title: Comparison of robotics, functional electrical stimulation, and motor learning methods for treatment of persistent upper extremity dysfunction after stroke: a randomized controlled trial.
abstract: OBJECTIVE
  To compare response to upper-limb treatment using robotics plus motor learning (ML) versus functional electrical stimulation (FES) plus ML versus ML alone, according to a measure of complex functional everyday tasks for chronic, severely impaired stroke survivors.
  
  
  METHODS
  Single-blind, randomized trial.
  
  
  METHODS
  Medical center.
  
  
  METHODS
  Enrolled subjects (N=39) were >1 year postsingle stroke (attrition rate=10%; 35 completed the study).
  
  
  METHODS
  All groups received treatment 5d/wk for 5h/d (60 sessions), with unique treatment as follows: ML alone (n=11) (5h/d partial- and whole-task practice of complex functional tasks), robotics plus ML (n=12) (3.5h/d of ML and 1.5h/d of shoulder/elbow robotics), and FES plus ML (n=12) (3.5h/d of ML and 1.5h/d of FES wrist/hand coordination training).
  
  
  METHODS
  Primary measure: Arm Motor Ability Test (AMAT), with 13 complex functional tasks; secondary measure: upper-limb Fugl-Meyer coordination scale (FM).
  
  
  RESULTS
  There was no significant difference found in treatment response across groups (AMAT: P≥.584; FM coordination: P≥.590). All 3 treatment groups demonstrated clinically and statistically significant improvement in response to treatment (AMAT and FM coordination: P≤.009). A group treatment paradigm of 1:3 (therapist/patient) ratio proved feasible for provision of the intensive treatment. No adverse effects.
  
  
  CONCLUSIONS
  Severely impaired stroke survivors with persistent (>1y) upper-extremity dysfunction can make clinically and statistically significant gains in coordination and functional task performance in response to robotics plus ML, FES plus ML, and ML alone in an intensive and long-duration intervention; no group differences were found. Additional studies are warranted to determine the effectiveness of these methods in the clinical setting.
authors.affiliation: Stroke Motor Control/Motor Learning Laboratory, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH.
authors.forename: Jessica
authors.initials: J
authors.lastname: McCabe
authors.affiliation: Stroke Motor Control/Motor Learning Laboratory, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH.
authors.forename: Michelle
authors.initials: M
authors.lastname: Monkiewicz
authors.affiliation: Department of Mathematics and Statistics, Cleveland State University, Cleveland, OH.
authors.forename: John
authors.initials: J
authors.lastname: Holcomb
authors.affiliation: Stroke Motor Control/Motor Learning Laboratory, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH.
authors.forename: Svetlana
authors.initials: S
authors.lastname: Pundik
authors.affiliation: Stroke Motor Control/Motor Learning Laboratory, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH. Electronic address: janis.daly@neurology.ufl.edu.
authors.forename: Janis J
authors.initials: JJ
authors.lastname: Daly
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D004185:Disability Evaluation; D004599:Electric Stimulation Therapy; D005260:Female; D006429:Hemiplegia / Q000503:physiopathology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities; D012371:Robotics; D016037:Single-Blind Method; D020521:Stroke / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D034941:Upper Extremity / Q000503:physiopathology*
keywords: Electric stimulation; FES; Randomized controlled trial, Rehabilitation; Robotics; Stroke; Upper extremity