Affiliations: [a] University of Maryland, School of Medicine, Department of Physical Therapy, 100 Penn Street, Baltimore, MD 21201, USA. Tel.: +1 410 706 7720; E-mail: [email protected] | [b] Gotenborg University, Department of Rehabilitation Medicine, Sahlgrenska University Hospital, S-413 45 Göteborg, Sweden | [c] Department of Rehabilitation Medicine, St. Maartenskliniek, PO Box 9011, 6500 GM Nijmegen, The Netherlands | [d] Sackler Faculty of Medicine, Department of Rehabilitation Medicine, Reuth Medical Center, Shderoth Hachail 2 Yad Eliyhau, Tel Aviv 61092, Israel
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Abstract: Objectives:To test if a combined stimulation-training program can improve selected hand functions and impairments of chronic stroke survivors. Design:Pretest-Posttest, multi-site 5-week training program. Stroke survivors (N = 77) with chronic upper limb paresis completed a home-based stimulation program combining activation of the wrist-fingers flexors and extensors with functional grasp, hold and release training. Subjects trained 2–3 times each day, 7 days a week. Outcome measures included: the Jebsen-Taylor simulated feeding (S-feed); light object lift (J-T light); heavy object lift (J–T heavy); Box and Blocks test (B&B); Nine-Hole Peg (9-HP); Ashworth scale (Spasticity); Visual analog scale-VAS (Pain). Paired t-tests (α < 0.01) were performed on each study outcome. Results:Simulated feeding time decreased from 39.1 ± 30.9 sec to 25.5 ± 23.3 sec (34.8% improvement). The task time of the J–T light decreased by 13.3 sec and the J–T heavy by 11.5 sec (44.9% and 40.9% improvement respectively). The number of blocks moved increased from 19.4 ± 11.6 to 24.5 ± 12.5 (26.3% improvement) and the time to complete the 9-HP decreased from 178.8 ± 170.8 to 105.0 ± 117.1 sec (58.7% improvement). Mean reduction of spasticity was 0.87 and 0.78 points at the elbow and wrist respectively. Patients with persistent pain (N = 33) reported mean reduction from 3.5 ± 2.5 to 1.9 ± 1.8. Conclusions:Five weeks of daily home training with a task-specific stimulation program improved selected hand functions and upper limb impairments associated with chronic post-stroke paresis.
