Translating animal doses of task-specific training to people with chronic stroke in 1-hour therapy sessions: a proof-of-concept study

Abstract

Objective: The purposes of this study were to (1) examine the feasibility of translating high-repetition doses of upper-extremity (UE) task-specific training to people with stroke within the confines of the current outpatient delivery system of 1-hour therapy sessions and (2) to gather preliminary data regarding the potential benefit of this intensity of training.

Methods: A total of 15 patients with chronic (>6 months) UE paresis caused by stroke underwent 3 weeks of baseline assessments followed by 6 weeks of the high-repetition intervention (3 sessions/wk for 6 weeks). During each 1-hour session, participants were challenged to complete 300 or more repetitions of UE functional task training (3 tasks x 100 repetitions). Assessments during and after the intervention were used to measure feasibility and potential benefit.

Results: For the 13 participants completing the intervention, the average number of repetitions per session was 322. The percentage of sessions attended was 97%. Participant ratings of pain and fatigue were low. Action Research Arm test scores improved an average of 8 points during the intervention and were maintained at the 1-month follow-up. Secondary measures of activity and participation increased, but the measure of impairment did not.

Conclusions: It is feasible to deliver hundreds of repetitions of task-specific training to people with stroke in 1-hour therapy sessions. Preliminary outcome data suggest that this intervention may be beneficial for some people with stroke.

Figures

Figure 1

Schematic of experimental design illustrating the time course of assessments and treatment. Abbreviated weekly assessments included the Action Research Arm test and grip strength.

Figure 2

Number of repetitions achieved at each session for the group (A) and for two individual subjects (B-D). Group values are means and standard errors.

Figure 3

Subject ratings of change in pain (A) and fatigue (B), calculated from numeric scale ratings reported before and after each treatment session. Values are means ± standard deviations. Negative values indicate that pain and fatigue diminished at the end of a treatment session compared to the beginning of that treatment session.

Figure 4

A: Time course of changes in the Action Research Arm test (ARAT) for the group. Values are means and standard errors. B: Scatterplot of total number of repetitions of task-specific training vs. change in ARAT score.