Evaluating the Effectiveness of Conventional Therapy and Robotics Therapy
Clinical Bottom Lines:
- Brokaw et al. (2014) explain on how the people affected by stroke can lead a more effective life through the use of robotics.
- McIntosh and Webberley (2016) state that stroke is the fifth leading cause of death in the U.S. and for the black people, it is in the position as one of the killer diseases.
- Some of the symptoms associated with stroke include numbness that affects the face, arms or legs. In most cases, one side of the body is left paralyzed hence the affected person cannot involve in normal activities such as walking or using their arms effectively.
- People affected with chronic stroke have long-lasting impairment that permanently affects carrying out of the ordinary activities with the involvement of the limbs functionality.
- The study by Brokaw et al. (2014) imply that there is a promise of improving the arm functionality through the use of robotics as a technological health care system.
Citations:
Brokaw, E. B., Nichols, D., Holley, R. J., & Lum, P. S. (2014). Robotic therapy provides a stimulus for upper limb motor recovery after stroke that is complementary to and distinct from conventional therapy. Neurorehabilitation and Neural Repair, 28(4), 367-376.
Fasoli, S. E., Krebs, H. I., Stein, J., Frontera, W. R., Hughes, R., & Hogan, N. (2004). Robotic therapy for chronic motor impairments after stroke: Follow-up results. Archives of Physical Medicine and Rehabilitation, 85(7), 1106-1111.
Fasoli, S. E., Krebs, H. I., Stein, J., Frontera, W. R., & Hogan, N. (2003). Effects of robotic therapy on motor impairment and recovery in chronic stroke. Archives of Physical Medicine and Rehabilitation, 84(4), 477-482.
Kitago, T., Goldsmith, J., Harran, M., Kane, L., Berard, J., Huang, S., … Huang, V. S. (2015). Robotic therapy for chronic stroke: General recovery of impairment or improved task-specific skill? Journal of Neurophysiology, 114(3), 1885-1894.
Kwakkel, G., & Meskers, C. G. (2014). Effects of robotic therapy of the arm after stroke. The Lancet Neurology, 13(2), 132-133.
Klamroth-Marganska, V., Blanco, J., Campen, K., Curt, A., Dietz, V., Ettlin, T., … Luft, A. (2014). Three-dimensional, task-specific robot therapy of the arm after stroke: a multicentre, parallel-group randomised trial. The Lancet Neurology, 13(2), 159-166.
Kwakkel, G., Kollen, B. J., & Krebs, H. I. (2007). Effects of robot-assisted therapy on upper limb recovery after stroke: a systematic review. Neurorehabilitation and neural repair.
Lo, A. C., Guarino, P. D., Richards, L. G., Haselkorn, J. K., Wittenberg, G. F., Federman, D. G., … & Bever Jr, C. T. (2010). Robot-assisted therapy for long-term upper-limb impairment after stroke. New England Journal of Medicine, 362(19), 1772-1783.
Lum, P. S., Burgar, C. G., Shor, P. C., Majmundar, M., & Van der Loos, M. (2002). Robot-assisted movement training compared with conventional therapy techniques for the rehabilitation of upper-limb motor function after stroke. Archives of physical medicine and rehabilitation, 83(7), 952-959.
Massie, C. L., Du, Y., Conroy, S. S., Krebs, H. I., Wittenberg, G. F., Bever, C. T., & Whitall, J. (2016). A clinically relevant method of analyzing continuous change in robotic upper extremity chronic stroke rehabilitation. Neurorehabilitation and neural repair, 30(8), 703-712.
Masiero, S., Celia, A., Rosati, G., & Armani, M. (2007). Robotic-assisted rehabilitation of the upper limb after acute stroke. Archives of physical medicine and rehabilitation, 88(2), 142-149.
McIntosh, J., & Webberley, D. (2016). Stroke: Causes, Symptoms, Diagnosis and Treatment. Medical News Today. Retrieved from http://www.medicalnewstoday.com/articles/7624.php?page=2
Level of Evidence:
The main problem as per the study is that the arm fixed with the robotics needs training activities that would allow the patient to lead a normal life. As such, the objective of this training includes ensuring that the patient can effectively complete the grasp and reach tasks. The study evaluates use of conventional therapy and robotics while comparing the effects of the two doses in functional training. The findings of the research were that the robotic therapy was more effective in improving the arm function as compared to the conventional therapy Brokaw et al. (2014).
Clinical Question:
For patients with stroke under the different studies conducted, between the use of Robotics therapy (RT) or Conventional therapy (CT), which method will be more effective in improving their limbs functionality?
The Studies:
The study by Fasoli et al. (2003) – It shows that robotic therapy can help in the recovery of stroke related issues where 10-12 people with motor impairments related to stroke were helped to recover. However, the research agrees that there was a need for conducting a study of the patients upon discharge to evaluate the lasting effects of the robotic therapy. Similarly, Brokaw et al. (2014) need to come up with the possible effects of the robotic therapy to complete the study of which of the two therapies was more sustainable. Fasoli et al. (2003) assert that a previous research led to the discovery that upon completion of the therapy, the impairment reductions were only sustained for less than three years of discharge hence Brokaw et al. (2014) study would be complete if it ventured in evaluating the future effects of the therapies.
The Research by Lum et al. (2002) – It reveals some of the reasons why the patients used in the research might have dropped out unlike in Brokaw et al. (2014). The two patients who dropped out from this study experienced pain such that they could no longer sustain the therapy. Lum et al. (2002) research was different from Brokaw et al. (2014) because it had a control experiment from which the experiments were compared to in gauging the improvement of the patients through the therapy. The research holds that use of robotic therapy is more effective in improving the quality of physical rehabilitation. Similarly, it increases the efficiency of therapists and alleviates labor intensive aspects.
