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Sanders Q, Chan V, Augsburger R, Cramer SC, Reinkensmeyer DJ, Do AH. Feasibility of Wearable Sensing for In-Home Finger Rehabilitation Early After Stroke. IEEE Trans Neural Syst Rehabil Eng 2020; 28:1363-1372. [PMID: 32305930 DOI: 10.1109/tnsre.2020.2988177] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Wearable grip sensing shows potential for hand rehabilitation, but few studies have studied feasibility early after stroke. Here, we studied a wearable grip sensor integrated with a musical computer game (MusicGlove). Among the stroke patients admitted to a hospital without limiting complications, 13% had adequate hand function for system use. Eleven subjects used MusicGlove at home over three weeks with a goal of nine hours of use. On average they achieved 4.1 ± 3.2 (SD) hours of use and completed 8627 ± 7500 grips, an amount comparable to users in the chronic phase of stroke measured in a previous study. The rank-order usage data were well fit by distributions that arise in machine failure theory. Users operated the game at high success levels, achieving note-hitting success >75% for 84% of the 1061 songs played. They changed game parameters infrequently (31% of songs), but in a way that logically modulated challenge, consistent with the Challenge Point Hypothesis from motor learning. Thus, a therapy based on wearable grip sensing was feasible for home rehabilitation, but only for a fraction of subacute stroke subjects. Subjects made usage decisions consistent with theoretical models of machine failure and motor learning.
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Stark A, Färber C, Tetzlaff B, Scherer M, Barzel A. Stroke patients' and non-professional coaches' experiences with home-based constraint-induced movement therapy: a qualitative study. Clin Rehabil 2019; 33:1527-1539. [PMID: 31104476 PMCID: PMC6716206 DOI: 10.1177/0269215519848813] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To investigate the experiences of chronic stroke patients and
non-professional coaches with home-based constraint-induced movement therapy
(homeCIMT). Design: Qualitative study embedded within a cluster randomized controlled trial
investigating the efficacy of homeCIMT to improve the use of the affected
arm in daily activities. Setting: Patients’ home environment. Participants: 13 stroke patients and 9 non-professional coaches’ alias family members who
had completed the four-week homeCIMT programme in the context of the
HOMECIMT trial. Interventions: Semi-structured interviews; qualitative data were analysed using the
methodology of the hermeneutic phenomenological data analysis. Results: We identified six themes in the qualitative analysis describing the
experiences of patients and non-professional coaches with homeCIMT: (1)
homeCIMT can be integrated into everyday life with varying degrees of
success; (2) training together may produce positive experiences as well as
strain; (3) self-perceived improvements during and following homeCIMT; (4)
using the affected arm in everyday life is challenging; (5) subjective
evaluation of and experiences with homeCIMT-specific exercises; and (6)
impact of professional therapists’ guidance and motivation during homeCIMT.
Statements regarding theme five and six were only provided by patients,
whereas the other themes contain both, the experiences of stroke patients
and non-professional coaches. Conclusion: Patients’ and non-professional coaches’ narratives offer a detailed insight
into the manifold experiences with the practical implementation of homeCIMT
that may help improve implementing the homeCIMT programme and similar
approaches involving increased training duration and intensity and/or
involvement of family members.
