Efficacy of Robotic Rehabilitation on Hand Function and Activity of Daily Living in Stroke Patients

Öz

Objective: This retrospective study aimed to investigate the contribution of upper extremity robotic rehabilitation to hand functions and activity of daily living in patients with chronic stroke. Methods: The files of 39 stroke patients who were found suitable for the study were included in the evaluation. Demographic data of patients' information including age, gender, duration of disease (month), hemiplegic side, Brunnstrom staging, Modified Ashworth Scale (MAS) were obtained. In addition, Jebsen Taylor Hand Function Test (JTHFT) and Canadian Occupational Performance Measure (COPM) pretreatment and posttreatment test records were evaluated. Results: Nineteen (52%) of the patients who participate in the study were female, 17 (48%) were male and their mean age was 50.2 ± 2.02. In posttreatment evaluations of JTHFT, there was no difference in 2 of the 7 sub parameters (lifting large light objects (p=0.074) and lifting large heavy objects (p=0.079)), while the other 5 parameters were statistically significant (p<0.005). After 3 weeks of treatment, a statistically significant improvement was observed in both sub parameters of COPM which were COPM/performance (p=0.004) and COPM/satisfaction (p=0.002). Conclusion: We think that the upper-extremity robot-assisted treatment, which is applied in conjunction with occupational therapy to stroke patients, improves the hand function of individuals and contributes to the improvement in activity-performance participation.

Anahtar Kelimeler

• STROKE
• ,ROBOTIC REHABILITATION
• UPPER EXTREMITY REHABILITATION

İnmeli Hastalarda Robotik Rehabilitasyonun El Fonksiyonları ve Günlük Yaşam Aktiviteleri Üzerine Etkisi

Öz

Amaç: Bu retrospektif çalışma ile kronik inmeli hastalarda üst ekstremite robotik rehabilitasyonun el fonksiyonları ve günlük yaşam aktivitelerine (GYA) olan katkısının incelenmesi amaçlanmıştır. Yöntem: İnme sonucu hemipleji gelişmiş ve üst ekstremite rehabilitasyon programına alınmış çalışma için uygun bulunan 39 hastanın dosyası değerlendirmeye dahil edildi. Hasta kayıt dosyalarından hastaların yaş, cinsiyet, hastalık (inme) süresi (ay), hemiplejik taraf, Brunnstrom evrelemesi, Modifiye Ashworth Skalası (MAS)’tan oluşan demografik verileri alındı. Ayrıca hastaların üst ekstremite fonksiyonel gelişimini ve GYA katılımı değerlendiren Jebsen Taylor El Fonksiyon Testi (JTEFT) ve Kanada Aktivite Performans Ölçeği (KAPÖ) tedavi öncesi ve tedavi sonrası test kayıtları incelendi. Bulgular: Çalışmaya katılan hastaların 19’u (%52) kadın iken 17’si (%48) erkekti ve yaş ortalamaları 50,2±2,02 idi. JTEFT’nin tedavi sonrası değerlendirmelerinde 7 alt parametrenin 2’sinde fark bulunmazken (iri hafif nesneleri kaldırma (p=0,074) ve iri ağır nesneleri kaldırma (p=0,079)), diğer 5 parametrede istatistiksel anlamlı fark olduğu saptandı (p<0,005). Hastaların 3 haftalık tedavi sonrası KAPÖ’nün performans ve memnuniyet olan her 2 alt parametresinde istatistiksel olarak anlamlı gelişme olduğu gözlendi (KAPÖ/performans (p=0,004); KAPÖ/memnuniyet (p=0,002)). Sonuç: Yapmış olduğumuz bu çalışmada konvansiyonel tedavi programı planlanan inmeli hastalara iş-uğraşı tedavisi ile birlikte uygulanan üst ekstremite robot yardımlı tedavinin bireylerin el fonksiyonlarını geliştirdiği ve aktivite-performans katılımında iyileşmeye katkı sağladığı düşüncesindeyiz.

Anahtar Kelimeler

• İnme
• Robotik Rehabilitasyon
• Üst Ekstremite Rehabilitasyonu

Kaynakça

1. Çevikol A, Çakçı A. İnme Rehabilitasyonu. İçinde: Oğuz H. Çakırbay H, Yanık B, editörler. Tıbbi Rehabilitasyon. 3. Baskı. İstanbul: Nobel Tıp Kitabevi; 2015:419-448.
2. Formisano R, Barbanti P, Catarci T, et al. Prolonged muscular flaccidity: frequency and association with unilateral spatial neglect after stroke. Acta Neurologica Scandinavica. 1993;88(5):313-315. doi:10.1111/j.1600-0404.1993.tb05349.x
3. Nichols-Larsen DS, Clark PC, Zeringue A, et al. Factors influencing stroke survivors’ quality of life during subacute recovery. Stroke. 2005;36(7):1480-1484. doi:10.1161/01.STR.0000170706.13595.4f
4. Santello M, Flanders M, Soechting JF. Postural hand synergies for tool use. J Neurosci. 1998;18(23):10105-10115. doi:10.1523/JNEUROSCI.18-23-10105.1998
5. Mason CR, Gomez JE, Ebner TJ. Hand synergies during reach-to-grasp. J Neurophysiol. 2001;86(6):2896-2910. doi:10.1152/jn.2001.86.6.2896
6. Kong KH, Chua KS, Lee J. Recovery of upper limb dexterity in patients more than 1 year after stroke: Frequency, clinical correlates and predictors. NeuroRehabilitation 2011;28(2):105-111. doi:10.3233/NRE-2011-0639
7. Gittler M, Davis AM. Guidelines for adult stroke rehabilitation and recovery. JAMA. 2018;319(8):820-821. doi:10.1001/jama.2017.22036
8. Dionísio A, Duarte IC, Patrício M, et al. The use of repetitive transcranial magnetic stimulation for stroke rehabilitation: a systematic review. J Stroke Cerebrovasc Dis. 2018;27(1):1-31. doi:10.1016/j.jstrokecerebrovasdis.2017.09.008

