Effectiveness of Gravity supported, Computer enhanced Exoskeleton to Promote Recovery of Upper Limb Function for Patients after Stroke “ A randomized control study

Recovery of the impaired upper limb is a crucial felt need and priority for these patients. Hemiparetic upper limb rehabilitation usually focus on compensatory strategies that use the intact upper limb to compensate for the impaired upper limb. With the understanding of neuroplasticity after acquired brain  injury, several new therapies such as  conventional occupational therapy methods, constraint-induced movement therapy (CIMT),  mirror therapy, functional electrical stimulation, mental practice and  virtual reality augmentation  focus on improving the neurologic recovery of the impaired upper limb.

Recently, robot-assisted therapy (RAT), a technology-based rehabilitation approach, which offers high-intensity, highly repetitive, task-specific UL training with real-time  feedback has been reported as an effective strategy in UL rehabilitation. The ArmeoSpring is a passive instrumented arm orthosis with a spring mechanism for adjustable arm weight support in a 3D workspace, and is helpful for patients who have restricted functions in their upper extremities due to various neurological disorders. Partial relief of the upper limb’s weight and mechanical-assisted therapy in a virtual workspace enables the  patient to produce a larger ROM within a 3-dimensional workspace. This enables repetitive and active exertion of goal-directed movements, with enlarged ROM  during the practice of complex motor tasks in an enriched learning environment.

In this randomized controlled study, we aim to study the effectiveness of technology enhanced rehabilitation of the upper limb using Armeospring  in sub acute and chronic  stroke patients who have been admitted for inpatien rehabilitation. Patients will be randomized to two groups. The intervention group will receive  ten technology enabled  upper limb training sessions using a gravity supported computer enhanced exoskeleton( Armeospring), while the control group will receive ten sessions of gravity eliminated exercises for the upper limb in the form of horizontal and vertical reach activities, with the exoskeleton fitted, but without activating the technology.  Both groups will also receive the standard conventional therapy. Both the patient and assessors will be blinded to the intervention. Pre and post-exposure, various motor and functional outcome measures will be assessed and analyzed statistically.  The outcomes   will be compared between those with subacute stroke vs chronic stroke, age<40 years vs > 40 years and mild upper extremity impairment vs moderate to severe impairment. The study will also compare the outcomes in patients who receive 10 sessions of Armeospring and a subset of patients who receive 20 sessions of therapy using Armeospring. The perception of patients undergoing treatment with Armeospring will also be studied using the  Patient Global perception of change score.