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Affiliation(s)
- Anne Stark
- 1 Department of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christine Färber
- 2 Department of Health Sciences, Faculty of Life Sciences, Hamburg University of Applied Sciences, Hamburg, Germany
| | - Britta Tetzlaff
- 1 Department of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Scherer
- 1 Department of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Barzel
- 1 Department of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,3 Department of Innovation and Collaboration in Ambulatory Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
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Hyakutake K, Morishita T, Saita K, Fukuda H, Shiota E, Higaki Y, Inoue T, Uehara Y. Effects of Home-Based Robotic Therapy Involving the Single-Joint Hybrid Assistive Limb Robotic Suit in the Chronic Phase of Stroke: A Pilot Study. Biomed Res Int 2019; 2019:5462694. [PMID: 31011576 DOI: 10.1155/2019/5462694] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 01/04/2019] [Accepted: 02/20/2019] [Indexed: 01/21/2023]
Abstract
Introduction Robotic therapy has drawn attention in the rehabilitation field including home-based rehabilitation. A previous study has reported that home-based therapy could be more effective for increasing upper limb activity than facility-based therapy. The single-joint hybrid assistive limb (HAL-SJ) is an exoskeleton robot developed according to the interactive biofeedback theory, and several studies have shown its effectiveness for upper limb function in stroke patients. A study of home-based robotic therapy has shown to enhance rehabilitation effectiveness for stroke patient with a paretic upper limb. However, home-based therapy involving a HAL-SJ in stroke patients with paretic upper limbs has not been investigated. The present study aimed to investigate paretic upper limb activity and function with home-based robotic therapy involving a HAL-SJ in stroke patients. Materials and Methods A home-based robotic therapy program involving a HAL-SJ was performed for 30 min per session followed by standard therapy for 30 min per session, 2 times a week, for 4 weeks (i.e., completion of all 8 sessions involved 8 h of rehabilitation), at home. After the intervention, patients were followed up by telephone and home visits for 8 weeks. The paretic upper limb activity and function were assessed using the Motor Activity Log (MAL; amount of use (AOU)), arm triaxial accelerometry (laterality index (LI)), the Fugl–Meyer assessment (FMA), and the action research arm test (ARAT), at baseline and week 4 and week 12 after the start of training. Results The study included 10 stroke patients (5 men; mean age, 61.1 ± 7.1 years). The AOU scores and LI significantly improved at week 4 after the start of training (p<0.05). However, no significant changes were observed in the LI at week 12 (p=0.161) and the FMA scores at both week 4 and week 12 (p=0.059 and p=0.083, respectively). The ARAT scores significantly improved at both week 4 and week 12 (p<0.05). Conclusion Home-based robotic therapy combined with conventional therapy could be a valuable approach for increasing paretic upper limb activity and maintaining paretic upper limb function in the chronic phase of stroke.
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Vloothuis JDM, Mulder M, Veerbeek JM, Konijnenbelt M, Visser‐Meily JMA, Ket JCF, Kwakkel G, van Wegen EEH. Caregiver-mediated exercises for improving outcomes after stroke. Cochrane Database Syst Rev 2016; 12:CD011058. [PMID: 28002636 PMCID: PMC6463929 DOI: 10.1002/14651858.cd011058.pub2] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Stroke is a major cause of long-term disability in adults. Several systematic reviews have shown that a higher intensity of training can lead to better functional outcomes after stroke. Currently, the resources in inpatient settings are not always sufficient and innovative methods are necessary to meet these recommendations without increasing healthcare costs. A resource efficient method to augment intensity of training could be to involve caregivers in exercise training. A caregiver-mediated exercise programme has the potential to improve outcomes in terms of body function, activities, and participation in people with stroke. In addition, caregivers are more actively involved in the rehabilitation process, which may increase feelings of empowerment with reduced levels of caregiver burden and could facilitate the transition from rehabilitation facility (in hospital, rehabilitation centre, or nursing home) to home setting. As a consequence, length of stay might be reduced and early supported discharge could be enhanced. OBJECTIVES To determine if caregiver-mediated exercises (CME) improve functional ability and health-related quality of life in people with stroke, and to determine the effect on caregiver burden. