Robot vs Therapist

#026 – Robot vs Therapist

ByAl-Jallad

Estimated reading time: 2 minutes, 9 seconds*

The effectiveness of Robot-Assisted Training for Arm Rehabilitation After Stroke

Robot???Therapist

  • This systematic review and meta analysis compared the effect of robot-assisted training (RAT) versus therapist-mediated training (TMT) for arm rehabilitation after stroke.

?Why?

Robot-assisted training is an innovative exercise-based therapy that enables the implementation of highly repetitive, intensive, adaptive, quantifiable, and task-specific arm training with feedback and motivation for boosting brain neuroplasticity.

Robotic devices, unlike humans, programmed to perform in different functional modes with a single click can relieve the burden of the shortage of rehabilitation providers and resources without fatigue

⏮️ Previously

  • Per usual, previous evidence is conflicted, where some found that RAT can improve arm strength, function and ADL, others, found that it can improve motor control and strength but without an effect on Basic ADL.
  • A study on 770 stroke participant, did not recommend the use of RAT in clinical practice, even though it led to improvement in motor impairments it did not improve arm function or ADL.

? Results

  • 35 trials with 2241 participant.
  • RAT was superior to TMT for UL motor impairment. Results from 29 trials and 1682 participant.
    • Measured using Fugl-Meyer Assessment of the Upper Extremity (FMA-UE).
  • Regarding UL capacity, RAT was noninferior to TMT. Results from 26 trials and 1557 participant.
    • Measured by using one of the following scales: Action Research Arm Test (ARAT), Wolf Motor Function Test (WMFT), Box and Blocks Test (BBT), Nine Hole Peg Test (9-HPT), Chedoke Arm and Hand Activity Inventory (CAHAI), Arm Motor Ability Test (AMAT).
  • Activities of Daily Living (ADL), RAT was noninferior to TMT. Results from 26 trials and 1468 participant.
    • Measured by one of the following scales: Functional Independence Measure (FIM), Barthel Index (BI), Motor Activity Log (MAL), and modified Rankin Scale (mRS).
  • Social Participation, RAT was noninferior to TMT. Results from 8 trials and 849 participant.
    • Measured by Stroke Impact Scale (SIS) or Medical Outcomes Study Short Form 36 (SF-36).

? Conclusion

  • Robot-assisted training is slightly superior to therapist-mediated training regarding motor impairment recovery but not greater than minimal clinically important difference.
  • Robot-assisted training noninferior to therapist-mediated training in improving upper limb capacity, activities of daily living, and social participation.

??‍♀️One Thing though!

  • In the conclusion, the authors stated that the results of the study supports the use of robot-assisted training in clinical practice.
  • But, what about money! One of the limitation of the study is that the authors did not discuss the cost-effectiveness of RAT.
  • Also, should I change my career? Will robots take our place? ?

?️Recommended

?Reference

*Calculation is based on the average reading speed that around 200 words per minute (wpm).

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