A Comparative Study of Effects of Combined Robot-Assisted and Task-Oriented Therapy in Subacute Versus Chronic Patients with Stroke---Gains via Motor Recovery or Compensation?

Stroke leads to a large cause of long-term adult disability worldwide. There is a substantial proportion of stroke patients left with upper extremity motor impairments and decreased daily function. One of the important goals of rehabilitation is to facilitate motor recovery and optimize functional outcomes of stroke patients. Functional improvement is likely to occur through combination of recovery and compensation. However, the underlying mechanisms of improved outcomes in stroke patients remain unclear. The processes of motor recovery and compensation in different stroke stages may be differential and the comparison of subacute and chronic stroke patients is understudied. Subacute and chronic stroke patients have potential to gain from rehabilitation interventions and spontaneous recovery to occur at these stages is attenuated. Acute stroke patients did not included due to high possibility of spontaneous recovery. Thus, we aim to examine movement strategies used (ie, normal or compensatory strategies) in subacute and chronic stroke patients. To improve outcomes through recovery or compensation is often mediated by learning and practice. Contemporary rehabilitation approaches, including robot-assisted therapy (RT) and task-oriented training (TOT), emphasize on restoring normal motor patterns instead of using compensatory strategies to optimize recovery. These 2 interventions have been validated individually as a promising approach to enhance patient’s outcomes through intensive and task-specific practice. Recent researchers have suggested that the most effective of therapeutic interventions may be based on the science of combination therapies. The combination therapy, RT combined with TOT, would be therefore proposed to promote motor recovery and functional performance for subacute and chronic patients with stroke in this study. Two parts of the study will be conducted in this 3-year research project: the evaluation study and intervention study. In the first year (ie, evaluation study), we will plan to recruit 60 participants (20 subacute stroke, 20 chronic stroke, and 20 age-matched healthy controls) to examine their movement strategies used in performing reaching and grasping tasks using kinematic motion analysis and to assess their muscle properties. The use of kinematic analysis can help clarify the motor performances through normative or adaptive strategies from biomechanical and motor control viewpoints. In the second and third years (ie, intervention study), we aim to investigate the treatment effects of combination therapy of RT and TOT on motor changes through recovery or compensation, muscle properties, hand dexterity, daily function performance, and quality of life in subacute and chronic stroke with difference levels of motor impairments. An estimated total of 30 subacute and 30 chronic strokes (including 15 patients with mild-to-moderate and 15 patients with moderate-to-severe motor impairments, respectively) will be recruited to participate in this part of study. All patients will receive RT+TOT intervention for 1.5 hours/day, 5 days/week for 4 weeks. Before and after treatment, kinematic analysis along with clinical assessments will be administered to the patients. This research project will examine the underlying mechanisms of motor changes (ie, recovery or compensation) after stroke and to provide scientific evidence of the effects of a novel combination therapy on motor recovery and functional improvement of stroke patients. After these investigations, we will move toward better understanding of what the mechanism of motor changes is, whether the combination intervention works, who benefits, and what outcomes achieve. The entire project will influence translating stroke rehabilitation research into practice and can benefit patients with stroke.

Project ID:PC10308-1036
External Project ID:MOST103-2314-B182-002