Deans' stroke musings: Comparison of Robotics, FES, and Motor Learning Methods for Treatment of Persistent Upper Extremity Dysfunction after Stroke: a Randomized Controlled Trial

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Wednesday, December 18, 2019

Comparison of Robotics, FES, and Motor Learning Methods for Treatment of Persistent Upper Extremity Dysfunction after Stroke: a Randomized Controlled Trial

With NO protocol written up and further study needed, this solved nothing to help survivors recover.

Comparison of Robotics, FES, and Motor Learning Methods for Treatment of Persistent Upper Extremity Dysfunction after Stroke: a Randomized Controlled Trial

Abstract

Objective:
To compare response to upper limb treatment using robotics (ROB) + motor learning (ML) vs. functional electrical stimulation (FES) + ML vs. ML alone, according to a measure of complex functional everyday tasks for chronic, severely impaired stroke survivors.

Design:
single-blind, randomized trial.

Setting
: Clinical research lab, Medical Center.

Participants:
39 enrolled subjects, >1 year post single stroke (attrition rate=10%; 35 completed the study). No adverse effects.

Interventions:
All groups received treatment 5 days/week, 5hrs/day (60 sessions), with unique treatment as follows: ML alone (n=11), 5hrs/day partial and whole task practice of complex functional tasks; ROB+ML (n=12), 3.5hrs/day ML and 1.5hrs/day shoulder/elbow robotics; FES+ML (n=12), 3.5hrs/day ML and 1.5hrs/day FES wrist/hand coordination training.

Main Outcome Measures
: Primary measure: Arm Motor Ability Test (AMAT), 13 complex

functional tasks; secondary measure: upper limb Fugl-Meyer coordination (FM).

Results:
No significant difference found in treatment response across groups (AMAT (p≥.584) and FM (p≥.590)). All three treatment groups demonstrated clinically and statistically significant

improvement in response to treatment (AMAT and FM, p≤.009). A group treatment paradigm of 1:3 (therapist:patient) ratio proved feasible for provision of the intensive treatment.

Conclusions:
Severely impaired stroke survivors with persistent (>1yr) upper extremity dysfunction can make clinically and statistically significant gains in coordination and functional task performance, in response to ROB+ML, FES+ML, and ML alone, in an intensive and long duration intervention, and no group difference was found. Additional study is warranted to determine the effectiveness of these methods in the clinical setting.