The Effect of Robot-Assisted Upper Extremity Rehabilitation on Motor Functions, Shoulder Pain, Cognitive Functions and Glenohumeral Subluxation in Patients With Early Subacute Stroke
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- 入组人数
- 36
- 试验地点
- 1
- 主要终点
- Fugl-Meyer Motor Assessment Scale
研究概览
简要总结
The goal of this randomized controlled clinical trial is to investigate the efficacy and safety of adding robot-assisted upper extremity therapy to conventional rehabilitation in patients with early subacute stroke.The primary objective is to evaluate whether integrating an upper extremity exoskeleton robot (ArmeoPower) with standard conventional therapy yields superior improvements compared to conventional physiotherapy alone. The study investigates outcomes across multiple clinical domains, including upper extremity motor functions, muscle tone/spasticity, hemiplegic shoulder pain, cognitive functions, glenohumeral subluxation, and overall functional independence in daily living activities.A total of 36 eligible stroke participants are randomly allocated into two parallel groups in a 1:1 ratio:Control Group (Conventional Therapy): Participants receive 30 sessions of conventional neurorehabilitation (40 minutes per session, 5 days per week for 6 weeks).Intervention Group (Robotic Therapy): Participants receive a combined protocol consisting of 20 sessions of conventional physiotherapy and 10 sessions of robot-assisted training (20 minutes per session, 2-3 times per week), completing a total of 30 intervention sessions over a 6-week period.Detailed clinical, functional, and structural assessments are conducted for all participants at baseline (pre-intervention) and immediately following the completion of the 6-week treatment protocol (post-intervention) to analyze within-group and between-group changes.
详细描述
Background and Rationale:Upper extremity hemiparesis, shoulder pain, and glenohumeral subluxation are highly prevalent complications following a stroke, severely limiting activities of daily living and overall functional independence. The early subacute period represents a critical therapeutic window characterized by peak neuroplasticity and spontaneous recovery. Standard conventional rehabilitation involves targeted techniques like Bobath, Brunnstrom, and Proprioceptive Neuromuscular Facilitation (PNF). However, achieving the necessary movement repetition and intensity remains a clinical challenge. Integrating robot-assisted training, such as the ArmeoPower exoskeleton system, provides intensive, highly repeatable, goal-oriented, and gamified sensorimotor training with real-time feedback. While literature focuses mostly on motor outcomes, comprehensive trials combining motor, pain, cognitive, and structural shoulder subluxation evaluations in the early subacute phase are scarce. This study aims to investigate whether adding robot-assisted upper extremity therapy to conventional rehabilitation yields superior clinical outcomes compared to conventional therapy alone.
Methodology and Randomization:This is a prospective, randomized, controlled clinical trial. A total of 36 eligible individuals with early subacute stroke and concurrent shoulder pain will be enrolled and randomly allocated in a 1:1 ratio into two parallel groups: the Robotic Therapy Group (n=18) and the Conventional Therapy Group (n=18). Randomization and allocation will be performed to minimize bias. To ensure the methodological rigor and minimize evaluation bias, the statistical analysis will be performed by a blinded biostatistician who is completely unaware of the group assignments, treatment allocations, and clinical outcomes.
Study Interventions:Conventional Therapy Group (Control): Participants will receive 30 sessions of conventional neurorehabilitation (40 minutes per session, 5 days a week for 6 weeks) incorporating neurodevelopmental techniques (Bobath, PNF, Brunnstrom), range of motion, stretching, and strengthening exercises.Robotic Therapy Group (Intervention): Participants will receive a combination of 20 sessions of conventional therapy and 10 sessions of robot-assisted training using the ArmeoPower exoskeleton system (20 minutes per session, 2-3 times per week), totaling 30 intervention sessions over 6 weeks.
Assessments:Detailed clinical and functional assessments will be conducted at baseline (pre-intervention) and immediately following the 6-week treatment protocol (post-intervention). Evaluated domains include upper extremity motor function, spasticity/muscle tone, shoulder pain severity, cognitive function, structural shoulder subluxation, and functional independence.
Note on Protocol Amendment and Ethics Approval:Following the thesis defense examination, a minor amendment to the study title was requested by the thesis jury. This title amendment was officially reviewed and approved by the Ankara Bilkent City Hospital Medical Research Ethics Committee (TABED). The initial institutional ethics approval was granted under number [TABED 1/1994/2025], and the subsequent approved title amendment was issued under the new approval number [TABED 1/2862/2026] on [01/07/2026]. Due to character limitations in the system's board approval field, the most recent amendment approval number has been entered.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Single (Outcomes Assessor)
入排标准
- 年龄范围
- 35 Years 至 70 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Stroke history between 2-4 weeks
- •No prior stroke
- •Age between 35-70 years
- •No prior diagnosis of orthopedic upper extremity disease or orthopedic upper extremity surgery
- •No prior diagnosis of neurological disease
- •Cognitive status suitable for rehabilitation
- •At a supported sitting level for the treatment group
- •Having shoulder pain as assessed by the Brief Pain Inventory before the study
排除标准
- •More than 1 month having passed since the stroke
- •Having experienced more than one stroke
- •Having a prior diagnosis of Impingement syndrome, Frozen shoulder, Rotator cuff injury
- •Having a prior diagnosis of Alzheimer's, Dementia, Parkinson's disease
- •Failure to provide the necessary participation in evaluation and treatment within the scope of the study
- •Suffering a second stroke during the study process
- •Discharge before completing the study process
- •Lack of willingness to participate in the study
- •Loss of voluntary participation in the study
研究组 & 干预措施
The Conventional Therapy Group
Participants in this group receive 30 sessions of standard conventional neurorehabilitation over a 6-week period.
