ContentList volumes - List articles in this issue
The arm studio to intensify the upper limb rehabilitation after stroke: Concept, acceptance, utilization and preliminary clinical results
OBJECTIVES: To assess the acceptance, utilization and clinical results of an arm studio designed to intensify treatment of the severely to moderately affected arm after stroke. In line with a distal bilateral approach, the equipment comprised 4 workstations, 1 finger trainer, and 3 machines for bilateral training of selected distal and proximal movements.
DESIGN: Open study.
SUBJECTS: Of 119 treated patients after subacute stroke, 30 completed a questionnaire and 24 were assessed.
METHODS: All patients completed 15 sessions, each of 30–45 min duration, on each of 2 workstations. Based on the patients’ impairment level they were divided into 3 groups, as follows: group A, plegic; group B, proximal and distal movements but hand non-functional; and group C, able to grasp and release an object. Motor functions were assessed with the Fugl-Meyer Score (FM, 0–66) for groups A (n = 6) and B (n = 6), and the Action Arm Research Test (ARAT, 0–57) for group C (n = 12).
RESULTS: No side-effects occurred. The patients regarded the training positively. The initial FM was 8.5 (standard deviation (SD) 3.3) and final FM 21.2 (SD 4.4) for group A, initial FM 25.3 (SD 6.9) and final FM 44.3 (SD 9.1) for group B, and initial ARAT 33.3 (SD 11.2) and final ARAT 43.5 (SD 10.7) for group C.
CONCLUSION: The use of the arm studio to intensify upper limb rehabilitation after stroke is promising, and a controlled study is warranted.
R. Buschfort, J. Brocke, A. Heß, C. Werner, A. Waldner, Stefan Hesse
- Truelsen T, Piechowski-Jozwiak B, Bonita R, Mathers C, Bogousslavsky J, Boysen G. Stroke incidence and prevalence in Europe: a review of available data. Eur J Neurol 2006; 13: 581–598-
- Weimar C, Ziegler A, König IR, Diener HC. Predicting functional outcome and survival after acute ischemic stroke. J Neurol 2002; 249: 888–895.
- Kwakkel G, Kollen BJ, an der Grond J, Prevo AJ. Probability of regaining dexterity in the flaccid upper limb. The impact of severity of paresis and time since onset in acute stroke. Stroke 2003; 34: 2181–2186.
- Kwakkel G, Wagenaar RC, Twisk JWR, Lankhorst GJ, Koetsier JC. Intensity of leg and arm training after primary middle-cerebral-artery stroke: a randomised trial. Lancet 1999; 354: 191–196.
- Hogan N, Krebs J, Charnnarong J, Srikrishna P, Sharon A. MIT-MANUS: a workstation for manual therapy and Training II. In: Proceedings of the SPIE Conference on Telemanipulator Technology 1992; 833: 28.
- Hesse S, Mehrholz J, Werner C. Roboter- und gerätegestützte Rehabilitation nach Schlaganfall. Dt Arztebl 2008; 105: 330–336.
- Mehrholz J, Platz T, Kugler J, Pohl M. Electromechanical and robot-assisted arm training for improving arm function and activities of daily living after stroke. Cochrane Database Syst Rev 2008; 8: CD006876.
- Fournier M, editor. The medico-mechanical equipment of Doctor Zander. Leiden: Museum Boerhave; 1989.
- Wevers L, van de Port I, Vermue M, Mead G, Kwakkel G. Effects of task-oriented circuit class training on walking competency after stroke: a systematic review. Stroke 2009; 40: 2450–2459.
- Hesse S, Schulte-Tigges G, Konrad M, Bardeleben A, Werner C. Robot-assisted arm trainer for the passive and active practice of bilateral forearm and wrist movement in hemiparetic subjects. Arch Phys Med Rehabil 2003; 84: 915–920.
- Hesse S, Kuhlmann H, Wilk J, Tomelleri C, Kirker SGB. A new electromechanical trainer for sensorimotor rehabilitation of paralysed fingers: a case series in chronic and acute stroke patients. J Neueroeng Rehabil 2008; 5: 21–26.
- Hesse S, Werner C, Pohl M, Mehrholz J, Puzich U, Krebs HI. Mechanical arm trainer for the treatment of severely affected arm after stroke: a single-blinded randomized trial in two centres. Am J Phys Med Rehabil 2008; 87: 779–788.
- Renner CIE, Woldag H, Atanasova R, Hummelsheim H. Change of facilitation during voluntary bilateral hand activation after stroke. J Neurol Sci 2005; 239: 25–30.
- Staines WR, McIllroy WE, Graham SJ, Black SE. Bilateral movement enhances ipsilesional cortical activity in acute stroke: a pilot functional MRI study. Neurology 2001; 56: 401–404.
- Muellbacher W, Richards C, Ziermann U, Wittenberg G, Weltz D, Boroojerdi B, et al. Improving hand function in chronic stroke. Arch Neurol 2002; 59: 1278–1282.
- Bütefisch C, Hummelsheim H, Denzler P, Mauritz KH. Repetitive training of isolated movements improves the outcome of motor rehabilitation of the centrally paretic hand. J Neurol Sci 1995; 130: 59–68.
- Higgins J, Salbach NM, Wood-Dauphinee S, Richards CL, Côté R, Mayo NE. The effect of a task-oriented intervention on arm function in people with stroke: a randomized controlled trial. Clin Rehabil 2006; 20: 296–310.
- Lange R, Nowak H, Haueisen J, Weiller C. Passive finger movement evoked fields in magnetoencephalography. Exp Brain Res 2001; 136: 194–199.
- Lotze M, Braun C, Birbaumer N, Anders S, Cohen LG. Motor learning elicited by voluntary drive. Brain 2003; 126: 866–872.
- Duncan PW, Lai SM, Keighley J. Defining post-stroke recovery: implications for design and interpretation of drug trials. Neuropharmacology 2000; 39: 835–841.
View at PubMed