Effectivity of Exoskeleton Robot-Assisted Therapy on Improving Muscle Strength in Post-Stroke Patient

Authors

  • Aulia Salwa Alfaina Diponegoro University, Indonesia
  • Rahmi Isma Asmara Putri Department of Rehabilitation Medicine, Faculty of Medicine, Diponegoro University, Indonesia
  • Hari Peni Julianti Department of Rehabilitation Medicine, Faculty of Medicine, Diponegoro University, Indonesia
  • Trianggoro Budisulistyo Department of Neurology, Faculty of Medicine, Diponegoro University, Indonesia
  • Rifky Ismail Department of Mechanical Engineering, Faculty of Engineering, Diponegoro University, Indonesia

DOI:

https://doi.org/10.36408/mhjcm.v8i3.588

Keywords:

Exoskeleton robot, muscle strength, stroke

Abstract

Background: Upper limb weakness is the most disability caused by stroke. The availability of physiotherapists is still limited in Indonesia. The exoskeleton robot is a developing technology that involve in stroke rehabilitation therapy.

Objective: To evaluate the effectiveness of exoskeleton robot-assisted therapy on improving muscle strength of patients after stroke.

Methods: An experimental study with two groups pre-test and post-test design carried out using consecutive sampling among outpatient stroke patients in Diponegoro National Hospital (RSND) and William Booth Hospital (RSWB), Semarang. Patients in the robotic group (RG) (n=8) received 16 training sessions. Each session consists of 30 passive and ten active-weighted elbow flexion-extension with the exoskeleton robot. Meanwhile, the control group (CG) (n=8) received equivalent training of conventional therapy. The primary outcome of muscle strength was measured by Manual Muscle Testing (MMT) and handheld dynamometer. Pre and post-test MMT score data in each group were analyzed by Wilcoxon test, while handheld dynamometer score data were analyzed by paired t-test. Data between the two groups were analyzed by Mann-Whitney test and unpaired t-test.

Results: Significant improvements were shown for the MMT score (RG: p=0.014, CG: p=0.034). There were significant handheld dynamometer score improvements on muscle strength for elbow flexor and extensor in RG (p = 0.008 and p = 0.005 respectively) and in CG (p=0.036 and p=0.008 respectively). No significant differences for MMT and handheld dynamometer score between the two groups.

Conclusion: The exoskeleton robot-assisted therapy was as effective as conventional therapy for improving muscle strength in stroke patients.

Downloads

Download data is not yet available.

References

1. Johnson W, Onuma O, Owolabi M, Sachdev S. Stroke: a global response is needed. Bull World Health Organ. 2016;94(9):634A-635A.
2. Kementerian Kesehatan Republik Indonesia. Hasil utama riset kesehatan dasar (Riskesdas). Jakarta (Indonesia): Kementerian Kesehatan Republik Indonesia; 2018. Available from: https://www.kemkes.go.id/resources/download/info-terkini/hasil-riskesdas-2018.pdf
3. Whitehead S, Baalbergen E. Post-stroke rehabilitation. South African Med J. 2019;109(2):81–3.
4. Groot JH De, Angulo SM, Meskers CGM, Heijden-maessen HCM Van Der, Arendzen JHH. Clinical biomechanics reduced elbow mobility affects the fl exion or extension domain in activities of daily living. JCLB. 2011;26(7):713–7.
5. Stiawan B, Effendy ADP, Zahra K, Azimi I. Rehaps (rehabilitasi pasca stroke) game rehabilitasi pasca stroke berbasis kinect untuk menguatkan memori gerak. e-Proceeding Appl Sci. 2018;4(2):699–707.
6. Kementerian kesehatan Republik Indonesia. Rencana pengembangan tenaga kesehatan tahun 2011 – 2025. Jakarta (Indonesia): Kementerian Kesehatan Republik Indonesia; 2011. Available from: https://www.who.int/workforcealliance/countries/inidonesia_hrhplan_2011_2025.pdf
7. Yang G, Deng J, Pang G, Zhang H, Li J, Deng B, et al. An IoT-enabled stroke rehabilitation system based on smart wearable armband and machine learning. IEEE J Transl Eng Heal Med. 2018;6.
8. Kementerian Kesehatan Republik Indonesia. Kebijakan dan strategi pencegahan dan pengendalian stroke di Indonesia. Jakarta (Indonesia): Kementerian Kesehatan Republik Indonesia; 2018. Available from: http://p2ptm.kemkes.go.id/uploads/VHcrbkVobjRzUDN3UCs4eUJ0dVBndz09/2017/10/Kebijakan_dan_Strategi_Pencegahan_dan_Pengendalian_Stroke_di_Indonesia_dr_Lily_Sriwahyuni_Sulistyowati_MM1.pdf
9. Ertl M, Meisinger C, Linseisen J, Baumeister S-E, Zickler P, Naumann M. Long-term outcomes in patients with stroke after in-hospital treatment—study protocol of the prospective stroke cohort augsburg (SCHANA study). Medicina. 2020; 56(6):280.
10. Franceschini M, Mazzoleni S, Goffredo M, Pournajaf S, Galafate D, Criscuolo S, et al. Upper limb robot-assisted rehabilitation versus physical therapy on subacute stroke patients?: a follow-up study. J Bodyw Mov Ther. 2019;1–5.
11. Jung JH, Lee HJ, Cho DY, Lim J, Lee BS, Kwon SH, et al. Effects of combined upper limb robotic therapy in patients with tetraplegic spinal cord injury. Ann Rehabil Med. 2019;43(4):445–57.
12. Zhang J, Wang T, Zhao Q, Liu S. Impacts of a lower limb exoskeleton robot on the muscle strength of tibialis anterior muscle in stroke patients. E3S Web Conf. 2020;185(03036):1–4.
13. Gambassi BB, Coelho-junior HJ, Schwingel PA, Jesus F De, Almeida F, Maria T, et al. Resistance training and stroke?: a critical analysis of different training programs. Stroke Res Treat. 2017;1–11.
14. Nunen MPM van, Gerrits KHL, Konijnenbelt M, Janseen TWJ, Haan A De. Recovery of walking ability using a robotic device in subacute stroke patients?: a randomized controlled study. Disabil Rehabil Assist Technol. 2014;1–8.
15. Tomic TJD, Savic AM, Vidakovic AS, Rodic SZ, Isakovic MS, Rodriguez-de-Pablo C, et al. ArmAssist robotic system versus matched conventional therapy for poststroke upper limb rehabilitation?: a randomized clinical trial. Biomed Res Int. 2017;1–7.
16. Dehem S, Gilliaux M, Palumbo S, Frederick A, Detrembleur C, Lejeune T. Effectiveness of upper-limb robotic-assisted therapy in the early rehabilitation phase after stroke?: A single-blind , randomised , controlled trial. Ann Phys Rehabil Med. 2019;62:313–20.
17. Fay DS, Gerow K. A biologist’s guide to statistical thinking and analysis. WormBook. Laramie (USA); 2013. 1–54 p.
18. Simic-Panic D, Boskovic K, Milisevic M, Zikic TR, Bosnjak MC, Tomasevic-Todorovic S, et al. The impact of comorbidity on rehabilitation outcome after ischemic stroke. Acta Clin Croat. 2018;57:5–15.
19. Lathuiliere A, Mareschal J, Graf CE. How to prevent loss of muscle mass and strength. Nutrients. 2019;(881):1–11.
20. Przewo?nik DA, Rajtar-zembaty A, Starowicz-filip A. The influence of cognitive , emotional and social factors on motivation for rehabilitation in patients after stroke The influence of cognitive , emotional and social factors on motivation for rehabilitation in patients after stroke. Neuropsychiatr i Neuropsychol. 2015;10(2):64–8.

Additional Files

Published

2021-11-05

How to Cite

1.
Alfaina AS, Putri RIA, Julianti HP, Budisulistyo T, Ismail R. Effectivity of Exoskeleton Robot-Assisted Therapy on Improving Muscle Strength in Post-Stroke Patient. Medica Hospitalia J. Clin. Med. [Internet]. 2021 Nov. 5 [cited 2024 Nov. 23];8(3):292-6. Available from: http://medicahospitalia.rskariadi.co.id/medicahospitalia/index.php/mh/article/view/588

Issue

Vol. 8 No. 3 (2021): Med Hosp; Nov 2021

Section

Original Article

Citation Check

License

Copyrights Notice
Copyrights:
Researchers publishing manuscrips at Medica Hospitalis: Journal of Clinical Medicine agree with regulations as follow:
Copyrights of each article belong to researchers, and it is likewise the patent rights
Researchers admit that Medica Hospitalia: Journal of Clinical Medicine has the right of first publication
Researchers may submit manuscripts separately, manage non exclusive distribution of published manuscripts into other versions (such as: being sent to researchers’ institutional repository, publication in the books, etc), admitting that manuscripts have been firstly published at Medica Hospitalia: Journal of Clinical Medicine
License:
Medica Hospitalia: Journal of Clinical Medicine is disseminated based on provisions of Creative Common Attribution-Share Alike 4.0 Internasional It allows individuals to duplicate and disseminate manuscripts in any formats, to alter, compose and make derivatives of manuscripts for any purpose. You are not allowed to use manuscripts for commercial purposes. You should properly acknowledge, reference links, and state that alterations have been made. You can do so in proper ways, but it does not hint that the licensors support you or your usage.