Effect of Robot-Assisted Hand Rehabilitation on Hand Function in Chronic Stroke Patients

손 재활 로봇의 적용이 만성 뇌졸중 환자의 손 기능 향상에 미치는 영향

  • Park, Jin-Hyuck (Dept. of Occupational therapy, Seoul St. Mary's Hospital)
  • Received : 2013.08.01
  • Accepted : 2013.10.11
  • Published : 2013.11.30


The purpose of this study was to investigate effect of robot-assisted hand rehabilitation(Amadeo(R)) on hand motor function in chronic stroke patients. This study used a single-subject experimental design with multiple baselines across individuals. Three chronic stroke survivors with mild to sever motor impairment took part in study. Each participants had 2 weeks interval of starting intervention. Participants received robot-assisted therapy(45min/session. 3session/wk for 6wks). Finger active range of motion(AROM) was assessed by Range of Assessment program in Amadeo(R), and test-retest reliability was verified using Pearson correlation analysis. To investigate effect of Amadeo(R), finger AROM was measured immediately after each sessions and Fugl-Meyer Assessment of Upper extremity, Motor Activity Log, Nine hole peg board test and Jebsen-Taylor hand motor function test were assessed at pre-post intervention. Results were analyzed by visual analysis and comparison of pre-post tests. The test-retest reliability of Range of Assessment was good(r=.99). After robot-assisted therapy, finger AROM of participant 1, 2, and 3 was respectively improved by 18%, 3.6%, and 6% each. Hand motor function of participant 1, 3 was improved on all four tests, but not effect in participant 2. Robot-assisted hand rehabilitation could improve finger AROM and effect on hand motor function in chronic stroke patients.



