Comparison of Robotics, Functional Electrical Stimulation, and Motor Learning Methods for Treatment of Persistent Upper Extremity Dysfunction After Stroke: A Randomized Controlled Trial

Authors

Jessica McCabe, Louis Stokes Cleveland Department of Veterans Affairs Medical Center
Michelle Monkiewicz, Louis Stokes Cleveland Department of Veterans Affairs Medical Center
John P. Holcomb, Cleveland State UniversityFollow
Svetlana Pundik, Louis Stokes Cleveland Department of Veterans Affairs Medical Center
Janis J. Daly, Louis Stokes Cleveland Department of Veterans Affairs Medical Center

Document Type

Article

Publication Date

6-2015

Publication Title

Archives of Physical Medicine and Rehabilitation

Abstract

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 post single 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.

Comments

Open Access

Repository Citation

McCabe, Jessica; Monkiewicz, Michelle; Holcomb, John P.; Pundik, Svetlana; and Daly, Janis J., "Comparison of Robotics, Functional Electrical Stimulation, and Motor Learning Methods for Treatment of Persistent Upper Extremity Dysfunction After Stroke: A Randomized Controlled Trial" (2015). Mathematics and Statistics Faculty Publications. 250.
https://engagedscholarship.csuohio.edu/scimath_facpub/250

DOI

10.1016/j.apmr.2014.10.022

Version

Publisher's PDF

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.

Volume

96

Issue

6