Stroke Programs

Innovative Modalities For Restoring Upper Limb Function Post Stroke

General Information on this clinical study

Principal Investigator: Janis Daly, Ph.D.

Clinical Coordinator: Kristi Butler

Contact Number: 216-791-3800 ext 3662

Contact Email: jjd17@case.edu

Program Title: Innovative Modalities For Restoring Upper Limb Function Post Stroke

Purpose

After strokes many patients are unable to engage in normal upper limb functional activities, which may restrict them from participation in meaningful life roles. For many, conventional rehabilitation does not restore upper limb function to a useful level.

The purpose of this research is to investigate the benefits of three promising motor learning interventions:

FIML

focused intensive, motor learning

ROB-ML

robotics and motor learning

FNS-ML

functional neuromuscular stimulation and motor learning

Methods

Forty-eight chronic subjects (> 12 months post stroke) will be randomized to one of the three groups. For all three groups, treatment will be offered 5 hrs/day, 5 days/week, for 12 weeks. Outcome measures will be collected at weeks 1, 6, 12, and three months after the end of treatment.

Measures will include muscle strength (Manual Muscle Testing); coordination of joint movement (Fugl-Meyer Coordination Scale); motor control of target acquisition, pathway maintenance; and smoothness of movement (robotics measures); performance of 22 functional tasks (Arm Motor Assessment Test); and quality of life (Stroke Impact Scale).

Results

Twenty-four subjects were enrolled in the study. Data for twelve subjects has been analyzed. Results showed significant gains for the ROB-ML and FNS-ML groups (p < .05). There were different patterns of significant gains for the two groups. The ROB-ML group had significant gains in shoulder/elbow coordinated joint movement, but only within synergy, as well as gains in motor control and functional task movement components of shoulder and elbow (p < .05). The FNS-ML group had significant gains in shoulder/elbow coordinated joint movement outside of synergy, as well as gains in wrist/hand coordinated joint movement and functional task movement components of wrist/hand (p < .05). These preliminary results suggest an exercise or training-specific response to treatment. Clinical Significance. Currently there is little evidence supporting the benefits of rehabilitation in the chronic phase following stroke, and no health care coverage for such care. Results in this study from severely involved subjects in the chronic phase following stroke, indicate that rehabilitation in the chronic phase can produce significant gains. Additionally, preliminary results suggest the specificity of gains in response to motor learning for shoulder/elbow versus wrist/hand interventions. Specifying treatment response will enable us to more accurately target treatment.