The study by Masiero et al. (2007) – It confirm that robotic therapy is an approved way of rehabilitating stroke patients. However, the research differs from Brokaw et al. (2014) in that it explores the future of robotics therapy where the NeRebot used is expected to effectively provide support for patients affected by stroke in the paretic and plegic upper limb. The study agrees that there is a need to conduct more research on therapy duration, intensity, and timing of the therapy. As per this study, it would be appropriate that Brokaw et al. (2014) used more numbers of the patients rather than the ten used to effectively quantify the role of therapists’ intervention.
The study by Fasoli et al. (2004) – It confirms that robotic therapy can improve the motor ability of the persons. The research supports Brokaw et al. (2014) findings that research can improve the motor abilities of the person affected with stroke after repetitive training. However, Fasoli et al. (2004) hold that there is a need for future research in robotic therapy that will enhance the retention of functional motor abilities and not only the recovery projected by other studies to last for only a short time.
The study by Kwakkel, Kollen, and Krebs (2007) – It is similar to that of Brokaw et al. (2014) which shows the result of usage of random effects model (REM). The finding of this research explains that the observed effect depends on distal and proximal arm robot training. As such, it is evident from the studies that MIME and MIT-MANUS robots can effectively be used in improving the motor functions which is through training of both the elbow and shoulder movements.
The study by Norouzi-Gheidari, Archambault and Fung (2012) – It confirms that there is no difference between Robot Therapy and Conventional therapy concerning motor control, strength and motor recovery. However, Norouzi-Gheidari, Archambault, and Fung (2012) agree with Brokaw et al. (2014) research by finding that robot therapy (RT) can be more effective that conventional therapy (CT) in that additional sessions of RT can lead to better therapy. RT is considered to be more advantageous in both cases in that it leads to delivering of high repetitive task with less therapeutic supervision.
The Patients:
Twelve enrolled patients were subjected to twelve hours of conventional therapy and then crossed to the robotics and then evaluated on their performance. Only ten of the enrolled patients completed the study which at some point may be attributed to the methods used in conducting the study.
Experimental Group:
Only ten patients completed the experiment hence this group formed the experimental group. The procedures used in conducting this research were ethical since they were approved by the institutional review board. Similarly, the patients used in the experiment were picked from the consent of the treating therapists through the National Rehabilitation Hospital (NRH). Among some of the factors that were considered in elimination of the patients considered not able to complete the study were severe sensory loss, excessive paint in joints and injury before stroke (Brokaw et al., 2014). The research was conducted in isolated laboratory in NRH which add on the research ethics adhered to in the study.
The evidence:
Lo et al. (2010) evaluated the effective strategies needed for patients with long-term effects of stroke. This study involved 127 patients where both control experiment and the two therapies, CT and RT were conducted. The research supports Brokaw et al. (2014) since the results agree that by 12 weeks, significant improvement was noted in robotic therapy. Takahashi et al. (2008) agree with other studies that robot based therapy had significant behavioral gains. Several motor learning theories not mentioned by Brokaw et al. (2014) such as maximum sensory input via tactile, active movement practice and interactive virtual reality computer games are emphasized.
Klamroth-Marganska et al. (2014) explain that neurorehabilitation therapy is safe and can enhance motor function of the patients’ arms. The potential of improving motor function is verified by the study where even months after a stroke the patients are confirmed to have a better motor function after the RT. 3D and 2D robotics training show robust improvement in patients as evidenced by Kitago et al. (2015). This study supports the argument by Brokaw et al. (2014) that there is no evidence that the skill learning mechanism is impaired after the patient is diagnosed with stroke.
Comments:
The strengths of this study:
- The commentary dictates that even though robotics therapy does not strengthen the muscles, it can help the patient lead a normal life through effective training. Massie et al. (2016) argue that there is a need for individual-level analysis in the study of robotics therapy. As such, Brokaw et al. (2014) would have found more detailed implications of robotics training among the participants. This is based on the assertion by Massie et al. (2016) whereby their study shows that different participants respond differently to the stroke therapies.
- The experiment was conducted while adhering to all the ethical procedures such as collecting of the subject samples through the necessary consultations and even conducting of the experiment in a private laboratory.
- The findings of the study correlate well with the findings of the other stroke studies conducted by other researchers.
The weakness of this study:
- The cost of the whole experiment was costly as it can be confirmed from the study by Kwakkel and Meskers (2014). The ARMin robot which is one of the equipment used in robotic therapy is the most commercially available but also the most expensive.
- Pang (2014) opines that there is a need to conduct more studies to cut on such health care costs which can lead to effective incorporation of robotics therapy in stroke treatment and care. Pang (2014)) Comments that the challenge of neurorehabilitation is attributed to by many factors which include more investigations to reduce the expenses.
- There was no control group of comparing the progress of the experiment which reduces the effectiveness of the experiment.
Other Citations:
Norouzi-Gheidari, N., Archambault, P. S., & Fung, J. (2012). Effects of robot-assisted therapy on stroke rehabilitation in upper limbs: systematic review and meta-analysis of the literature. Journal of rehabilitation research and development, 49(4), 479-493.
Pang, M. Y. (2014). Including upper extremity robotic therapy during early inpatient stroke rehabilitation may not lead to better outcomes than conventional treatment. Journal of physiotherapy, 60(3), 166.
Takahashi, C. D., Der-Yeghiaian, L., Le, V., Motiwala, R. R., & Cramer, S. C. (2008). Robot-based hand motor therapy after stroke. Brain, 131(2), 425-437.
Appraised by: Date Appraised:
