Arm Rehabilitation Study After Stroke

Of the 700,000 individuals who experience a new or recurrent stroke each year, a majority
have considerable residual disability. Sixty-five percent (65%) of patients at 6 months are
unable to incorporate the paretic hand effectively into daily activities. In turn, this
degree of functional deficit contributes to a reduced quality of life after stroke. The
extent of disability has been underplayed by the use of the Barthel Index that captures only
basic activities of daily living such as self-care and does not extend to activities and
participation at higher levels of functioning that are most affected by a residual upper
extremity disability. The past decade has witnessed an explosion of different therapy
interventions designed to capitalize on the brain's inherent capability to rewire and learn
well into old age and more importantly for rehabilitation, after injury. The most effective
arm-focused interventions with the strongest evidence and potentially the most immediate and
cost-effective appeal for the current health-care environment share a common emphasis on
focused task-specific training applied with an intensity higher than usual care. Therefore,
our primary aim is to compare the efficacy of a fully defined, hybrid combination of the
most effective interventions (forced-use/constraint-induced therapy and
skill-based/impairment-mitigating motor learning training), the Accelerated Skill
Acquisition Program (ASAP), to an equivalent dose of usual and customary outpatient therapy.

INCLUSION

Ischemic or hemorrhagic stroke.

Hemiparesis in an upper extremity.

Age 21+.

Able to communicate in English.

Willing to attend outpatient therapy & f/u evaluations for 1 yr.

Some active finger extension.

EXCLUSION

Traumatic or non-vascular brain injury, subarachnoid hemorrhage, AV malformation.

History of psychiatric illness requiring hospitalization within past 24 mos.

Active drug treatment for dementia.

Neurologic condition that may affect motor response (e.g. Parkinson's, ALS, MS).

History of head trauma requiring >48 hours of hospitalization within past 12 mos.

Amputation of all fingers or thumb of hemiparetic (weak) arm.

Treated with Botox in affected arm within last 3 months.