Two new studies have shown positive outcomes for stroke survivors to regain upper extremity function. One study found no relationship between brain lesion volume and upper extremity impairment; the other study found stroke survivors can perform everyday tasks with the assistance of a robotic arm as efficaciously as manual practice to improve upper extremity impairment.
“These studies were looking at two entirely different aspects of a stroke, yet they both suggest that stroke patients can indeed regain function years and years after the initial event,” Stephen Page, PhD, OTR/L, associate professor of Health and Rehabilitation Sciences in Ohio State’s College of Medicine, stated in a news release. “Unfortunately, we know that this is not a message that many patients and especially their clinicians may be getting, so the patients may not be reaching their true potential for recovery.
In the first study, published in the Archives of Physical Medicine and Rehabilitation, researchers collected data on 139 participants with chronic stroke and stable, active, distal upper extremity movement related to their lesion volume and upper extremity movement. Researchers assessed the data using the upper extremity section of the Fugl-Meyer (FM) assessment and the Arm Motor Ability Test (AMAT) Functional Ability (FA) and Time scales.
Study results showed impairment was not related to lesion volume and age and lesion volume only accounted for about 6% of the variance in AMAT FA and AMAT Time.
“Historically, lesion size has been thought to influence recovery, but we didn’t find that to be the case when looking at regaining arm and hand movement,” Page said. “This has important implications because we know clinicians look closely at lesion volume and may make decisions about the type and duration of therapy, and that some may communicate likelihood for recovery to patients based on that size. Many people think the window for therapy is roughly 6 months, but we think it’s much longer.”
The second study, published in Clinical Rehabilitation, included participants who exhibited chronic, stable, moderate upper extremity impairment. Split into two groups and supervised by a therapist, one group used a portable robotic-assisted arm to perform repetitive task-specific practice for 30 minutes, 3 days a week for 8 weeks, whereas the other group performed the same activity regimen manually. The upper extremity FM, Canadian Occupational Performance Measure (COPM) and Stroke Impact Scale (SIS) were administered on two occasions before intervention and once after intervention.
After intervention, researchers found that the two groups exhibited nearly identical FM score increases of 2.1 points, whereas the group using the robotic arm exhibited larger score changes on all but one of the COPM and SIS subscales. This included a 12.5-point increase on the SIS recovery subscale.
“Our results are exciting not just because we showed robotics-assisted therapy can offer equal benefit. We showed that both groups got better, even among patients who had suffered strokes as long as 8 years ago,” Page said. “Study participants who trained with the robotic arm also reported feeling stronger and more positive about the rehabilitation process.
“Loss of upper extremity movement remains one of the most common and devastating stroke-induced impairments. And the fact is that more stroke survivors are expected yet studies and pathways to optimize rehabilitative therapy for these millions are not always emphasized. In particular, we know active rehabilitation programs help people regain function, but we still don’t know who will benefit the most from these types of therapy,” Page said. “Both of these studies give us insights about patients who will respond best — and most importantly, that we have to give these patients every chance possible to get better, because they can keep getting better.”
For more information:
Page SJ. Clin Rehabil. 2013;27:494-503.
Disclosure: The researchers were supported by the American Stroke Association and by grants from the National Institutes of Health.