Upper Extremity Robot-Assisted Therapy in Stroke Patients

NCT06382454 | Not Yet Recruiting DMC

• 1 other identifier: E2-23-5921
• Study Type: interventional
• Target: 40
• Locations: 1 country
• Sites: 1

Brief Summary

Upper extremity hemiparesis is one of the most common symptoms after stroke. Robot-assisted therapies have been used as an approach to rehabilitation of upper extremity hemiplegia in recent years. Robot-assisted therapy is an approach to post-stroke rehabilitation that uses robotic devices to provide motor or task-oriented training to patients. When the literature is examined, there are studies showing that robot-assisted therapies are similar or superior to conventional methods. In order to provide the most effective rehabilitation approach in upper extremity robots, it is suggested that it may be more accurate to consider the robotic device as a training platform consisting of various therapeutic techniques and principles, not as a tool alone. A robotic system will be used to overcome the disadvantages of the existing robotic systems in the literature such as not providing support to the patient at the time of need, not providing fluidity in shoulder movements by not taking into account the scapulohumeral rhythm in upper extremity movements, long installation times, and ignoring task-oriented training. The system to be used is a self-aligning exoskeleton system for robot-assisted upper extremity rehabilitation. The system provides safe and versatile rehabilitation at increasing intensity and also allows for objective assessments. The aim of this clinical study was to evaluate the efficacy of robot-assisted upper limb rehabilitation in stroke patients.

Conditions

Stroke; Upper Extremity

Keywords

Stroke; Robot-Assisted Therapies; Upper Extremity; Exoskeleton Robot; Motor Performance

Outcome Measures

Primary Outcomes (5)

• Modified Ashworth Scale

  Spasticity of the patients will be evaluated with the Modified Ashworth Scale (MAS). The MAS, which assesses resistance to passive movement, is the most widely used method for the evaluation of muscle tone in the clinic. Spasticity is graded as 0, 1, 1+, 2, 3 and 4 according to the resistance of the muscle.

  5 minutes

• Fugl-Meyer Assessment Upper Extremity

  The Fugl Meyer Assessment is a disease-specific assessment designed to evaluate motor function, balance, sensory qualities and joint function in individuals after stroke. The scale consists of 5 sections: motor function, sensory function, balance (standing-sitting), range of motion and joint pain. Scoring is based on the ability to complete each item using a 3-point ordinal scale, where 0 = cannot perform, 1 = partially perform and 2 = fully perform. It is stated in the literature that the scale can also be divided. Therefore, in our study, the upper extremity part of the scale will be used in the evaluation of upper extremity performance before and after treatment. The total score that can be obtained from the Fugl Meyer Upper Extremity assessment is 66 and includes items evaluating joint movements, coordination-speed and reflex activities related to the shoulder, elbow, forearm, wrist and hand.

  15 minutes

• Action Research Arm Test

  Action Research Arm Test (ARAT) is a performance-based test that assesses upper extremity skills and functional level. The test has 4 subgroups evaluating coarse grasping, fine grasping, fingertip grasping and gross movement and 19 evaluation items in total. Scoring is between 0 and 3; 0 means 'movement cannot be performed at all' and 3 means 'performance is normal'. For the test, objects of special sizes and shapes suitable for the relevant grasping styles are required.

  15 minutes

• Box and Block Test

  The Box and Block Test, which provides a measure of manual dexterity, is administered with two adjacent boxes with a 15.2 cm high partition between them. One of the two boxes, both 53.7 x 25.4 x 8.5 cm in size, is filled with 150 wooden blocks of 2.5 cm3 each. The patient should attempt to move the maximum number of blocks within 60 seconds by grasping each block and carrying it across the compartment to the other compartment.

  1 minutes

• Nine Hole Peg Test

  The test consists of a platform with 9 holes and 9 rods. The platform will be placed directly in front of the individuals and the rods will be adjusted so that the rods are on the dominant hand side and the holes are on the non-dominant hand side. After the test rules are explained to the individuals, the individuals will be given the opportunity to practice before the application. Individuals will be asked to insert the rods on the board as fast as possible. The test results will be recorded by measuring the time from the moment the individuals touch the first stick to the moment the last stick is attached to the platform with a stopwatch. Then, they will be asked to remove the 9 bars one by one with the same hand and the removal time will be recorded. The test will be performed for the non-dominant hand using the same method, but this time the platform will be rotated in front of the non-dominant hand.

