Does More Practice Improve Arm Movement After Stroke?
| Status: | Completed |
|---|---|
| Conditions: | Neurology |
| Therapuetic Areas: | Neurology |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 4/21/2016 |
| Start Date: | May 2010 |
| End Date: | October 2015 |
Dose Response of Movement Practice During Stroke Rehabilitation
Arm weakness happens a lot after a stroke. People often get physical or occupational therapy
after their stroke to learn how to use their arm again. This study will help figure out how
much therapy should be given to restore as much arm function as possible.
after their stroke to learn how to use their arm again. This study will help figure out how
much therapy should be given to restore as much arm function as possible.
Dose has emerged as a key factor promoting functional recovery after stroke. Currently, a
lack of data on the dose-response relationship impedes progress in the field of stroke
rehabilitation. The goal of the proposed project is to define the range of doses of movement
practice that produce the greatest improvements in outcomes in people with chronic stroke.
Borrowing from animal models of stroke, dose in humans can be quantified by the number of
repetitions of task-specific practice.
Our central hypothesis is that there exists a range of doses for people with stroke, below
which, there is minimal benefit, and above which, further practice does not result in
further benefit. The range of beneficial doses is likely to vary based on the severity of
motor deficits and the presence of non-motor deficits in other domains. Using a randomized,
parallel dose-response design, we will evaluate the benefits of four different doses of
task-specific upper extremity training with matched schedules of 1 hr sessions, 4
sessions/wk for 8 wks, in 100 people with chronic stroke. Total repetition doses to be
evaluated (3200, 6400, 9600, & individualized-maximum) are based on our preliminary data.
The individualized-maximum group may extend their sessions beyond 8 wks until meeting
defined stop criteria.
Our primary aim will test whether larger total doses result in better outcomes than smaller
total doses. Benefits of the four doses will be evaluated at the impairment, activity, and
participation levels, since understanding the dose-response relationship at all levels of
measurement is critical for advancing rehabilitation research. We hypothesize that
improvements will be greatest in the 9600 and individualized-maximum, followed by the 6400,
and then the 3200 repetition dose groups. Our secondary aim is to characterize the
dose-response relationship of upper extremity task-specific practice. With data from
multiple assessment points, individual curve modeling will be used to estimate dose ranges,
below which, there is minimal benefit, and above which, further practice does not result in
further benefit. Furthermore, we will determine how various factors modify the dose
estimates. We hypothesize that the severity of motor deficits will be the primary modifier
of the dose-response relationship, with larger doses needed for those with more mild motor
deficits. We further expect that needed doses will be larger for those with depression and
hemispatial neglect.
Our team is well-positioned to investigate the critical issue of dose because of our
expertise in stroke rehabilitation research and measurement, our understanding of the
challenges of clinical practice and clinical research, and our ready access to this patient
population. Expected outcomes from this project are empirically-driven estimates indicating
the amount of movement practice required to drive maximal improvements and how these
estimates can be individually modified for people undergoing stroke rehabilitation. Our
estimates will immediately impact rehabilitation research and clinical practice. The
importance of this project transcends stroke rehabilitation; our primary results will be of
high value to many other rehabilitation populations also impeded by the lack of knowledge
regarding dose-response relationships.
lack of data on the dose-response relationship impedes progress in the field of stroke
rehabilitation. The goal of the proposed project is to define the range of doses of movement
practice that produce the greatest improvements in outcomes in people with chronic stroke.
Borrowing from animal models of stroke, dose in humans can be quantified by the number of
repetitions of task-specific practice.
Our central hypothesis is that there exists a range of doses for people with stroke, below
which, there is minimal benefit, and above which, further practice does not result in
further benefit. The range of beneficial doses is likely to vary based on the severity of
motor deficits and the presence of non-motor deficits in other domains. Using a randomized,
parallel dose-response design, we will evaluate the benefits of four different doses of
task-specific upper extremity training with matched schedules of 1 hr sessions, 4
sessions/wk for 8 wks, in 100 people with chronic stroke. Total repetition doses to be
evaluated (3200, 6400, 9600, & individualized-maximum) are based on our preliminary data.
The individualized-maximum group may extend their sessions beyond 8 wks until meeting
defined stop criteria.
Our primary aim will test whether larger total doses result in better outcomes than smaller
total doses. Benefits of the four doses will be evaluated at the impairment, activity, and
participation levels, since understanding the dose-response relationship at all levels of
measurement is critical for advancing rehabilitation research. We hypothesize that
improvements will be greatest in the 9600 and individualized-maximum, followed by the 6400,
and then the 3200 repetition dose groups. Our secondary aim is to characterize the
dose-response relationship of upper extremity task-specific practice. With data from
multiple assessment points, individual curve modeling will be used to estimate dose ranges,
below which, there is minimal benefit, and above which, further practice does not result in
further benefit. Furthermore, we will determine how various factors modify the dose
estimates. We hypothesize that the severity of motor deficits will be the primary modifier
of the dose-response relationship, with larger doses needed for those with more mild motor
deficits. We further expect that needed doses will be larger for those with depression and
hemispatial neglect.
Our team is well-positioned to investigate the critical issue of dose because of our
expertise in stroke rehabilitation research and measurement, our understanding of the
challenges of clinical practice and clinical research, and our ready access to this patient
population. Expected outcomes from this project are empirically-driven estimates indicating
the amount of movement practice required to drive maximal improvements and how these
estimates can be individually modified for people undergoing stroke rehabilitation. Our
estimates will immediately impact rehabilitation research and clinical practice. The
importance of this project transcends stroke rehabilitation; our primary results will be of
high value to many other rehabilitation populations also impeded by the lack of knowledge
regarding dose-response relationships.
Inclusion Criteria:
- Ischemic or hemorrhagic stroke as determined by a stroke neurologist and consistent
with neuroimaging
- Time since stroke will include subjects 6-months or more post-stroke
- Cognitive skills to actively participate (score of 0-1 on items 1b and 1c of the NIH
Stroke Scale (NIHSS)
- Unilateral upper extremity weakness (score of 1-3 on item 5 (arm item) on the NIHSS)
Exclusion Criteria:
- Subject unavailable for 2-month follow-up
- Inability to follow-2-step commands
- Psychiatric diagnoses
- Current participation in other stroke treatment (i.e.- Botox)
- Other neurological diagnoses
- If participant lives further than one hour away and is unwilling to travel for
assessment and treatment sessions.
- Pregnancy
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