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (October 2015), CENTRAL (the Cochrane Library, 2015, Issue 10), MEDLINE (1946 to October 2015), Embase (1980 to December 2015), CINAHL (1982 to December 2015), SPORTDiscus (1985 to December 2015), three additional databases (two in October 2015, one in December 2015), and six additional trial registers (October 2015). We also screened reference lists of relevant publications and contacted authors in the field. SELECTION CRITERIA Randomised controlled trials comparing CME to usual care, no intervention, or another intervention as long as it was not caregiver-mediated, aimed at improving motor function in people who have had a stroke. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials. One review author extracted data, and assessed quality and risk of bias, and a second review author cross-checked these data and assessed quality. We determined the quality of the evidence using GRADE. The small number of included studies limited the pre-planned analyses. MAIN RESULTS We included nine trials about CME, of which six trials with 333 patient-caregiver couples were included in the meta-analysis. The small number of studies, participants, and a variety of outcome measures rendered summarising and combining of data in meta-analysis difficult. In addition, in some studies, CME was the only intervention (CME-core), whereas in other studies, caregivers provided another, existing intervention, such as constraint-induced movement therapy. For trials in the latter category, it was difficult to separate the effects of CME from the effects of the other intervention.We found no significant effect of CME on basic ADL when pooling all trial data post intervention (4 studies; standardised mean difference (SMD) 0.21, 95% confidence interval (CI) -0.02 to 0.44; P = 0.07; moderate-quality evidence) or at follow-up (2 studies; mean difference (MD) 2.69, 95% CI -8.18 to 13.55; P = 0.63; low-quality evidence). In addition, we found no significant effects of CME on extended ADL at post intervention (two studies; SMD 0.07, 95% CI -0.21 to 0.35; P = 0.64; low-quality evidence) or at follow-up (2 studies; SMD 0.11, 95% CI -0.17 to 0.39; P = 0.45; low-quality evidence).Caregiver burden did not increase at the end of the intervention (2 studies; SMD -0.04, 95% CI -0.45 to 0.37; P = 0.86; moderate-quality evidence) or at follow-up (1 study; MD 0.60, 95% CI -0.71 to 1.91; P = 0.37; very low-quality evidence).At the end of intervention, CME significantly improved the secondary outcomes of standing balance (3 studies; SMD 0.53, 95% CI 0.19 to 0.87; P = 0.002; low-quality evidence) and quality of life (1 study; physical functioning: MD 12.40, 95% CI 1.67 to 23.13; P = 0.02; mobility: MD 18.20, 95% CI 7.54 to 28.86; P = 0.0008; general recovery: MD 15.10, 95% CI 8.44 to 21.76; P < 0.00001; very low-quality evidence). At follow-up, we found a significant effect in favour of CME for Six-Minute Walking Test distance (1 study; MD 109.50 m, 95% CI 17.12 to 201.88; P = 0.02; very low-quality evidence). We also found a significant effect in favour of the control group at the end of intervention, regarding performance time on the Wolf Motor Function test (2 studies; MD -1.72, 95% CI -2.23 to -1.21; P < 0.00001; low-quality evidence). We found no significant effects for the other secondary outcomes (i.e. PATIENT motor impairment, upper limb function, mood, fatigue, length of stay and adverse events; caregiver: mood and quality of life).In contrast to the primary analysis, sensitivity analysis of CME-core showed a significant effect of CME on basic ADL post intervention (2 studies; MD 9.45, 95% CI 2.11 to 16.78; P = 0.01; moderate-quality evidence).The methodological quality of the included trials and variability in interventions (e.g. content, timing, and duration), affected the validity and generalisability of these observed results. AUTHORS' CONCLUSIONS There is very low- to moderate-quality evidence that CME may be a valuable intervention to augment the pallet of therapeutic options for stroke rehabilitation. Included studies were small, heterogeneous, and some trials had an unclear or high risk of bias. Future high-quality research should determine whether CME interventions are (cost-)effective.
