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Three ways to improve arm function in the chronic phase after stroke by robotic priming combined with mirror therapy, arm training and movement-oriented therapy

  • Yi-chun Li
    Affiliations
    Department of Occupational Therapy, College of Medicine, I-Shou University, Kaohsiung, Taiwan
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  • Keh-chung Lin
    Correspondence
    Corresponding author: Keh-chung Lin, ScD, OTR, School of Occupational Therapy, College of Medicine, National Taiwan University, and Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, 17, F4, Xu Zhou Road, 10055, Taipei, Taiwan. Tel: +886-2-3366-8180.
    Affiliations
    School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan

    Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
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  • Chia-ling Chen
    Affiliations
    Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan

    Graduate Institute of Early Intervention, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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  • Grace Yao
    Affiliations
    Department of Psychology, National Taiwan University, Taipei, Taiwan
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  • Ya-ju Chang
    Affiliations
    Neuroscience Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan

    School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan

    Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
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  • Ya-yun Lee
    Affiliations
    School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
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  • Chien-ting Liu
    Affiliations
    Department of Physical Medicine and Rehabilitation, Taipei Tzuchi Hospital, Buddhist Tzuchi Medical Foundation, New Taipei City, Taiwan
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  • Wen-Shiang Chen
    Affiliations
    Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei City, Taiwan
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Published:March 16, 2023DOI:https://doi.org/10.1016/j.apmr.2023.02.015

      Abstract

      Objective

      To examine the effects of bilateral robotic priming combined with mirror therapy (R-mirr) versus bilateral robotic priming combined with bilateral arm training (R-bilat), relative to the control approach of bilateral robotic priming combined with movement-oriented training (R-mov) in patients with stroke.

      Design

      A single-blind, preliminary, randomized controlled trial.

      Setting

      Four outpatient rehabilitation settings.

      Participants

      Outpatients with stroke and mild to moderate motor impairment (N = 63).

      Interventions

      Patients received 6 weeks of clinic-based R-mirr, R-bilat, or R-mov for 90 minutes/day, 3 days/week, plus a transfer package at home for 5 days/week.

      Main Outcome Measures

      Fugl-Meyer Assessment upper extremity subscale (FMA-UE), ABILHAND, and Stroke Impact Scale (SIS) version 3.0 scores before, immediately after, and 3 months after treatment as well as the lateral pinch strength and the accelerometry before and immediately after treatment.

      Results

      The posttest results favored R-mirr over R-bilat and R-mov on the FMA-UE score (P<.05). Follow-up analysis revealed that significant improvement in FMA-UE score was retained at the 3-month follow-up in the R-mirr over R-bilat or R-mov (P<.05). Significant improvements were not observed in the R-mirr over R-bilat and R-mov on other outcomes.

      Conclusions

      Between-groups differences were only detected for the primary outcome – FMA-UE. That was R-mirr was more effective at enhancing upper-limb motor improvement, and the effect has the potential to be maintained at 3 months of follow-up.

      Keywords

      List of abbreviations:

      ANCOVA (Analysis of Covariance), FMA-UE (Fugl-Meyer Assessment upper extremity subscale), LMM (linear mixed model), NIHSS (National Institutes of Health Stroke Scale), R-bilat (bilateral robotic primed bilateral arm training), R-mov (bilateral robotic primed movement-oriented training), R-mirr (bilateral robotic primed mirror therapy), SIS (Stroke Impact Scale version 3.0), UE (upper extremity)
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