Stroke is one of the leading causes of disability worldwide. Although mortality is
decreasing, the number of people living with the effects of stroke has increased due to
the increasing and aging population. It has been observed that 26% of patients have
decreased basic daily living activities and 50% have decreased mobility after stroke.
Effective therapy in stroke rehabilitation should include repetitive, functional and
task-specific exercises performed with high intensity and duration. In this context, in
addition to traditional treatments, many new treatment approaches have come to the fore
in recent years. Robot-assisted treatment (RAT) is one of these new treatment approaches.
The use of robotic technology in rehabilitation has gained importance especially in the
last 15 years and developments in this regard continue to increase. RAT is an innovative
approach that includes intensive, repeatable, interactive and personalized applications.
This technology-based treatment increases the efficiency of rehabilitation care with its
features of intensity, interaction, flexibility and adaptability to the patient
performance and needs. It has no significant side effects and is well tolerated by
patients. In the literature on robot-assisted treatment, different robotic devices have
been used in various studies and different treatment protocols have been applied. This
treatment has been reported to provide significantly greater improvement in function
compared to conventional usual care. Studies in the literature on RAT demonstrate the
feasibility of using these technologies in large patient groups.
The most common and devastating consequence of post-stroke disability is functional
disability in the upper extremity. The functional prognosis of the lower extremity is
generally better than the upper extremity after stroke. 20-30% of patients can walk
normally, and 75% can reach some stage of ambulation. However, only 5% of patients return
to normal upper extremity function, while 23-43% show inadequate functional recovery.
Therefore, upper extremity rehabilitation requires more time and effort than lower
extremity rehabilitation.
Bertani et al. In their published meta-analysis, they stated that robot-assisted
rehabilitation is more effective in improving upper extremity motor function, especially
in patients with chronic stroke, compared to conventional therapy. Amadeo (Tyromotion,
Graz, Austria), an end-effector robotic rehabilitation device designed for hand
rehabilitation, has shown feasibility and preliminary efficacy for stroke in the subacute
phase. A randomized controlled trial with 17 patients compared conventional occupational
therapy with Amadeo robotic therapy and after forty sessions, both groups showed
significant improvement, but robotic intervention caused a greater improvement in hand
function as measured by Fugl-Meyer and Motricity Index. Robotic hand therapy has started
to take its place in routine rehabilitation protocols today. Considering the scarcity of
studies on robotic hand therapy, it has been seen that larger-scale and long-term
follow-up studies are needed. The aim in this study is to demonstrate the effectiveness
of robot-assisted hand therapy in patients with chronic stroke and to compare this
effectiveness in patients with different Brunnstrom stages.