Robot-assisted movement training compared with conventional therapy techniques for the rehabilitation of upper-limb motor function after stroke
Abstract
Objective To compare the effects of robot-assisted movement training with conventional techniques for the rehabilitation of upper-limb motor function after stroke.Design Randomized controlled trial, 6-month follow-up.Setting A Department of Veterans Affairs rehabilitation research and development center.Participants Consecutive sample of 27 subjects with chronic hemiparesis (>6mo after cerebrovascular accident) randomly allocated to group.Interventions All subjects received twenty-four 1-hour sessions over 2 months. Subjects in the robot group practiced shoulder and elbow movements while assisted by a robot manipulator. Subjects in the control group received neurodevelopmental therapy (targeting proximal upper limb function) and 5 minutes of exposure to the robot in each session.Main outcome measures Fugl-Meyer assessment of motor impairment, FIMtrade mark instrument, and biomechanic measures of strength and reaching kinematics. Clinical evaluations were performed by a therapist blinded to group assignments.Results Compared with the control group, the robot group had larger improvements in the proximal movement portion of the Fugl-Meyer test after 1 month of treatment (P<.05) and also after 2 months of treatment (P<.05). The robot group had larger gains in strength (P<.02) and larger increases in reach extent (P<.01) after 2 months of treatment. At the 6-month follow-up, the groups no longer differed in terms of the Fugl-Meyer test (P>.30); however, the robot group had larger improvements in the FIM (P<.04).Conclusions Compared with conventional treatment, robot-assisted movements had advantages in terms of clinical and biomechanical measures. Further research into the use of robotic manipulation for motor rehabilitation is justified.
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Computerized Arm Training Improves the Motor Control of the Severely Affected Arm After Stroke
Hesse, S., Werner, C., Pohl, M., Rückriem, S., Mehrholz, J., & Lingnau, M.-L. (2005) · Stroke · doi:10.1161/01.str.0000177865.37334.ce · Cited by 329 · see citing works
A Standardized Approach to the Fugl-Meyer Assessment and Its Implications for Clinical Trials
See, J., Dodakian, L., Chou, C., Chan, V., McKenzie, A. L., Reinkensmeyer, D. J., & Cramer, S. C. (2013) · Neurorehabilitation and neural repair · doi:10.1177/1545968313491000 · Cited by 308 · see citing works
Poststroke Upper Extremity Rehabilitation: A Review of Robotic Systems and Clinical Results
Brewer, B. R., McDowell, S. K., & Worthen‐Chaudhari, L. (2007) · Topics in Stroke Rehabilitation · doi:10.1310/tsr1406-22 · Cited by 302 · see citing works
“The MIME system described previously also has a passive mode that moves the subject’s arm along a specific, desired trajectory.(24,25,34) The REHAROB system uses industrial robots to passively move the upper limb with the goal of decreasing spasticity.”
MethodWeb-based telerehabilitation for the upper extremity after stroke
Reinkensmeyer, D. J., Pang, C. T., Nessler, J. A., & Painter, C. C. (2002) · IEEE Transactions on Neural Systems and Rehabilitation Engineering · doi:10.1109/tnsre.2002.1031978 · Cited by 291 · see citing works
Hornby, T. G., Zemon, D. H., & Campbell, D. D. (2005) · Physical Therapy · doi:10.1093/ptj/85.1.52 · Cited by 284 · see citing works
Lum, P. S., Burgar, C. G., & Shor, P. C. (2004) · IEEE Transactions on Neural Systems and Rehabilitation Engineering · doi:10.1109/tnsre.2004.827225 · Cited by 282 · see citing works
“Previously, we reported the results of a clinical trial of the mirror-image movement enabler (MIME) robotic device in chronic stroke subjects [5], [6].”
BackgroundMethodInfluentialWagner, J. M., Rhodes, J. A., & Patten, C. (2008) · Physical Therapy · doi:10.2522/ptj.20070255 · Cited by 278 · see citing works
Development and pilot testing of HEXORR: Hand EXOskeleton Rehabilitation Robot
Schabowsky, C. N., Godfrey, S. B., Holley, R. J., & Lum, P. S. (2010) · Journal of NeuroEngineering and Rehabilitation · doi:10.1186/1743-0003-7-36 · Cited by 280 · see citing works
ALTENMÜLLER, E. O., Marco‐Pallarés, J., Münte, T. F., & Schneider, S. (2009) · Annals of the New York Academy of Sciences · doi:10.1111/j.1749-6632.2009.04580.x · Cited by 278 · see citing works
The Effectiveness of the Bobath Concept in Stroke Rehabilitation: What is the Evidence?
