Electrical stimulation driving functional improvements and cortical changes in subjects with stroke Little therapy, little physical activity: rehabilitation within the first 14 days of organized stroke unit care. Home-based Computer Assisted Arm Rehabilitation (hCAAR) robotic device for upper limb exercise after stroke: results of a feasibility study in home setting Home-based Reach-to-Grasp training for people after stroke is feasible: a pilot randomised controlled trial The HAAPI (Home Arm Assistance Progression Initiative) Trial Reduced-Intensity Modified Constraint-Induced Movement Therapy Versus Conventional Therapy for Upper Extremity Rehabilitation After Stroke Effects of intensity of arm training on hemiplegic upper extremity motor recovery in stroke patients: a randomized controlled trial Home-Based Nerve Stimulation to Enhance Effects of Motor Training in Patients in the Chronic Phase After Stroke Machine-Based, Self-guided Home Therapy for Individuals With Severe Arm Impairment After Stroke A Self-Administered Graded Repetitive Arm Supplementary Program (GRASP) Improves Arm Function During Inpatient Stroke Rehabilitation: A Multi-Site Randomized Controlled Trial Priming the motor system enhances the effects of upper limb therapy in chronic stroke. Repetitive arm functional tasks after stroke (RAFTAS): a pilot randomised controlled trial Afferent stimulation provided by glove electrode during task-specific arm exercise following stroke Improving selected hand functions using a noninvasive neuroprosthesis in persons with chronic stroke. A low cost virtual reality system for home based rehabilitation of the arm following stroke: a randomised controlled feasibility trial A home-based rehabilitation program for the hemiplegic upper extremity by power-assisted functional electrical stimulation Modified constraint-induced therapy extension: using remote technologies to improve function. Does the use of Nintendo Wii SportsTM improve arm function? Trial of WiiTM in Stroke: a randomized controlled trial and economics analysis Effects of home-based sensory and motor amplitude electrical stimulation on arm dysfunction in chronic stroke Effects of training with a passive hand orthosis and games at home in chronic stroke: a pilot randomised controlled trial Home-based electromyography-triggered stimulation in chronic stroke Is modified constraint-induced movement therapy more effective than bimanual training in improving arm motor function in the subacute phase post stroke? A randomized controlled trial Motor Recovery and Cortical Reorganization After Mirror Therapy in Chronic Stroke Patients Home-based telerehabilitation shows improved upper limb function in adults with chronic stroke: a pilot study.
It has been proposed that somatosensory stimulation in the form of electromyographically triggered neuromuscular electrical stimulation ( NMES ) to the peripheral nerve can influence functional measures of motor performance in subjects with stroke and can additionally produce changes in cortical excitability . Using a controlled , double-blind design , we studied the effects of intensive ( 60 h/3 weeks ) treatment at home with NMES compared with a sham treatment , applied to the extensor muscles of the hemiplegic forearm to facilitate h and opening in 16 chronic stroke subjects . We investigated improvement in functional use of the h and and change in cortical activation as measured by functional magnetic resonance imaging ( fMRI ) . Following treatment , subjects improved on measures of grasp and release of objects ( Box and Block Test and Jebsen Taylor H and Function Test [ JTHFT ] : small objects , stacking , heavy cans ) , isometric finger extension strength , and self-rated Motor Activity Log ( MAL ) : Amount of Use and How Well score . The sham subjects did not improve on any grasp and release measure or self-rated scale , but did improve on isometric finger extension strength . Importantly , however , following crossover , these subjects improved further in the measure of strength , grasp and release ( Box and Block [ JTHFT ] : page turning ) , and self-rated MAL : Amount of Use score and How Well score . Using fMRI and a finger-tracking task , an index of cortical intensity in the ipsilateral somatosensory cortex increased significantly from pre-test to post-test following treatment . Cortical activation , as measured by voxel count , did not change . These findings suggest that NMES may have an important role in stimulating cortical sensory areas allowing for improved motor function OBJECTIVE To examine rehabilitation interventions and result ing physical activity patterns of patients managed in acute stroke units to help inform development of a r and omized controlled trial of very early rehabilitation . DESIGN An open observational study of patient activity and therapist report of patient interventions . A survey of stroke unit re sources . METHODS Patients less than 14 days post-stroke from 5 metropolitan stroke units were observed over 2 consecutive weekdays at 10-minute intervals between 08.00 h and 17.00 h. Physical activity , location and person(s ) present were ascertained at each observation . Therapists completed treatment records . Senior staff completed stroke unit surveys . RESULTS Patients after stroke ( n=58 ) were with therapists 5.2 % of the observed day . Few patients ( 17.1 % ) received  daily therapy  by more than one therapist . When patients received therapy , average session times were 24 minutes of physiotherapy , 23 minutes of occupational therapy and 33 minutes of speech pathology .  