Bewegungstherapie der oberen Extremitäten mit einem Roboterball bei Schlaganfallpatienten – Ergebnisse einer randomisierten kontrollierten Crossover-Studie

Zusammenfassung

Hintergrund Der Schlaganfall ist für die betroffenen Patienten häufig mit motorischen Einschränkungen der oberen Extremitäten verbunden. Ein Ziel der anschließenden Rehabilitation ist die möglichst selbstständige Bewältigung der vielfältigen Aufgaben des täglichen Lebens. Neue Therapieverfahren nutzen verschiedene Hardwarekomponenten, um digitale Therapieinhalte umzusetzen. Diese können eine sinnvolle Ergänzung zu etablierten Standardverfahren darstellen.

Ziel der Arbeit In dieser Studie soll der Effekt eines innovativen bewegungstherapeutischen Therapiekonzepts mit einem Roboterball auf motorische Parameter bei Schlaganfallpatienten überprüft werden.

Material und Methoden An der Crossover-Studie nahmen 25 Patienten (60,0 ± 10,0 Jahre, 172,5 ± 13,8 cm, 79,5 ± 13,8 kg, 89,8 ± 72,6 Monate post-stroke) teil. Der Interventions- sowie der Kontrollzeitraum umfassten jeweils 12 Wochen. Das Training mit dem Roboterball erfolgte als Ergänzung zur Standardtherapie zweimal pro Woche für jeweils 45 min. Verschiedene spielerische Inhalte wurden mithilfe von einem Tablet und einem Smartphone durchgeführt.

Ergebnisse Die isometrische Greifkraft konnte um 4,5 ± 3,6 kg (p = 0,000) erhöht werden. Die unilaterale Geschicklichkeit im Roundblock-Test verbesserte sich um 7,5 ± 6,3 gültige Versuche (p = 0,000). Die durch den QuickDASH-Fragebogen erhobene subjektive Gesundheitswahrnehmung der Patienten verbesserte sich um 12,4 ± 13,0 Punkte (p = 0,001).

Diskussion Die zusätzliche Therapie mit dem Roboterball konnte die Funktionsfähigkeit der oberen Extremitäten bei chronischen Schlaganfallpatienten verbessern sowie deren subjektive Gesundheitswahrnehmung positiv beeinflussen. Hingegen stagnierte die Leistungsfähigkeit bei alleiniger Standardtherapie. Moderat betroffene Patienten profitierten am stärksten. Sehr stark ausgeprägte motorische oder kognitive Symptomatik führte teilweise zum Dropout. Die Ergebnisse sollten mit größeren Stichproben verifiziert werden.

Abstract

Background Stroke is associated with motor impairments of the upper extremities. The defining goal of rehabilitation is independent execution of activities of daily living. New therapy procedures use different hardware components to implement digital therapy contents. These can be useful complements to established therapy protocols.

Objectives The aim of this study was to examine the effect of movement therapy with a robotic ball on motor function parameters in stroke patients.

Materials and methods 25 patients (60.0 ± 10.0 years, 172.5 ± 13.8 cm, 79.5 ± 13.8 kg, 89.8 ± 72.6 months post-stroke) took part in this crossover study. The intervention and control periods comprised 12 weeks each. Training with the robotic ball was done in addition to standard therapy two times a week for 45 min each. Different game activities were carried out with the help of a tablet and a smartphone.

Results Isometric grip strength improved by 4.5 ± 3.6 kg (p = 0.000), and unilateral dexterity increased by 7.5 ± 6.3 valid tries (p = 0.000) in the round block test. The self-reported disabilities of the arm, shoulder and hand were assessed using the QuickDASH questionnaire and showed improvements by 12.4 ± 13.0 points (p = 0.001).

Conclusions Additional therapy using the robotic ball improved upper extremity motor function and self-perceived health status in chronic stroke patients. However, performance stagnated when standard therapy was implemented alone. Moderately affected patients seem to benefit the most. The presence of very severe motor or cognitive symptoms led, in part, to some dropouts. The results need to be verified using larger patient populations.

Schlüsselwörter

Schlaganfall - Motorik - Roboterball - Obere Extremität - Exergaming

Keywords

stroke - motor function - robotic ball - upper extremities - exergaming

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