Potential of motor recovery in upper limb after a 3-month robot assisted therapy in subacute stroke patients.
Ms Ophelie COURTIALa, Dr Christophe DURETa, Dr François-Xavier LABORNEb, Prof Jean-Michel GRACIESc, Dr Emilie HUTINc
a Centre de Rééducation Fonctionnelle Les Trois Soleils, Médecine Physique et de Réadaptation, Unité de Neurorééducation, Boissise-Le-Roi, France, b SAMU 91, Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France, c Laboratoire Analyse et Restauration du Mouvement (ARM), EA BIOTN, Hôpitaux Universitaires Henri Mondor, Assistance Publique - Hôpitaux de Paris, Université Paris-Est Créteil, France
Introduction: Following stroke, the use of robotic in rehabilitation program leads to increase the number of movement performed on each session. The present study aimed to investigate predictive factors of upper limb motor recovery after a 3-month robot-assisted therapy added to conventional occupational therapy.
Methods: In this retrospective study, 22 post-stroke patients (9 women, 53±18y, delay post-stroke at baseline, M2, 63±25 days) performed robot-assisted shoulder/elbow training in subacute phase (InMotion 2.0, 50±17 sessions over 3 months). All participants underwent evaluations before (M2) and after the training (M5) using the clinical score of Fugl-Meyer (FM) and the hand mean velocity (V) measured by the robot in reaching tasks on horizontal plane toward 3 directions (forward, inside and outside). A predictive model of the patient benefit was tested using Receiver Operating Curve analysis (ROC), based on two criteria: an increase of 9 pts in FM1 and of 0.04 m/s in hand velocity.
Results: At M5, the FM score increased by 28% (p=1.2E-3, t-test) and V by 122% (p=1.2E-7). Concerning the ROC analysis, based on the first criteria, +9 pts of FM score at M5, the probability (AUC) is 0.86 with a 17 pts FM cut-off at M2 (p=4.32E-5) and 0.64 with a 0.02 m/s velocity cut-off at M2 (p=2.62E-2). Based on the second criteria, +0.04 m/s of hand velocity at M5, the probability is 0.93 with a 20 pts FM cut-off (p=7.34E-16), while the velocity cut-off is no significant.
Discussion: The potential functional benefit (+9 pts of the Fugl-Meyer score1), associated with a rehabilitation program including robot-assistive training between the 2nd and the 5th months after stroke might be predicted from baseline evaluation.
1Arya KN, Verma R, Garg RK.Estimating the minimal clinically important difference of an upper extremity recovery measure in subacute stroke patients. Top Stroke Rehabilitation, 2011;18:599-610.
Keywords : Subacute stroke, Robotic, Fugl-Meyer, Kinematic