The Efficacy of Proprioceptive Neuromuscular Facilitation-Based Robot-Assisted Therapy in Individuals With Stroke: A Randomized Controlled Trial.

OBJECTIVES: The effects of combining robot-assisted therapy (RAT) with other physiotherapy approaches in stroke rehabilitation are of current interest. The aim of this study was to investigate the effect of proprioceptive neuromuscular facilitation (PNF)-based RAT on upper extremity (UE) motor performance, spasticity, activities of daily living (ADL), and quality of life (QoL) in individuals with stroke. DESIGN: Single-blind randomized controlled trial. SETTING: Neurologic rehabilitation unit at a university. PARTICIPANTS: Thirty-nine individuals with stroke were enrolled in the study (RAT, n=20; Control group [CG], n=19). INTERVENTIONS: Both groups received 30 minutes of conventional rehabilitation per session; in addition, RAT completed 30 minutes of PNF and commonly used daily movement patterns with a robotic device, whereas CG performed the same exercises manually. All interventions were delivered 3 days per week for 8 weeks (60 min/session). MAIN OUTCOME MEASURES: Participants' UE performance was assessed using the Fugl-Meyer Upper Extremity Scale, Action Research Arm Test, Box and Block Test, and Nine-Hole Peg Test. Spasticity severity was assessed using the Modified Ashworth Scale, and ADL, QOL were assessed using ACTIVLIM, ABILHAND, Stroke Impact Scale (SIS). RESULTS: Mean age was 58.40±14.95 years in the RAT and 54.79±16.47 years in the CG. Fugl-Meyer Upper Extremity Scale, ACTIVLIM, ABILHAND, and SIS significantly increased in all groups after treatment (P<.05). At posttreatment, RAT showed significantly greater improvements than CG in Fugl-Meyer Upper Extremity Scale, Action Research Arm Test, Box and Block Test, Nine-Hole Peg Test, and muscle spasticity. In addition, decreases in wrist flexor and elbow flexor measurements were associated with 8.065- and 5.051-fold higher odds of being in the RAT, respectively. CONCLUSIONS: Conventional treatment combined with PNF-based RAT application has been shown to be more effective than traditional training in improving spasticity, motor performance, ADL, and QoL of patients with stroke.