title: Machine-Based, Self-guided Home Therapy for Individuals With Severe Arm Impairment After Stroke: A Randomized Controlled Trial.
abstract: 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 randomized 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: University of California at Irvine, CA, USA dzonderv@uci.edu.
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Zondervan
authors.affiliation: UC Irvine Medical Center, CA, USA.
authors.forename: Renee
authors.initials: R
authors.lastname: Augsburger
authors.affiliation: University of California at Irvine, CA, USA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Bodenhoefer
authors.affiliation: University of California at Irvine, CA, USA.
authors.forename: Nizan
authors.initials: N
authors.lastname: Friedman
authors.affiliation: University of California at Irvine, CA, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Reinkensmeyer
authors.affiliation: University of California at Irvine, CA, USA.
authors.forename: Steven C
authors.initials: SC
authors.lastname: Cramer
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D001132:Arm / Q000473:pathology*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010291:Paresis / Q000209:etiology* / Q000534:rehabilitation*; D010865:Pilot Projects; D020127:Recovery of Function; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications*; D016896:Treatment Outcome
keywords: exercise therapy; rehabilitation; self care; stroke; upper extremity