Kollen, B. J., Lennon, S., Lyons, B., Wheatley-Smith, L., Scheper, M., Buurke, J. H., Halfens, J., Geurts, A. C. H., & Kwakkel, G. (2009) · Stroke · doi:10.1161/strokeaha.108.533828 · Cited by 274 · see citing works
“43 However, only the study of Lum et al 44 showed superiority for robotic therapy.”
BackgroundMethodResultInfluentialRobot-assisted movement training for the stroke-impaired arm: Does it matter what the robot does?
Kahn, L. E., Lum, P. S., Rymer, W. Z., & Reinkensmeyer, D. J. (2006) · The Journal of Rehabilitation Research and Development · doi:10.1682/jrrd.2005.03.0056 · Cited by 275 · see citing works
“The benefits of robot-assisted therapy are comparable with or better than that of conventional therapy [11–12].”
MethodMehrholz, J., Hädrich, A., Platz, T., Kügler, J., & Pohl, M. (2012) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd006876.pub3 · Cited by 275 · see citing works
Assessment of movement quality in robot- assisted upper limb rehabilitation after stroke: a review
Nordin, N., Xie, S. Q., & Wünsche, B. C. (2014) · Journal of NeuroEngineering and Rehabilitation · doi:10.1186/1743-0003-11-137 · Cited by 270 · see citing works
“[88,89] report a significant improvement in the extent of reach to shoulder-level target in comparison to healthy control subjects.”
BackgroundConnelly, L., Jia, Y., Toro, M. L., Stoykov, M. E., Kenyon, R. V., & Kamper, D. G. (2010) · IEEE Transactions on Neural Systems and Rehabilitation Engineering · doi:10.1109/tnsre.2010.2047588 · Cited by 271 · see citing works
Design, Implementation and Clinical Tests of a Wire-Based Robot for Neurorehabilitation
Rosati, G., Gallina, P., & Masiero, S. (2007) · IEEE Transactions on Neural Systems and Rehabilitation Engineering · doi:10.1109/tnsre.2007.908560 · Cited by 267 · see citing works
“The integration of robotic therapy into current practice may increase therapists’ efficiency and effectiveness by alleviating labor-intensive aspects of physical rehabilitation [2], [3], i.”
BackgroundChanging Motor Synergies in Chronic Stroke
Dipietro, L., Krebs, H. I., Fasoli, S. E., Volpe, B. T., Stein, J. M., Bever, C. T., & Hogan, N. (2007) · Journal of Neurophysiology · doi:10.1152/jn.01295.2006 · Cited by 265 · see citing works
“Graying of the population will increase the prevalence of stroke and has prompted the development of robotic tools for delivering movement therapy (Krebs et al. 1998; Lum et al. 2002; Reinkesmeyer et al. 2000), evaluating patients’ progress, and augmenting our understanding of the process of neuro-recovery (Krebs et a…”
Lang, C. E., MacDonald, J. R., & Gnip, C. (2007) · Neurology Report · doi:10.1097/01.npt.0000260568.31746.34 · Cited by 265 · see citing works
Surface EMG pattern recognition for real-time control of a wrist exoskeleton
Khokhar, Z. O., Xiao, Z. G., & Menon, C. (2010) · BioMedical Engineering OnLine · doi:10.1186/1475-925x-9-41 · Cited by 257 · see citing works
“Combining sEMG signals with robotic therapy can optimize the coordination of motor commands and actual movement [4-6].”
BackgroundVolpe, B. T., Lynch, D., Rykman, A., Ferraro, M., Galgano, M. A., Hogan, N., & Krebs, H. I. (2008) · Neurorehabilitation and neural repair · doi:10.1177/1545968307311102 · Cited by 256 · see citing works
“These emerging data have stimulated the clinical development of activity-based techniques based on a combination of the control of guidance and speed of the movements and intensive practice.(14-19) In patients with chronic stroke referred to an outpatient clinic, we have attempted to establish a standard therapistdeli…”
MethodBilateral arm training: Why and who benefits?
