Functional Outcomes Can Vary by Dose: Learning-Based Sensorimotor Training for Patients Stable Poststroke

Byl, Nancy N.; Pitsch, Erica A.; Abrams, Gary

doi:10.1177/1545968308317431

Cited by 74 publications

(74 citation statements)

References 19 publications

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“…Increased exposure to novel therapy methods has, however, produced inconsistent results, with reports of positive dose-response effects (learning-based sensorimotor training [35]), no effect of increased dose (neuromuscular electrical stimulation [36]), and an inverse response to higher dose interventions (constraint-induced movement therapy [CIMT] [36]). The latter result raises the possibility of a limit on the amount of RA training that is beneficial.…”

Section: Discussionmentioning

confidence: 99%

Robot-assisted upper-limb therapy in acute rehabilitation setting following stroke: Department of Veterans Affairs multisite clinical trial

Burgar¹,

Lum²,

Scremin³

et al. 2011

JRRD

153

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Abstract-This randomized, controlled, multisite Department of Veterans Affairs clinical trial assessed robot-assisted (RA) upper-limb therapy with the Mirror Image Movement Enabler (MIME) in the acute stroke rehabilitation setting. Hemiparetic subjects (n = 54) received RA therapy using MIME for either up to 15 hours (low-dose) or 30 hours (high-dose) or received up to 15 hours of additional conventional therapy in addition to usual care (control). The primary outcome measure was the FuglMeyer Assessment (FMA). The secondary outcome measures were the Functional Independence Measure (FIM), Wolf Motor Function Test, Motor Power, and Ashworth scores at intake, discharge, and 6-month follow-up. Mean duration of study treatment was 8.6, 15.8, and 9.4 hours for the low-dose, high-dose, and control groups, respectively. Gains in the primary outcome measure were not significantly different between groups at follow-up. Significant correlations were found at discharge between FMA gains and the dose and intensity of RA. Intensity also correlated with FMA gain at 6 months. The high-dose group had greater FIM gains than controls at discharge and greater tone but no difference in FIM changes compared with low-dose subjects at 6 months. As used during acute rehabilitation, motor-control changes at follow-up were no less with MIME than with additional conventional therapy. Intensity of training with MIME was positively correlated with motor-control gains.Clinical Trial Registration: ClinicalTrials.gov, NCT00223808, "Assisted Movement Neuro-rehabilitation: VA Multi-site Clinical Trial"; http://www.clinicaltrials.gov/ct2/show/NCT00223808

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Section: Discussionmentioning

confidence: 99%

Robot-assisted upper-limb therapy in acute rehabilitation setting following stroke: Department of Veterans Affairs multisite clinical trial

Burgar¹,

Lum²,

Scremin³

et al. 2011

JRRD

153

View full text Add to dashboard Cite

show abstract

“…Participants in the conventional therapy group were given a booklet of tabletop exercises for home therapy of the hand developed by experienced occupational therapists and implemented in a prior clinical trial [42] and were instructed on how to correctly perform each hand exercise (see Appendix, available online only). Both groups were asked to perform self-guided therapy for at least 3 h/wk over at least three sessions per week, for three consecutive weeks, for a total of 9 h of therapy; such a dose had been found previously to be sufficient to induce significant improvements in hand movement ability [8,[43][44][45]. Both groups were also asked to manually record the amount of time they spent performing their self-guided therapy on a written exercise log.…”

Section: Interventionsmentioning

confidence: 99%

“…Intensive movement practice can reduce hand impairment [2][3][4][5][6], but issues such as cost and access may limit the dose of rehabilitation exercise delivered one-onone with a therapist. Because of these and other factors, most individuals do not perform the large number of exercise repetitions required during therapy to maximize recovery [7][8]. Home-based rehabilitation programs may be prescribed after stroke with the intent to increase the amount of rehabilitation exercise individuals perform.…”

Section: Introductionmentioning

confidence: 99%

Home-based hand rehabilitation after chronic stroke: Randomized, controlled single-blind trial comparing the MusicGlove with a conventional exercise program

