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

So you proved something useful but did nothing with it. NO protocol, nothing. Useless.  You'd be fired in my lab. 

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

John Holcomb

2014, Archives of Physical Medicine and Rehabilitation

Please cite this article as: McCabe J, Monkiewicz M, Holcomb J, Pundik S, Daly JJ, Comparisonof Robotics, FES, and Motor Learning Methods for Treatment of Persistent Upper ExtremityDysfunction after Stroke: a Randomized Controlled Trial,

 ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION 

 

 Authors: Jessica McCabe, M.P.T. 1
; Michelle Monkiewicz, D.P.T. 1
; John Holcomb, Ph.D. 2
 , Svetlana Pundik, M.D., M.S. 1
; Janis J. Daly, Ph.D., M.S. 1*
 
Author  affiliations: 

1. Stroke Motor Control/Motor Learning Laboratory of the Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH 44106 2. Department of Mathematics and Statistics, Cleveland State University, Cleveland OH 44016
*
Dr. Daly  currently holds the position of Director, Brain Rehabilitation Research Center of Excellence, Malcom Randall Gainesville DVA Medical Center. Research Career Scientist, DVA.; Professor, Department of Neurology, College of Medicine, University of Florida.; Director, Brain Rehabilitation Research Program, McKnight Brain Institute, University of Florida.

 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.