  10 minutes

Secondary Outcomes (3)

• ACTIVLIM

  5 minutes

• ABILHAND Assessment

  5 minutes

• Stroke Impact Scale

  10 minutes

Study Arms (2)

Treatment Group

EXPERIMENTAL

30 minutes of individualized trunk, lower extremity and upper extremity exercises; the other 30 minutes will be treated with the robotic system. In the robot-assisted treatment, a total of 12 movements will be used, including the movement patterns that patients have the most difficulty in daily life and two movement patterns used in the Proprioceptive Neuromuscular Facilitation approach. Individual-specific rehabilitation program; individual-specific trunk, lower extremity and upper extremity exercises to be applied in both groups will consist of the following exercises according to the needs of the patients, and the degree of difficulty will be planned according to the needs of the patients. All patients will be treated for 8 weeks, 3 days a week, 60 minutes a day.

Device: Assist-On Arm Robot Group

Control Group

ACTIVE COMPARATOR

For 30 minutes, exercises including trunk, lower extremity and upper extremity exercises specific to the individual will be practiced, while the movement patterns to be used in the robotic system will be practiced in the other 30 minutes with the physiotherapist. Individual-specific rehabilitation program; individual-specific trunk, lower extremity and upper extremity exercises to be applied in both groups will consist of the following exercises according to the needs of the patients, and the degree of difficulty will be planned according to the needs of the patients. All patients will be treated for 8 weeks, 3 days a week, 60 minutes a day.

Other: Control Group

Interventions

Assist-On Arm Robot Group DEVICE

30 minutes of individualized trunk, lower extremity and upper extremity exercises; the other 30 minutes will be treated with the robotic system. In the robot-assisted treatment, a total of 12 movements will be used, including the movement patterns that patients have the most difficulty in daily life and two movement patterns used in the Proprioceptive Neuromuscular Facilitation approach. Individual-specific rehabilitation program; individual-specific trunk, lower extremity and upper extremity exercises to be applied in both groups will consist of the following exercises according to the needs of the patients, and the degree of difficulty will be planned according to the needs of the patients. All patients will be treated for 8 weeks, 3 days a week, 60 minutes a day.

Also known as: Assist-On Arm Robot

Treatment Group

Control Group OTHER

For 30 minutes, exercises including trunk, lower extremity and upper extremity exercises specific to the individual will be practiced, while the movement patterns to be used in the robotic system will be practiced in the other 30 minutes with the physiotherapist. Individual-specific rehabilitation program; individual-specific trunk, lower extremity and upper extremity exercises to be applied in both groups will consist of the following exercises according to the needs of the patients, and the degree of difficulty will be planned according to the needs of the patients. All patients will be treated for 8 weeks, 3 days a week, 60 minutes a day.

Control Group

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Spasticity of the upper extremity muscles is 2 or less according to the Modified Ashworth Scale
• Stroke patients with a Mini Mental State Examination score of 24 and above will be included in the study

You may not qualify if:

• Have a neurological disease other than stroke that may affect upper extremity movements
• Surgery or botox application for upper extremity spasticity in the last 6 months
• History of upper extremity fracture or surgery
• Attending another rehabilitation program
• Individuals who do not agree to participate in the study and do not give written informed consent will be excluded from the study.

Sponsors & Collaborators

• Hacettepe University: lead
• Interact Medical Technologies Inc.: collaborator

Study Sites (1)

Hacettepe University, Faculty of Physical Therapy and Rehabilitation

Ankara, Altındağ, Ankara, 06100, Turkey (Türkiye)

Location

MeSH Terms

Conditions

Stroke

Interventions

Control Groups

Condition Hierarchy (Ancestors)

Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Vascular Diseases; Cardiovascular Diseases

Intervention Hierarchy (Ancestors)

Epidemiologic Research Design; Epidemiologic Methods; Investigative Techniques; Research Design; Methods

Study Officials

• Muhammed Kılınç, Prof.

  Hacettepe University

  STUDY DIRECTOR

Central Study Contacts

İzel Demirhan, Msc

CONTACT

+905379858812; izel.dmrhn16@gmail.com

Ender Ayvat, Assoc. Prof.

CONTACT

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Research Assistant

Study Record Dates

• First Submitted: March 27, 2024
• First Posted: April 24, 2024
• Study Start: May 6, 2024
• Primary Completion: March 30, 2025
• Study Completion: March 30, 2025
• Last Updated: May 7, 2024

Record last verified: 2024-05

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)