Background:Upper-limb robot-mediated therapy is usually carried out in active-assisted mode because it enables performance of many movements. However, assistance may reduce the patient’s own efforts which could limit motor recovery. Objective:The aim of this study was to compare the effects of active-assisted and active-unassisted robotic interactions on motor recovery in subacute stroke patients with moderate hemiparesis. Methods:Fourteen patients underwent a 6-week combined upper limb program of usual therapy and robotic therapy using either the active-unassisted (n = 8) or active-assisted (n = 6) modes. In the active-assisted group, assistance was only provided for the first 3 weeks (1st period) and was then switched off for the remaining 3 weeks (2nd period). The Fugl-Meyer Assessment (FMA) was carried out pre- and post-treatment. The mean number of movements performed and the mean working distance during the 1st and 2nd periods were compared between groups. Results:FMA score improved post-treatment in both groups with no between-group differences: active-assisted group: +8±6 pts vs active-unassisted group: +10±6 pts (ns). Between the 1st and 2nd periods, there was a statistical trend towards an improvement in the number of movements performed (p = 0.06) in the active-unassisted group (526±253 to 783±434, p = 0.06) but not in the active-assisted group (882±211 to 880±297, ns). Another trend of improvement was found for the working distance in the active-unassisted group (8.7±4.5 to 9.9±4.7, p = 0.09) but not in the active-assisted group (14.0±0 to 13.5±1.1, ns). Conclusions:The superiority of the non-assistive over assistive robotic modes has not been demonstrated. However, the non-assistive mode did not appear to reduce motor recovery in this population, despite the performance of fewer movements on shorter working distance compared with the group who had assistance. It seems that the requirement of effort could be a determinant factor for recovery in neurorehabilitation however further well-design studies are needed to fully understand this phenomenon.

中文翻译：

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主动辅助与主动非辅助机器人介导的上肢治疗亚急性脑卒中的比较

背景：上肢机器人介导的治疗通常在主动辅助模式下进行，因为它可以执行许多动作。然而，援助可能会减少患者自己的努力，这可能会限制运动恢复。目的：本研究的目的是比较主动辅助和主动-非辅助机器人交互对中度偏瘫亚急性卒中患者运动恢复的影响。方法：14 名患者接受了为期 6 周的常规治疗和机器人治疗的联合上肢计划，使用主动-独立（n = 8）或主动辅助（n = 6）模式。在主动辅助组中，仅在前 3 周（第 1 期）提供辅助，然后在其余 3 周（第 2 期）关闭辅助。Fugl-Meyer 评估 (FMA) 在治疗前和治疗后进行。比较各组之间在第 1 和第 2 阶段执行的平均运动次数和平均工作距离。结果：治疗后两组 FMA 评分均有所改善，无组间差异：主动辅助组：+8±6 分 vs 主动非辅助组：+10±6 分 (ns)。在第 1 和第 2 阶段之间，主动-无辅助组（526±253 至 783±434，p = 0.06）的运动次数有改善（p = 0.06）的统计趋势，但在主动组中则不然-辅助组（882±211 到 880±297，ns）。发现主动无辅助组的工作距离有另一个改善趋势（8.7±4.5 到 9.9±4.7，p = 0.09），但在主动辅助组中没有发现（14.0±0 到 13.5±1.1，ns）。结论：非辅助机器人模式优于辅助机器人模式的优势尚未得到证实。然而，尽管与有帮助的组相比，在更短的工作距离内的动作较少，但非辅助模式似乎并未减少该人群的运动恢复。似乎努力的要求可能是神经康复恢复的决定因素，但是需要进一步的精心设计的研究来充分理解这种现象。