Waller, S. M., & Whitall, J. (2008) · Neurorehabilitation · doi:10.3233/nre-2008-23104 · Cited by 253 · see citing works
“compared MIME training (using both unimanual and bimanual modes) to a standard neurodevelopmental therapeutic training approach in 27 subjects with moderate severity paresis [35].”
MethodAdvances in upper limb stroke rehabilitation: a technology push
Loureiro, R. C. V., Harwin, W., Nagai, K., & Johnson, M. J. (2011) · Medical & Biological Engineering & Computing · doi:10.1007/s11517-011-0797-0 · Cited by 252 · see citing works
“the MIT-MANUS [27] and MIME studies [66, 67].”
Alia, C., Spalletti, C., Lai, S., Panarese, A., Lamola, G., Bertolucci, F., Vallone, F., Garbo, A. D., Chisari, C., Micera, S., et al. (2017) · Frontiers in Cellular Neuroscience · doi:10.3389/fncel.2017.00076 · Cited by 256 · see citing works
Sivan, M., O’Connor, R. J., Makower, S., Levesley, M. C., & Bhakta, B. (2011) · Journal of Rehabilitation Medicine · doi:10.2340/16501977-0674 · Cited by 248 · see citing works
Robot-aided sensorimotor arm training improves outcome in patients with chronic stroke
Ferraro, M., Palazzolo, J. J., Krol, J., Krebs, H. I., Hogan, N., & Volpe, B. T. (2003) · Neurology · doi:10.1212/01.wnl.0000095963.00970.68 · Cited by 242 · see citing works
Ang, K. K., Guan, C., Chua, K. S. G., Ang, B. T., Kuah, C. W. K., Wang, C., Phua, K. S., Chin, Z. Y., & Zhang, H. (2010) · Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC) · doi:10.1109/iembs.2010.5626782 · Cited by 241 · see citing works
“Recent rehabilitation using robots alleviates the labor-intensive aspects of physical rehabilitation by human therapists [17], and a study has shown that robots deliver effective movement therapy [18].”
BackgroundCustomized interactive robotic treatment for stroke: EMG-triggered therapy
Dipietro, L., Ferraro, M., Palazzolo, J. J., Krebs, H. I., Volpe, B. T., & Hogan, N. (2005) · IEEE Transactions on Neural Systems and Rehabilitation Engineering · doi:10.1109/tnsre.2005.850423 · Cited by 241 · see citing works
Constraint-induced movement therapy for upper extremities in people with stroke
Corbetta, D., Sirtori, V., Castellini, G., Moja, L., & Gatti, R. (2015) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd004433.pub3 · Cited by 248 · see citing works
Robotic therapy for chronic motor impairments after stroke: follow-up results
Fasoli, S. E., Krebs, H. I., Stein, J. M., Frontera, W. R., Hughes, R. L., & Hogan, N. (2004) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2003.11.028 · Cited by 238 · see citing works
Pang, M. Y. C., Harris, J. E., & Eng, J. J. (2006) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2005.08.113 · Cited by 232 · see citing works
McCabe, J., Monkiewicz, M., Holcomb, J. P., Pundik, S., & Daly, J. J. (2014) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2014.10.022 · Cited by 222 · see citing works
“In contrast with these inaccurate beliefs, our results are consistent with others who have demonstrated the possibility of motor recovery beyond that time period, through the application of a variety of treatment methods.(3,4,13-17,19,40,43,46-57)”
ResultMehrholz, J., Platz, T., Kügler, J., & Pohl, M. (2008) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd006876.pub2 · Cited by 222 · see citing works
A Review of Active Hand Exoskeletons for Rehabilitation and Assistance
du Plessis, T., Djouani, K., & Oosthuizen, C. C. (2021) · Robotics · doi:10.3390/robotics10010040 · Cited by 221 · see citing works
“that highly repetitive task training can help the recovery of motor functions [10,11].”
BackgroundLum, P. S., Reinkensmeyer, D. J., Mahoney, R. M., Rymer, W. Z., & Burgar, C. G. (2002) · Topics in Stroke Rehabilitation · doi:10.1310/9kfm-kf81-p9a4-5ww0 · Cited by 218 · see citing works
ARMin II - 7 DoF rehabilitation robot: mechanics and kinematics
Mihelj, M., Nef, T., & Riener, R. (2007) · Proceedings - IEEE International Conference on Robotics and Automation/Proceedings · doi:10.1109/robot.2007.364112 · Cited by 215 · see citing works
“Several studies prove that arm therapy has positive effects on the rehabilitation progress of stroke patients (see [1], [2], [3], [4] and [5] for review).”