干预措施: Conventional Physiotherapy (Other)
The Robotic Therapy Group
Participants in this group receive a combined protocol consisting of 20 sessions of conventional physiotherapy and 10 sessions of robot-assisted upper extremity training, totaling 30 sessions over a 6-week period.
干预措施: Robot-Assisted Upper Extremity Therapy (Device)
The Robotic Therapy Group
Participants in this group receive a combined protocol consisting of 20 sessions of conventional physiotherapy and 10 sessions of robot-assisted upper extremity training, totaling 30 sessions over a 6-week period.
干预措施: Conventional Physiotherapy (Other)
结局指标
主要结局
Fugl-Meyer Motor Assessment Scale
时间窗: Baseline and 6 weeks
The Fugl-Meyer Motor Assessment Scale reflects the stages of motor development. Each item in the assessment is scored out of 2 points. Each parameter is scored as follows: 0: Failure, 1: Partially successful performance, 2: Completely successful performance. The maximum achievable upper extremity motor performance score is 66 points. In upper extremity assessment, 53-66 points indicate full capacity, 48-52 points indicate sufficient capacity, 32-47 points indicate limited capacity, and 31 points and below indicate poor capacity. The Fugl-Meyer Motor Assessment Scale (FMAS) evaluates upper extremity motor function totals 66 points, with a maximum of 36 points for the upper arm, 10 points for the wrist, 14 points for the hand, and 6 points for coordination. A high score indicates good motor function. In our study, only the FMAS upper extremity motor function score was used to evaluate upper extremity motor functions.
Brunnstrom Motor Assessment
时间窗: Baseline and 6 weeks
This is a test that evaluates the motor development of hemiplegic individuals. In this test, the recovery process of a hemiplegic individual is defined in six stages. According to this staging, the lowest stage is stage I (flaccid, lack of voluntary movement), and the highest stage is stage VI (isolated joint movement). The upper extremity, lower extremity, and hand are evaluated separately. Higher Brunnstrom stages indicate better motor development.
Modified Ashworth Scale
时间窗: Baseline and 6 weeks
Muscle tone was assessed using the Modified Ashworth Scale (MAS). MAS is an updated version of the Ashworth Scale, first described by Ashworth in 1964 to measure the increase in muscle tone. This scale evaluates the resistance during passive movement of an extremity on a scale of 6 points (0, 1, 1+, 2, 3, 4) from 0 to 4. Although its validity and reliability are debated due to the lack of guidelines regarding positioning and application, MAS is widely used today in the assessment of spasticity because it does not require any tools and is easy to apply. The tone of the shoulder flexor and adductor, elbow flexor, wrist, and finger flexor muscles in the upper extremity of the individuals included in the study was assessed according to their MAS. All muscle groups were scored according to their MAS after a single, rapid, passive stretch, starting from their shortest position.
Brief Pain Inventory
时间窗: Baseline and 6 weeks
It uses numerical rating scales from 0 to 10. The BPI scale defines pain as follows: 1 - 4 = Mild Pain, 5 - 6 = Moderate Pain, 7 - 10 = Severe Pain. Since pain can vary significantly throughout the day, the BPI asks patients to rate their pain at the time they respond to the questionnaire. In addition, the questionnaire asks the participant to indicate the worst, least, and average pain in the previous week. "0 = no interference; 10 = completely interferes". The BPI evaluates pain by dividing it into 2 subheadings: pain intensity and interference of pain with daily functioning. Pain intensity is calculated by averaging the worst, least, average, and current pain scores, which are queried between items 3 and 6. Interference of pain with daily functioning is calculated by averaging 7 items that assess interference with general activity, mood, walking ability, normal work, relationships, sleep, and enjoyment of life. In the study, patients were questioned about shoulder pain.
Montreal Cognitive Assessment Test
时间窗: Baseline and 6 weeks
MoCA was developed as a rapid screening test for mild cognitive impairment. MoCA assesses various cognitive functions, including attention and concentration, executive functions, memory, language, visualization skills, abstract thinking, calculation, and orientation. The MoCA takes approximately 10 minutes to administer. The maximum possible total score is 30. Therefore, a score of 21 or higher is considered normal.
Finger Width Palpation Method
时间窗: Baseline and 6 weeks
This is a palpation technique used by clinicians to determine whether shoulder subluxation is actually present. The space between the acromion and the humeral head is palpated to determine how many finger widths can fit into it. The number of fingers is related to a subluxation grading system. The grading increases with the amount of subluxation. A 0-5 grading scheme is used: 0: No subluxation 1. ½ finger width space 2. 1 finger width space 3. 1½ finger width space 4. 2 finger width space 5. 2½ finger width space
Functional Independence Measure (FIM)
时间窗: Baseline and 6 weeks
This scale helps identify and classify cognitive and motor disabilities, and determines independence in daily life. It is a measure that assesses a person's performance in daily living activities. It consists of two sections: motor function and cognitive function. Items are scored from 1 to 7 (1 = full assistance, 7 = full independence). The total score ranges from 18 to 126. A score of 18 indicates complete dependence, while a score of 126 indicates complete independence.
次要结局
未报告次要终点
研究者
HALE ÖZDEMİR
Principal Investigator
Ankara Bilkent Sehir Hastanesi