Electromechanical and Robot-Assisted Arm Training After Stroke
Background and Purpose—More than two thirds of all patients after stroke have difficulties with reduced arm function. Electromechanical and robot-assisted arm training devices are used in rehabilitation and might help to improve arm function after stroke. Our systematic review examined the effectiveness of electromechanical and robot-assisted arm training for improving generic activities of daily living, arm function, and arm muscle strength in patients after stroke and also assessed the acceptability and safety of the therapy.
Methods—We searched the Cochrane Stroke Group’s Trials Register (last searched July 2011), the Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library 2011, Issue 7), MEDLINE (1950 to July 2011), EMBASE (1980 to July 2011), CINAHL (1982 to July 2011), AMED (1985 to July 2011), SPORTDiscus (1949 to July 2011), PEDro (searched August 2011), COMPENDEX (1972 to July 2011), and INSPEC (1969 to July 2011). We also hand-searched relevant conference proceedings, searched trials and research registers, checked reference lists, and contacted trialists, experts, and researchers in our field as well as manufacturers of commercial devices. Two review authors independently selected trials for inclusion, assessed trial quality, and extracted the data. The primary outcome was activities of daily living; secondary outcomes were impairments such as motor function and motor strength. To minimize bias we included only randomized controlled trials comparing electromechanical and robot-assisted arm training for recovery of arm function with other rehabilitation interventions or no treatment.
Results—We included 19 trials (involving 666 participants) in this review. Electromechanical and robot-assisted arm training did improve activities of daily living (standardized mean difference, 0.43, 95% CI, 0.11–0.75; P=0.009; I2=67%; Figure) as well as arm function (standardized mean difference, 0.45; 95% CI, 0.20–0.69; P=0.0004; I2=45%), but arm muscle strength did not improve (standardized mean difference, 0.48, 95% CI, −0.06 to 1.03; P=0.08; I2=79%). Electromechanical and robot-assisted arm training did not increase the risk of patients to dropout (risk difference, 0.00; 95% CI, −0.04 to 0.04; P=0.82; I2=0.0%), and adverse events were rare.
Conclusions—Patients who receive electromechanical and robot-assisted arm training after stroke are more likely to improve their generic activities of daily living. Paretic arm function may also improve, but not arm muscle strength. However, the results must be interpreted with caution because there were variations between the trials in the duration and amount of training, type of treatment, and in the patient characteristics.
Our results were not conclusive. We found that patients who receive electromechanical-assisted arm training after stroke are more likely to improve their generic activities of daily living and may improve arm function. The findings indicate, however, that motor strength of the paretic arm is not more likely to improve when patients after stroke train with electromechanical devices or robots. Because adverse events were rare, based on the data of 19 trials, these devices could be applied as a rehabilitation tool, but we still do not know when and how often they should be used.
There is still a need for well-designed large-scale multicenter studies to evaluate benefits and harms of electromechanical-assisted arm training after stroke. Further research should address specific questions about the optimal type, timing, frequency, and duration of electromechanical and robot-assisted arm training.
This article is based on a Cochrane Review published in The Cochrane Library 2012, Issue 6 (see www.-thecochranelibrary.com for information). Cochrane Reviews are regularly updated as new evidence emerges and in response to feedback, and The Cochrane Library should be consulted for the most recent version of the review.1
- Received August 16, 2012.
- Accepted August 16, 2012.
- © 2012 American Heart Association, Inc.