Long-Dose Intensive Therapy Is Necessary for Strong, Clinically Significant, Upper Limb Functional Gains and Retained Gains in Severe/Moderate Chronic Stroke

Abstract

Background. Effective treatment methods are needed for moderate/severely impairment chronic stroke. Objective. The questions were the following: (1) Is there need for long-dose therapy or is there a mid-treatment plateau? (2) Are the observed gains from the prior-studied protocol retained after treatment? Methods. Single-blind, stratified/randomized design, with 3 applied technology treatment groups, combined with motor learning, for long-duration treatment (300 hours of treatment). Measures were Arm Motor Ability Test time and coordination-function (AMAT-T, AMAT-F, respectively), acquired pre-/posttreatment and 3-month follow-up (3moF/U); Fugl-Meyer (FM), acquired similarly with addition of mid-treatment. Findings. There was no group difference in treatment response ( P ≥ .16), therefore data were combined for remaining analyses (n = 31; except for FM pre/mid/post, n = 36). Pre-to-Mid-treatment and Mid-to-Posttreatment gains of FM were statistically and clinically significant ( P < .0001; 4.7 points and P < .001; 5.1 points, respectively), indicating no plateau at 150 hours and benefit of second half of treatment. From baseline to 3moF/U: (1) FM gains were twice the clinically significant benchmark, (2) AMAT-F gains were greater than clinically significant benchmark, and (3) there was statistically significant improvement in FM ( P < .0001); AMAT-F ( P < .0001); AMAT-T ( P < .0001). These gains indicate retained clinically and statistically significant gains at 3moFU. From posttreatment to 3moF/U, gains on FM were maintained. There were statistically significant gains in AMAT-F ( P = .0379) and AMAT-T P = .003.

Current therapy for the upper limb after stroke: a cross-sectional survey of UK therapists

“…Despite this, the findings of this survey indicate that the reported overall dose of therapy is relatively small when compared with what is known to be effective from animal models of stroke rehabilitation34 and so may not realise the potential for recovery. This argument is supported by findings from other studies; several large, well-conducted trials offering similar amounts of upper limb therapy to those reported in the current study found minimal benefit35 36 while trials that used higher doses reported meaningful and significant changes 37 38. In addition to research trials, large improvements in upper limb functioning have been reported in a NHS-funded clinical service (the Queen’s Square Upper Limb Programme) that delivers 90 hours of multidisciplinary upper limb rehabilitation over 3 weeks 33.…”

Neurocognitive robot-assisted rehabilitation of hand function: a randomized control trial on motor recovery in subacute stroke

“…The therapy intensity delivered in this study typically exceeded the amount of movement practice reported in the literature for conventional physio-or occupational therapy sessions (1.45 rep/min vs 0.92 rep/min) [60]. Still, compared to the knowledge gained from animal studies and to recent high-dose clinical studies [61][62][63], this intensity might not be sufficient. It is important to note, however, that one "repetition" using the neurocognitive approach is not directly comparable to, e.g., reaching movements as typically reported in the literature.…”

Neurocognitive robot-assisted rehabilitation of hand function: a randomized control trial on motor recovery in subacute stroke

“…The therapy intensity delivered in this study typically exceeded the amount of movement practice reported in the literature for conventional physio-or occupational therapy sessions (1.45 rep/min vs 0.92 rep/min) [58]. Still, compared to the knowledge gained from animal studies and to recent highdose clinical studies [59][60][61], this intensity might not be sufficient. It is important to note, however, that one "repetition" using the neurocognitive approach is not directly comparable to, e.g., reaching movements as typically reported in the literature.…”