Effects of Robot-Assisted Rehabilitation on Hand Function of People With Stroke: A Randomized, Crossover-Controlled, Assessor-Blinded Study.

IMPORTANCE: The effects of robot-assisted task-oriented training with tangible objects among patients with stroke remain unknown. OBJECTIVE: To investigate the effects of robot-assisted therapy (RT) with a Gloreha device on sensorimotor and hand function and ability to perform activities of daily living (ADLs) among patients with stroke. DESIGN: Randomized, crossover-controlled, assessor-blinded study. SETTING: Rehabilitation clinic. PARTICIPANTS: Patients (N = 24) with moderate motor and sensory deficits. INTERVENTION: Patients participated in 12 RT sessions and 12 conventional therapy (CT) sessions, with order counterbalanced, for 6 wk, with a 1-mo washout period. OUTCOMES AND MEASURES: Performance was assessed four times: before and after RT and before and after CT. Outcomes were measured using the Fugl-Meyer Assessment-Upper Extremity (FMA-UE), Box and Block Test, electromyography of the extensor digitorum communis (EDC) and brachioradialis, and a grip dynamometer for motor function; Semmes-Weinstein hand monofilament and the Revised Nottingham Sensory Assessment for sensory function; and the Modified Barthel Index (MBI) for ADL ability. RESULTS: RT resulted in significantly improved FMA-UE proximal (p = .038) and total (p = .046) and MBI (p = .030) scores. Participants' EDC muscles exhibited higher efficacy during the small-block grasping task of the Box and Block Test after RT than after CT (p = .050). CONCLUSIONS AND RELEVANCE: RT with the Gloreha device can facilitate whole-limb function, leading to beneficial effects on arm motor function, EDC muscle recruitment efficacy, and ADL ability for people with subacute and chronic stroke. WHAT THIS ARTICLE ADDS: The evidence suggests that a task-oriented approach combined with the Gloreha device can facilitate engagement in whole-limb active movement and efficiently promote functional recovery.

Comparative Assessment of Two Robot-Assisted Therapies for the Upper Extremity in People With Chronic Stroke.

OBJECTIVE: We investigated the effects on motor and daily function of robot-assisted therapies in people with chronic stroke using the Bi-Manu-Track (BMT) and InMotion 3.0 (IMT) compared with control treatment (CT). METHOD: In this comparative efficacy trial, 30 participants were randomized to receive BMT, IMT, or CT. Outcome measures included the Fugl-Meyer Assessment (FMA), Modified Ashworth Scale (MAS), Motor Activity Log (MAL), and Medical Research Council (MRC) scale. RESULTS: The IMT group improved more in FMA and proximal MAS scores than the BMT group (both ps < .01) and the CT group (p < .01 and p = .03, respectively). The IMT and BMT groups showed clinically relevant improvements after treatment on the MRC rather than the MAL. CONCLUSION: The results indicate that the IMT might improve motor function. The IMT and BMT groups showed similar benefits for muscle power but limited improvements in self-perceived use of the affected arm.

Sequencing bilateral robot-assisted arm therapy and constraint-induced therapy improves reach to press and trunk kinematics in patients with stroke.

