Self-training to improve UE function at the chronic stage post-stroke: a pilot randomized controlled trial

Abstract

Background and purpose: On-going practice and use of the weaker upper extremity (UE) are important for maintaining and improving function in individuals with chronic stroke. The effectiveness of two self-training programs for UE function and daily-use was compared.

Methods: In this pilot, single-blinded clinical trial, individuals with chronic stroke were randomized to video-games or traditional self-training (1-hour/day, 6-times/week, 5 weeks). Assessments were performed pre-intervention (an average of two assessments), post-intervention, and at 4-week follow-up. The primary outcome was the functional ability of the upper extremity [The Action Research Arm Test (ARAT)]. Secondary measures were the daily use of the upper extremity [Motor Activity Log (MAL)] and manual dexterity (Box and Block Test). Repeated measures ANOVA was used to test the effectiveness and estimate effect sizes.

Results: Twenty-four of the 142 participants screened by phone were randomized to video-games [N = 13, mean (SD) age – 59.1 (10.5)] or traditional [N = 11, mean (SD) age – 64.9 (6.9)] self-training. Significant between-group differences were not detected. ARAT significantly improved by 13.9% and 9.6% following the video-games and traditional self-training programs (respectively), with a large effect size. MAL (quantity) also improved significantly between pre- intervention to follow-up with medium-large effect size.

Conclusions: UE functional improvement can be achieved by self-training at the chronic stage and, therefore, should be encouraged by clinicians.

Implications for rehabilitation

• Video-games or traditional self-training programs can be used to practice repetitive UE movements without the supervision of a clinician

• Self-training of the UE is beneficial at the chronic stage post-stroke and, therefore, should be encouraged

• The type of self-training (video-games or traditional) should be suited to the client's abilities and preferences.

• The compliance of self-training using video-games during the follow-up period was higher than the traditional self-training. This is important since self-training programs for chronic stroke need to be long-term and sustainable.

Keywords:

• Stroke rehabilitation
• virtual reality
• chronic stroke

Acknowledgements

The authors thank Tal Koschitzky for her skillful data collection. The authors thank all the participants. This work was performed in partial fulfillment of the requirements for a OT M.Sc. degree of (Ronit Weiss, Anat Yacoby, Shlomit Reif, Rachel Malka), Sackler Faculty of Medicine, Tel Aviv University, Israel.

Disclosure statement

The authors report that they have no conflicts of interest.

Funding

D. R. was funded by the [European Community's] Seventh Framework Program [FP7/2007–2013] under Grant agreement no. 277023 titled Virtual Reality Intervention for Stroke Rehabilitation.