Hybrid Rehabilitation Therapies on Upper-Limb Function and Goal Attainment in Chronic Stroke

Abstract

This study examined the treatment effects between unilateral hybrid therapy (UHT; unilateral robot-assisted therapy [RT] + modified constraint-induced movement therapy) and bilateral hybrid therapy (BHT; bilateral RT + bilateral arm training) compared with RT. Thirty patients with chronic stroke were randomized to UHT, BHT, or RT groups. Preliminary efficacy was assessed using the Fugl-Meyer Assessment (FMA), the Chedoke Arm and Hand Activity Inventory (CAHAI), and the goal attainment scaling (GAS). Possible adverse effects of abnormal muscle tone, pain, and fatigue were recorded. All groups showed large improvements in motor recovery and individual goals. Significant between-group differences were found on GAS favoring the hybrid groups but not on FMA and CAHAI. No adverse effects were reported. Hybrid therapies are safe and applicable interventions for chronic stroke and favorable for improving individual functional goals. Treatment effects on motor recovery and functional activity might be similar among the three groups.

Keywords

rehabilitation stroke randomized controlled trial occupational therapy

Get full access to this article

View all access options for this article.

References

Alt Murphy

Resteghini

Feys

Lamers

. (2015). An overview of systematic reviews on upper extremity outcome measures after stroke. BMC Neurology, 15, Article 29. doi:10.1186/s12883-015-0292-6

Ashford

Jackson

Turner-Stokes

(2015). Goal setting, using goal attainment scaling, as a method to identify patient selected items for measuring arm function. Physiotherapy, 101, 88-94. doi:10.1016/j.physio.2014.04.001

Barreca

Gowland

C. K.

Stratford

Huijbregts

Griffiths

Torresin

. . . Masters

(2004). Development of the chedoke arm and hand activity inventory: Theoretical constructs, item generation, and selection. Topics in Stroke Rehabilitation, 11(4), 31-42. doi:10.1310/JU8P-UVK6-68VW-CF3W

Bohannon

R. W.

Smith

M. B.

(1987). Interrater reliability of a modified Ashworth scale of muscle spasticity. Physical Therapy in Sport, 67, 206-207.

Boonstra

A. M.

Schiphorst Preuper

H. R.

Reneman

M. F.

Posthumus

J. B.

Stewart

R. E.

(2008). Reliability and validity of the visual analogue scale for disability in patients with chronic musculoskeletal pain. International Journal of Rehabilitation Research, 31(2), 165-169. doi:10.1097/MRR.0b013e3282fc0f93

Chang

W. H.

Kim

Y. H.

(2013). Robot-assisted therapy in stroke rehabilitation. Journal of Stroke, 15, 174-181. doi:10.5853/jos.2013.15.3.174

Cohen

(2013). Statistical power analysis for the behavioral sciences. New York: Routledge, https://doi.org/10.4324/9780203771587.

Gladstone

D. J.

Danells

C. J.

Black

S. E.

(2002). The Fugl-Meyer assessment of motor recovery after stroke: A critical review of its measurement properties. Neurorehabilitation & Neural Repair, 16, 232-240.

Grant

Ponsford

(2014). Goal attainment scaling in brain injury rehabilitation: Strengths, limitations and recommendations for future applications. Neuropsychological Rehabilitation, 24, 661-677. doi:10.1080/09602011.2014.901228

10.

Hatem

S. M.

Saussez

Della Faille

Prist

Zhang

Dispa

Bleyenheuft

(2016). Rehabilitation of motor function after stroke: A multiple systematic review focused on techniques to stimulate upper extremity recovery. Frontiers in Human Neuroscience, 10, Article 442. doi:10.3389/fnhum.2016.00442

11.

Hesse

Schulte-Tigges

Konrad

Bardeleben

Werner

(2003). Robot-assisted arm trainer for the passive and active practice of bilateral forearm and wrist movements in hemiparetic subjects. Archives of Physical Medicine and Rehabilitation, 84, 915-920.