BACKGROUND: The combination of robot-assisted therapy (RT) and a modified form of constraint-induced therapy (mCIT) shows promise for improving motor function of patients with stroke. However, whether the changes of motor control strategies are concomitant with the improvements in motor function after combination of RT and mCIT (RT + mCIT) is unclear. This study investigated the effects of the sequential combination of RT + mCIT compared with RT alone on the strategies of motor control measured by kinematic analysis and on motor function and daily performance measured by clinical scales. METHODS: The study enrolled 34 patients with chronic stroke. The data were derived from part of a single-blinded randomized controlled trial. Participants in the RT + mCIT and RT groups received 20 therapy sessions (90 to 105 min/day, 5 days for 4 weeks). Patients in the RT + mCIT group received 10 RT sessions for first 2 weeks and 10 mCIT sessions for the next 2 weeks. The Bi-Manu-Track was used in RT sessions to provide bilateral practice of wrist and forearm movements. The primary outcome was kinematic variables in a task of reaching to press a desk bell. Secondary outcomes included scores on the Wolf Motor Function Test, Functional Independence Measure, and Nottingham Extended Activities of Daily Living. All outcome measures were administered before and after intervention. RESULTS: RT + mCIT and RT demonstrated different benefits on motor control strategies. RT + mCIT uniquely improved motor control strategies by reducing shoulder abduction, increasing elbow extension, and decreasing trunk compensatory movement during the reaching task. Motor function and quality of the affected limb was improved, and patients achieved greater independence in instrumental activities of daily living. Force generation at movement initiation was improved in the patients who received RT. CONCLUSION: A combination of RT and mCIT could be an effective approach to improve stroke rehabilitation outcomes, achieving better motor control strategies, motor function, and functional independence of instrumental activities of daily living. TRIAL REGISTRATION: ClinicalTrials.gov. NCT01727648.

Consumer Attitudes and Preferences for Healthy Boxed Meal Attributes in Taiwan: Evidence from a Choice Experiment.

Consumers have realized the importance of a healthy diet, hoping to reduce the occurrence of obesity and chronic diseases. Therefore, healthy boxed meals with low calories and high protein are gaining attention. This study divided the attributes of healthy boxed meals into five categories, namely, taste, nutrition facts, traceability certification, carbon footprint label, and price, and investigated the relationship between consumer preferences and willingness to pay (WTP) using a choice experiment. A purposive sampling procedure was used to collect 495 valid questionnaires. The results indicate the following: (1) when purchasing healthy boxed meals, the respondents were most concerned with traceability certification and nutrition facts; (2) the respondents were willing to pay a premium for meals with traceability certification (NTD 4.6) and nutrition facts (NTD 4.4); (3) respondents > 40 years with an average monthly salary of > NTD 30,000 who worked out regularly and were in the process of muscle building, fat loss, or weight control had higher WTP for meals with nutrition labels; and (4) female respondents who were 30-39 years old with a college or university education or above had higher WTP for meals with traceable ingredients. The results may help healthy boxed meal companies understand and pay attention to consumer needs, which will, in turn, provide a reference for future product development and marketing strategies.

Effects of a wearable sensor-based virtual reality game on upper-extremity function in patients with stroke.

BACKGROUND: PABLO is a virtual reality game where a motion sensor system is used. Few studies have investigated the effects of the PABLO system in stroke rehabilitation. We investigated the effects of upper-extremity virtual reality training with the PABLO system in patients with stroke. METHODS: Stroke patients were randomly assigned to the virtual reality (n = 19) or standard rehabilitation groups (n = 18). Total of 18 sessions were conducted twice per week. The primary outcome measure was the Fugl-Meyer Assessment-Upper Extremity subscale. Secondary outcome measures included the active ranges of motion of the shoulder and elbow, the box and block test, hand grip strength, and the Stroke Impact Scale. Enjoyment of activities and side effects were also recorded. FINDINGS: No difference was observed between two groups in primary outcome. Virtual reality group exhibited greater improvements in the hand dexterity between groups (p = .05). In active motion, virtual reality group showed greater improvement in shoulder flexion between groups (p = .03). Virtual reality group also showed greater improvements in elbow pronation between groups (p = .03). The groups differed in their assessments of how enjoyment the rehabilitation activities were found (p = .01). No significant differences between groups were observed in any other tests. INTERPRETATION: Interventions based on the PABLO virtual reality system improved upper extremity hand function, shoulder and elbow movements, and elicited a higher degree of enjoyment from study participants, than did traditional treatment. TRIALS REGISTRATION: The study protocol was registered at ClinicalTrials.gov PRS (No.NCT04296032).

Robotic-assisted hand therapy for improvement of hand function in children with cerebral palsy: a case series study.