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Affiliation(s)
- Judith DM Vloothuis
- Amsterdam Rehabilitation Research Centre, ReadeDepartment of NeurorehabilitationOvertoom 283PO Box 58271AmsterdamNetherlands1054 HW
| | - Marijn Mulder
- VU University Medical CenterDepartment of Rehabilitation Medicine, MOVE Research Institute AmsterdamAmsterdamNetherlands
| | - Janne M Veerbeek
- VU University Medical CenterDepartment of Rehabilitation Medicine, MOVE Research Institute AmsterdamAmsterdamNetherlands
- VU University Medical CenterDepartment of Rehabilitation Medicine, Physical TherapyDe Boelelaan 1118AmsterdamNoor‐HollandNetherlands1007 MB
| | - Manin Konijnenbelt
- Amsterdam Rehabilitation Research Centre, ReadeDepartment of NeurorehabilitationOvertoom 283PO Box 58271AmsterdamNetherlands1054 HW
| | - Johanna MA Visser‐Meily
- University Medical Center Utrecht and De HoogstraatBrain Center Rudolf MagnusHeidelberglaan 100PO Box 85500UtrechtNetherlands3508 GA
| | - Johannes CF Ket
- Vrije Universiteit AmsterdamMedical LibraryDe Boelelaan 1117AmsterdamNetherlands1081 HV
| | - Gert Kwakkel
- VU University Medical CenterDepartment of Rehabilitation Medicine, MOVE Research Institute Amsterdam, Amsterdam NeurosciencesDe Boelelaan 1118AmsterdamNetherlands1007 MB
| | - Erwin EH van Wegen
- Amsterdam Neurosciences, VU University Medical CenterDepartment of Rehabilitation Medicine, MOVE Research Institute AmsterdamPO Box 7057AmsterdamNetherlands1007 MB
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Waddell KJ, Birkenmeier RL, Moore JL, Hornby TG, Lang CE. Feasibility of high-repetition, task-specific training for individuals with upper-extremity paresis. Am J Occup Ther 2016; 68:444-53. [PMID: 25005508 DOI: 10.5014/ajot.2014.011619] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE. We investigated the feasibility of delivering an individualized, progressive, high-repetition upper-extremity (UE) task-specific training protocol for people with stroke in the inpatient rehabilitation setting. METHOD. Fifteen patients with UE paresis participated in this study. Task-specific UE training was scheduled for 60 min/day, 4 days/wk, during occupational therapy for the duration of a participant's inpatient stay. During each session, participants were challenged to complete ≥300 repetitions of various tasks. RESULTS. Participants averaged 289 repetitions/session, spending 47 of 60 min in active training. Participants improved on impairment and activity level outcome measures. CONCLUSION. People with stroke in an inpatient setting can achieve hundreds of repetitions of task-specific training in 1-hr sessions. As expected, all participants improved on functional outcome measures. Future studies are needed to determine whether this high-repetition training program results in better outcomes than current UE interventions.
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Affiliation(s)
- Kimberly J Waddell
- Kimberly J. Waddell, MS, OTR/L, is Occupational Therapist, Rehabilitation Institute of Chicago, Chicago, IL
| | - Rebecca L Birkenmeier
- Rebecca L. Birkenmeier, OTD, OTR/L, is Research Assistant Professor, Program in Occupational Therapy, Program in Physical Therapy, Department of Neurology, Washington University School of Medicine, St. Louis, MO
| | - Jennifer L Moore
- Jennifer L. Moore, PT, DHS, NCS, is Clinical Therapy Lead and Physical Therapist, Rehabilitation Institute of Chicago, Chicago, IL
| | - T George Hornby
- T. George Hornby, PhD, PT, is Research Scientist, Rehabilitation Institute of Chicago, Chicago, IL, and Associate Professor, Department of Physical Therapy and Kinesiology and Nutrition, University of Illinois at Chicago
| | - Catherine E Lang
- Catherine E. Lang, PhD, PT, is Associate Professor, Program in Physical Therapy, Program in Occupational Therapy, Department of Neurology, Washington University School of Medicine, 4444 Forest Park Avenue, Campus Box 8502, St. Louis, MO 63108-2212;
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Nilsen DM, Gillen G, Geller D, Hreha K, Osei E, Saleem GT. Effectiveness of interventions to improve occupational performance of people with motor impairments after stroke: an evidence-based review. Am J Occup Ther 2015; 69:6901180030p1-9. [PMID: 25553742 DOI: 10.5014/ajot.2015.011965] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We conducted a review to determine the effectiveness of interventions to improve occupational performance in people with motor impairments after stroke as part of the American Occupational Therapy Association's Evidence-Based Practice Project. One hundred forty-nine studies met inclusion criteria. Findings related to key outcomes from select interventions are presented. Results suggest that a variety of effective interventions are available to improve occupational performance after stroke. Evidence suggests that repetitive task practice, constraint-induced or modified constraint-induced movement therapy, strengthening and exercise, mental practice, virtual reality, mirror therapy, and action observation can improve upper-extremity function, balance and mobility, and/or activity and participation. Commonalities among several of the effective interventions include the use of goal-directed, individualized tasks that promote frequent repetitions of task-related or task-specific movements.