The more time that family members were present , the longer the treatment time . Four to 11 min of upper-limb therapy was provided . Muscle weakness and left hemiparesis were associated with less upper-limb activity . CONCLUSION These acute stroke care units were re source d according to recommended staff-patient ratios . Patients received little therapy and had low levels of physical activity Background Home-based robotic technologies may offer the possibility of self-directed upper limb exercise after stroke as a means of increasing the intensity of rehabilitation treatment . The current literature has a paucity of robotic devices that have been tested in a home environment . The aim of this research project was to evaluate a robotic device Home-based Computer Assisted Arm Rehabilitation ( hCAAR ) that can be used independently at home by stroke survivors with upper limb weakness . Methods hCAAR device comprises of a joystick h and le moved by the weak upper limb to perform tasks on the computer screen . The device provides assistance to the movements depending on users ability . Nineteen participants ( stroke survivors with upper limb weakness ) were recruited . Outcome measures performed at baseline ( A0 ) , at end of 8-weeks of hCAAR use ( A1 ) and 1 month after end of hCAAR use ( A2 ) were : Optotrak kinematic variables , Fugl Meyer Upper Extremity motor subscale ( FM-UE ) , Action Research Arm Test ( ARAT ) , Medical Research Council ( MRC ) and Modified Ashworth Scale ( MAS ) , Chedoke Arm and H and Activity Inventory ( CAHAI ) and ABILH AND . Results Two participants were unable to use hCAAR : one due to severe paresis and the other due to personal problems . The remaining 17 participants were able to use the device independently in their home setting . No serious adverse events were reported . The median usage time was 433 minutes ( IQR 250 – 791 min ) . A statistically significant improvement was observed in the kinematic and clinical outcomes at A1 . The median gain in the scores at A1 were by : movement time 19 % , path length 15 % and jerk 19 % , FM-UE 1 point , total MAS 1.5 point , total MRC 2 points , ARAT 3 points , CAHAI 5.5 points and ABILH AND 3 points . Three participants showed clinical ly significant improvement in all the clinical outcomes . Conclusions The hCAAR feasibility study is the first clinical study of its kind reported in the current literature ; in this study , 17 participants used the robotic device independently for eight weeks in their own homes with minimal supervision from healthcare professionals . Statistically significant improvements were observed in the kinematic and clinical outcomes in the study Objective : To determine feasibility of a r and omised controlled trial ( RCT ) of home-based Reach-to-Grasp training after stroke . Design : single-blind parallel group RCT . Participants : Residual arm deficit less than 12 months post-stroke . Interventions : Reach-to-Grasp training in 14 one-hour therapist ’s visits over 6 weeks , plus one hour self- practice per day ( total 56 hours ) . Control : Usual care . Main Measures : Action Research Arm Test ( ARAT ) , Wolf Motor Function Test ( WMFT ) , pre-r and omisation , 7 , 12 , 24 weeks post-r and omisation . Results : Forty-seven participants ( Reach-to-Grasp=24 , usual care=23 ) were r and omised over 17 months .  Reach-to-Grasp participants received a median ( IQR ) 14 ( 13,14 ) visits , and performed 157 ( 96,211 ) repetitions per visit ; plus 30 minutes ( 22,45 ) self- practice per day . Usual care participants received 10.5 ( 5,14 ) therapist visits , comprising 38.6 ( 30,45 ) minutes of arm therapy with 16 ( 6,24 ) repetitions of functional tasks per visit . Median ARAT scores in the reach-to-grasp group were 8.5 ( 3.0,24.0 ) at baseline and 14.5 ( 3.5,26.0 ) at 24 weeks compared to median of 4 at both time points ( IQR : baseline ( 3.0,14.0 ) , 24 weeks ( 3.0,30.0 ) ) in the usual-care group . Median WMFT tasks completed at baseline and 24 weeks were 6 ( 3.0,11.5 ) and 8.5 ( 4.5,13.5 ) respectively in the reach-to-grasp group and 4 ( 3.0,10.0 ) , 6 ( 3.0,14.0 ) in the usual care group . Incidence of arm pain was similar between groups . The study was stopped before 11 patients reached the 24 weeks assessment . Conclusions : An RCT of home-based Reach-to-Grasp training after stroke is feasible and safe . With ARAT being our preferred measure it is estimated that 240 participants will be needed for a future two armed trial Background . Geographical location , socioeconomic status , and logistics surrounding transportation impede access of poststroke individuals to comprehensive rehabilitative services . Robotic therapy may enhance telerehabilitation by delivering consistent and state-of-the art therapy while allowing remote monitoring and adjusting therapy for underserved population s.  