Researchers test technological support with robots and functional electrical stimulation

Credit: Robotics and Functional Electrical Stimulation for Stroke Rehabilitation.

Some robots can provide additional clinical benefit in the rehabilitation of stroke patients as an addition to standard therapy. For another procedure, the functional electrical stimulation of individual muscles or muscle groups, such an additional benefit cannot be proven. These are the results of a study based on scientific findings that the Austrian Institute for the Evaluation of Health Technologies (AIHTA) carried out together with a German working group for guidelines and has now published. After a critical analysis of over 53 studies, the AIHTA recommends a health economic assessment before these additional therapy options are applied.

In Austria alone, the lives of 25,000 people change suddenly every year: They suffer a stroke and many of them subsequently have paralysis of the lower or upper extremities. However, immediate rehabilitation measures often help patients regain full mobility, with walking and everyday activities being the primary rehabilitation goals. However, good rehabilitation programs are resource-intensive and there is therefore great hope for supplementation with robots or functional electrical stimulation of the muscles. To what extent these measures achieve a real additional clinical benefit, AIHTA has now examined together with a working group (ReMoS / Rehabilitation of Mobility After Stroke – AG) of the Association of Scientific and Medical Societies in Germany (AWMF).

The comprehensive analysis was based on a total of more than 55 randomized clinical trials and a Cochrane review. These studies examined the specific use of robotic rehabilitation (RAR) and functional electrical stimulation (FES) in different therapy situations. “The range of available devices is extremely large for both RAR and FES,” commented Priv. Doz. Claudia Wild, director of the AIHTA. “The expectations are correspondingly high, but unfortunately – as our study shows – only partially met. For example, we were able to determine an additional benefit for some RAR interventions in combination with standard therapy compared to standard therapy without RAR, but not for FES.”

In fact, some types of RAR can benefit the therapeutic process, especially when RAR is used for arm rehabilitation for patients with subacute stroke. However, evidence of an additional benefit of RAR as an aid to gait training is weaker. It is believed that these improvements are caused by more intensive and frequent patient training, which is achieved without any additional effort on the part of physical therapists. “The use of RAR can therefore be very useful,” concludes Dr. Wild. “It can improve the therapy results and possibly even help to relieve physical therapists of time and physical stress. We recommend, however, that the use also be evaluated in health economic analyzes, since the additional benefit could not be proven for all robots and the heterogeneity of the products can be observed. This analysis should also take into account the severity of the stroke, as well as the therapeutic context and conditions. “

The FES, on the other hand, disappointed expectations of additional benefits. These expectations primarily concern strengthening of paralyzed muscles through external electrical stimulation, as well as improved blood flow or blood flow. To investigate the advantages of FES, a total of 26 clinical studies by AIHTA and German colleagues were evaluated. They found that accompanying standard therapy with electrical stimulation rarely brought any additional benefit. However, there is evidence that sub-intervention of FES (FES with surface electrodes while walking) is not inferior to a conventional ankle orthosis. In this case, a health economic assessment could also be helpful. In addition, six other randomized controlled studies are ongoing to investigate an additional clinical benefit of the FES. For Dr. Wildly this is a welcome addition to the database, which may also provide new insights.

Overall, the study, now available online, shows a mixed picture of the clinical benefit of advanced adjunct therapies in standard stroke rehabilitation. Some RAR interventions offer additional benefits that FES do not. A critical evaluation is therefore recommended in each case before use in standard therapy.

The robotic exoskeleton training expands the possibilities for stroke rehabilitation

More information:
Goetz, G. et al. (2021): Robotics and functional electrical stimulation for stroke rehabilitation.

Provided by the Austrian Institute for Assessment of Health Technologies (AIHTA)

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