12.

Hsieh

Y. W.

C. Y.

Liao

W. W.

Lin

K. C.

K. Y.

Lee

C. Y.

(2011). Effects of treatment intensity in upper limb robot-assisted therapy for chronic stroke: A pilot randomized controlled trial. Neurorehabilitation & Neural Repair, 25, 503-511. doi:10.1177/1545968310394871

13.

Hsieh

Y. W.

C. Y.

Wang

W. E.

Lin

K. C.

Chang

K. C.

Chen

C. C.

Liu

C. T.

(2017). Bilateral robotic priming before task-oriented approach in subacute stroke rehabilitation: A pilot randomized controlled trial. Clinical Rehabilitation, 31, 225-233. doi:10.1177/0269215516633275

14.

Huang

P. C.

Hsieh

Y. W.

Wang

C. M.

C. Y.

Huang

S. C.

Lin

K. C.

(2014). Predictors of motor, daily function, and quality-of-life improvements after upper-extremity robot-assisted rehabilitation in stroke. American Journal of Occupational Therapy, 68, 325-333. doi:10.5014/ajot.2014.010546

15.

Hung

C. S.

Hsieh

Y. W.

C. Y.

Lin

Y. T.

Lin

K. C.

Chen

C. L.

(2016). The effects of combination of robot-assisted therapy with task-specific or impairment-oriented training on motor function and quality of life in chronic stroke. PM&R: The Journal of Injury, Function, and Rehabilitation, 8, 721-729. doi:10.1016/j.pmrj.2016.01.008

16.

Hurn

Kneebone

Cropley

(2006). Goal setting as an outcome measure: A systematic review. Clinical Rehabilitation, 20, 756-772. doi:10.1177/0269215506070793

17.

Kiresuk

T. J.

Sherman

R. E.

(1968). Goal attainment scaling: A general method for evaluating comprehensive community mental health programs. Community Mental Health Journal, 4, 443-453. doi:10.1007/BF01530764

18.

Kitago

Krakauer

J. W.

(2013). Motor learning principles for neurorehabilitation. Handbook of Clinical Neurology, 110, 93-103. doi:10.1016/B978-0-444-52901-5.00008-3

19.

Krasny-Pacini

Evans

Sohlberg

M. M.

Chevignard

(2016). Proposed criteria for appraising goal attainment scales used as outcome measures in rehabilitation research. Archives of Physical Medicine and Rehabilitation, 97, 157-170. doi:10.1016/j.apmr.2015.08.424

20.

Kwakkel

Veerbeek

J. M.

van Wegen

E. E.

Wolf

S. L.

(2015). Constraint-induced movement therapy after stroke. Lancet Neurol, 14, 224-234. doi:10.1016/S1474-4422(14)70160-7

21.

Liao

W. W.

C. Y.

Hsieh

Y. W.

Lin

K. C.

Chang

W. Y.

(2012). Effects of robot-assisted upper limb rehabilitation on daily function and real-world arm activity in patients with chronic stroke: A randomized controlled trial. Clinical Rehabilitation, 26, 111-120. doi:10.1177/0269215511416383

22.

Lin

K. C.

Chang

Y. F.

C. Y.

Chen

Y. A.

(2009). Effects of constraint-induced therapy versus bilateral arm training on motor performance, daily functions, and quality of life in stroke survivors. Neurorehabilitation & Neural Repair, 23, 441-448. doi:10.1177/1545968308328719

23.

Lin

K. C.

Chen

Y. A.

Chen

C. L.

C. Y.

Chang

Y. F.

(2010). The effects of bilateral arm training on motor control and functional performance in chronic stroke: A randomized controlled study. Neurorehabilitation & Neural Repair, 24, 42-51. doi:10.1177/1545968309345268

24.

