title: Invited commentary on comparison of robotics, functional electrical stimulation, and motor learning methods for treatment of persistent upper extremity dysfunction after stroke: a randomized controlled trial.
abstract: In this issue of Archives of Physical Medicine and Rehabilitation, Jessica McCabe and colleagues report findings from their methodologically sound, dose-matched clinical trial in 39 patients beyond 6 months poststroke. In this phase II trial, the effects of 60 treatment sessions, each involving 3.5 hours of intensive practice plus either 1.5 hours of functional electrical stimulation (FES) or a shoulder-arm robotic therapy, were compared with 5 hours of intensive daily practice alone. Although no significant between-group differences were found on the primary outcome measure of Arm Motor Ability Test and the secondary outcome measure of Fugl-Meyer Arm motor score, 10% to 15% within-group therapeutic gains were on the Arm Motor Ability Test and Fugl-Meyer Arm. These gains are clinically meaningful for patients with stroke. However, the underlying mechanisms that drive these improvements remain poorly understood. The approximately $1000 cost reduction per patient calculated for the use of motor learning (ML) methods alone or combined with FES, compared with the combination of ML and shoulder-arm robotics, further emphasizes the need for cost considerations when making clinical decisions about selecting the most appropriate therapy for the upper paretic limb in patients with chronic stroke.
authors: Department of Rehabilitation Medicine, VU University Medical Centre, MOVE Research Institute Amsterdam, Amsterdam, The Netherlands; Department of Neurorehabilitation, Reade Center of Rehabilitation and Rheumatology, Amsterdam, The Netherlands. Electronic address: g.kwakkel@vumc.nl.
authors: Gert
authors: G
authors: Kwakkel
authors: Department of Rehabilitation Medicine, VU University Medical Centre, MOVE Research Institute Amsterdam, Amsterdam, The Netherlands.
authors: Erwin E
authors: EE
authors: van Wegen
authors: Department of Rehabilitation Medicine, VU University Medical Centre, MOVE Research Institute Amsterdam, Amsterdam, The Netherlands.
authors: Carel M
authors: CM
authors: Meskers
mesh_terms: D004599:Electric Stimulation Therapy; D005260:Female; D006429:Hemiplegia / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D026741:Physical Therapy Modalities; D012371:Robotics; D000071939:Stroke Rehabilitation; D034941:Upper Extremity / Q000503:physiopathology*
keywords: Electric stimulation; Rehabilitation; Robotics; Stroke; Upper extremity