Article

OBJECTIVE: To compare response to upper-limb treatment using robotics plus motor
learning (ML) versus functional electrical stimulation (FES) plus ML versus ML
alone, according to a measure of complex functional everyday tasks for chronic,
severely impaired stroke survivors. DESIGN: Single-blind, randomized trial.
SETTING: Medical center. PARTICIPANTS: Enrolled subjects (N=39) were >1 year
postsingle stroke (attrition rate=10%; 35 completed the study). INTERVENTIONS:
All groups received treatment 5d/wk for 5h/d (60 sessions), with unique treatment
as follows: ML alone (n=11) (5h/d partial- and whole-task practice of complex
functional tasks), robotics plus ML (n=12) (3.5h/d of ML and 1.5h/d of
shoulder/elbow robotics), and FES plus ML (n=12) (3.5h/d of ML and 1.5h/d of FES
wrist/hand coordination training). MAIN OUTCOME MEASURES: Primary measure: Arm
Motor Ability Test (AMAT), with 13 complex functional tasks; secondary measure:
upper-limb Fugl-Meyer coordination scale (FM). RESULTS: There was no significant
difference found in treatment response across groups (AMAT: P>/=.584; FM
coordination: P>/=.590). All 3 treatment groups demonstrated clinically and
statistically significant improvement in response to treatment (AMAT and FM
coordination: P</=.009). A group treatment paradigm of 1:3 (therapist/patient)
ratio proved feasible for provision of the intensive treatment. No adverse
effects. CONCLUSIONS: Severely impaired stroke survivors with persistent (>1y)
upper-extremity dysfunction can make clinically and statistically significant
gains in coordination and functional task performance in response to robotics
plus ML, FES plus ML, and ML alone in an intensive and long-duration
intervention; no group differences were found. Additional studies are warranted
to determine the effectiveness of these methods in the clinical setting.
CI - Copyright (c) 2015 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS