Publication: The impact of robotic rehabilitation on mid-thigh and calf circumferences and functional outcomes of stroke patients
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Date
2022
Authors
Nawi, Nur Fasihah Mat
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Abstract
Stroke has emerged as the global leading cause of disability in many countries, including Malaysia. Inadvertently, due to the escalating numbers of stroke survivors, poses a burden affecting economic and social well-being in these countries. Adjunct robotic treatment has created a major turning point in stroke rehabilitation in improving stroke survivors' functional status and quality of life. Therefore, this study aimed to assess the impact of robotic rehabilitation on the mid-thigh and calf circumferences and functional outcomes of stroke patients. In this prospective cohort study, stroke patients were divided into conventional rehabilitation (CR) (n=10) and robotic rehabilitation (RR) (n=10) groups by using the purposive sampling method. The managing team pre-planned eligibility into the CR and RR as standard practice. The CR received a five-day-a-week home-based rehabilitation program, with the duration of two hours per day divided into two sessions, and three sessions of rehabilitation at the tertiary centre for four weeks. The program includes muscle strengthening, balance, mobility exercise, functional physiotherapy and occupational therapy. RR received a one-hour traditional conventional physiotherapy and occupational therapy program and one hour of robotic therapy program by using the HALĀ® Cyberdyne lower-limb, for five days a week. Outcome measures were the mid-thigh circumferences, calf circumferences, Functional Ambulation Categories (FAC), 6-Minute Walk Test (6MWT) and World Health Organization Quality of Life Brief Version (WHOQOL-BREF) questionnaire. For data analysis, repeated measures analysis of variance was used. A total of 20 participants completed the study. The median age was 46.50 (17) years old, predominant male (65%), with ischaemic stroke in origin (90%), and 60% of participants in the overweight in the Body mass index (BMI) category. The median stroke onset duration was 4.00(3.50). A significant time effect was observed in the RR groups. There is a significant increment of the paretic mid-thigh circumferences between the baseline and week 2 and baseline and week 4 timeframe (p<0.05). On the normal side of the mid-thigh circumferences, significant time effects were between baseline to week 4 (p<0.05). The average means of mid- thigh circumferences after four weeks of therapy were significantly different between CR and RR groups (F1,18 = 12.49, p=0.02). For the calf circumferences, a significant time effect (p<0.05) was observed between baseline and week 4 and week2 to week 4 on the normal side. While the paretic side showed a significant time effect within all study periods (p<0.05). Both groups showed improvement in the FAC and 6MWD (p<0.05). Improvements were seen more in RR by week 4 as even though RR starts from a lower baseline, by week4, RR was able to overtake the CR in the FAC and 6MWD. It is concluded that ART has shown significant effects on the mid-thigh and calf circumferences and functional outcomes of stroke patients. However, larger sample size and more specific study targeting the muscle mass should be considered to strengthen the evidence.
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