A comparison of the effects and usability of two exoskeletal robots with and without robotic actuation for upper extremi
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RESEARCH
A comparison of the effects and usability of two exoskeletal robots with and without robotic actuation for upper extremity rehabilitation among patients with stroke: a single‑blinded randomised controlled pilot study Jin Ho Park1, Gyulee Park2, Ha Yeon Kim2, Ji‑Yeong Lee1, Yeajin Ham1, Donghwan Hwang2, Suncheol Kwon2 and Joon‑Ho Shin1,2*
Abstract Background: Robotic rehabilitation of stroke survivors with upper extremity dysfunction may yield different out‑ comes depending on the robot type. Considering that excessive dependence on assistive force by robotic actuators may interfere with the patient’s active learning and participation, we hypothesised that the use of an active-assistive robot with robotic actuators does not lead to a more meaningful difference with respect to upper extremity rehabili‑ tation than the use of a passive robot without robotic actuators. Accordingly, we aimed to evaluate the differences in the clinical and kinematic outcomes between active-assistive and passive robotic rehabilitation among stroke survivors. Methods: In this single-blinded randomised controlled pilot trial, we assigned 20 stroke survivors with upper extrem‑ ity dysfunction (Medical Research Council scale score, 3 or 4) to the active-assistive robotic intervention (ACT) and passive robotic intervention (PSV) groups in a 1:1 ratio and administered 20 sessions of 30-min robotic intervention (5 days/week, 4 weeks). The primary (Wolf Motor Function Test [WMFT]-score and -time: measures activity), and sec‑ ondary (Fugl-Meyer Assessment [FMA] and Stroke Impact Scale [SIS] scores: measure impairment and participation, respectively; kinematic outcomes) outcome measures were determined at baseline, after 2 and 4 weeks of the inter‑ vention, and 4 weeks after the end of the intervention. Furthermore, we evaluated the usability of the robots through interviews with patients, therapists, and physiatrists. Results: In both the groups, the WMFT-score and -time improved over the course of the intervention. Time had a significant effect on the WMFT-score and -time, FMA-UE, FMA-prox, and SIS-strength; group × time interaction had a significant effect on SIS-function and SIS-social participation (all, p 19 years; (2) the presence of hemiplegia owing to ischemic or haemorrhagic stroke; (3) stroke duration > 3 months; (4) hemiplegic shoulder and elbow flexion/extension with a Medical Research Council scale score of 3 or 4 for muscle strength; (5) the affected upper extremity Fugl-Meyer
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Assessment score (FMA) of 21–50; (6) shoulder and elbow flexor spasticity with the Modified Ashworth Scale score ≤ 1 +; (7) cognitive function of the level that facilitates the understanding and obeying of instructions of this study; and (8) the absence of a limited range of motion of the shoulder and elbow joint, as determined by the neutral zero method. The exclusion criteria were as follows: (1) a history of surgical treatment of the affected upper extremity; (2) a musculoskeletal problem of the upper extremity su
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