BackgroundA Review on the Relationship Between Sound and Movement in Sports and Rehabilitation
Schaffert, N., Janzen, T. B., Mattes, K., & Thaut, M. H. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.00244 · Cited by 208 · see citing works
Cui, X., Chen, W., Jin, X. H., & Agrawal, S. K. (2016) · IEEE/ASME Transactions on Mechatronics · doi:10.1109/tmech.2016.2618888 · Cited by 205 · see citing works
“Research performed with robotic training devices, introduced during the last two decades, show that these devices are effective in motor rehabilitation and can potentially reduce the expense of treatment [2].”
BackgroundConstraint-induced movement therapy for upper extremities in stroke patients
Sirtori, V., Corbetta, D., Moja, L., & Gatti, R. (2009) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd004433.pub2 · Cited by 206 · see citing works
Comparison of Two Techniques of Robot-Aided Upper Limb Exercise Training After Stroke
Stein, J. M., Krebs, H. I., Frontera, W. R., Fasoli, S. E., Hughes, R. L., & Hogan, N. (2004) · American Journal of Physical Medicine & Rehabilitation · doi:10.1097/01.phm.0000137313.14480.ce · Cited by 202 · see citing works
“More recently, improved motor function in the limb segments exercised after robot-aided exercise has been shown in individuals with chronic stable deficits after stroke.(19,20) Robot-aided exercise can be provided using a variety of treatment paradigms, including passive movements, active assistive exercises, resistiv…”
BackgroundA Review on Upper Limb Rehabilitation Robots
Qassim, H. M., & Hasan, W. Z. W. (2020) · Applied Sciences · doi:10.3390/app10196976 · Cited by 200 · see citing works
“[38] MIME Assistive >6 months 27 24 sessions 8 weeks 1 h/workday the reach ability and the proximal arm strength were largely improved”
BackgroundInfluentialSheean, G. L., Lannin, N. A., Turner‐Stokes, L. F., Rawicki, B., & Snow, B. J. (2010) · European Journal of Neurology · doi:10.1111/j.1468-1331.2010.03129.x · Cited by 198 · see citing works
Sprouting, regeneration and circuit formation in the injured spinal cord: factors and activity
Maier, I. C., & Schwab, M. E. (2006) · Philosophical Transactions of the Royal Society B Biological Sciences · doi:10.1098/rstb.2006.1890 · Cited by 197 · see citing works
“Good success was also achieved through forelimb training with robots that do not require immobilization of the other arm (Lum et al. 2002a,b; Fasoli et al. 2003; Ferraro et al. 2003; Riener et al. 2005).”
BackgroundFischer, H. C., Stubblefield, K. A., Kline, T., Luo, X., Kenyon, R. V., & Kamper, D. G. (2007) · Topics in Stroke Rehabilitation · doi:10.1310/tsr1401-1 · Cited by 194 · see citing works
Telerehabilitation Research: Emerging Opportunities
Winters, J. M. (2002) · Annual Review of Biomedical Engineering · doi:10.1146/annurev.bioeng.4.112801.121923 · Cited by 194 · see citing works
Burgar, C. G., Lum, P. S., Scremin, A. M. E., Garber, S. L., der Loos, H. F. M. V., Kenney, D. E., & Shor, P. C. (2011) · The Journal of Rehabilitation Research and Development · doi:10.1682/jrrd.2010.04.0062 · Cited by 190 · see citing works
“Our first clinical trial enrolled chronic stroke subjects (>6 months poststroke) and compared the results from equal amounts of RA and conventional therapy delivered during 24 sessions over 8 weeks [4–6].”
ResultBabaiasl, M., Mahdioun, S. H., Jaryani, P., & Yazdani, M. (2015) · Disability and Rehabilitation Assistive Technology · doi:10.3109/17483107.2014.1002539 · Cited by 184 · see citing works
“In two RCTs, it was shown that MIME can improve impairment and muscle activation in sub-acute and chronic stroke patients [52,53].”
BackgroundResultStaubli, P., Nef, T., Klamroth-Marganska, V., & Riener, R. (2009) · Journal of NeuroEngineering and Rehabilitation · doi:10.1186/1743-0003-6-46 · Cited by 183 · see citing works
Control Strategies for Patient-Assisted Training Using the Ankle Rehabilitation Robot (ARBOT)
Saglia, J. A., Tsagarakis, N. G., Dai, J. S., & Caldwell, D. G. (2012) · IEEE/ASME Transactions on Mechatronics · doi:10.1109/tmech.2012.2214228 · Cited by 181 · see citing works
Ju, M., Lin, C. K., Lin, D.-H., Hwang, I.-S., & Chen, S. (2005) · IEEE Transactions on Neural Systems and Rehabilitation Engineering · doi:10.1109/tnsre.2005.847354 · Cited by 180 · see citing works
“An alternative approach was adopted in the active-constrained mode of mirror image movement enabler (MIME) system [8], [9].”
MethodInfluentialKutner, N. G., Zhang, R. V., Butler, A. J., Wolf, S. L., & Alberts, J. L. (2010) · Physical Therapy · doi:10.2522/ptj.20090160 · Cited by 179 · see citing works
Response to upper-limb robotics and functional neuromuscular
Daly, J. J., Hogan, N., Perepezko, E., Krebs, H. I., Rogers, J. M., Goyal, K. S., Dohring, M. E., Fredrickson, E., Nethery, J., & Ruff, R. L. (2005) · The Journal of Rehabilitation Research and Development · doi:10.1682/jrrd.2005.02.0048 · Cited by 179 · see citing works
“Others showed that robotics could produce impairment gains [1–2] and delayed gains in the FIM [4], a measure of gross function that does not focus on motor ability of the involved upper limb.”
BackgroundMethodA Framework to Describe, Analyze and Generate Interactive Motor Behaviors
Jarrassé, N., Charalambous, T., & Burdet, E. (2012) · PLoS ONE · doi:10.1371/journal.pone.0049945 · Cited by 176 · see citing works
“Even if the ‘‘passive mode’’ used in first stage, where the arm is moved by the robot, is similar to an assistance scheme, the ‘‘active mode’’ in which robot is only correcting patient movements ‘‘just-as-needed’’ is similar to an education scheme [41,42,63,64].”
Brain–machine interfaces: computational demands and clinical needs meet basic neuroscience
Mussa-Ivaldi, F. A. (2003) · Trends in Neurosciences · doi:10.1016/s0166-2236(03)00121-8 · Cited by 174 · see citing works
Wu, C., Huang, P.-C., Chen, Y., Lin, K., & Yang, H.-W. (2013) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2013.02.007 · Cited by 173 · see citing works
Noninvasive brain stimulation in stroke rehabilitation
Webster, B. R., Celnik, P., & Cohen, L. (2006) · NeuroRx · doi:10.1016/j.nurx.2006.07.008 · Cited by 168 · see citing works
- Authors
- Lum, P. S., Burgar, C. G., Shor, P. C., Majmundar, M., & Van der Loos, M.
- Affiliations
- Virginia Commonwealth University (US)
- ORCID
- Lum, Peter S.
- Venue
- Archives of Physical Medicine and Rehabilitation
- Publisher
- Elsevier BV
- Published
- 2002-07
- Volume
- 83
- Issue
- 7
- Pages
- 952-959
- ISSN
- 0003-9993 (ISSN-L)
- OpenAlex
- W2113585314
- Cited by
- 1,159
- References
- 46
- Citations by year
- 2026: 19 · 2025: 20 · 2024: 25 · 2023: 26 · 2022: 48 · 2021: 34 · 2020: 41 · 2019: 57 · 2018: 67 · 2017: 61 · 2016: 81 · 2015: 58 · 2014: 62 · 2013: 68 · 2012: 55
- FWCI
- 28.49
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of Physical Medicine and Rehabilitation (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
- Physical Sciences › Engineering › Biomedical Engineering › Prosthetics and Rehabilitation Robotics
- Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
- Keywords
- stroke rehabilitation, upper limb motor function, hemiparesis, neurodevelopmental treatment, Fugl-Meyer Assessment, FIM, arm muscle strength, reaching kinematics, chronic stroke
- MeSH terms
- Stroke Rehabilitation, Aged, Analysis of Variance, Arm, Biomechanical Phenomena, Chronic Disease, Feedback, Follow-Up Studies, Humans, Muscle Contraction, Paresis, Robotics, Stress, Mechanical, Motion Therapy, Continuous Passive, Range of Motion, Articular, Treatment Outcome, Sample Size, Stroke
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