BACKGROUND: Most types of robot-assisted training (RT) have been used in Cerebral Palsy (CP) patients only focus on proximal upper extremity. Few of study investigated the effect of distal upper extremity training. CASE REPORT: Pediatric CP patients (N.=7) participated the RT sessions for 6 weeks (12 60-min sessions 2 times a week). Performance was assessed at 3 time points (pretest, posttest, and 1-month follow-up). RT significantly improved in body structure and function domains: FMA-UE scores (P=0.002). On electromyography, significant improvements in the mean brachioradialis muscle amplitude (P=0.015) and electrical agonist-antagonist muscle ratio (P=0.041) in the 1-inch cube-grasping task. The effects were maintained after 1 month. CLINICAL REHABILITATION IMPACT: RT using a Gloreha device which focuses on the distal part of the upper limb benefit on body structure and function, including upper-extremity motor function, brachioradialis muscle recruitment, and coordination in children with cerebral palsy.

Predicting admission to post-acute inpatient rehabilitation in patients with acute stroke.

OBJECTIVE: To identify predictors of admission to post-acute inpatient rehabilitation settings follow-ing acute care for stroke survivors in Taiwan. DESIGN: Prospective observation study. PARTICIPANTS: Stroke survivors (n = 558) admitted to acute care wards for inpatient rehabilitation (62% male; mean age 60.0 ± 12.2 years). METHODS: The primary outcome was whether survivors were admitted to post-acute inpatient rehabilitation settings after discharge from acute care wards. Logistic regression model was adopted to examine the predictors of admission to post-acute inpatient rehabilitation. A receiver operating characteristic curve was drawn to compute the ability of the predictors to discriminate the outcome. RESULTS: Multivariate analysis results indicated Activity Measure Post-Acute Care "6-Clicks" Basic Mobility score to be the only significant predictor of admission to post-acute inpatient rehabilitation (odds ratio = 0.44, 95% confidence interval: 0.34-0.56). Receiver operating characteristic curve analysis results indicated that the cut-off point for Basic Mobility was 13 (standardized score: 33.99). This yielded a sensitivity value of 0.98 and a specificity value of 0.96 for determining the admission to post-acute inpatient rehabilitation. CONCLUSION: Activity Measure Post-Acute Care "6-Clicks" Basic Mobility subscale scores at admission for acute care can predict admission to post-acute inpatient rehabilitation for stroke survivors in Taiwan. This tool can aid clinicians in formulating adequate discharge plans at an early stage, and thus improve the quality of care.

Combining Afferent Stimulation and Mirror Therapy for Improving Muscular, Sensorimotor, and Daily Functions After Chronic Stroke: A Randomized, Placebo-Controlled Study.

OBJECTIVE: Mirror therapy (MT) combined with mesh glove (MG) afferent stimulation (MT + MG) has been suggested as an effective intervention for motor recovery in patients with stroke. This study aimed to further determine the treatment effects of the MT + MG approach on muscular properties, sensorimotor functions, and daily function. DESIGN: This was a single-blind, randomized, placebo-controlled study. Forty-eight participants with chronic stroke were recruited from medical centers and were randomly assigned to the MT, MT + MG, and MT with sham MG stimulation (MT + sham) groups. The intervention consisted of 1.5 hrs/day, 5 days/wk for 4 wks. Primary outcomes were the Fugl-Meyer Assessment and muscular properties (muscle tone and stiffness). Secondary outcomes included measures of sensorimotor and daily functions. RESULTS: Compared with the MT and MT + sham groups, the MT + MG group demonstrated improved muscular properties. The MT + MG and MT + sham groups showed greater improvement in manual dexterity and daily function than the MT group did. No beneficial effects on the Fugl-Meyer Assessment and other sensorimotor outcomes were found for the MT + MG group. CONCLUSIONS: Although no significant group differences were found in the Fugl-Meyer Assessment, MT + MG induced distinctive effects on muscular properties, manual dexterity, and daily function.