title: Community-based exercise for upper limb paresis: a controlled trial with telerehabilitation.
abstract: BACKGROUND
  Arm paresis remains a major impairment after stroke despite the best conventional rehabilitation. Randomized, controlled trials of intensive exercise programs have demonstrated improvements in arm function for patients with chronic stroke. However, the gains achieved have been relatively modest for the large investments in patient and therapist time.
  
  
  OBJECTIVE
  To evaluate the safety, acceptance, adherence, and effectiveness of a community-based exercise program for upper limb paresis in patients with chronic stroke and the effects of telerehabilitation monitoring in kiosks distributed through the community.
  
  
  METHODS
  Longitudinal cohort with geographic control group. The experimental group received devices needed for a home exercise program based on the Carr and Shepherd "Motor Learning Program" and were instructed to practice the exercises at least twice a week at the kiosk and at least 3 more days a week at home. The control group received usual care.
  
  
  RESULTS
  Compared with the control group, patients in the experimental group demonstrated significant gains in arm function as measured by the Wolf Motor Function Test, 9-Hole Peg Test, Motricity Index, and Nottingham Extended Activities of Daily Living Questionnaire. The intervention received high satisfaction ratings and produced no adverse events. Only 30% of the subjects attended kiosks regularly. Outcomes for this group did not differ significantly from those who only practiced at home.
  
  
  CONCLUSIONS
  Home- and community-based exercise for arm paresis is safe and effective. Telerehabilitation interventions will need additional enhancements to improve effectiveness. The optimal upper extremity exercise prescription poststroke remains to be established.
authors: UOC Cura e Riabilitazione delle Fragilità, Azienda Unità Sanitaria Locale 11, Empoli, Italy.
authors: Francesco
authors: F
authors: Benvenuti
authors: University of Maryland, Baltimore County, MD, USA.
authors: Mary
authors: M
authors: Stuart
authors: UOC Cura e Riabilitazione delle Fragilità, Azienda Unità Sanitaria Locale 11, Empoli, Italy.
authors: Veruska
authors: V
authors: Cappena
authors: UOC Cura e Riabilitazione delle Fragilità, Azienda Unità Sanitaria Locale 11, Empoli, Italy.
authors: Sara
authors: S
authors: Gabella
authors: UOC Cura e Riabilitazione delle Fragilità, Azienda Unità Sanitaria Locale 11, Empoli, Italy.
authors: Sara
authors: S
authors: Corsi
authors: UOC Cura e Riabilitazione delle Fragilità, Azienda Unità Sanitaria Locale 11, Empoli, Italy.
authors: Antonio
authors: A
authors: Taviani
authors: Dipartimento Tecnico Funzionale, Azienda Unità Sanitaria Locale 7, Siena, Italy.
authors: Antonio
authors: A
authors: Albino
authors: Signo Motus srl, Messina, Italy.
authors: Sandro
authors: S
authors: Scattareggia Marchese
authors: National Center for Medical Rehabilitation Research, National Institutes of Health, Bethesda, MD, USA weinricm@mail.nih.gov.
authors: Michael
authors: M
authors: Weinrich
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003153:Community Health Services; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D010291:Paresis / Q000209:etiology / Q000534:rehabilitation*; D020127:Recovery of Function; D020521:Stroke / Q000150:complications; D000071939:Stroke Rehabilitation; D017216:Telemedicine; D016896:Treatment Outcome
keywords: paresis; stroke; telerehabilitation; upper limb