Effects of Combined therapy in Chronic Stroke patients on Motor and Daily function：A Randomized controlled trial

• Main Authors: Tai Chieh Wu, 吳岱潔
• Other Authors: C. Y. Wu
• Format: Others
• Published: 2012
• Online Access: http://ndltd.ncl.edu.tw/handle/86476212157603568603

碩士 === 長庚大學 === 職能治療學系 === 100 === Objective To compare the effects of robot-assisted training combine constraint-induced movement therapy on motor impairment, motor performance and basic/instrumental activities of daily living function in 49 stroke patients. Background Robot-assisted training(RT) and constraint-induced movement therapy(CIT) are both evidence-based therapy in stroke rehabilitation. Most of the reviews showed RT was suitable for variously impaired patients. It is one emerging approach with the advantage of high-intensity, repetitive, and task-specific training, which have potential to enhance motor impairment of paretic arm. However, Robot-assisted training did not significantly improve activities of daily living(ADL). In contrast, several randomized controlled trials have demonstrated the effects of CIT and dCIT on improving motor ability and functional use of the affected upper-limb in patients with stroke, but inclusion criteria in CIT are more than other training. In order to overcome the limitations of a single treatment, there is a trend to combine the advantages of different treatment. Therefore, we hypothesized that participants who received combined therapy would improve motor ability, motor performance, reduce the gaps on entering the dCIT program, and translate gains in motor function into functional performance. Method Forty nine patients were randomized into combination(RCIT), robot(HRT) and control(CR) group. Each subjects received 90 minutes therapy, every weekdays, over 4 weeks. Robot-assisted training using the Bi-Manu-Track specifically trained distal arm movements by practicing bilateral elbow pronation and supination as well as wrist flexion and extension in passive, active and resistive modes. Constraint-induced movement therapy focused on the intensive training of the affected arm in functional activities. Pre-treatment and post-treatment measurement were taken. Outcome measurements included clinical measures involving the Fugl-Meyer Upper Extremity Motor Function Test(FM), the Wolf Motor Function Test (WMFT), the Functional Ambulation Categories(FAC), Functional Independence Measure( FIM), the Nottingham Extended ADL scale(NEADL). Results 49 participants completed our intervention protocols, no significant between-group differences were found in baseline characteristics. Significant between-group difference and large effect were shown on the FMA total(p=.003,η2=.225) and distal part score(p=.028,η2=.279) after treatment. The RCIT group showed greater improvements in both total and distal part on FMA than CR group. There was an interesting thing that RT group was better than CR group on FMA total score (p=.028,η2=.279)and distal part score(p=.239,η2=.122) only in patients with lower motor baseline. The RCIT group also better in mobility on FAC score than RT and CR group(p=.015,η2=.171). In activity and participation domain, RCIT showed greater improvements in living affairs (p=.03,η2=.144), self-care(p=.126,η2=.206), mobility( p=.328,η2=.117) and motor (p=.328,η2=.116)domain. RCIT showed mostly higher score than RT group, and it’s more obviously in higher baseline group. Conclusion The current results show combined therapy produced better improvement in motor impaired, motor performance, mobility, and partial daily activities than RT or CR group. The result has larger effect size in higher upper limb function patients before treatment. It suggests that the group of lower upper limb function may be more applicable to robot-assisted therapy for longer time, then using constraint-induced movement therapy transfer the efficacy to daily life.