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Affiliation(s)
- Dawn M Nilsen
- Dawn M. Nilsen, EdD, OTL, is Assistant Professor of Rehabilitation and Regenerative Medicine (Occupational Therapy), Columbia University, New York, NY;
| | - Glen Gillen
- Glen Gillen, EdD, OTR/L, FAOTA, is Associate Professor of Rehabilitation and Regenerative Medicine (Occupational Therapy), Columbia University, New York, NY
| | - Daniel Geller
- Daniel Geller, MS, MPH, OTR/L, Kimberly Hreha, OTR/L, Ellen Osei, MS, OTR/L, and Ghazala T. Saleem, MS, OTR/L, are Doctoral Students, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Kimberly Hreha
- Daniel Geller, MS, MPH, OTR/L, Kimberly Hreha, OTR/L, Ellen Osei, MS, OTR/L, and Ghazala T. Saleem, MS, OTR/L, are Doctoral Students, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Ellen Osei
- Daniel Geller, MS, MPH, OTR/L, Kimberly Hreha, OTR/L, Ellen Osei, MS, OTR/L, and Ghazala T. Saleem, MS, OTR/L, are Doctoral Students, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Ghazala T Saleem
- Daniel Geller, MS, MPH, OTR/L, Kimberly Hreha, OTR/L, Ellen Osei, MS, OTR/L, and Ghazala T. Saleem, MS, OTR/L, are Doctoral Students, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
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Souza WC, Conforto AB, Orsini M, Stern A, André C. Similar Effects of Two Modified Constraint-Induced Therapy Protocols on Motor Impairment, Motor Function and Quality of Life in Patients with Chronic Stroke. Neurol Int 2015; 7:5430. [PMID: 26294941 PMCID: PMC4508540 DOI: 10.4081/ni.2015.5430] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 01/03/2015] [Indexed: 01/05/2023] Open
Abstract
Modified constraint-induced movement therapy (CIMT) protocols show motor function and real-world arm use improvement. Meanwhile it usually requires constant supervision by physiotherapists and is therefore more expensive than customary care. This study compared the preliminary efficacy of two modified CIMT protocols. A two-group randomized controlled trial with pre and post treatment measures and six months follow-up was conducted. Nineteen patients with chronic stroke received 10 treatment sessions distributed three to four times a week over 22 days. CIMT3h_direct group received 3 hours of CIMT supervised by a therapist (n=10) while CIMT1.5h_direct group had 1.5 hours of supervised CIMT+1.5 hours home exercises supervised by a caregiver (n=9). Outcome measures were the Fugl-Meyer Assessment, the Motor Activity Log, and the Stroke Specific Quality of Life Scale. The modified CIMT protocols were feasible and well tolerated. Improvements in motor function, real-world arm use and quality of life did not differ significantly between treated groups receiving either 3 or 1.5 hours mCIMT supervised by a therapist.
