Training improves upper limb motor function in chronic stroke survivors with severe paresis

Brauer, S. G., Barker, R. N. and Carson, R. G. (2006). Training improves upper limb motor function in chronic stroke survivors with severe paresis. In: , Society for Neuroscience Abstracts. Society for Neuroscience Annual Meeting, Atlanta, Georgia, USA, (). 14-18 October, 2006.


Author Brauer, S. G.
Barker, R. N.
Carson, R. G.
Title of paper Training improves upper limb motor function in chronic stroke survivors with severe paresis
Conference Paper Type Published Abstract
Conference name Society for Neuroscience Annual Meeting
Conference location Atlanta, Georgia, USA
Conference dates 14-18 October, 2006
Proceedings title Society for Neuroscience Abstracts
Place published Online
Publisher Society for Neuroscience
Publication date 2006
Volume number 32
Issue number Program No. 451.1.
Language eng
Formatted Abstract/Summary Background
Stroke survivors with severe upper limb paresis frequently have insufficient underlying motor activity to perform task related practice. We developed a reaching training device, Sensori-Motor Active Rehabilitation Training of the Arm (SMART Arm), specifically designed to make intensive and repetitive task related practice possible for stroke survivors with severe upper limb paresis. The aim of this study was to assess the efficacy of training reaching using the SMART Arm, with and without EMG triggered functional electrical stimulation (FES), in stroke survivors with severe paresis.

Method
A single blind randomized clinical trial was conducted with 42 stroke survivors who were >6mths post stroke who were unable to contract triceps against gravity (MRC grade 1 or 2), yet had a detectable surface EMG signal. Of the 33 participants who completed the study, 10 received EMG triggered FES to triceps brachii coupled with the SMART Arm reaching task, 13 received the SMART Arm reaching task alone and 10 received no intervention. Each intervention group received 12 one hour training sessions over a four week period. Assessments prior to, at completion and 2 months after training included clinical and laboratory measures of upper limb motor impairment and functional activity.

Results
Training of reaching using the SMART Arm with and without EMG triggered FES led to significant improvements in arm motor impairment and function that were maintained at two month follow-up. Peak distance reached and force produced increased and resistance to passive movement decreased (p <0.01). There was a trend (p=0.06) for an increase in triceps to biceps RMS ratio post intervention in the intervention groups. There was no change in any measures in controls.

Conclusion
The study findings confirm that intensive and repetitive task related practice promotes upper limb recovery, even in stroke survivors with severe and chronic paresis. Training with EMG triggered FES did not produce superior benefits, thus the reduction of the degrees of freedom and feedback provided by the SMART Arm may be more important than electrical stimulation in retraining reaching in this severely affected population. However, as some participants experienced difficulty triggering with triceps EMG activity, our future research will investigate movement outcome as an alternative method for voluntarily triggering ES. 
Subjects 110603 Motor Control
Q-Index Code EX
Q-Index Status Provisional Code
Institutional Status Unknown

 
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Created: Fri, 23 Jan 2009, 13:43:19 EST by Ms Lynette Adams on behalf of School of Human Movement Studies