BACKGROUND Robot-based rehabilitation for persons post-stroke may improve arm function and daily-life activities as measured by clinical scales, but its effects on motor strategies during functional tasks are still poorly investigated. This study aimed at assessing the effects of robot-therapy versus arm-specific physiotherapy in persons post-stroke on motor strategies derived from upper body instrumented kinematic analysis, and on arm function measured by clinical scales. METHODS Forty persons in the sub-acute and chronic stage post-stroke were recruited. This sample included all those subjects, enrolled in a larger bi-center study, who underwent instrumented kinematic analysis and who were randomized in Center 2 into Robot (R_Group) and Control Group (C_Group). R_Group received robot-assisted training. C_Group received arm-specific treatment delivered by a physiotherapist. Pre- and post-training assessment included clinical scales and instrumented kinematic analysis of arm and trunk during a virtual untrained task simulating the transport of an object onto a shelf. Instrumented outcomes included shoulder/elbow coordination, elbow extension and trunk sagittal compensation. Clinical outcomes included Fugl-Meyer Motor Assessment of Upper Extremity (FM-UE), modified Ashworth Scale (MAS) and Functional Independence Measure (FIM). RESULTS R_Group showed larger post-training improvements of shoulder/elbow coordination (Cohen's d = - 0.81, p = 0.019), elbow extension (Cohen's d = - 0.71, p = 0.038), and trunk movement (Cohen's d = - 1.12, p = 0.002). Both groups showed comparable improvements in clinical scales, except proximal muscles MAS that decreased more in R_Group (Cohen's d = - 0.83, p = 0.018). Ancillary analyses on chronic subjects confirmed these results and revealed larger improvements after robot-therapy in the proximal portion of FM-UE (Cohen's d = 1.16, p = 0.019). CONCLUSIONS Robot-assisted rehabilitation was as effective as arm-specific physiotherapy in reducing arm impairment (FM-UE) in persons post-stroke, but it was more effective in improving motor control strategies adopted during an untrained task involving vertical movements not practiced during training. Specifically, robot therapy induced larger improvements of shoulder/elbow coordination and greater reduction of abnormal trunk sagittal movements. The beneficial effects of robot therapy seemed more pronounced in chronic subjects. Future studies on a larger sample should be performed to corroborate present findings. TRIAL REGISTRATION www.ClinicalTrials.gov NCT03530358. Registered 21 May 2018. Retrospectively registered.

中文翻译：

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机器人治疗对中风后人上半身运动学和手臂功能的影响：一项随机对照试验。

背景技术如通过临床量表测量的，基于机器人的中风后康复可以改善手臂功能和日常生活活动，但是在功能性任务期间其对运动策略的影响仍然缺乏研究。这项研究旨在评估卒中后机器人治疗与手臂特异性物理治疗对上身运动学分析得出的运动策略以及通过临床量表测量的手臂功能的影响。方法招募了40名卒中后亚急性和慢性阶段的人。该样本包括所有参加较大的双中心研究的受试者，他们接受了仪器运动学分析，并在中心2中被随机分为机器人（R_Group）和对照组（C_Group）。R_Group接受了机器人辅助培训。C_Group接受了物理治疗师提供的针对手臂的治疗。训练前和训练后的评估包括临床秤以及在模拟对象物在架子上运输的虚拟未训练任务期间对手臂和躯干进行的运动学分析。检测的结果包括肩/肘协调，肘伸和躯干矢状位补偿。临床结果包括Fugl-Meyer上肢运动评估（FM-UE），改良的Ashworth量表（MAS）和功能独立性测量（FIM）。结果R_Group表现出更大的训练后肩膀/肘关节协调性（Cohen d =-0.81，p = 0.019），肘部伸展（Cohen's d =-0.71，p = 0.038）和躯干运动（Cohen d =-1.12，p） = 0.002）。两组的临床量均显示出可比的改善，除了近端肌肉MAS在R_Group中下降更多外（Cohen d =-0.83，p = 0.018）。对慢性受试者的辅助分析证实了这些结果，并显示在机器人治疗后，FM-UE的近端有较大改善（Cohen d = 1.16，p = 0.019）。结论机器人辅助康复在减少中风后人的手臂损伤（FM-UE）方面与手臂特定的物理疗法一样有效，但在改善未经训练的运动中采用的运动控制策略（涉及训练中未进行的垂直运动）方面更有效。具体来说，机器人疗法可以使肩/肘协调度得到更大的改善，并可以减少躯干矢状位异常运动。在慢性受试者中，机器人治疗的有益作用似乎更为明显。应该对更大的样本进行进一步的研究，以证实目前的发现。试用注册www.ClinicalTrials.gov NCT03530358。已于2018年5月21日注册。已追溯注册。