The H and Mentor Pro ( HMP ) was incorporated within a home exercise program ( HEP ) to improve upper-extremity ( UE ) functional capabilities poststroke . Objective . To determine the efficacy of a home-based telemonitored robotic-assisted therapy as part of a HEP compared with a dose-matched HEP-only intervention among individuals less than 6 months poststroke and characterized as underserved . Methods . In this prospect i ve , single-blinded , multisite , r and omized controlled trial , 99 hemiparetic participants with limited access to UE rehabilitation were r and omized to either ( 1 ) the experimental group , which received combined HEP and HMP for 3 h/d ×5 days ×8 weeks , or ( 2 ) the control group , which received HEP only at an identical dosage . Weekly communication between the supervising therapist and participant promoted compliance and progression of the HEP and HMP prescription . The Action Research Arm Test and Wolf Motor Function Test along with the Fugl-Meyer Assessment ( UE ) were primary and secondary outcome measures , respectively , undertaken before and after the interventions . Results . Both groups demonstrated improvement across all UE outcomes . Conclusions . Robotic + HEP and HEP only were both effectively delivered remotely . There was no difference between groups in change in motor function over time . Additional research is necessary to determine the appropriate dosage of HMP and HEP Background . Constraint-induced movement therapy ( CIMT ) is a rehabilitation approach for arm paresis consisting of an intensive schedule of treatment ( 6 h/d ) . The high dem and of re sources for CIMT is a critical issue for its implementation in the Italian health system . Objective . To compare the effects of a reduced-intensity modified CIMT ( mCIMT ) program that included splinting the unaffected arm for 12 hours daily with the effects of a conventional rehabilitation program for arm paresis in patients with stroke . Methods . Sixty-six participants with hemiparesis ( 3 - 24 months poststroke ) who could extend the wrist and several fingers at least 10 ° were r and omly assigned to mCIMT or conventional rehabilitation .  Each group underwent 10 ( 2 h/d ) treatment sessions ( 5 d/wk for 2 weeks ) . Patients were assessed with the Wolf Motor Function Test ( WMFT-FA and WMFT-T ) , the Motor Activity Log ( MAL-AOU and MAL-QOM ) , and the Ashworth Scale before and after treatment and 3 months later . Results . Between-groups analysis showed that the mCIMT group overall had greater improvement than the control group in terms of the WMFT-FA ( P = .010 ) , MAL-AOU ( P < .001 ) , and MAL-QOM ( P < .001 ) . Differences between groups were significant both after treatment ( P < .01 ) and at the 3-month follow-up ( P < .01 ) , although 40 % of participants did not complete the 3-month assessment . Furthermore , the mCIMT group showed a greater decrease of Ashworth Scale score than the control group at 3 months ( P = .021 ) . Conclusion . Two hours of CIMT may be more effective than conventional rehabilitation in improving motor function and use of the paretic arm in patients with chronic stroke Objective : To investigate the effects of different intensities of arm rehabilitation training on the functional recovery of  hemiplegic upper extremity . Design : A r and omized controlled trial . Interventions : Thirty-two stroke patients meeting the enrolment criteria were r and omly divided into three groups : group A ( n = 11 ) , group B ( n = 10 ) and group C ( n = 11 ) . Each group received arm training for 1 hour , 2 hours and 3 hours a day respectively , 5 days per week , for a period of six weeks . Main measures : Motor function was assessed by Fugl-Meyer Assessment , Action Research Arm Test and Barthel Index , carried out before treatment , two weeks , four weeks and six weeks after treatment . Results : When comparing the three groups , the Fugl-Meyer Assessment improvement was more significant in group C ( 20.50 ± 7.84 ) than that in group A ( 11.90 ± 6.52 ) and group B ( 13.80 ± 6.41 ) after four weeks of treatment ( P < 0.05 ) . The Action Research Arm Test score improvement was more significant in group C ( 7.30 ± 2.95 ) than in group A ( 3.30 ± 2.91 ) ( P < 0.05 ) . After six weeks of treatment , the Fugl-Meyer Assessment and Action Research Arm Test score improvements were more significant in group C ( 24.50 ± 7.96 , 10.90 ± 3.60 ) and group B ( 19.70 ± 7.09 , 8.70 ± 4.62 ) than in group A ( 13.00 ± 6.38 , 5.30 ± 3.40 ) ( P < 0.05 ) . There were no significant differences of Barthel Index among the three groups ( P > 0.05 ) . In each group , Fugl-Meyer Assessment , Action Research Arm Test and Barthel Index scores increased significantly after six weeks of treatment ( P < 0.05 ) . Conclusions : An increase in the intensity of arm training might improve the motor function of the arm after stroke Background . Somatosensory stimulation in the form of repetitive peripheral nerve stimulation ( RPSS ) is a promising strategy to improve motor function of the upper limb in chronic stroke . Home-based RPSS may be an alternative to hospital-based RPSS . Objectives . To investigate the feasibility and safety of an innovative program of home-based RPSS combined with motor training and to collect preliminary data on the efficacy of this program to enhance h and motor function in patients in the chronic phase after stroke . Methods . Twenty patients were r and omized to either active or sham RPSS associated with daily motor training performed at home over 4 consecutive weeks . All the patients were able to perform tasks of the Jebsen – Taylor Test ( JTT ) . The primary outcome measures were feasibility , evaluated by self-reported compliance with the intervention , and safety ( adverse events ) . Secondary outcomes comprised improvements in h and function in the JTT after end of treatment and after a 4-month follow-up period . Results . There were no relevant adverse events . Compliance with RPSS and motor training was significantly greater in the active group than in the sham group . Upper extremity performance improved significantly more in the active group compared with the sham group at the end of treatment . This difference remained significant 4 months later , even when differences in compliance with motor training were considered . Conclusions . Home-based active RPSS associated