Robot-Assisted Therapy for Long-Term Upper-Limb Impairment after Stroke
Open accessAbstract
BACKGROUND: Effective rehabilitative therapies are needed for patients with long-term deficits after stroke. METHODS: In this multicenter, randomized, controlled trial involving 127 patients with moderate-to-severe upper-limb impairment 6 months or more after a stroke, we randomly assigned 49 patients to receive intensive robot-assisted therapy, 50 to receive intensive comparison therapy, and 28 to receive usual care. Therapy consisted of 36 1-hour sessions over a period of 12 weeks. The primary outcome was a change in motor function, as measured on the Fugl-Meyer Assessment of Sensorimotor Recovery after Stroke, at 12 weeks. Secondary outcomes were scores on the Wolf Motor Function Test and the Stroke Impact Scale. Secondary analyses assessed the treatment effect at 36 weeks. RESULTS: At 12 weeks, the mean Fugl-Meyer score for patients receiving robot-assisted therapy was better than that for patients receiving usual care (difference, 2.17 points; 95% confidence interval [CI], -0.23 to 4.58) and worse than that for patients receiving intensive comparison therapy (difference, -0.14 points; 95% CI, -2.94 to 2.65), but the differences were not significant. The results on the Stroke Impact Scale were significantly better for patients receiving robot-assisted therapy than for those receiving usual care (difference, 7.64 points; 95% CI, 2.03 to 13.24). No other treatment comparisons were significant at 12 weeks. Secondary analyses showed that at 36 weeks, robot-assisted therapy significantly improved the Fugl-Meyer score (difference, 2.88 points; 95% CI, 0.57 to 5.18) and the time on the Wolf Motor Function Test (difference, -8.10 seconds; 95% CI, -13.61 to -2.60) as compared with usual care but not with intensive therapy. No serious adverse events were reported. CONCLUSIONS: In patients with long-term upper-limb deficits after stroke, robot-assisted therapy did not significantly improve motor function at 12 weeks, as compared with usual care or intensive therapy. In secondary analyses, robot-assisted therapy improved outcomes over 36 weeks as compared with usual care but not with intensive therapy. (ClinicalTrials.gov number, NCT00372411.)
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Extensive training of raters and centralization of outcome assessments can reduce variability but do not completely eliminate it and come with additional costs.
“While extensive training of raters and centralization of outcome assessments (whenever possible) can reduce variability, it does not completely eliminate it and comes with its own additional costs.276”
From QSAR without borders (2020) · cites this paper as [276]
Robotic technology can provide repeatable, reliable, and speedy assessment of continuous measures of impairment and its change during recovery.
“One way to minimize this measurement variability issue is to replace human raters with robotic technology that can provide repeatable, reliable and speedy assessment of continuous measures of impairment and its change during recovery.”
From QSAR without borders (2020) · cites this paper as [276]
Robotic devices can be used simultaneously for both assessment and rehabilitation, which can be done faster and more frequently.
“Robotic devices are less sensitive to the skills and expertise of a human rater, can reduce inter- and intra-rater variability, can be used simultaneously for both assessment and rehabilitation, which can be done faster and more frequently, and can further be used in a home setting thus minimizing patient burden and inconvenience.276”
From QSAR without borders (2020) · cites this paper as [276]
Robotic devices are less sensitive to the skills and expertise of a human rater and can reduce inter- and intra-rater variability.
“Robotic devices are less sensitive to the skills and expertise of a human rater, can reduce inter- and intra-rater variability, can be used simultaneously for both assessment and rehabilitation, which can be done faster and more frequently, and can further be used in a home setting thus minimizing patient burden and inconvenience.276”
From QSAR without borders (2020) · cites this paper as [276]
Robotic devices can be used in a home setting, minimizing patient burden and inconvenience.
“Robotic devices are less sensitive to the skills and expertise of a human rater, can reduce inter- and intra-rater variability, can be used simultaneously for both assessment and rehabilitation, which can be done faster and more frequently, and can further be used in a home setting thus minimizing patient burden and inconvenience.276”
From QSAR without borders (2020) · cites this paper as [276]
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- Authors
- Lo, A. C., Guarino, P. D., Richards, L. G., Haselkorn, J. K., Wittenberg, G. F., Federman, D. G., Ringer, R. J., Wagner, T. H., Krebs, H. I., Volpe, B. T., Bever, C. T., Bravata, D. M., Duncan, P. W., Corn, B. H., Maffucci, A. D., Nadeau, S. E., Conroy, S. S., Powell, J. M., Huang, G. D., & Peduzzi, P.
- Affiliations
- Brown University (US)
- University of Florida (US)
- University of Washington (US)
- University of Maryland, Baltimore (US)
- Yale University (US)
- VA Palo Alto Health Care System (US)
- Massachusetts Institute of Technology (US)
- Cornell University (US)
- Richard L. Roudebush VA Medical Center (US)
- Duke University (US)
- VA Office of Research and Development (US)
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2010-05-13
- Volume
- 362
- Issue
- 19
- Pages
- 1772-1783
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- PMC
- PMC5592692
- OpenAlex
- W2119985669
- Cited by
- 1,397
- References
- 4
- Citations by year
- 2026: 47 · 2025: 55 · 2024: 52 · 2023: 56 · 2022: 93 · 2021: 99 · 2020: 75 · 2019: 99 · 2018: 94 · 2017: 118 · 2016: 121 · 2015: 93 · 2014: 108 · 2013: 91 · 2012: 80
- FWCI
- 94.83
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Aging (P30AG028740, P30AG028747)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD045343)
- 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 impairment, motor recovery, intensive treatment, Fugl-Meyer Assessment, Wolf Motor Function Test, Stroke Impact Scale
- MeSH terms
- Stroke Rehabilitation, Adult, Aged, Aged, 80 and over, Disability Evaluation, Female, Humans, Male, Middle Aged, Motor Activity, Robotics, Least-Squares Analysis, Treatment Outcome, Health Care Costs, Recovery of Function, Stroke, Physical Therapy Modalities, Upper Extremity
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