Authors (including presenting author) :
Li YM(1), Chan KK(1), Mok WS(1), Ho WS(1), Leung CF(1), Yip CT(1), Chen CY(1), Lee HS(1), Hui N(1)
Affiliation :
(1)Occupational Therapy Department, United Christian Hospital
Introduction :
Upper limb hemiparesis following stroke is prevalent and leads to difficulties in an individual's functional independence. The recovery of hand function is, therefore, an important topic in stroke rehabilitation. One neoteric and potential approach is robotic-assisted training. Soft robotic glove serves as a portable and inexpensive training equipment, providing real-time sensorimotor feedback to stimulates a patient's motor return and motivation. Additionally, robots facilitate more intensive and manpower-saving training compared to conventional strategies. Bilateral hand training, focusing on repetitive practice of bilateral arm movements in symmetrical or alternating patterns, has been found to enhance the coupling effects and restoration of interhemispheric transcallosal inhibition. As a result, more neural networks can be established for successful motor execution and bimanual coordination in activities of daily living (ADL). In this study, we aim to investigate the effectiveness of soft robotic bilateral hand therapy in stroke patients.
Objectives :
To investigate the effectiveness of soft robotic bilateral hand therapy in in-patient acute and subacute stroke patients.
Methodology :
This study adopted a pre-post-study design. Patients with cerebrovascular accidents (CVA) and Functional Test for the Hemiplegic Upper Extremity (FTHUE) level 1 to 4, admitted to UCH acute stroke unit and rehabilitation ward from March to December 2024, were eligible for the recruitment. All patients received 10 sessions of soft robotic bilateral hand training. A pneumatic soft robotic glove system was employed, assisting the healthy hand in driving the affected hand to move synchronously. Task-oriented ADL tasks, such as holding a bottle, were also integrated. During the program, participants also received functional training to further promote their independence in ADL. Pre- and post-outcome measurements, including hand grip strength, FTHUE, Fugl-Meyer Assessment-Upper Extremity (FMA-UE), Motricity Index-Arm, and Modified Barthel Index (MBI), were adopted. For data analysis, paired sample T-tests (for hand grip) and Wilcoxon Signed-Rank Tests (for FTHUE, FMA-UE, Motricity Index-Arm, MBI) were utilized.
Result & Outcome :
23 stroke patients (mean age = 64.00, SD = 13.62) were recruited and completed the robotic program. Their baseline mean FTHUE level was 1.91 (SD= 0.95). They completed the 10-session training on average on post-admission day 22.91. For upper limb function, significant improvements were found in all outcome measures, including hand grip strength (t = 3.66, p = 0.001), FTHUE (z = 3.62, p < 0.001), FMA-UE (z = 3.92, p < 0.001), and Motricity Index-Arm (z = 3.72, p < 0.001). For the functional aspect, a significant increase in MBI (z = 4.20, p < 0.001) was also observed. In conclusion, significant improvements in hand function and ADL ability were demonstrated in acute and subacute stroke patients after completing bilateral robotic hand therapy.
Clinically, soft robotic bilateral hand therapy provides intensive evidence-based rehabilitation with less supervision from a therapist for stroke with severely impaired upper limb function. Moreover, the training is cost-effective and can be applied to more potential patients at a reasonable cost. Yet, a larger sample size with control group is suggested for future studies. Besides, a long-term follow-up studies from in-patient to out-patient phrase is also suggested.
