Bimanual Arm Training in Acute Stroke

Use of a Bimanual Arm Training Device in Acute Inpatient Stroke Rehabilitation, a Pre-post Cohort Study

Recent studies have shown that completing bilateral simultaneous movements during upper extremity practice may result in facilitation of coactivation and interhemispheric activation of both the ipsilesional and contralesional brain areas, with one limb entraining the other and enabling the limbs to function as a unit. Other research has proposed that the use of virtual-reality (VR) activities during treatment sessions can improve upper extremity function following stroke as it is motivating, challenging, offers external feedback that may facilitate motor learning, and allows for the "high-intensity, repetitious practice necessary to drive recovery". Coupling bilateral simultaneous upper extremity movement and virtual-reality activities is the Bimanual Arm Trainer (BAT), a non-powered mechanical device by which the non-paretic upper extremity moves the paretic arm. The purpose of this study is to determine the effectiveness of the Bimanual Arm Trainer (BAT) compared to traditional occupational therapy treatment sessions as these relate to upper extremity functional return following stroke, as measured by scores on the Action Research Arm Test (ARAT) and Upper Extremity Fugl-Meyer Assessment (UE-FMA) measures. The investigators plan to use retrospective data for a pre-implementation group, comparing this data to prospectively collected post-implementation data. ARAT scores are routinely collected and will be used for comparison between groups. UE-FMA measures are commonly used in this area of research, and will be taken to provide additional context for the post-implementation group.

Study Overview

• Status: Completed
• Conditions: Stroke, Acute; Upper Extremity Paresis
• Intervention / Treatment: Device: Bimanual Arm Trainer

Detailed Description

The medical charts of patients with a diagnosis of stroke will be reviewed retroactively to determine if there is a significant difference in improvement of upper extremity function (measured by ARAT and UE-FMA scores) following traditional occupational therapy services vs. use of the bimanual arm trainer. Medical charts of patients from November 2019 to November 2020 will be reviewed to obtain ARAT scores of patients who received traditional occupational therapy services. The Bimanual Arm Trainer was obtained in April 23, 2020; however, due to the pandemic, it was not able to be utilized until November 13, 2020. Patients from Review Board-approval onward will be assessed for ARAT and FMA-UE scores while using the device.

Duration: A minimum of 10 minutes for 3 separate sessions with Occupational Therapy for BAT participation. 15-30 minutes with Occupational Therapy (OT) within 3 days of admission and discharge for ARAT administration. The investigators anticipate that without mixed retrospective/prospective collection sample (post intervention application), the investigators will be able to reach the investigators' target participant number in 12 months after approval.

This study will not use a placebo or non-treatment group. The investigators will compare data retrospectively to patients who received standard care prior to the BAT being accessible within the investigators' rehabilitation department. Once the BAT was obtained and training occurred on the unit among staff members, the device was considered standard of care treatment to qualifying stroke patients; therefore, there is not a placebo group in the prospective portion of this study. Appropriate patient's will receive treatment sessions on the BAT regardless of participation in this study.

• Study Type: Observational
• Enrollment (Actual): 54

Contacts and Locations

Study Locations

• United States
  • Maryland
    • Baltimore, Maryland, United States, 21224
      • Johns Hopkins Specialty Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

• Sampling Method: Probability Sample

Study Population

Persons with acute or sub-acute stroke, with upper extremity paresis, admitted to an Acute Inpatient Rehab (IRF/AIR) unit.

Description

Inclusion Criteria:

• Diagnosis of acute stroke.
• Score of <17 on admission ARAT.
• Participation ≥ 3 BAT training sessions.

Exclusion Criteria:

• Impaired cognition impacting ability to participate in virtual reality system
• Pain resulting in poor tolerance of range of motion.
• Impaired sitting balance or poor tolerance of sitting in upright posture in chair without armrests.
• Spasticity in the affected upper extremity Modified Ashworth Scale (MAS) of 3 or greater.

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Traditional Occupational Therapy; participants receiving traditional occupational therapy treatments and interventions provided in the inpatient rehabilitation setting. This includes, but is not limited to , therapeutic activity, therapeutic exercise, neuromuscular re-education. This group is retrospectively collected, and will not include participants who had access to the BAT.
Bimanual Arm Trainer; Participants who are prospectively enrolled, who are appropriate for BAT use. Participants will receive additional traditional occupational therapy interventions, as deemed appropriate by treating therapists.	Device: Bimanual Arm Trainer; tabletop/desktop device that couples bilateral simultaneous upper extremity movement with virtual reality games or activities via computer monitor

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Action Research Arm Test score	a standardized tool that assesses UE functional limitations based off of 19 action-based items. Scores range from a minimum of 0 to a maximum of 57 points, with higher scores reflecting greater upper extremity functioning.	Within 72 hours of admission and up to 72 hours of discharge for all participants

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Upper Extremity Fugl-Meyer Assessment score	The UE-FMA is a body-functional level assessment of upper arm movement and sensation. Scores range from a minimum of o to a maximum of 66 points, with higher scores reflecting greater control of movement.	Within 72 hours of admission and Up to 72 hours of discharge for all participants in the BAT group

Collaborators and Investigators

• Sponsor: Johns Hopkins University
• Investigators: Principal Investigator: Matthew Babunovic, DPT, Johns Hopkins University

Study record dates

Study Major Dates

• Study Start (Actual): May 10, 2022
• Primary Completion (Actual): November 14, 2023
• Study Completion (Actual): November 14, 2023

Study Registration Dates

• First Submitted: October 20, 2021
• First Submitted That Met QC Criteria: October 20, 2021
• First Posted (Actual): November 4, 2021

Study Record Updates

• Last Update Posted (Estimated): November 17, 2023
• Last Update Submitted That Met QC Criteria: November 15, 2023
• Last Verified: November 1, 2023

More Information

Terms related to this study

• Keywords: rehabilitation; Physical Therapists; Occupational Therapists
• Additional Relevant MeSH Terms: Cardiovascular Diseases; Vascular Diseases; Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Neurologic Manifestations; Stroke; Paresis
• Other Study ID Numbers: IRB00303045

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: Yes
• product manufactured in and exported from the U.S.: No