with motor training was feasible , was safe , and led to long-lasting enhancement of paretic arm performance in the chronic phase after stroke for those who can perform the JTT . These results point to the need for an efficacy trial Background . Few therapeutic options exist for the millions of persons living with severe arm impairment after stroke to increase their dose of arm rehabilitation . This study compared self-guided , high-repetition home therapy with a mechanical device ( the resonating arm exerciser [ RAE ] ) to conventional therapy in patients with chronic stroke and explored RAE use for patients with subacute stroke . Methods . A total of 16 participants with severe upper-extremity impairment ( mean Fugl-Meyer [ FM ] score = 21.4 ± 8.8 out of 66 ) > 6 months poststroke were r and omized to 3 weeks of exercise with the RAE or conventional exercises . The primary outcome measure was FM score 1 month posttherapy . Secondary outcome measures included Motor Activity Log , Visual Analog Pain Scale , and Ashworth Spasticity Scale . After a 1-month break , individuals in the conventional group also received a 3-week course of RAE therapy . Results . The change in FM score was significant in both the RAE and conventional groups after training ( 2.6 ± 1.4 and 3.4 ± 2.4 , P = .008 and .016 , respectively ) . These improvements were not significant at 1 month . Exercise with the RAE led to significantly greater improvements in distal FM score than conventional therapy at the 1-month follow-up ( P = .02 ) . In a separate cohort of patients with subacute stroke , the RAE was found feasible for exercise . Discussion . In those with severe arm impairment after chronic stroke , home-based training with the RAE was feasible and significantly reduced impairment without increasing pain or spasticity . Gains with the RAE were comparable to those found with conventional training and also included distal arm improvement Background and Purpose — More than 70 % of individuals who have a stroke experience upper limb deficits that impact daily activities . Increased amount of upper limb therapy has positive effects ; however , practical and inexpensive methods of therapy are needed to deliver this increase in therapy . Methods — This was a multi-site single blind r and omized controlled trial to determine the effectiveness of a 4-week self-administered grade d repetitive upper limb supplementary program ( GRASP ) on arm recovery in stroke . 103 in patients with stroke were r and omized to the experimental group ( GRASP group , n=53 ) or the control group ( education protocol , n=50 ) . The primary outcome measure was the Chedoke Arm and H and Activity Inventory ( CAHAI ) , a measure of upper limb function in activities of daily living . Secondary measures were used to evaluate grip strength and paretic upper limb use outside of therapy time . Intention-to-treat analysis was performed . Group differences were tested using analysis of covariance . Results — At the end of the 4-week intervention ( approximately 7 weeks poststroke ) , the GRASP group showed greater improvement in upper limb function ( CAHAI ) compared to the control group ( mean difference 6.2 ; 95 % CI : 3.4 to 9.0 ; P<0.001 ) . The GRASP group maintained this significant gain at 5 months poststroke . Significant differences were also found in favor of the GRASP protocol for grip strength and paretic upper limb use . No serious adverse effects were experienced . Conclusion — A self-administered homework exercise program provides a cost- , time- , and treatment-effective delivery model for improving upper limb recovery in subacute stroke After stroke , the function of primary motor cortex ( M1 ) between the hemispheres may become unbalanced . Techniques that promote a re-balancing of M1 excitability may prime the brain to be more responsive to rehabilitation therapies and lead to improved functional outcomes . The present study examined the effects of Active-Passive Bilateral Therapy ( APBT ) , a putative movement-based priming strategy design ed to reduce intracortical inhibition and increase excitability within the ipsilesional M1 . Thirty-two patients with upper limb weakness at least 6 months after stroke were r and omized to a 1-month intervention of self-directed motor practice with their affected upper limb ( control group ) or to APBT for 10 - 15 min prior to the same motor practice ( APBT group ) . A blinded clinical rater assessed upper limb function at baseline , and immediately and 1 month after the intervention . Transcranial magnetic stimulation was used to assess M1 excitability . Immediately after the intervention , motor function of the affected upper limb improved in both groups ( P < 0.005 ) . One month after the intervention , the APBT group had better upper limb motor function than control patients ( P < 0.05 ) . The APBT group had increased ipsilesional M1 excitability ( P < 0.025 ) , increased transcallosal inhibition from ipsilesional to contralesional M1 ( P < 0.01 ) and increased intracortical inhibition within contralesional M1 ( P < 0.005 ) . None of these changes were found in the control group . APBT produced sustained improvements in upper limb motor function in chronic stroke patients and induced specific and sustained changes in motor cortex inhibitory function . We speculate that APBT may have facilitated plastic reorganization in the brain in response to motor therapy . The utility of APBT as an adjuvant to physical therapy warrants further consideration Background Repetitive functional task practise ( RFTP ) is a promising treatment to improve upper limb recovery following stroke . We report the findings of a study to determine the feasibility of a multi-centre r and omised controlled trial to evaluate this intervention . Methods A pilot r and omised controlled trial recruited patients with new reduced upper limb function within 14 days of acute stroke from three stroke units . Participants were r and omised to receive a four week upper limb RFTP therapy programme consisting of goal setting , independent activity practise , and twice weekly therapy review s in addition to usual post stroke rehabilitation , or usual post stroke rehabilitation .  