Abstract: Objective: To investigate whether early therapy with a
novel robotic device can reduce motor impairment and enhance
functional recovery of poststroke patients with hemiparetic and
hemiplegic upper limb.
Design: A single-blind randomized controlled trial, with an
Setting: Neurologic department and rehabilitation hospital.
Participants: Thirty-five patients with acute (1wk of onset),
unilateral, ischemic embolic, or thrombotic stroke.
Interventions: Patients of both groups received the same
dose and length per day of standard poststroke multidisciplinary
rehabilitation. Patients were randomly assigned to 2
groups. The experimental group (n17) received additional
early sensorimotor robotic training, 4 hours a week for 5
weeks; the control group (n18) was exposed to the robotic
device, 30 minutes a week, twice a week, but the exercises
were performed with the unimpaired upper limb. Training by
robot consisted of peripheral manipulation of the shoulder and
elbow of the impaired limb, correlated with visual stimuli.
Main Outcome Measures: The Fugl-Meyer Assessment
(FMA) of upper-extremity function (shoulder/elbow and coordination
and wrist/hand subsections) to measure each trained
limb segment; the Medical Research Council (MRC) score to
measure the strength of muscle force during 3 actions: shoulder
abduction (MRC deltoid), elbow flexion (MRC biceps), and
wrist flexion (MRC wrist flexors); the FIM instrument and its
motor component; and the Trunk Control Test (TCT) and
Modified Ashworth Scale (MAS).
Results: Compared with the patients in the control group,
the experimental group showed significant gains in motor impairment
and functional recovery of the upper limb after robot
therapy, as measured by the MRC deltoid (P.05) and biceps
(P.05) scores, the FMA for the proximal upper arm (P.05),
the FIM instrument (P.05), and the FIM motor score
(P.01); these gains were also sustained at the 3- and 8-month
follow-up. The FMA and MRC wrist flexor test findings did
not differ statistically either at the end of training or at the
follow-up sessions. We found no significant differences in
MAS and TCT in either group in any of the evaluations. No
adverse effects occurred and the robotic approach was very
Conclusions: Patients who received robotic therapy in addition
to conventional therapy showed greater reductions in
motor impairment and improvements in functional abilities.
Robotic therapy may therefore effectively complement standard
rehabilitation from the start, by providing therapeutic
support for patients with poststroke plegic and paretic upper