Effect of Gravity on Robot-Assisted Motor Training After Chronic Stroke: A Randomized Trial

Conroy SS, Whitall J, Dipietro L, Jones-Lush LM, Zhan M, Finley MA, Wittenberg GF, Krebs HI, Bever CT. Effect of gravity on robot-assisted motor training after chronic stroke: a randomized trial.ObjectivesTo determine the efficacy of 2 distinct 6-week robot-assisted reaching programs compared with an intensive conventional arm exercise program (ICAE) for chronic, stroke-related upper-extremity (UE) impairment. To examine whether the addition of robot-assisted training out of the horizontal plane leads to improved outcomes.DesignRandomized controlled trial, single-blinded, with 12-week follow-up.SettingResearch setting in a large medical center.ParticipantsAdults (N=62) with chronic, stroke-related arm weakness stratified by impairment severity using baseline UE motor assessments.InterventionsSixty minutes, 3 times a week for 6 weeks of robot-assisted planar reaching (gravity compensated), combined planar with vertical robot-assisted reaching, or intensive conventional arm exercise program.Main Outcome MeasureUE Fugl-Meyer Assessment (FMA) mean change from baseline to final training.ResultsAll groups showed modest gains in the FMA from baseline to final with no significant between group differences. Most change occurred in the planar robot group (mean change ± SD, 2.94±0.77; 95% confidence interval [CI], 1.40–4.47). Participants with greater motor impairment (n=41) demonstrated a larger difference in response (mean change ± SD, 2.29±0.72; 95% CI, 0.85–3.72) for planar robot-assisted exercise compared with the intensive conventional arm exercise program (mean change ± SD, 0.43±0.72; 95% CI, –1.00 to 1.86).ConclusionsChronic UE deficits because of stroke are responsive to intensive motor task training. However, training outside the horizontal plane in a gravity present environment using a combination of vertical with planar robots was not superior to training with the planar robot alone.