Zondervan¹,

Friedman²,

Chang³

et al. 2016

J Rehabil Res Dev

138

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Abstract-Individuals with chronic stroke have limited options for hand rehabilitation at home. Here, we sought to determine the feasibility and efficacy of home-based MusicGlove therapy. Seventeen participants with moderate hand impairment in the chronic phase of stroke were randomized to 3 wk of home-based exercise with either the MusicGlove or conventional tabletop exercises. The primary outcome measure was the change in the Box and Blocks test score from baseline to 1 mo posttreatment. Both groups significantly improved their Box and Blocks test score, but no significant difference was found between groups. The MusicGlove group did exhibit significantly greater improvements than the conventional exercise group in Motor Activity Log Quality of Movement and Amount of Use scores 1 mo posttherapy (p = 0.007 and p = 0.04, respectively). Participants significantly increased their use of MusicGlove over time, completing 466 gripping movements per day on average at study end. MusicGlove therapy was not superior to conventional tabletop exercises for the primary end point but was nevertheless feasible and led to a significantly greater increase in self-reported functional use and quality of movement of the impaired hand than conventional home exercises.Clinical Trial Registration: ClinicalTrials.gov; "Influence of Timing on Motor Learning"; NCT01769326;  https://clinicaltrials.gov/ct2/show/NCT01769326

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“…Therefore, the recovery mechanism after brain damage can be viewed as a process induced by exercise training. Previous studies have reported that higher intensity and activeassisted mode of the robot-assisted therapy movement may lead to better improvement in motor function (30,34,35). Upper extremity training in patients with stroke using the Neuro-X® provides an environment that allows suitable training of each patient using the maximum remaining muscle strength of the affected arm.…”

Section: Discussionmentioning

confidence: 99%

Effects of newly developed compact robot-aided upper extremity training system (Neuro-X®) in patients with stroke: A pilot study

Kim¹,

Won²,

Seo³

et al. 2018

J Rehabil Med

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LAY ABSTRACTAlthough robot-assisted rehabilitation therapy of the upper extremity after stroke has been widely studied, robotic devices are still expensive and voluminous. This newly developed compact upper extremity training system (Neuro-X®) was inexpensive, small-sized, easy to move, and has two muscle strength measurements and six treatment modes. We aimed to evaluate the effects of newly developed compact Neuro-X® system in patients with chronic stroke. Neuro-X® training system can improve the function of the upper extremity and cognition in patients with stroke after six weeks of training and be used for functional recovery of the upper extremity in patients with stroke.Objective: Robot-assisted rehabilitation therapy of the upper extremity after stroke has been studied widely; however, robotic devices remain expensive and bulky. The aim of this study was to evaluate the effects of a newly developed, compact upper extremity training system (Neuro-X®) in patients with chronic stroke. Design: Pilot study. Subjects: Fifteen patients with hemiplegia. Methods: Chronic patients with stroke underwent upper extremity training using a newly developed upper extremity training system (Neuro-X®; Apsun Inc., Seoul, Korea). Patients were evaluated using the Fugl-Meyer Assessment (FMA), Hand Function Test (HFT), Modified Ashworth Scale (MAS), and Korean Mini-Mental Status Evaluation (K-MMSE).The assessment started with "pre 1 evaluation" (A 1 ), followed by repeated "pre 2 evaluation" (A 2 ) after 6 weeks without receiving any treatment, in order to generate repeated baseline data. After the A 2 evaluation, upper extremity training was performed for 6 weeks. Post-training evaluation (B) was performed after treatment. Obtained data (A 1 -A 2 -B) were compared. Results: During the non-intervention phase (A 1 to A 2 ), no significant changes were found in the aforementioned evaluations. However, in the intervention phase (A 2 to B), results of the FMA and HFT, and K-MMSE scores, except the MAS score, increased significantly (p < 0.05). Conclusion: The Neuro-X® training system improves functioning of the upper extremity and cognition in patients with stroke after 6 weeks of training.

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Functional Outcomes Can Vary by Dose: Learning-Based Sensorimotor Training for Patients Stable Poststroke

Abstract: Learning-based sensorimotor training based on the principles of neuroplasticity was associated with improved function in patients stable poststroke. The gains were dose specific with the greatest change measured in subjects participating in the high-intensity treatment group.

Cited by 74 publications

References 19 publications

Robot-assisted upper-limb therapy in acute rehabilitation setting following stroke: Department of Veterans Affairs multisite clinical trial

Robot-assisted upper-limb therapy in acute rehabilitation setting following stroke: Department of Veterans Affairs multisite clinical trial

Home-based hand rehabilitation after chronic stroke: Randomized, controlled single-blind trial comparing the MusicGlove with a conventional exercise program

Effects of newly developed compact robot-aided upper extremity training system (Neuro-X®) in patients with stroke: A pilot study

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