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  • Intensive Motor Learning Can Improve Function Poststroke, Even if it Begins a Year Later

    Authors of a small study of motor learning (ML) treatment with patients poststroke claim that not only can the approach make a difference more than a year after the stroke event, but that ML alone works about as well as ML that uses robot-assisted training or functional electrical stimulation (FES). They say that the real key to success may have more to do with the intensity of therapy sessions—5 hours a day, 5 days a week, for 12 weeks—than with any particular combination of treatments.

    The randomized controlled trial compared treatment approaches among 35 patients who had experienced a stroke more than 1 year earlier and still had an upper extremity impairment. Participants were included if they had at least a trace muscle contraction in the wrist extensors, and mobility and function sufficient for independent activities.

    Researchers divided the participants into 3 groups: the first received ML alone (11), the second received ML plus a robotic intervention targeted at shoulder/elbow (12), and the third received ML plus FES targeted at wrist/hand training (12). All participants received 300 hours of treatment over the course of 3 months. Results were published in the June issue of the Archives of Physical Medicine and Rehabilitation.

    While no group improved more than another in statistically significant ways, all participants registered significant improvements in the Fugl-Meyer (FM) coordination assessment, with average improvement that nearly doubled baseline scores. Across-group improvements were also registered in the Arm Motor Ability Test (AMAT).

    Authors write that the similar improvement patterns among the 3 groups may be attributed to the fact that all 3 groups "received treatment that was based on ML principles," and that the time spent in ML without the technologies "served to consolidate newly learned joint coordination that was gained through the use of either robotics or FES."

    According to authors, the overall improvements across all groups say more about the intensity and duration of treatment than the technologies involved.

    "The current clinical practice milieu prevents the provision of long-duration, high-intensity treatment," authors write. "One reason for the lack of provision of long-duration interventions in standard clinical care is the out-of-date belief that no more recovery can occur after 3 to 6 months poststroke. In contrast with these inaccurate beliefs, our results are consistent with others who have demonstrated the possibility of motor recovery beyond that time period, through the application of a variety of treatment methods."

    Though researchers acknowledge that long-duration, high-intensity treatment can seem like a barrier, authors also noted a potential way to increase efficiencies: group treatment. In their trial, all treatment was conducted by 1 physical therapist working with 3 participants simultaneously. However, they warn, no research was conducted to determine if this 1:3 ratio was optimal.

    In addition to the small number of participants, authors noted 2 other limitations to their study: no comparison of FES with robotic treatment targeted at the same area, and the absence of any follow-up data.

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.

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