Stroke, Upper Extremity Paresis
Conditions
Keywords
stroke, chronic, rehabilitation, robot therapy, arm therapy
Brief summary
The goal of this study is to determine whether task-oriented, robot-aided therapy is more effective than conventional physical and occupational therapy at promoting functional recovery of the affected arm in chronic hemiparetic stroke patients.
Detailed description
Robotic therapy will be performed with ARMin, which is a robotic arm exoskeleton that permits 3D movements of both proximal and distal arm joints. Combined with an audiovisual display, this device allows virtual training of Activities of Daily Living (ADL) and therapeutic gaming. A patient-responsive controller enables the assistance of the device only as needed. Chronic stroke patients (\>6 months post stroke) will be randomly assigned to either an experimental or a control group. The experimental group will perform task-related intensive therapy with the support of ARMin. Therapists will treat the patients of the control group with standard motor relearning therapy.
Interventions
DEVICErobot therapy (ARMin)
therapy of the affected arm with a robot for eight weeks, three times weekly for one hour
OTHERconventional therapy
physical and occupational therapy of the affected arm for eight weeks, three times weekly for one hour
Sponsors
Sensory Motor Systems Lab, ETH Zurich
Balgrist University Hospital
Reha Rheinfelden
Zuercher Hoehenklinik Wald
University of Zurich
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age 18 or more * first-ever stroke (hemorrhagic or ischemic), verified by brain imaging * stroke more than six months prior to the study * termination of conventional therapy and stable recovery stage (outpatients) * moderate to severe motor impairment of the arm (upper limb portion of FMA score between 8 and 38) * ability to sit in a chair without any additional support and without leaning on the back rest * written informed consent signed by the subject (or an authorized representative)
Exclusion criteria
* Excessive spasticity of the affected arm (mAS ≥ 3) * any serious medical or psychiatric illness * participation in any clinical investigation within 4 weeks prior to the start of this study * anticipated need for any major surgery during the study * women known to be pregnant or lactating * Orthopedic, rheumatologic or other disease restricting movements of the paralyzed upper extremity * shoulder subluxation (palpatory \> 2 fingers) * diseased or damaged skin at the paralyzed arm * inability to communicate effectively with the neurological examiner such that the validity of the patient's data could be compromised * cyber sickness * pace-maker or other implanted electric devices * body weight \> 120kg * serious cognitive deficits and aphasia preventing the performance of the ARMin treatment * participation in any therapeutic treatment (outside therapy) performed with the paralyzed arm during the planned study - including baseline and follow up.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Fugl Meyer Assessment Scale | four and one weeks prior to intervention, four weeks after intervention started, at the end of intervention(eight weeks), two months and six months follow-up |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Wolf Motor Function Test, Stroke Impact Scale, Motor Activity Log, modified Ashworth Scale, abnormal joint synergies, active range of motion (ROM), muscle strength, and spatial precision of hand positioning. | three and one weeks prior to intervention, four weeks after intervention started, at the end of intervention(eight weeks), two months and six months follow-up | — |
| fMRI | before and after 8 weeks therapy, 2-months follow-up | in 20 Patients fMRI will be recorded while patients interact with an MR-compatible manipulandum |
Countries
Switzerland
Outcome results
None listed