The recruitment rate ; adherence to the RFTP therapy programme ; usual post stroke rehabilitation received ; attrition rate ; data quality ; success of outcome assessor blinding ; adverse events ; and the views of study participants and therapists about the intervention were recorded . Results Fifty five eligible patients were identified , 4 - 6 % of patients screened at each site . Twenty four patients participated in the pilot study . Two study sites met the recruitment target of 1–2 participants per month . The median number of face to face therapy sessions received was 6 [ IQR 3–8 ] . The median number of daily repetitions of activities recorded was 80 [ IQR 39–80 ] . Data about usual post stroke rehabilitation were available for 18/24 ( 75 % ) . Outcome data were available for 22/24 ( 92 % ) at one month and 20/24 ( 83 % ) at three months . Outcome assessors were unblinded to participant group allocation for 11/22 ( 50 % ) at one month and 6/20 ( 30 % ) at three months . Four adverse events were considered serious as they result ed in hospitalisation . None were related to study treatment . Feedback from patients and therapists about the RFTP programme was mainly positive . Conclusions A multi-centre r and omised controlled trial to evaluate an upper limb RFTP therapy programme provided early after stroke is feasible and acceptable to patients and therapists , but there are issues which need to be addressed when design ing a Phase III study . A Phase III study will need to monitor and report not only recruitment and attrition but also adherence to the intervention , usual post stroke rehabilitation received , and outcome assessor blinding . Trial registration International St and ard R and omised Controlled Trials Number ( IS RCT N ) Background : Sensory amplitude electrical stimulation ( SES ) and repetitive task practice reduce impairments and arm dysfunction when delivered separately following stroke . Objective : To determine if home-based , task-specific arm exercise was more effective when administered concurrent with SES . Methods : Thirty-eight subjects with chronic stroke and mean Fugl-Meyer Assessment ( FMA ) score 28/66 ( 15–45 ) participated . Subjects were r and omly assigned to an SES ( n = 20 ) or sham stimulation ( n = 18 ) group . Subjects engaged in task-based home exercise for 30 minutes , twice daily , for four weeks while wearing a glove electrode on the impaired h and . Experimental subjects received SES while control subjects received sham stimulation during exercise . Primary outcome measures : FMA and Arm Motor Ability Test ( AMAT ) . Results : There were no significant between-group differences for outcome measures . There was a significant difference between the pre- and post-test scores in the SES group AMAT median time ( P = 0.003 95 % confidence interval ( CI ) : −14.304 , −6.365 ; effect size : 0.84 ) . Practice time was not associated with changes in outcomes . Subjects with more sensorimotor dysfunction had significantly greater improvements on AMAT median time ( P = 0.037 ) . There was a significant relationship between baseline FMA score and FMA change score ( r = 0.402 ; P = 0.006 ) . Conclusions : This study describes a unique SES delivery system via glove electrode that enabled delivery of SES during home-based arm task practice in stroke survivors .  Task practice with concurrent SES did not demonstrate significantly better effects than task practice with sham stimulation , however there was a trend for greater improvement in one activity measure BACKGROUND AND PURPOSE Loss of upper extremity function following stroke remains a major rehabilitation challenge . The purpose of this investigation was to determine whether the H and master system ( NESS Ltd. , Ra'anana , Israel ) could improve selected h and functions in persons with chronic upper extremity paresis following stroke . METHODS Twenty-nine poststroke subjects consented to participate in a home-based , 3-week , nonr and omized case series trial . Main outcome measures included 3 activities of daily living ( ADL ) tasks : ( 1 ) lifting a 2-h and led pot , ( 2 ) holding a bag while st and ing with a cane , and ( 3 ) a subject-selected-ADL . Secondary outcomes included lifting a 600-g weight , grip strength , electrically induced finger motion , Fugl-Meyer spherical grasp , and perceived pain scale . RESULTS Comparing baseline to study end point with the neuroprosthesis , the percent of successful trials with lifting the pot , weight , and bag ( 0 % v 93 % , 14 % v 100 % , and 17 % v 93 % , respectively ) increased significantly . All subjects performed successfully their selected ADL and improved their Fugl-Meyer scores using the neuroprosthesis . Grip strength ( 6.4 + /- 7.3N v 17.7 + /- 6.2N ) and active finger motion ( 0.5 + /- 1.2 cm v 8.4 + /- 2.6 cm ) also improved with the neuroprosthesis . Pain scores significantly decreased in subjects reporting pain at baseline . Responses to question naire were favorable