Date Presented 4/20/2018
Stroke survivors frequently exhibit motor impairments in one upper extremity. The current study showed that 120-min daily sessions of occupational practice augmented by electrical stimulation significantly increased affected arm use and performance of valued occupations.
Primary Author and Speaker: Stephen Page
Additional Authors and Speakers: Valerie Hill
Contributing Authors: Peter Levine, Kari Dunning, Lauren Wengard
PURPOSE AND BACKGROUND: The purpose of this study was to compare the effects of ½-hr, 1-hr, and 2-hr daily training sessions of repetitive task-specific training (RTP) incorporating an electrical stimulation neuroprosthesis in chronic stroke survivors. Stroke remains a leading cause of disability worldwide, and upper extremity (UE) hemiparesis is the most prevalent impairment encountered by occupational therapy practitioners. Despite the increasing prevalence of this population, there remains a paucity of efficacious interventions for stroke survivors with moderately impaired UEs.
METHOD: This study was a randomized controlled intervention trial with multiple baseline design. Participants were 36 people exhibiting moderate arm hemiparesis secondary to stroke >1 yr prior to study entry. They participated in 30-, 60-, or 120-min therapy RTP sessions every weekday for 8 wk. During the sessions, participants wore the neuroprosthesis to enable performance of valued activities identified largely by the participants themselves. To ensure transfer to participants’ real-world environments, most sessions were home based, with participants coming to the clinic for “tune-up” sessions. A fourth group participated in a structured home exercise program (HEP). The Action Research Arm Test (ARAT), upper extremity section of the Fugl-Meyer Assessment (FMA), Arm Motor Ability Test (AMAT), and Box and Block Test (BB) were administered twice before intervention and once after intervention.
Repeated measures analysis of variance for each continuous dependent variable was performed next, in which multiple measurements for the same participant were modeled at two time points (pretest and posttest). The dependent variables were FMA, BB, AMAT, and ARAT scores. The model included categories of time (pretest and posttest), group, and Time × Group interactions.
RESULTS: The groups were not significantly different in any demographic or motor measure at baseline. After intervention, the 120-min group exhibited significantly larger changes on the AMAT and FM (p < .01); on the BB, the 120-min group exhibited larger changes, but the differences were nonsignificant. On the ARAT, both the 60-min and 120-min groups showed significant increases after intervention. The HEP group showed nominal or no changes on all measures.
CONCLUSION: A longer daily duration of electrical stimulation consistently rendered larger motor outcomes in moderately impaired participants with stroke. The study also confirms earlier pilot work suggesting the efficacy of this approach for chronic moderately impaired people with stroke.
IMPACT STATEMENT: The results suggest the optimal daily duration at which functional electrical stimulation—a commonly used modality in occupational therapy practice—should be used in one of the most prevalent populations encountered by practitioners. Adult neurorehabilitation, stroke, and older adults (because stroke is largely a disease of older adults) are all significant priorities for the American Occupational Therapy Association and prevalent populations encountered by occupational therapy practitioners.
References
Page, S. J., Levine, P., & Blazak, B. (2016). “Reps” aren’t enough: Augmenting functional electrical stimulation with behavioral supports significantly reduces impairment in moderately impaired stroke. Archives of Physical Medicine and Rehabilitation, 97, 747–752. https://doi.org/10.1016/j.apmr.2016.01.004
Persch, A., Page, S. J., & Murray, C. (2012). Paretic upper extremity movement gains are retained 3 months after training with an electrical stimulation neuroprosthesis. Archives of Physical Medicine and Rehabilitation, 93, 2122–2125. https://doi.org/10.1016/j.apmr.2011.09.016
