Comparison of Robotics, Functional Electrical Stimulation, and Motor Learning Methods for Treatment of Persistent Upper Extremity Dysfunction After Stroke: A Randomized Controlled Trial
Comparison of Robotics, Functional Electrical Stimulation, and Motor Learning Methods for Treatment of Persistent Upper Extremity Dysfunction After Stroke: A Randomized Controlled Trial
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DOI：
10.1016/j.apmr.2014.10.022
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发表时间：
2015-06-01
影响因子：
4.3
通讯作者：
Daly, Janis J.
中科院分区：
文献类型：
--
作者：
McCabe, Jessica;Monkiewicz, Michelle;Daly, Janis J.
目的：根据对慢性严重受损卒中幸存者复杂功能性日常任务的测量，比较使用机器人加运动学习（ML）与功能性电刺激（PES）加ML与单独ML对上肢治疗的反应。设计：单盲随机试验。设置：医疗中心。参与者：登记的受试者（N=39）为单次卒中后>1年干预措施：两组均接受治疗5 d/wk，共5 b/d（60次），特别待遇如下：ML单独给药（n=11）（复杂功能任务的5小时/天部分和全部任务实践），机器人技术加ML（n=12）（3.5小时/天的ML和1.5小时/天的肩/肘机器人），和FES + ML（n=12）（ML 3.5h/d和FES腕/手协调训练1.5h/d）。主要结果测量：主要测量：手臂运动能力测试（AMAT），具有13个复杂功能任务;次要测量：结果：两组治疗反应无显著性差异（AMAT：P >=.584; FM协调：P >=.590）。所有3个治疗组均表现出治疗应答的临床和统计学显著改善（AMAT和FM协调：P 1 y）上肢功能障碍可以在强化和长期干预中对机器人+ML、FES + ML和单独ML的协调和功能任务表现产生临床和统计学显著增益;没有发现组间差异。2需要进一步的研究来确定这些方法在临床环境中的有效性。(C)2015年美国康复医学大会
Objective: To compare response to upper-limb treatment using robotics plus motor learning (ML) versus functional electrical stimulation (PES) plus ML versus ML alone, according to a measure of complex functional everyday tasks for chronic, severely impaired stroke survivors.Design: Single-blind, randomized trial.Setting: Medical center.Participants: Enrolled subjects (N=39) were >1 year postsingle stroke (attrition rate=10%; 35 completed the study).Interventions: All groups received treatment 5d/wk for 5b/d (60 sessions), with unique treatment as follows: ML alone (n=11) (5h/d partial- and whole-task practice of complex functional tasks), robotics plus ML (n=12) (3.5h/d of ML and 1.5h/d of shoulder/elbow robotics), and FES plus ML (n=12) (3.5h/d of ML and 1.5h/d of FES wrist/hand coordination training).Main Outcome Measures: Primary measure: Arm Motor Ability Test (AMAT), with 13 complex functional tasks; secondary measure: upper-limb Fugl-Meyer coordination scale (FM).Results: There was no significant difference found in treatment response across groups (AMAT: P >=.584; FM coordination: P >=.590). All 3 treatment groups demonstrated clinically and statistically significant improvement in response to treatment (AMAT and FM coordination: P 1y) upper-extremity dysfunction can make clinically and statistically significant gains in coordination and functional task performance in response to robotics plus ML, FES plus ML, and ML alone in an intensive and long-duration intervention; no group differences were found. Additional studies are warranted to determine the effectiveness of these methods in the clinical setting. (C) 2015 by the American Congress of Rehabilitation Medicine