regarding the utility and therapeutic benefits of the device . CONCLUSIONS We conclude that the H and master is a safe and effective noninvasive neuroprosthesis for improving the studied h and functions and impairments in selected persons with chronic hemiplegia secondary to stroke Objective : To assess the feasibility of conducting a r and omised controlled trial of a home-based virtual reality system for rehabilitation of the arm following stroke . Design : Two group feasibility r and omised controlled trial of intervention versus usual care . Setting : Patients ’ homes . Participants : Patients aged 18 or over , with residual arm dysfunction following stroke and no longer receiving any other intensive rehabilitation . Interventions : Eight weeks ’ use of a low cost home-based virtual reality system employing infra-red capture to translate the position of the h and into game play or usual care . Main measures : The primary objective was to collect information on the feasibility of a trial , including recruitment , collection of outcome measures and staff support required . Patients were assessed at three time points using the  Wolf Motor Function Test , Nine-Hole Peg Test , Motor Activity Log and Nottingham Extended Activities of Daily Living . Results : Over 15 months only 47 people were referred to the team . Twenty seven were r and omised and 18 ( 67 % ) of those completed final outcome measures . Sample size calculation based on data from the Wolf Motor Function Test indicated a requirement for 38 per group . There was a significantly greater change from baseline in the intervention group on midpoint Wolf Grip strength and two subscales of the final Motor Activity Log . Training in the use of the equipment took a median of 230 minutes per patient . Conclusions : To achieve the required sample size , a definitive home-based trial would require additional strategies to boost recruitment rates and adequate re sources for patient support Purpose . To assess the effects of daily power-assisted functional electrical stimulation ( FES ) home program therapy in chronic stroke . Methods . A total of 20 consecutively enrolled stroke patients with spastic upper-extremity impairments > 1 year after stroke were recruited for this non-blinded r and omized controlled trial . Subjects were assigned to control and FES groups and followed for 5 months . The FES group used a power-assisted FES device to induce greater muscle contraction by electrical stimulation in proportion to the integrated electromyography ( EMG ) signal picked up on surface electrodes . Target muscles were the extensor carpi radialis longus ( ECRL ) and extensor carpi radialis brevis ( ECRB ) , extensor digitorum communis ( EDC ) , extensor indicis proprius ( EIP ) , and deltoid ( Del ) . Patients underwent 30 ∼ 60 min FES sessions at home about 6 days/week . Root mean square ( RMS ) of ECRL , EDC and Del maximum voluntary EMGs , active range of motion ( ROM ) of wrist and finger extension and shoulder flexion , modified Ashworth scale ( MAS ) , and clinical tests were investigated before and after FES training . Results . The FES group displayed significantly greater improvements in RMS , active ROM , MAS and functional h and tests , and was able to smoothly perform activities of daily life using the hemiplegic upper extremities . Conclusions . Daily power-assisted FES home program therapy can effectively improve wrist and finger extension and shoulder flexion . Proprioceptional sensory feedback might play an important role in power-assisted FES therapy OBJECTIVE To determine efficacy of a modified constraint-induced therapy extension ( mCITE ) protocol , in which persons with stroke participated in therapy sessions via the Internet . DESIGN Pre-post , single-blinded case series . SETTING Outpatient clinic . PARTICIPANTS Four people with stroke who experienced stroke more than 1 year prior to study entry exhibiting upper-limb hemiparesis and nonuse . INTERVENTION Subjects participated in online , 30-minute therapy sessions , 3 times a week for 10 weeks using personal computer-based cameras and free network meeting software . During the same period , subjects ' less affected h and s and wrists were restrained every weekday for 5 hours . Patients completed online logs to document restraint use and activities practice d at home . MAIN OUTCOME MEASURES The Motor Activity Log ( MAL ) and Wolf Motor Function Test ( WMFT ) . We also used a structured interview to ask patients about their satisfaction with the protocol . RESULTS After intervention , subjects exhibited marked improvements in more affected arm use ( + 2.7 , + 2.06 , + 1.7 , + 2,83 , respectively ) , quality of movement ( + 2.1 , + 2.1 , + 2.03 , + 1.9 , respectively ) , as measured by the MAL , and speed increases while performing WMFT tasks . Subjects ' mCITE satisfaction and adherence were high , and motor changes translated to ability to perform valued activities . CONCLUSIONS A home-based , modified constraint-induced movement therapy program is feasible and appears to increase more affected arm use and function using commercially available , inexpensive technologies Objective : The Trial of Wii ™ in Stroke investigated the efficacy of using the Nintendo Wii Sports ™ ( WiiTM ) to improve affected arm function after stroke . Design : Multicentre , pragmatic , parallel group , r and omized controlled trial . Setting : Home-based rehabilitation . Subjects : A total of 240 participants aged 24–90 years with arm weakness following a stroke within the previous six months . Intervention : Participants were r and