Int. 2017;2017:7659893.
  • Raffaeli W, Arnaudo E. Pain as a disease: An overview. J Pain Res. 2017;10:2003-2008.
  • Serrezuela RR, Quezada MT, Zayas MH, et al. Robotic therapy for the hemiplegic shoulder pain: A pilot study. J Neuroeng Rehabil. 2002;17:1-12.
  • Kim MG; Lee SA, Park EJ, et al. Elastic dynamic sling on subluxation of hemiplegic shoulder in patients with subacute stroke: a multicenter randomized controlled trial. Int J Environ Res Public Health. 2022;19(16):9975.
  • Masiero S, Armani M, Ferlini G, et al. Randomized trial of a robotic assistive device for the upper extremity during early inpatient stroke rehabilitation. Neurorehabil Neural Repair. 2014;28:377-386.
  • Chien WT, Chong YY, Tse MK, et al. Robot-assisted therapy for upper-limb rehabilitation in subacute stroke patients: A systematic review and meta-analysis. Brain Behav. 2020;10(8):e01742.
  • Harrison M, Ryan T, Gardiner C, et al. Psychological and emotional needs, assessment, and support post-stroke: A multi-perspective qualitative study. Top Stroke Rehabil. 2017;24:119-125.
  • Bornheim S, Croisier JL, Maquet P, et al. Transcranial direct current stimulation associated with physical-therapy in acute stroke patients - A randomized, triple blind, sham-controlled study. Brain Stimul. 2020;13:329-336.
  • Tang WK, Lau CG, Mok V, et al. Impact of anxiety on health-related quality of life after stroke: A cross-sectional study. Arch Phys Med Rehabil. 2013;94:2535-2541.
  • Rafsten L, Danielsson A, Sunnerhagen KS. Anxiety after stroke: A systematic review and meta-analysis. J Rehabil Med. 2018;50:769-778.
  • Cumming TB, Churilov L, Collier J, et al. Early mobilization and quality of life after stroke: Findings from AVERT. Neurology. 2019;93:E717-E728.
  • Lo Buono V, Corallo F, Bramanti Pet al. Coping strategies and health-related quality of life after stroke. J Health Psychol. 2017;22:16-28.
  • Armagan, O. Post stroke aphasia and quality of life. Turkish J Cerebrovasc Dis. 2011;17:89-94.
  • Yoo DH, Kim SY. Effects of upper limb robot-assisted therapy in the rehabilitation of stroke patients. J Phys Ther Sci. 2015;27:677-679.
  • Lum PS, Burgar CG, Shor PC, et al. Robot-assisted movement training compared with conventional therapy techniques for the rehabilitation of upper-limb motor function after stroke. Arch Phys Med Rehabil. 2002;83:952-959.
  • Germanotta M, Cruciani A, Pecchioli C, et al. Reliability, validity and discriminant ability of the instrumental indices provided by a novel planar robotic device for upper limb rehabilitation. J Neuroeng Rehabil. 2018;15:39.
Toplam 38 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Fizyoterapi
Bölüm Araştırma Makalesi
Yazarlar

Hüseyin Melih Göktuğ Akpulat 0000-0002-5114-9054

Şebnem Avcı 0000-0003-3712-0551

Gönderilme Tarihi 6 Şubat 2024
Kabul Tarihi 19 Şubat 2025
Yayımlanma Tarihi 1 Ağustos 2025
Yayımlandığı Sayı Yıl 2025 Cilt: 12 Sayı: 2

Kaynak Göster

Vancouver Akpulat HMG, Avcı Ş. İnme sonrası ilave bir robotik terapi üst ekstremite fonksiyonları, ağrı, anksiyete ve yaşam kalitesini iyileştirebilir mi? JETR. 2025;12(2):69-78.