Authors (including presenting author) :
LEUNG EKH(1); WAN J(1); CHAN KCJ(1); LAU AFC(1)
Affiliation :
(1)Occupational Therapy Department, Pok Oi Hospital
Introduction :
The muscular tonicity or muscle control imbalances are often found in people with stroke. These patients lose independent control of selected muscle groups, resulting in coupled joint movements that are often inappropriate for the desired Activity of Daily Living (ADL) tasks. In the motor relearning theory (Carr and Shepherd, 1989), it proposed the training in motor control required anticipatory actions and ongoing repetitive practice. To further enhance relearning, the motor tasks involved are practiced within a context that can be task or environment specific. To assist the patient to tackle these problems, Occupational Therapy Department, NTWC has decided to introduce the state-of-art upper limb robotic arm therapy (robotic arm therapy) to strengthen the rehabilitation for precision motor relearning with individual joints and muscle group training which ultimate aim to improve ADL performance. In the robotic arm therapy, Occupational Therapists (OTs) can provide assist-as-needed guidance in the individualized 2/3D movement in expected action and ongoing practice to enhance ADL performance. The augmented feedback allows OTs to know accurate patient performance and enhance patient’s motivation in training with this interactive robotic arm therapy.
Objectives :
The study aims to review the effectiveness of Robotic Arm Therapy in patients with stroke, based on the outcome of the entry-exit comparison of the stroke rehabilitation in OT, POH, and identify the potential group of patients whom can get most benefits to enhance ADL performance.
Methodology :
All newly referred stroke patients (N=50; M/F: 34/16) who had completed robotic arm therapy program from May, 2019 to Oct, 2020 are selected. Demographic data are stated in table 1 and figure 1 (Age, AMT, Sessions and Functional Test for Hemiplegic Upper Extremity). Outcome in ADL and upper limbs functions will be analyzed. Action Research Arm Test (ARAT) includes grasp, grip, pinch and gross movement evaluation; FTHUE, power grip and pinch grip are selected to assess the upper limb functions. Modified Barthel Index (MBI) is applied for ADL performance.(Table and figure are not inserted here)
Result & Outcome :
The outcome comparisons by pair sample t-test of entry and exit program (ARAT, power & pinch grip and MBI) are stated in table 2a. FTHUE level comparisons by Wilcoxon sign rank test are stated in table 2b (tables are not inserted here)
Reviewing the outcome of the program, it shows significant improvement in ARAT (p=0.000), power grip (p=0.000), pinch grip (p=0.000), FTHUE (p=0.000) and MBI (p=0.000). It shows that the robotic arm therapy can enhance upper limb, hand function and ADL performance. By comparing the data of FTHUE in entry and exit program, it shows that cases with FTHUE level 3 to 5, that can initiate grasping tasks, in entry program (n=26) have the greatest improvement. In which 46.67% cases have 1 level of improvement, 26.67% cases have 2 level of improvement, 20% cases have 3 level of improvement, and 6.66% cases have 4 level improved. With robotic arm therapy, the improvement in upper limb function can enhance in ADL performance i.e. feeding, grooming and dressing tasks.
As a whole, robotic arm therapy can be one of the essential components in Hong Kong stroke rehabilitation in the future.