omly assigned to exercise daily for six weeks using the WiiTM or arm exercises at home . Main measures : Primary outcome was change in the affected arm function at six weeks follow-up using the Action Research Arm Test . Secondary outcomes included occupational performance , quality of life , arm function at six months and a cost effectiveness analysis . Results : The study was completed by 209 participants ( 87.1 % ) . There was no significant difference in the primary outcome of affected arm function at six weeks follow-up ( mean difference −1.7 , 95 % CI −3.9 to 0.5 , p = 0.12 ) and no significant difference in secondary outcomes , including occupational performance , quality of life or arm function at six months , between the two groups . No serious adverse events related to the study treatment were reported . The cost effectiveness analysis showed that the WiiTM was more expensive than arm exercises £ 1106 ( SD 1656 ) vs. £ 730 ( SD 829 ) ( probability 0.866 ) . Conclusion : The trial showed that the WiiTM was not superior to arm exercises in home-based rehabilitation for stroke survivors with arm weakness .  The WiiTM was well tolerated but more expensive than arm exercises Objective : To examine the effects of a home-based arm exercise programme of sensory and motor amplitude electrical stimulation . Design : Non-concurrent , multiple-baseline , single-subject design . Subjects : Ten adults with chronic arm hemiparesis following stroke . Subjects ranged in age from 38 to 74 years and were 2 - 16 years post stroke . Three subjects had right-sided involvement ; seven had left . Intervention : Subjects completed an eight-week , individualized , home programme of neuromuscular and sensory amplitude electrical stimulation . All subjects engaged in stimulation-assisted task-specific exercises for 15 minutes 2 -3 times daily . Participants with sensory deficits received an additional 15 minutes of sensory amplitude stimulation twice daily . The Action Research Arm Test was used to examine arm function ; the Stroke Rehabilitation Assessment of Movement was used to examine movement quality ; and the Modified Ashworth Assessment of Spasticity was used to examine muscle tone . Results : A statistically significant improvement was demonstrated by six of the 10 subjects on the Action Research Arm Test , and five subjects on the Stroke Rehabilitation Assessment of Movement . Four subjects had ≥ 10 % improvement on the Modified Ashworth Assessment of Spasticity . Two subjects demonstrated significant improvement on all three outcome measures ; six subjects improved on two or more measures ; and seven subjects improved on one or more measure . Subjects who improved on two or more measures tended to have had more recent onset of stroke , were older and had higher baseline motor and functional capacity . Conclusion : Subjects with chronic stroke can experience impairment and functional improvements following a home-based programme of motor and sensory amplitude electrical stimulation Objectives : To compare user acceptance and arm and h and function changes after technology-supported training at home with conventional exercises in chronic stroke . Secondly , to investigate the relation between training duration and clinical changes . Design : A r and omised controlled trial . Setting : Training at home , evaluation at research institute . Subjects : Twenty chronic stroke patients with severely to mildly impaired arm and h and function . Interventions : Participants were r and omly assigned to six weeks ( 30 minutes per day , six days a week ) of self-administered home-based arm and h and training using either a passive dynamic wrist and h and orthosis combined with computerised gaming exercises ( experimental group ) or prescribed conventional exercises from an exercise book ( control group ) . Main measures : Main outcome measures are the training duration for user acceptance and the Action Research Arm Test for arm and h and function . Secondary outcomes are the Intrinsic Motivation Inventory , Fugl-Meyer assessment , Motor Activity Log , Stroke Impact Scale and grip strength . Results : The control group reported a higher training duration ( 189 versus 118 minutes per week , P = 0.025 ) . Perceived motivation was positive and equal between groups ( P = 0.935 ) . No differences in clinical outcomes over training between groups were found ( P ⩾ 0.165 ) . Changes in Box and Block Test correlated positively with training duration ( P = 0.001 ) . Conclusions : Both interventions were accepted . An additional benefit of technology-supported arm and h and training over conventional arm and h and exercises at home was not demonstrated . Training duration in itself is a major contributor to arm and h and function improvements Objectives : ( 1 ) To determine the feasibility of a home-based electromyography triggered neuromuscular stimulation ( ETMS ) programme ; and ( 2 ) to determine ETMS efficacy in increasing affected wrist extension and reducing affected arm impairment . Design : R and omized , controlled , pre-lpost , cross-over design . Setting : Outpatient rehabilitation hospital . Patients : Twelve chronic stroke patients with palpable muscle contraction in their affected wrist extensors but no movement ( 7 males ; mean age=59.75 years , age range 44 - 75 years ; mean time since stroke=52.75 months , range 13 - 131 months ) . Intervention : Subjects were r and omly assigned to receive either : ( a ) ETMS use twice every weekday in 35-min increments during an eight-week period followed by an eight-week home exercise programme ( ETMS/home