The HAAPI (Home Arm Assistance Progression Initiative) Trial

Wolf, Steven L.; Sahu, Komal; Bay, R. Curtis; Buchanan, Sharon; Reiss, Aimee; Linder, Susan M; Rosenfeldt, Anson B.; Alberts, Jay L.

doi:10.1177/1545968315575612

Cited by 97 publications

(103 citation statements)

References 51 publications

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“…Further, multiple baselines in a previous sample failed to show a change in scores due to repeated testing. 7 Nonetheless, the magnitude of change seen here is similar to the magnitudes of change seen in many other motor intervention studies at this later time point post stroke (for examples from recent studies see 47–49 ) and to changes in routine outpatient care, 50 but is substantially smaller than magnitudes of change seen in interventions delivered earlier after stroke. 10, 51 The lack of a dose effect in this study highlights the importance of explicitly testing dose-response hypotheses with more than two dose groups in carefully controlled Phase II trials.…”

Section: Discussionsupporting

confidence: 80%

Dose response of task‐specific upper limb training in people at least 6 months poststroke: A phase II, single‐blind, randomized, controlled trial

Lang

Strube²,

Bland

et al. 2016

Annals of Neurology

185

202

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Objective 1) Determine if higher doses of motor therapy in chronic post-stroke hemiparesis result in better outcomes compared to lower doses, and 2) Evaluate potential modifiers of the dose-response relationship. Methods Eighty-five adults with UE paresis ≥ 6 months after stroke were randomized to one of four dose groups in this single-blind, parallel, RCT. The dosing parameter manipulated was amount of task-specific training, as indexed by the number of task repetitions. Groups received 3200, 6400, 9600, or Individualized Maximum (IM) repetitions, during 1 hr sessions, 4 days/week for 8 weeks. The intervention was an individualized, progressive task-specific upper limb training program designed to improve upper limb functional motor capacity. The primary outcome was the slope of the Action Research Arm Test (ARAT) during the intervention. Effects of dose and potential modifiers of the dose-response relationship were evaluated with hierarchical linear models. Results ARAT scores for the 3200, 9600, and IM groups improved over time as indicated by slopes (ΔARAT/wk, mean ± SEs) of 0.40 ± 0.15, 0.31 ± 0.16, and 0.66 ± 0.14, respectively (p < 0.05). The slope of the 6400 group was smaller (−0.05 ± 0.15) and significantly different from the 3200 and IM groups (p < 0.001). Initial motor capacity, neglect, and other tested characteristics did not modify the dose-response relationship. Interpretation Overall, treatment effects were small. There was no evidence of a dose-response effect of task-specific training on functional capacity in people with long-standing upper limb paresis post stroke.

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Section: Discussionsupporting

confidence: 80%

Dose response of task‐specific upper limb training in people at least 6 months poststroke: A phase II, single‐blind, randomized, controlled trial

Lang

Strube²,

Bland

et al. 2016

Annals of Neurology

185

202

View full text Add to dashboard Cite

show abstract

“…The magnitude of change seen here was similar to the magnitudes of change seen in many other motor rehabilitation studies at this later time point post stroke (for examples from recent studies see 15-17 ) and to changes in routine outpatient care, 18 but is smaller than magnitudes of change seen earlier after stroke, 19,20 when the natural trajectory of recovery exerts a powerful beneficial effect. Modest changes were also seen with the secondary outcomes of self-reported performance measured with the Stroke Impact Scale – Hand Function subscale and the Canadian Occupational Performance Measure.…”

Section: Strokesupporting

confidence: 84%

Consideration of Dose and Timing When Applying Interventions After Stroke and Spinal Cord Injury

Basso

Lang

2017

Journal of Neurologic Physical Therapy

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Nearly four decades of investigation into the plasticity of the nervous system suggest that both timing and dose could matter. This paper provides a synopsis of our lectures at the IV STEP meeting which presented a perspective of current data on the issues of timing and dose for adult stroke and spinal cord injury motor rehabilitation. For stroke, the prevailing evidence suggests that greater amounts of therapy do not result in better outcomes for upper extremity interventions, regardless of timing. Whether or not greater amounts of therapy result in better outcomes for lower extremity and mobility interventions needs to be explicitly tested. For spinal cord injury, there is a complex interaction of timing post injury, task-specificity, and the microenvironment of the spinal cord. Inflammation appears to be a key determinant of whether or not an intervention will be beneficial or maladaptive, and specific re-training of eccentric control during gait may be necessary. To move beyond the limitations of our current interventions and to effectively reach nonresponders, greater precision in task-specific interventions that are well-timed to the cellular environment may hold the key. Neurorehabilitation that ameliorates persistent deficits, attains greater recovery and reclaims non-responders will decrease institutionalization, improve quality of life and prevent multiple secondary complications common after stroke and SCI.

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“…The participants also showed clinically significant improvements in Action Reach Arm Test scores (18.7%, p = 0.01). A recent large randomized controlled trial compared the effects of the HM in combination with a home exercise program (HEP) with the effects of HEP alone on moderately impaired patients with stroke (as indicated by baseline FMA scores of 34.1 ± 12.1 and 33.3 ± 12.0, respectively) [46]. They found that the combination of HM and HEP and a dose equivalent HEP therapy alone were equally effective, suggesting that both traditional and HM augmented therapies are effective in improving UL outcomes.…”

Section: Discussionmentioning

confidence: 99%

Tongue-controlled robotic rehabilitation: A feasibility study in people with stroke

et al. 2016

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Abstract-Stroke survivors with severe upper limb (UL) impairment face years of therapy to recover function. Robotassisted therapy (RT) is increasingly used in the field for goaloriented rehabilitation as a means to improve UL function. To be used effectively for wrist and hand therapy, the current RT systems require the patient to have a minimal active range of movement in the UL, and those that do not have active voluntary movement cannot use these systems. We have overcome this limitation by harnessing tongue motion to allow patients to control a robot using synchronous tongue and hand movement. This novel RT device combines a commercially available UL exoskeleton, the Hand Mentor, and our custom-designed Tongue Drive System as its controller. We conducted a proof-of-concept study on six nondisabled participants to evaluate the system usability and a case series on three participants with movement limitations from poststroke hemiparesis. Data from two stroke survivors indicate that for patients with chronic, moderate UL impairment following stroke, a 15-session training regimen resulted in modest decreases in impairment, with functional improvement and improved quality of life. The improvement met the standard of minimal clinically important difference for activities of daily living, mobility, and strength assessments.

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The HAAPI (Home Arm Assistance Progression Initiative) Trial

Cited by 97 publications

References 51 publications

Dose response of task‐specific upper limb training in people at least 6 months poststroke: A phase II, single‐blind, randomized, controlled trial

Dose response of task‐specific upper limb training in people at least 6 months poststroke: A phase II, single‐blind, randomized, controlled trial

Consideration of Dose and Timing When Applying Interventions After Stroke and Spinal Cord Injury

Tongue-controlled robotic rehabilitation: A feasibility study in people with stroke

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