Effect of upper-limb robot-assisted therapy combined with pneumatic gloves on upper limb function in young and...

This study aimed to evaluate the effects of an end-effector-type upper-limb robot-assisted therapy (UL-RAT) combined with pneumatic gloves (PGs) on improving upper limb function in young and middle-aged stroke patients.

Forty young and middle-aged stroke patients were recruited and randomized into two groups, including a UL-RAT&PG group and a control group, with 20 cases in each group. The control group received conventional upper limb occupational therapy once a day, 5 days a week, for a total of 4 weeks. The UL-RAT&PG group received the combination of UL-RAT and PGs once a day, 5 days a week, for a total of 4 weeks. To evaluate their upper limb function, the primary assessment indices were the Fugl-Meyer assessment extremities (FMA-UE) and Action Research Arm Test (ARAT), and the secondary assessment indices included the Canadian Occupational Performance Measure (COPM), modified Ashworth Scale (MAS), National Institutes of Health Stroke Scale (NIHSS), and modified Barthel index (MBI). To assess brain plasticity, Quantitative electroencephalogram (qEEG) and diffusion tensor imaging (DTI) were performed. Additionally, Enzyme-linked immunosorbent assay (ELISA) and quantitative reverse transcription polymerase chain reaction (qRT-PCR) assay were conducted to evaluate serum brain-derived neurotrophic factor (BDNF) and microRNA-132 (miRNA-132) levels. Finally, the Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), and Exercise Adherence Questionnaire Scale (EAQ) were used to assess patients' emotional states and compliance with the therapy.

After treatment, both groups showed significantly greater improvements in upper limb function. The FMA-UE, ARAT, COPM-executive ability, COPM-satisfaction, and MBI scores of the UL-RAT&PG group were 52.30 ± 1.94, 47.65 ± 7.41, 4.61 ± 1.86, 5.92 ± 1.65, and 87.10 ± 11.11, that all considerably higher than those of the control group (38.6 ± 16.97, 29.90 ± 15.39, 3.39 ± 1.66, 3.61 ± 1.67, and 69.95 ± 17.62), and their NIHSS scores were 1.75 ± 1.12, significantly lower than those of the control group (3.70 ± 1.63). DTABR scores and corticospinal tract (CST) morphology showed positive changes in both groups, indicating an improvement in brain plasticity. The serum BDNF and miRNA-132 levels of both groups were markedly higher than before treatment. In addition, SAS and SDS scores of the control group were 34.55 ± 8.48 and 45.25 ± 12.01, and = UL-RAT&PG groups were 37.85 ± 5.72 and 38.70 ± 8.99, all significantly lower than those before treatment (37.85 ± 9.92 and 49.95 ± 12.59, 42.95 ± 7.62 and 46.10 ± 11.29), indicating that their negative emotions have alleviated. However, the above results of serum BDNF, miRNA-132, SAS, and SDS had no statistical difference between the two groups. Notably, compared to the control group (49.95 ± 12.59), patients in the UL-RAT&PG group had a higher EAQ score (46.10 ± 11.29), indicating better exercise compliance.

The combination of the UL-RAT and PGs can significantly improve upper limb function, compliance, serum BDNF, and serum miRNA-132, and attenuate depression and anxiety in young and middle-aged stroke patients. Trial registration The study was registered on the Chinese Clinical Trial Registry (ChiCTR2500097887).