Forearm- and Wrist-Prioritized Robotic Therapy in Stroke Rehabilitation: A Clinical Trial With 3-Month Follow-Up

To compare the efficacy of forearm- and wrist-prioritized robotic training on upper extremity motor recovery in individuals with stroke.

Randomized controlled trial.

Four outpatient rehabilitation clinics.

Thirty individuals with stroke were randomized to either a forearm-prioritized robotic training group (n=15) or a wrist-prioritized robotic training group (n=15).

Participants in both groups received 45 minutes of robotic training and 45 minutes of impairment-oriented training per session, 3 times per week for 6 weeks. The forearm-prioritized group initiated robotic training with the forearm practice module of the Bi-Manu-Track robotic device, followed by the wrist module. In contrast, the wrist-prioritized group began with the wrist module and then proceeded to the forearm module.

The Fugl-Meyer assessment for Upper Extremity and Medical Research Council scale before, immediately after, and 3 months after treatment, as well as Wolf Motor Function Test and Stroke Impact Scale before and immediately after treatment.

The wrist-prioritized group demonstrated significantly greater improvements in distal motor function (P<.01, η²=0.19) and muscle strength (P=.04, η²=0.14), while the forearm-prioritized group showed superior gains in proximal motor recovery (P=.03, η²=0.17). A trend toward retention of distal gains was observed in the wrist-prioritized group at 3-month follow-up (P=.05, η²=0.13).

Our findings suggest that forearm- and wrist-prioritized regimens provide different benefits. The focus of robotic training may affect specific aspects of upper extremity motor recovery in stroke, highlighting the need for individually tailored strategies based on patient-specific deficits. However, further research is needed to validate the findings.