exercise programme ) ( n=8 ) ; or ( b ) an eight-week home exercise programme followed by use of ETMS twice every weekday in 35-min increments during an eight-week period ( home exercise programme ) ( n=4 ) . Main outcome measures : The Fugl-Meyer , Action Research Arm Test and goniometry . Results : After home exercise programme participation , subjects showed nominal or no changes on any of the outcome measures . After ETMS , patients showed modest impairment reductions , as shown by the Fugl-Meyer , and no Action Research Arm Test changes . However , both groups showed a 218 increase in active affected wrist extension after ETMS use . Conclusion : ETMS use is feasible in the home environment . Neither participation in a traditional home exercise programme nor ETMS use conveyed changes on the Fugl-Meyer or Action Research Arm Test . However , ETMS use increased active affected limb extension . This new movement may provide a potential pathway for subjects to participate in other interventions , such as modified constraint induced therapy Objective : To compare the effect of modified constraint-induced movement therapy ( mCIMT ) to bimanual task-related training for patients in the subacute phase post stroke . Design : A single-blinded r and omized controlled trial . Setting s : Inpatient and outpatient rehabilitation clinics and the patient ’s home . Subjects : Thirty patients in the subacute phase post stroke ( 2–16 weeks ) were r and omized to modified constraint-induced movement therapy with an emphasis on unimanual tasks , or bimanual task-related training , emphasizing bimanual tasks . All trained with a therapist 4 hours a week for four weeks , followed by a 2–3 hours daily self-training program . Patients in the  modified constraint-induced movement therapy  group were supposed to wear a restraining mitt on the unaffected h and for 4 hours a day for four weeks . Main measures : Blinded assessment s at pre and post treatment and after three months with Action Research Arm Test as a primary outcome measure , Nine-Hole Peg Test and Motor Activity Log . Results : Power calculations suggested an inclusion of 60 patients , but due to recruitment difficulties the trial was stopped after an interim analysis at 30 patients . There was no difference in change ( P > 0.05 ) between the groups on any of the measures , neither at post treatment nor at follow-up assessment s. From pre-intervention to follow-up assessment the modified constraint-induced movement therapy group obtained a mean change score of 17.77 ( 14.66 ) on Action Research Arm Test , the bimanual group 15.47 ( 13.59 ) . Conclusion : Bimanual training was as effective as modified constraint-induced movement therapy in improving arm motor function . Wearing a mitt seems unnecessary for most patients in the subacute phase post stroke when focused affected arm training is provided Objective . To evaluate for any clinical effects of home-based mirror therapy and subsequent cortical reorganization in patients with chronic stroke with moderate upper extremity paresis . Methods . A total of 40 chronic stroke patients ( mean time post .onset , 3.9 years ) were r and omly assigned to the mirror group ( n = 20 ) or the control group ( n = 20 ) and then joined a 6-week training program . Both groups trained once a week under supervision of a physiotherapist at the rehabilitation center and practice d at home 1 hour daily , 5 times a week . The primary outcome measure was the Fugl-Meyer motor assessment ( FMA ) . The grip force , spasticity , pain , dexterity , h and -use in daily life , and quality of life at baseline — posttreatment and at 6 months — were all measured by a blinded assessor . Changes in neural activation patterns were assessed with functional magnetic resonance imaging ( fMRI ) at baseline and posttreatment in an available subgroup ( mirror , 12 ; control , 9 ) . Results . Posttreatment , the FMA improved more in the mirror than in the control group ( 3.6 ± 1.5 , P < .05 ) , but this improvement did not persist at follow-up . No changes were found on the other outcome measures ( all Ps > .05 ) . fMRI results showed a shift in activation balance within the primary motor cortex toward the affected hemisphere in the mirror group only ( weighted laterality index difference 0.40 ± 0.39 , P < .05 ) . Conclusion . This phase II trial showed some effectiveness for mirror therapy in chronic stroke patients and is the first to associate mirror therapy with cortical reorganization . Future research has to determine the optimum practice intensity and duration for improvements to persist and generalize to other functional domains OBJECTIVE This pilot study investigates the use of telerehabilitation to improve upper limb performance in chronic stages of stroke recovery . DESIGN Intervention study with pre/post/one month follow-up tests . METHODS Seven adults with chronic stroke participated in the study . Tests consisted of lab-based clinical and kinematic assessment s. Participants completed the Upper Limb Training and Assessment ( ULTrA ) program at home . Training was 5 days/week , 60 min/day for 6 weeks with intermittent supervision of participants . RESULTS Participants showed improvements in the training program tasks as well as clinical and kinematic assessment s. Results also suggest there may be auxiliary benefits in cognitive function . CONCLUSIONS A home-based telerehabilitation program is a viable approach to provide rehabilitation in chronic stages of stroke
Aim : To investigate the effectiveness of self-directed arm interventions in adult stroke survivors .