Wrist Robot-Assisted Rehabilitation Treatment in Subacute and Chronic Stroke Patients: From Distal-to-Proximal Motor Recovery

In this paper, the recovery of proximal and distal segments in stroke patients who received distal training alone was investigated. Forty (20 subacute and 20 chronic) stroke patients were recruited to perform wrist robot-assisted rehabilitation training. The upper extremity, shoulder-elbow, and wrist subsections of the Fugl-Meyer assessment scale were used to assess the motor recovery of distal and proximal segments. In addition, the modified Ashworth scale, motricity index, and box and block test were used as clinical outcome measures together with kinematic parameters to evaluate the effects of the training. Significant increases in the wrist and shoulder-elbow subsections of the Fugl-Meyer assessment scale, motricity index, and box and block test were found in both the groups. Average changes in shoulder-elbow and upper extremity subsections of the Fugl-Meyer assessment scale in the subacute group (6.10 +/- 6.60 and 15.65 +/- 14.04) were significantly higher (p < 0.05)than those in the chronic group (2.30 +/- 2.76 and 6.60 +/- 4.64). In addition, significant increases in the movement velocity, movement smoothness, and movement quality were observed in the subacute group. Our findings provide evidence that following a robot-assisted rehabilitation treatment, there is a distal-to-proximal generalization in subacute stroke patients.