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Affiliation(s)
- Wilma Costa Souza
- Federal University of Rio de Janeiro, Rehabilitation Center of Rio de Janeiro, Brazil
| | - Adriana B. Conforto
- Neurostimulation Laboratory, Hospital das Cĺinicas/São Paulo University, Brazil
| | - Marco Orsini
- Neurology Department, Centro Universitário Augusto Mottta, UNISUAM, Bonsucesso, Brazil
| | - Annette Stern
- School of Psychology, University of Surrey, Guildford, UK
| | - Charles André
- Department of Neurology, School of Medicine, Federal University of Rio de Janeiro, Brazil
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Barzel A, Ketels G, Tetzlaff B, Krüger H, Haevernick K, Daubmann A, Wegscheider K, Scherer M. Enhancing activities of daily living of chronic stroke patients in primary health care by modified constraint-induced movement therapy (HOMECIMT): study protocol for a cluster randomized controlled trial. Trials 2013; 14:334. [PMID: 24124993 PMCID: PMC3853576 DOI: 10.1186/1745-6215-14-334] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Accepted: 10/01/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Stroke leads to constant rehabilitation needs even at the chronic stage. However, although many stroke patients receive physical or occupational therapy in primary health care, treatment prescriptions do not generally specify therapeutic goals; in particular, participation is not established as an explicit therapeutic goal in the ambulatory setting. The primary aim of this study is to evaluate the efficacy of a therapy regimen for chronic stroke patients (modified 'constraint-induced movement therapy (CIMT) at home') with impaired hand or arm function with regard to the prerequisites of participation in everyday activities: a sufficient arm and hand function. 'CIMT at home' will be compared with conventional physical and occupational therapy ('therapy as usual'). METHODS/DESIGN The study is a parallel cluster randomized controlled trial with therapy practices as clusters (n = 48). After written consent from the patients (n = 144), the therapists will be randomly assigned to treat either the intervention or the control group. Blinded external assessors will evaluate the patients using standardized outcome measures before and after the intervention, and six months later. The two coprimary endpoint assessments of arm and hand function as prerequisites for participation (defined as equal involvement in activities of daily living) are the motor activity log (quality of arm and hand use) and the Wolf motor function test (arm and hand function). These assessments are made four weeks post-treatment and relativized to baseline performance. Changes in primary outcomes will be analyzed with mixed models, which consider the hierarchical structure of the data and will be adjusted to the baseline measurements and sex. The primary analysis will be the comparison of the two randomized groups, with respect to the adjusted averages for each of the two coprimary endpoints. To keep an overall significance level of 5%, the two endpoints will be tested at the significance level of 5% each in hierarchical order. DISCUSSION A modification of the CIMT, feasible in the patients' homes (CIMT at home), appears to be a promising therapeutic approach in the ambulatory care of chronic stroke patients. With proven efficacy and practicality, a participation-oriented, stroke-specific treatment would be available in primary care. TRIAL REGISTRATION ClinicalTrials.gov NCT01343602.
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Affiliation(s)
- Anne Barzel
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Gesche Ketels
- Physiotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Britta Tetzlaff
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Heike Krüger
- Physiotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Kerstin Haevernick
- Physiotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Anne Daubmann
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Karl Wegscheider
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Martin Scherer
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
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Reiss AP, Wolf SL, Hammel EA, McLeod EL, Williams EA. Constraint-Induced Movement Therapy (CIMT): Current Perspectives and Future Directions. Stroke Res Treat 2012; 2012:159391. [PMID: 22577601 DOI: 10.1155/2012/159391] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Revised: 02/14/2012] [Accepted: 02/15/2012] [Indexed: 11/17/2022] Open
Abstract
Constraint-induced movement therapy (CIMT) has gained considerable popularity as a treatment technique for upper extremity rehabilitation among patients with mild-to-moderate stroke. While substantial evidence has emerged to support its applicability, issues remain unanswered regarding the best and most practical approach. Following the establishment of what can be called the "signature" CIMT approach characterized by intense clinic/laboratory-based practice, several distributed forms of training, collectively known as modified constraint therapy (mCIMT), have emerged. There is a need to examine the strengths and limitations of such approaches, and based upon such information, develop the components of a study that would compare the signature approach to the best elements of mCIMT, referred to here as "alternative" CIMT. Based upon a PEDro review of literature, limitations in mCIMT studies for meeting criteria were identified and discussed. A suggestion for a "first effort" at a comparative study that would both address such limitations while taking practical considerations into account is provided.
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