  1. V.M. Parker, D.T. Wade, R.L. Hewer, "Loss of arm function after stroke: Measurement, frequency, and recovery", International Rehabilitation Medicine, Vol. 8, No. 2, pp 69-73, 1986.
  2. T.S. Oslen, "Arm and leg paresis as outcome predictors in stroke rehabilitation", Stroke, Vol. 21, No. 2, pp. 247-251, 1990.
  3. B.B. Johansson, "Current trends in stroke rehabilitation. A review with focus on brain plasticity", Acta Neurologica Scandinavica, Vol. 123, No. 3, pp. 147-159, 2011.
  4. C. Butefisch, H. Hummelsheim, P. Denzler, K.H. Mauritz, "Repetitive training of isolated movements improves the outcome of motor rehabilitation of centrally paretic hand", Journal of Neurological Science, Vol. 130, No. 1, pp. 59-68, 2005.
  5. J. Carey, T. Kimberley, S. Lewis, F. Auebach, L. Dorsey, P. Rundquis, "Analysis of fMRI and finger tracking training in subjects with chronic stroke", Brain, Vol. 125, No. 4, pp. 773-788, 2002.
  6. E. Taub, N.E. Miller, T.A. Novack, E.W. Cook, W.C. Fleming, C.S. Nepomuceno, "Technique to improve chronic motor deficit after stroke", Archives of Physical Medicine and Rehabilitation, Vol. 74, No. 4, pp. 347-354, 1993.
  7. C. Takahashi, L. Der-Yeghiaian, V. Le, S.C. Cramer, "Robot-based hand motor therapy after stroke", Brain, Vol. 131, No. 2, pp. 425-437, 2008.
  8. S.L. Wolf, C.J. Winstein, J.P. Miller, E. Taub, G. Uswatte, D. Morris, "Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: the EXCITE randomized clinical trial", Journal of the American Medical Association, Vol. 296, No. 17, pp. 2095-2104, 2006.
  9. P.S. Lum, C.G. Burgar, P.C. Shor, M. Majmundar, M. Van der Loos, "Robot-assisted movement training compared with conventional therapy techniques for the rehabilitation of upper limp motor function after stroke", Archives of Physical Medicine and Rehabilitation, Vol. 83, No. 7, pp. 951-959, 2002.
  10. C.G. Bugar, P.S. Lum, P.C. Shor, H.F. Machiel Van der Loos, "Development of robots for rehabilitation therapy: The Palo Alto VA/Stanford experience", Journal of Rehabilitation Research and Development, Vol. 37, No. 3, pp. 663-673, 2000.
  11. B.H. Dobkin, "Strategies for stroke rehabilitation", Lancet Neurology, Vol. 3, No. 9, pp. 528-536, 2004.
  12. S.E. Fasoli, H.I. Krebs, J. Stein, N. Hogan, "Robotic technology and stroke rehabilitation: Translating research into practice", Topic in Stroke Rehabilitation, Vol. 11, No, 4, pp. 11-19, 2004.
  13. D. Reinkensmeyer, J. Emken, S. Cramer, "Robotics, motor learning, and neurologic recovery", Annual Review of Biomedical Engineering, Vol. 6, pp. 497-525, 2004.
  14. B.T. Volpe, M. Ferraro, D. Lynch, P. Christos, J. Krol, C. Trudell, "Robotics and other devices in the treatment of patients recovering from stroke", Current Neurology and Neuroscience Reports, Vol. 5, No. 6, pp. 465-470, 2005.
  15. G.B. Prange, M.J. Jannink, C.G. Groothuis-Oudshoorn, H.J. Hermens, M.J. Ijzerman, "Systematic review of the effect of robot-aided therapy on recovery of the hemiparetic arm after stroke", Journal of Rehabilitation Research and development, Vol. 43, No. 2, pp. 171-184, 2006.
  16. M.L. Aisen, H.I. Krebs, N. Hogan, F. McDowell, B.T. Volpe, "The effect of robot-assisted therapy and rehabilitative training on motor recovery following stroke", Archives of Neurology, Vol. 54, No. 4, pp. 443-446, 1997.
  17. M. Ferraro, J.J. Palazzolo, J. Krol, H.I. Krebs, N. Hogan, B.T. Volpe, "Robot-aided sensorimotor arm training improves outcome in patients with chronic stroke", Neurology, Vol. 61, No. 11, pp. 1604-1607, 2003.
  18. L.E. Kahn, P.S. Lum, W.Z. Rymer, D.J. Reinkensmeyer, "Robot-assisted movement training for the stroke-impaired arm: Does it matter what the robot does?", Journal of Rehabilitation Research & Development, Vol. 43, No. 5, pp. 619-630, 2006.
  19. H.I. Krebs, B.T. Volpe, M. Ferraro, S. Fasoli, J. Palazzolo, B. Rohrer, "Robot-aided neuro-rehabilitation: From evidence-based to science- based rehabilitation", Topics in Stroke Rehabilitation, Vol. 8, No. 4, pp. 54-70, 2002.
  20. S. Hesse, H. Schmidt, C. Werner, A. Bardeleben, "Upper and lower extremity robotic devices for rehabilitation and for studying motor control", Current Opinion in Neurology, Vol. 16, No. 6, pp. 705-710, 2003.
  21. C.H. Hwang, J.W. Seong, D.S. Son, "Individual finger synchronized robot-assisted hand rehabilitation in subacute-chronic stroke: a prospective randomized clinical trial of efficacy", Clinical Rehabilitation, Vol. 26, No. 8, pp. 696-704, 2012.
  22. P. Sale, V. Lombardi, M. Franceschini, "Hand robotics rehabilitation: feasibility and preliminary results of a robotic treatment in patient with hemiparesis", Stroke Research and Treatment, Vol. 2012, Article ID: 820931, 2012.
  23. K.H. Jung, H.G. Ha, H.J. Shin, S.H. Ohn, D.H. Sung, K.W. Lee, Y.H. Kim, "Effect of robot-assisted gait therapy on locomotor recovery in stroke patients", Korean Academy of Rehabilitation Medicine, Vol. 32, No. 3, pp. 258-266, 2008.
  24. P.W. Duncan, L. Goldstein, D. Matchar, G. Divine, J. Feussner, "Measurement of motor recovery after stroke: Outcome assessment and sample size requirement", Stroke, Vol. 23, No. 8, pp. 1084-1089, 1992.
  25. H. Nakayama, H.S. Jorgenson, H.O. Raaschou, T.S. Oslen, "Compensation in recovery of upper extremity function after stroke: The copenhagen stroke study", Archives of Physical Medicine and Rehabilitation, Vol. 75, No. 8, pp. 852-857, 1994.
  26. SMEDEA Co., Ltd, "Professional Rehabilitation Catalog", Seoul, 2010.
  27. C.A. Tromboly, M.V. Radomski, "Occupational Therapy for Physical Dysfunction (5th ed.)", Baltimore: Lippncott Williams & Wilkins, 2002.
  28. A.R. Fugl-Meyer, L. Jaasko, I. Leyman, S. Olsson, S. Steglind, "The post-stroke patient. 1. a method for evaluation of physical performance", Scandinavian Journal of Rehabilitation Medicine, Vol. 7, No. 1, pp. 13-31, 1975.
  29. J. Stanford, J. Moreland, L.R. Swanson, P.W. Stratford, C. Gowland, "Reliability of the Fugl-Meyer Assessment for testing motor performance in patients following stroke", Physical Therapy, Vol. 73, No. 7, pp. 447-454, 1993.
  30. S.J. Page, P. Levine, S. Sisto, Q. Bond, M.V Johnston, "Stroke patient's and therapist's opinions of constraint-induced movement therapy", Clinical Rehabilitation, Vol. 16, No. 1, pp. 55-60, 2002.
  31. J.H. van der Lee, H. Beckerman, D.L. Knol, H.C. de Vet, L.M. Bouter, "Clinimetric properties of motor activity log for the assessment of arm use in hemiparetic patients", Stroke, Vol. 35, No. 6, pp. 1410-1414, 2004.
  32. G. Uswatte, E. Taub, D. Morris, K. Ligth, P.A. Thompson, "The Motor Acitivity Log-28: Assessing daily use of the hemiparetic arm after stroke", Neurology, Vol. 67, No. 7, pp. 1189-1194, 2006.
  33. A. Mitchell, S. Muniz, M.A. Vollmer, "Adult norm for a commercially available Nine Hole Peg Test for finger dexterity", American Journal of Occupational Therapy, Vol. 57, No. 3, pp. 570-574, 2003.
  34. R.H. Jebsen, N. Taylor, R.B. Trieschmann, M.J. Trotter, L.A. Howard, "An objective and standardized test of hand function", Archives of Physical Medicine and Rehabilitation, Vol. 50, No. 6, pp. 311-319, 1969.
  35. S.K. Charles, H.I. Krebs, B.T. Volpe, D. Lynch, N. Hogan, "Wrist rehabilitation following stroke: Initial clinical results", Chicago: Omnipress, 2005.
  36. S. Hesse, H. Kuhlmann, J. Wilk, C. Tomelleri, S.G. Kirker, "A new electromechanical trainer for sensorimotor rehabilitation of paralysed fingers: a case series in chronic and acute stroke patients", Journal of Neuroengineering and rehabilitation, Vol. 5, pp. 21-26, 2008.
  37. S. Adamovich, A. Merians, R. Boian, M. Recce, M. Tremanine, H. Poizner, "A virtual reality based exercise system for hand rehabilitation post-stroke: transfer to function", Conf Proc IEEE Eng Med Biol Soc, Vol. 7, pp. 4936-4939, 2004.
  38. V. Brooks, S. Stoney, "Motor mechanisms: The role of the pyramidal system in motor control", Annual Review of Physiology, Vol. 33, No. 1, pp. 337-392, 1971.
  39. D. Humphrey, E. Schmidt, W. Thompson, "Predicting measures of motor performance from multiple cortical spike trains", Science, Vol. 170, No. 3959, pp. 758-762, 1970.
  40. F. Miles, E. Evart, "Concepts of motor organization", Annual Review of Psychology, Vol. 30, No. 1, pp. 327-362, 1979.
  41. D. Waldvogel, P. van Gelderen, K. Ishii, M. Hallett, "The effect of movement amplitude on activation in functional magnetic resonance imaging studies", Journal of Cerebral Blood Flow and Metabolism, Vol. 19, No. 11, pp. 1209-1212, 1999.
  42. C.E. Cruze, S.L. DeJong, J.A. Beebe, "Use of a novel robotic interface to study finger motor control", Annals of Biomedical Engineering, Vol. 38, No. 2, pp. 259-268, 2009.
  43. E.B. Brokaw, I. Black, R.J. Holley, P.S. Lum, "Hand Spring Operated Movement Enhancer (HandSOME): A portable, passive hand exoskeleton for stroke rehabilitation", IEEE Transactions on Neural Systems and Rehabilitation Engineering, Vol. 19, No. 4, pp. 391-399, 2011.
  44. J. Stein, L. Bishop, G. Gillen, R. Helbok, "Robot-Assisted Exercise for Hand Weakness After Stroke: A Pilot Study", American Journal of Physical Medicine & Rehabilitation, Vol. 90, No. 11, pp. 887-894, 2011.

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