Journal of Neurology

, Volume 261, Issue 5, pp 1037–1045 | Cite as

Sequential combination of robot-assisted therapy and constraint-induced therapy in stroke rehabilitation: a randomized controlled trial

  • Yu-wei Hsieh
  • Keh-chung Lin
  • Yi-shiung Horng
  • Ching-yi WuEmail author
  • Tai-chieh Wu
  • Fang-ling Ku
Techniques in Clinical Science


Robot-assisted therapy (RT) and constraint-induced therapy (CIT) both show great promise to improve stroke rehabilitation outcomes. Although the respective treatment efficacy of RT and CIT has been validated, the additive effects of RT combined with CIT remain unknown. This study investigated the treatment effects of RT in sequential combination with a distributed form of CIT (RT + dCIT) compared with RT and conventional rehabilitation (CR). Forty-eight patients with stroke were enrolled and randomized to receive one of the three interventions for 4 weeks. Primary outcomes assessed the changes of motor impairment and motor function on the Fugl-Meyer Assessment (FMA) and Wolf Motor Function Test (WMFT). Secondary outcomes, including the Motor Activity Log (MAL) and accelerometers, examined functional performance during daily activities. The three treatment groups improved significantly on most primary and secondary outcomes over time. The combined RT + dCIT group exhibited significantly greater improvement on the FMA and functional ability subscale of the WMFT than the RT and CR groups. The improvements on the MAL and accelerometers were not significantly different among the three groups. RT in sequential combination with CIT led to additive effects on participants’ motor ability and functional ability to perform motor tasks after stroke, which support that combined therapy can be an effective means to intensify outcomes. Further research investigating the potential long-term effects of combination therapy, especially on real-life performance, would be valuable.


Stroke Combination therapy Robotic rehabilitation Constraint-induced therapy Upper extremity 



This study was supported in part by the National Health Research Institutes (NHRI-EX103-10010PI, and NHRI-EX102-9920PI), the National Science Council (NSC-102-2314-B-182-001, NSC-100-2314-B-002-008-MY3, NSC-102-2314-B-002-154-MY2, and NSC-102-2628-B-182-005-MY3), Chang Gung Memorial Hospital (CMRPD 1C0402), and the Healthy Ageing Research Center at Chang Gung University (EMRPD1D0291 and CMRPD1B0331) in Taiwan.

Conflicts of interest

The authors have no conflicts of interest.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Yu-wei Hsieh
    • 1
    • 2
  • Keh-chung Lin
    • 3
    • 4
  • Yi-shiung Horng
    • 5
    • 6
  • Ching-yi Wu
    • 1
    • 2
  • Tai-chieh Wu
    • 7
  • Fang-ling Ku
    • 8
  1. 1.Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of MedicineChang Gung UniversityTaoyuanTaiwan
  2. 2.Healthy Aging Research CenterChang Gung UniversityTaoyuanTaiwan
  3. 3.School of Occupational Therapy, College of MedicineNational Taiwan UniversityTaipeiTaiwan
  4. 4.Division of Occupational Therapy, Department of Physical Medicine and RehabilitationNational Taiwan University HospitalTaipeiTaiwan
  5. 5.Department of Physical Medicine and Rehabilitation, Taipei Tzu Chi HospitalBuddhist Tzu Chi Medical FoundationTaipeiTaiwan
  6. 6.Department of MedicineTzu Chi UniversityHualienTaiwan
  7. 7.Division of Occupational Therapy, Department of RehabilitationShin Kong Wu Ho-Su Memorial HospitalTaipeiTaiwan
  8. 8.Department of Physical Medicine and RehabilitationKaohsiung Municipal Ta-Tung HospitalKaohsiungTaiwan

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