Background

Evidence from animal studies suggests that greater reductions in poststroke motor impairment can be attained with significantly higher doses and intensities of therapy focused on movement quality. These studies also indicate a dose-timing interaction, with more pronounced effects if high-intensity therapy is delivered in the acute/subacute, rather than chronic, poststroke period.

Objective

To compare 2 approaches of delivering high-intensity, high-dose upper-limb therapy in patients with subacute stroke: a novel exploratory neuroanimation therapy (NAT) and modified conventional occupational therapy (COT).

Methods

A total of 24 patients were randomized to NAT or COT and underwent 30 sessions of 60 minutes time-on-task in addition to standard care. The primary outcome was the Fugl-Meyer Upper Extremity motor score (FM-UE). Secondary outcomes included Action Research Arm Test (ARAT), grip strength, Stroke Impact Scale hand domain, and upper-limb kinematics. Outcomes were assessed at baseline, and days 3, 90, and 180 posttraining. Both groups were compared to a matched historical cohort (HC), which received only 30 minutes of upper-limb therapy per day.

Results

There were no significant between-group differences in FM-UE change or any of the secondary outcomes at any timepoint. Both high-dose groups showed greater recovery on the ARAT (7.3 ± 2.9 points; P = .011) but not the FM-UE (1.4 ± 2.6 points; P = .564) when compared with the HC.

Conclusions

Neuroanimation may offer a new, enjoyable, efficient, and scalable way to deliver high-dose and intensive upper-limb therapy.

中文翻译：

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将新型神经动画体验与亚急性中风高剂量强化上肢训练的传统疗法进行比较：SMARTS2 随机试验

背景

来自动物研究的证据表明，以运动质量为重点的治疗剂量和强度显着提高，可以更大程度地减少中风后运动损伤。这些研究还表明剂量-时间相互作用，如果在急性/亚急性期而不是慢性期、卒中后时期进行高强度治疗，效果会更明显。

客观的

比较为亚急性中风患者提供高强度、高剂量上肢治疗的两种方法：一种新型探索性神经动画疗法 (NAT) 和改良的常规职业疗法 (COT)。

方法

共有 24 名患者被随机分配到 NAT 或 COT，除了标准护理外，还接受了 30 次 60 分钟的任务时间治疗。主要结果是 Fugl-Meyer 上肢运动评分 (FM-UE)。次要结果包括动作研究手臂测试 (ARAT)、握力、中风冲击量表手域和上肢运动学。在基线和训练后第 3、90 和 180 天评估结果。两组都与匹配的历史队列 (HC) 进行比较，后者每天仅接受 30 分钟的上肢治疗。

结果

在任何时间点，FM-UE 变化或任何次要结果都没有显着的组间差异。与 HC 相比，两个高剂量组在 ARAT（7.3 ± 2.9 分；P = 0.011）上表现出更大的恢复，但在 FM-UE（1.4 ± 2.6 分；P = .564）上则没有。

结论

神经动画可以提供一种新的、令人愉快的、有效的和可扩展的方式来提供高剂量和强化的上肢治疗。