A. C.

Guarino

P. D.

Richards

L. G.

Haselkorn

J. K.

Wittenberg

G. F.

Federman

D. G.

. . . Peduzzi

(2010). Robot-assisted therapy for long-term upper-limb impairment after stroke. New England Journal of Medicine, 362, 1772-1783. doi:10.1056/NEJMoa0911341

25.

Masiero

Poli

Rosati

Zanotto

Iosa

Paolucci

Morone

(2014). The value of robotic systems in stroke rehabilitation. Expert Review of Medical Devices, 11, 187-198. doi:10.1586/17434440.2014.882766

26.

McCombe Waller

Whitall

. (2008). Bilateral arm training: Why and who benefits? Neurorehabilitation, 23, 29-41.

27.

Page

S. J.

Fulk

G. D.

Boyne

(2012). Clinically important differences for the upper-extremity Fugl-Meyer Scale in people with minimal to moderate impairment due to chronic stroke. Physical Therapy, 92, 791-798. doi:10.2522/ptj.20110009

28.

Pignolo

(2009). Robotics in neuro-rehabilitation. Journal of Rehabilitation Medicine, 41, 955-960. doi:10.2340/16501977-0434

29.

Rowe

V. T.

Neville

(2018). Task oriented training and evaluation at home. OTJR: Occupation, Participation and Health, 38, 46-55. doi:10.1177/1539449217727120

30.

Stinear

C. M.

Petoe

M. A.

Anwar

Barber

P. A.

Byblow

W. D.

(2014). Bilateral priming accelerates recovery of upper limb function after stroke: A randomized controlled trial. Stroke, 45, 205-210. doi:10.1161/STROKEAHA.113.003537

31.

Stoykov

M. E.

Madhavan

(2015). Motor priming in neurorehabilitation. Journal of Neurologic Physical Therapy, 39(1), 33-42. doi:10.1097/NPT.0000000000000065

32.

Timmermans

A. A.

Spooren

A. I.

Kingma

Seelen

H. A.

(2010). Influence of task-oriented training content on skilled arm-hand performance in stroke: A systematic review. Neurorehabilitation & Neural Repair, 24, 858-870. doi:10.1177/1545968310368963

33.

Turner-Stokes

(2009). Goal attainment scaling (GAS) in rehabilitation: A practical guide. Clinical Rehabilitation, 23, 362-370. doi:10.1177/0269215508101742

34.

Turner-Stokes

Fheodoroff

Jacinto

Maisonobe

(2013). Results from the Upper Limb International Spasticity Study-II (ULISII): A large, international, prospective cohort study investigating practice and goal attainment following treatment with botulinum toxin A in real-life clinical management. BMJ Open, 3(6), Article e002771. doi:10.1136/bmjopen-2013-002771

35.

Veerbeek

J. M.

Langbroek-Amersfoort

A. C.

van Wegen

E. E.

Meskers

C. G.

Kwakkel

(2017). Effects of robot-assisted therapy for the upper limb after stroke. Neurorehabilitation & Neural Repair, 31, 107-121. doi:10.1177/1545968316666957

36.

Winstein

C. J.

Stein

Arena

Bates

Cherney

L. R.

Cramer

S. C.

. . . Zorowitz

R. D.

(2016). Guidelines for adult stroke rehabilitation and recovery: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 47, e98-e169. doi:10.1161/STR.0000000000000098

37.

Guarino

A. C.

Peduzzi

Wininger

(2016). Long-term effectiveness of intensive therapy in chronic stroke. Neurorehabilitation & Neural Repair, 30, 583-590. doi:10.1177/1545968315608448

38.

Yang

C. L.

Lin

K. C.

Chen

H. C.

C. Y.

Chen

C. L.

(2012). Pilot comparative study of unilateral and bilateral robot-assisted training on upper-extremity performance in patients with stroke. American Journal of Occupational Therapy, 66, 198-206. doi:10.5014/ajot.2012.003103