Pai-Chuan Huang, Yu-Wei Hsieh, Chin-Man Wang, Ching-Yi Wu, Shu-Chun Huang, Keh-Chung Lin; Predictors of Motor, Daily Function, and Quality-of-Life Improvements After Upper-Extremity Robot-Assisted Rehabilitation in Stroke. Am J Occup Ther 2014;68(3):325-333. doi: 10.5014/ajot.2014.010546.
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© 2019 American Occupational Therapy Association
OBJECTIVE. A subgroup of patients benefiting most from robot-assisted therapy (RT) has not yet been described. We examined the predictors of improved outcomes after RT.
METHOD. Sixty-six patients with stroke receiving RT were analyzed. The outcome measures were the Fugl-Meyer Assessment (FMA), Wolf Motor Function Test (WMFT), Motor Activity Log (MAL), and Stroke Impact Scale (SIS). The potential predictors were age, side of lesion, time since onset, Modified Ashworth Scale (MAS) scores, accelerometer data, Box and Block Test (BBT) scores, and kinematic parameters.
RESULTS. BBT scores were predictive of FMA (29%) and MAL (9%−15%) improvements. Reduced shoulder flexion synergy, as measured by less shoulder abduction during forward reach, and MAS–distal were predictive of WMFT–function improvements. MAS–distal was predictive of SIS–physical improvements. Demographic variables did not predict outcomes.
CONCLUSION. Manual dexterity was a valuable predictor of motor impairment and daily function after RT. Outcomes at different levels may have different predictors.
Patients with stroke who initially demonstrate good manual dexterity, as measured by the BBT, may have a better chance than those who do not to improve UE motor impairment and daily function; therefore, they should receive intensive therapy as is offered by RT, for example.
Factors related to typical movement, such as reduced shoulder abduction during forward reach and less distal muscle tone, are related to improvements at motor function and quality-of-life levels.
None of the demographic variables used in this study (i.e., age, side of lesion, and time since stroke onset) predicted improved motor function or daily function of UE and therefore should not be used to limit participation in intensive rehabilitation.
Only 29% of the variance associated with improved movement control was accounted for by the chosen predictor variables in this study; therefore, 71% of the variance has not been accounted for and may be found in mental attitude or other variables not included in this study. Patients should not be excluded from intensive therapy only on the basis of dexterity testing. Further study illuminating a greater understanding of characteristics associated with recovery from stroke is needed.
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