RESUMEN
BACKGROUND: The SMART (SensoriMotor Active Rehabilitation Training) Arm is a nonrobotic device designed to allow stroke survivors with severe paresis to practice reaching. It can be used with or without outcome-triggered electrical stimulation (OT-stim) to augment movement. The aim of this study was to evaluate the efficacy of SMART Arm training when used with or without OT-stim, in addition to usual care, as compared with usual care alone during inpatient rehabilitation. METHODS: Eight stroke survivors received 20 hours of SMART Arm training over 4 weeks; they were randomly assigned to either (1) SMART Arm training with OT-stim or (2) SMART Arm training alone. Usual therapy was also provided. A historical cohort of 20 stroke survivors formed the control group and received only usual therapy. The primary outcome was Motor Assessment Scale Item 6, Upper Arm Function. RESULTS: Findings for all participants were comparable at baseline. SMART Arm training, with or without OT-stim, led to a significantly greater improvement in upper arm function than usual therapy alone (P = .024). There was no difference in improvement between training with or without OT-stim. Initial motor severity and presence of OT-stim influenced the number of repetitions performed and the progression of SMART Arm training practice conditions. CONCLUSION: Usual therapy in combination with SMART Arm training, with or without OT-stim, appears to be more effective than usual therapy alone for stroke survivors with severe paresis. These findings warrant further investigation into the benefits of SMART Arm training for stroke survivors with severe paresis undergoing inpatient rehabilitation during the subacute phase of recovery.
Asunto(s)
Brazo/fisiología , Estimulación Eléctrica , Terapia por Ejercicio/métodos , Movimiento/fisiología , Accidente Cerebrovascular/terapia , Resultado del Tratamiento , Adulto , Anciano , Anciano de 80 o más Años , Evaluación de la Discapacidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Recuperación de la Función , Estudios Retrospectivos , Método Simple Ciego , Estadísticas no Paramétricas , Adulto JovenRESUMEN
QUESTIONS: In adults undergoing rehabilitation after stroke, does 30 minutes of daily stretch of the wrist and finger flexors for four weeks prevent or reverse contracture, decrease pain, or improve upper-limb activity? Are any gains maintained one week and five weeks after the cessation of stretching? DESIGN: Randomised controlled trial with concealed randomisation, assessor blinding, and intention-to-treat analysis. PARTICIPANTS: 40 adults undergoing rehabilitation after stroke or stroke-like brain injury, who were unable to actively extend the affected wrist. INTERVENTION: Both groups received routine upper-limb retraining five days a week. In addition, the experimental group received 30 minutes daily stretch of the wrist and finger flexors five days a week for four weeks. OUTCOME MEASURES: The primary outcome was contracture, measured as torque-controlled passive wrist extension with the fingers extended. Secondary outcomes were pain at rest measured on a 10-cm visual analogue scale, and upper-limb activity measured using the Motor Assessment Scale. Outcomes were collected at baseline, post-intervention, and one and five weeks after cessation of intervention. RESULTS: The mean effect on passive range of wrist extension was 3.8 [corrected] degrees (95% CI -2.5 to 10.1) [corrected] after 4 weeks of daily stretch, 4.1 degrees (95% CI -4.0 to 12.3) after a week of no stretch, and 3.5 degrees (95% CI -4.6 to 11.7) after a further four weeks. CONCLUSION: These data suggest that four weeks of regular stretching has little or no effect on wrist contracture after stroke. However the estimate of the size of this effect is not sufficiently precise to rule out the possibility of a marginally worthwhile effect. The stretch had no significant effect on upper-limb pain, and did not result in significantly improved upper-limb activity.
Asunto(s)
Contractura/terapia , Terapia por Ejercicio/métodos , Ejercicio Físico/fisiología , Rehabilitación de Accidente Cerebrovascular , Articulación de la Muñeca/fisiopatología , Adulto , Anciano , Anciano de 80 o más Años , Contractura/etiología , Contractura/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Cooperación del Paciente , Modalidades de Fisioterapia , Rango del Movimiento Articular/fisiología , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/fisiopatología , Resultado del TratamientoRESUMEN
OBJECTIVE: To evaluate the effects of 4 weeks of hand splinting on the length of finger and wrist flexor muscles, hand function, and pain in people with acquired brain impairment. DESIGN: Randomized, assessor-blinded trial. SETTING: Rehabilitation center in Australia. PARTICIPANTS: Twenty-eight adults with acquired brain impairment, all within 6 months of the first injury. There was 1 withdrawal. INTERVENTIONS: Subjects in both experimental (n=17) and control (n=11) groups participated in routine therapy-motor training for upper-limb use and upper-limb stretches-5 days a week. The experimental group also wore an immobilizing hand splint in the functional position (10 degrees -30 degrees wrist extension) for a maximum of 12 hours each night for the duration of the 4-week intervention period. MAIN OUTCOME MEASURES: The length of the wrist and extrinsic finger flexor muscles was evaluated by measuring the torque-controlled range of wrist extension with the fingers extended. Functional hand use was evaluated with the Motor Assessment Scale. Pain was evaluated with a visual analog scale. RESULTS: The effects of splinting were statistically nonsignificant and clinically unimportant. At follow-up, estimates of treatment effects slightly favored the control group: range of motion at the wrist favored controls by 2 degrees (95% confidence interval [CI], -7.2 degrees to 3.2 degrees ), function favored controls by 0.2 points (95% CI, -2.7 to 2.3), and pain favored the experimental group by 1cm (95% CI, -4.6 to 2.2). CONCLUSIONS: An overnight splint-wearing regimen with the affected hand in the functional position does not produce clinically beneficial effects in adults with acquired brain impairment.