Efficacy of Upper Extremity Robotic Therapy in Subacute Poststroke Hemiplegia: An Exploratory Randomized Trial.

BACKGROUND AND PURPOSE: Our aim was to study the efficacy of robotic therapy as an adjuvant to standard therapy during poststroke rehabilitation. METHODS: Prospective, open, blinded end point, randomized, multicenter exploratory clinical trial in Japan of 60 individuals with mild to moderate hemiplegia 4 to 8 weeks post stroke randomized to receive standard therapy plus 40 minutes of either robotic or self-guided therapy for 6 weeks (7 days/week). Upper extremity impairment before and after intervention was measured using the Fugl-Meyer assessment, Wolf Motor Function Test, and Motor Activity Log. RESULTS: Robotic therapy significantly improved Fugl-Meyer assessment flexor synergy (2.1±2.7 versus -0.1±2.4; P<0.01) and proximal upper extremity (4.8±5.0 versus 1.9±5.5; P<0.05) compared with self-guided therapy. No significant changes in Wolf Motor Function Test or Motor Activity Log were observed. Robotic therapy also significantly improved Fugl-Meyer assessment proximal upper extremity among low-functioning patients (baseline Fugl-Meyer assessment score <30) and among patients with Wolf Motor Function Test ≥120 at baseline compared with self-guided therapy (P<0.05 for both). CONCLUSIONS: Robotic therapy as an adjuvant to standard rehabilitation may improve upper extremity recovery in moderately impaired poststroke patients. Results of this exploratory study should be interpreted with caution. CLINICAL TRIAL REGISTRATION: URL: http://www.umin.ac.jp/. Unique identifier: UMIN000001619.

Flow volume and cross-sectional area of the extracranial vertebral arteries and its relation to vascular lesions or anatomical variations in the posterior circulation.

We examined whether the time-averaged maximum velocity (TAMV), flow volume (FV) or cross-sectional area (CA) in the vertebral arteries (VA) as determined by ultrasonography was related to vascular lesions or variations in the intracranial part of the posterior circulation. Three hundred nine patients without severe stenosis in the carotid circulation (159 males, 150 females, mean age of 69.1 years) underwent both colour duplex ultrasonography and magnetic resonance angiography (MRA) and were thus analyzed. According to the MRA findings, the patients were divided as follows; 22 patients with severe stenosis in the bilateral PCA or VA or basilar artery (V group) and 287 patients without (N group). The N group was then further divided as follows; 144 patients with no (P0 group); 89 with one (P1) and 54 with both posterior communicating arteries (P2) detected on MRA. TAMV, FV and CA were compared among these groups. Both TAMV and FV of V group were significantly lower than those of N group (35.3 vs. 42.6 cm/sec in TAMV, 98.2 vs. 135.3 mL/min in FV, p < 0.001 and 0.0001, respectively). The FVs and CAs in the P0 through P2 groups were all significantly different according to the number of posterior communicating arteries (149.3 vs. 128.0 vs. 109.8 mL/min, 22.5 vs. 20.2 vs. 16.5 mm2, both p < 0.001) while TAMVs in these groups did not differ substantially. The FV in both VAs were thus found to be related to the vascular lesions or variations in the posterior circulation.