9. Klamroth-Marganska V. Stroke rehabilitation: therapy robots and assistive devices. Adv Exp Med Biol. 2018;1065:579-587. doi:10.1007/978-3-319-77932-4_35
10. Pérez-Cruzado D, Merchán-Baeza JA, González-Sánchez M, et al. Systematic review of mirror therapy compared with conventional rehabilitation in upper extremity function in stroke survivors. Aust Occup Ther J. 2017;64(2):91-112. doi:10.1111/1440-1630.12342
11. Dursun N, Dursun E, Sade I, ve ark. Constraint induced movement therapy: efficacy in a Turkish stroke patient population and evaluation by a new outcome measurement tool. Eur J Phys Rehabil Med. 2009;45(2):165-170.
12. Mazzoleni S, Turchetti G, Palla I, et al. Acceptability of robotic technology in neuro-rehabilitation: preliminary results on chronic stroke patients. Comput Methods Programs Biomed. 2014;116(2):116-122. doi:10.1016/j.cmpb.2013.12.017
13. Fasoli SE, Krebs HI, Hogan N. Robotic technology and stroke rehabilitation: translating research into practice. Top Stroke Rehabil. 2004;11(4):11-19. doi:10.1310/G8XB-VM23-1TK7-PWQU
14. Brewer BR, McDowell SK, Worthen-Chaudhari LC. Poststroke upper extremity rehabilitation: a review of robotic systems and clinical results. Top Stroke Rehabil. 2007;14(6):22-44. doi:10.1310/tsr1406-22
15. Cinnera AM, Pucello A, Lupo A, et al. Upper limb motor improvement in chronic stroke after combining botulinum toxin A injection and multi-joints robot-assisted therapy: a case report. Oxf Med Case Reports. 2019;10:omz097. doi:10.1093/omcr/omz097
16. Sale P, Lombardi V, Franceschini M. Hand robotics rehabilitation: feasibility and preliminary results of a robotic treatment in patients with hemiparesis. Stroke Res Treat. 2012:820931. doi:10.1155/2012/820931.
17. Singh N, Saini M, Anand S, et al. Robotic exoskeleton for wrist and fingers joint in post-stroke neuro-rehabilitation for low-resource settings. IEEE Trans Neural Syst Rehabil Eng. 2019;27(12):2369-2377. doi:10.1109/TNSRE.2019.2943005
18. Rahman T, Sample W, Jayakumar S, et al. Passive exoskeletons for assisting limb movement. J Rehabil Res Dev. 2006;43(5):583-590. doi:10.1682/jrrd.2005.04.0070
19. Demirbaş Badıllı Ş, Barkana D, İnal S. Üst ekstremite rehabilitasyon robotları. Türkiye Klinikleri J Physiother Rehabil-Special Topics. 2015;1(1):1-5.
20. Laut J, Porfiri M, Raghavan P. The present and future of robotic technology in rehabilitation. Phys Med Rehabil Rep. 2016;4:312-319. doi:10.1007/s40141-016-0139-0
21. Babaiasl M, Mahdioun SH, Jaryani P, et al. A review of technological and clinical aspects of robot-aided rehabilitation of upper-extremity after stroke. Disabil Rehabil Assist Technol. 2016;11(4):263-280. doi:10.3109/17483107.2014.1002539
22. Kwakkel G, Kollen BJ, Krebs HI. Effects of robot-assisted therapy on upper limb recovery after stroke: a systematic review. Neurorehabil Neural Repair. 2008;22(2):111-121. doi:10.1177/1545968307305457
23. Muellbacher W, Richards C, Ziemann U. Improving hand function in chronic stroke. Arch Neurol. 2002;59:1278-1282. doi:10.1001/archneur.59.8.1278
24. Corbetta D, Sirtori V, Castellini G, et al. Constraint-induced movement therapy for upper extremities in people with stroke. Cochrane Database Syst Rev. 2015;2015(10):CD004433. doi:10.1002/14651858.CD004433.pub3
25. Etoom M, Hawamdeh M, Hawamdeh Z, et al. Constraint-induced movement therapy as a rehabilitation intervention for upper extremity in stroke patients: systematic review and meta-analysis. Int J Rehabil Res. 2016;39(3):197-210. doi:10.1097/MRR.0000000000000169