Effectiveness of robotics in improving upper extremity functions among people with neurological dysfunction: a systematic review.

PURPOSE: The primary focus of this review was to find out the effectiveness of robotics in improving upper extremity functions among people with neurological problems in the arena of physical rehabilitation. MATERIAL AND METHODS: Two reviewers independently scrutinized the included studies. The selected studies underwent quality assessment by Physiotherapy Evidence Database (PEDro) scale. Randomized Controlled Trial (RCT) having a score of four or more were included in the review. A search was conducted in PUBMED, MEDLINE, CINAHL, EMBASE, PROQUEST, science direct, Cochrane Library, PEDro and Google Scholar. RESULTS: A total of 202 studies were identified. After removal of duplication, inclusion and exclusion criteria's n = 23 studies were included in the review process. For analysis, only the primary outcome measures of the studies were taken into account. Studies finally included in analysis were n = 21. The included studies were 19 in stroke, 1 in cerebral palsy (CP) and 1 study in multiple sclerosis (MS). No RCTs were reportedly found in spinal cord injury (SCI), Parkinson and motor neuron disease (MND). CONCLUSIONS: Studies related to stroke showed a clear definiteness in the improvement of upper extremity functions. On the contrary, there still remains a need for quality trials in CP, MS to establish the efficacy of robotics in upper extremity rehabilitation.

Current Practice "Constraints" in the Uptake and Use of Intensive Upper Extremity Training: A Canadian Perspective.

BACKGROUND: Intensive upper extremity training (IUET) has demonstrated efficacy in clinical and functioning outcomes in children with hemiplegia. However, implementation in the clinical context requires novel service models and knowledge translation. AIMS: To map implementation of IUET in Canada, to identify factors associated with the implementation and best practices for implementation. METHODS: Mixed-methods design; descriptive statistics, chi-square tests. Individual phone interviews and focus groups with purposeful sampling. Thematic analysis; telephone surveys with managers of 31 pediatric rehabilitation centers across Canada. Four focus groups across Canada and one in the Netherlands. RESULTS: Implementation of IUET group interventions is limited in Canada (7/31). Barriers included beliefs and values related to evidence-based practice, opportunities for continuing education, researchers-clinicians partnerships, access to scientific literature, and the presence of a champion. Pressure from parents and media presenting IUET as a novel and effective therapy, support and flexibility of families, having the critical mass of clients and a managerial willingness to accommodate new ideas and restructure service provision were some facilitators. CONCLUSIONS: Uptake of the evidence requires many steps described in the knowledge translation cycle. Factors identified in the study could be considered in most clinical settings to facilitate the uptake of research evidence for IUET.

Impact of task-oriented training based on acupuncture rehabilitation on upper extremity function and quality of life of patients with early stroke.

BACKGROUND: Eighty percent of stroke patients develop upper limb dysfunction, especially hand dysfunction, which has a very slow recovery, resulting in economic burden to families and society. AIM: To investigate the impact of task-oriented training based on acupuncture therapy on upper extremity function in patients with early stroke. METHODS: Patients with early stroke hemiplegia who visited our hospital between January 2021 and October 2022 were divided into a control group and an observation group, each with 50 cases. The control group underwent head acupuncture plus routine upper limb rehabilitation training (acupuncture therapy). In addition to acupuncture and rehabilitation, the observation group underwent upper limb task-oriented training (30 min). Each group underwent treatment 5 d/wk for 4 wk. Upper extremity function was assessed in both groups using the Fugl-Meyer Assessment-Upper Extremity (FMA-UE), Wolf Motor Function Rating Scale (WMFT), modified Barthel Index (MBI), and Canadian Occupational Performance Measure (COPM). Quality of life was evaluated using the Short-Form 36-Item Health Survey (SF-36). Clinical efficacy of the interventions was also evaluated. RESULTS: Before intervention, no significant differences were observed in the FMA-UE, MBI, and WMFT scores between the two groups (P > 0.05). After intervention, the FMA-UE, WMFT, MBI, COPM-Functional Mobility and Satisfaction, and SF-36 scores increased in both groups (P < 0.05), with even higher scores in the observation group (P < 0.05). The observation group also obtained a higher total effective rate than the control group (P < 0.05). CONCLUSION: Task-oriented training based on acupuncture rehabilitation significantly enhanced upper extremity mobility, quality of life, and clinical efficacy in patients with early stroke.

Measuring unsupported arm lifts as an outcome in pulmonary rehabilitation of chronic obstructive pulmonary disease patients.

Pulmonary rehabilitation includes upper and lower extremity exercise training. While validated tests such as the six-minute walk distance (6MWD) and shuttle walk tests are available to evaluate the effectiveness of lower extremity training, the optimal method of evaluating the effectiveness of upper extremity training has not been determined. This study evaluates the potential utility of unsupported arm lifts (UALs) testing as an outcome measurement for pulmonary rehabilitation. Records of chronic obstructive pulmonary disease (COPD) patients who underwent outpatient pulmonary rehabilitation at our institution were reviewed. Outcomes assessed before and immediately after the intervention included 6MWD, the self-administered Chronic Respiratory Questionnaire (CRQ-SA), and UALs. For the latter, the patient repeatedly raises a wooden dowel from thigh to arm level, with the number of repetitions per minute used as the outcome. Changes in variables from pre- to post-pulmonary rehabilitation were analyzed using paired t test. Pearson correlation coefficients were used to evaluate associations. Of the 241 patients, 51% were male. Mean age was 69 ± 9 years, body mass index was 28 ± 7 kg/m(2), and forced expiratory volume in 1 second was 50 ± 20 percent-predicted. All studied variables increased significantly post-pulmonary rehabilitation: the 6MWD by 45 ± 50 m (effect size 0.49), the CRQ-SA total score by 0.84 ± 0.86 units (effect size 0.89), and UAL by 12 ± 13 lifts/minute (effect size 0.75; p < 0.0001 for all). As a measure of upper extremity exercise capacity, UAL appears to be responsive to the comprehensive pulmonary rehabilitation intervention. Using effect sizes, the degree of improvement appears to be between that of 6MWD and CRQ-SA. UAL may be a useful outcome assessment for pulmonary rehabilitation in COPD patients.

Influence and significance of bilateral upper-extremity training on recovery of upper-extremity motor function for hemiplegic patients with mild-moderate cerebral apoplexy: a randomised controlled study.

Background: The recovery of coordination ability of both hands is conductive to improving the activity of daily living for hemiplegic patients. Objective: To explore the influence and significance of bilateral upper-extremity training on recovery of upper-extremity motor function for hemiplegic patients with mild-moderate cerebral apoplexy. Methods: Patients were divided into control group and experimental group. The patients in the control group only exercised the upper limbs on the affected side, while the patients in the experimental group exercised the upper limbs on both sides. The Fugl Mayer Assessment Upper Extremity Scale (FMA-UE), Upper Extermities Functional Test (UEFT), modified Barthel index (MBI) and Brunnstrom scores were evaluated in the two groups before and after treatment. Results: After four weeks, six weeks and eight weeks of treatment, scores of FMA-UE, UEFT, MBI and Brunnstrom for patients increased with the extension of training time, and FMA-UE, UEFT, MBI and Brunnstrom scores for patients of the two groups after four weeks six weeks and eight weeks of treatment showed a significant difference (P<0.05). Conclusion: The improvement of upper-extremity motor function can be facilitated via relatively conventional training of bilateral upper-extremity training adopted by hemiplegic patients with mild-moderate cerebral apoplexy.