Baker, K; (2014) The use of a robotic device for upper limb retraining in subacute stroke. Doctoral thesis , UCL (University College London).

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Abstract

Stroke is a significant cause of disability in the population. When the arm is affected by stroke, functional recovery may be poor. The use of robotic aids to enhance arm recovery is a novel treatment adjunct. There is a growing support for using robots as an adjunct to therapy but there has been little translation from research into clinical use. The investigations reported in this thesis aimed to bridge the gap between research and clinical use of these devices. To achieve this,five stages were carried out: Firstly a systematic literature review of outcomes measure used for the upper limb was conducted.to establish the most reliable, valid and responsive scales. This review found a battery of measures (ABILHAND, CHAI, STREAM, FMA, ARAT, EQ5D, DASH, NIHSS). An evaluation of 125 consecutive acute stroke patients established the proportion of patients that potentially benefited from rehabilitation using a robotic device. This found that around 50% of subjects could use a robotic aid and that it was practically feasible to carry out the intervention. A pilot RCT performed on 37 participants using the battery of measures found a significant difference with use of the robotic device on the ABILHAND, This was not seen with the other measures, however there was a trend towards improvement in motor performance and function in the robotic group. In depth interviews with participants found subjects perceived gains with using the robot but fatigue stopped them using it for longer periods. Psychometric analysis of the outcome measures used found difficulties with the instruments in reflecting clinically change. The studies showed that a robotic device could be used practically; however stratifying subjects into arm severity would help provide further information over who could benefit from the intervention. Identifying appropriate ways of measuring changes that are clinically meaningful would also be beneficial.

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