Abstract

Background:

In this trial we combined the effect of purposeful activity and electrical stimulation therapy (PA-EST) to promote transition of severely hemiparetic upper limb to auxiliary upper limb in chronic stroke survivors in a single-case study.

Objective:

The purpose of this study was to examine the effect of PA-EST on the upper limb motor function in a crossover randomized controlled trial.

Methods:

The study included eight stroke survivors (age: 63.1±10.9 years) who were receiving home-based visiting occupational therapy. The average time since stroke onset was 8.8±5.6 years. All participants had severely hemiparetic upper limb, with the Fugl–Meyer Assessment upper extremity (FMA-U) score of 21.3±8.5. Participants were randomly assigned to group A or B. Group A received PA-EST for 3 months (phase 1), followed by standard stretching and exercise for 3 months (phase 2), whereas group B had the inverse order of treatments. To avoid carry-over effect, 1-month washout period was provided between the phase 1 and 2. Two-way analysis of variance (ANOVA) with repeated measures was used for the analysis. The primary outcome was FMA-U, and the secondary outcomes were, Motor Activity Log (MAL; amount of use [AOU] and quality of movement [QOM]), and Goal attainment scale-light (GAS-light).

Results:

Repeated measures-ANOVA revealed a significant interaction between type of intervention and time for FMA-U (F = 16.303, P = 0.005), MAL AOU (F = 7.966, P = 0.026) and QOM (F = 6.408, P = 0.039), and GAS-light (F = 6.905, P = 0.034), where PA-EST was associated with significantly improved motor function and goal achievement compared with standard stretching.

Conclusions:

The PA-EST may have greater effects than stretch/exercise in the recovery of hand function as reflected in FMA-U, MAL, and GAS-light. Our results suggest that PA-EST is an important and useful home-based rehabilitation program for promoting the use of the severely hemiparetic upper limb in chronic stroke survivors.

中文翻译：

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有目的的基于活动的电刺激治疗对慢性中风幸存者的家庭康复效果：一项交叉随机对照试验

摘要

背景：

在这项试验中，我们结合了有目的的活动和电刺激疗法 (PA-EST) 的效果，以促进慢性中风幸存者的严重偏瘫上肢向辅助上肢的转变。

客观的：

本研究的目的是在一项交叉随机对照试验中检查 PA-EST 对上肢运动功能的影响。

方法：

该研究包括接受家庭访问职业治疗的八名中风幸存者（年龄：63.1±10.9 岁）。卒中发病的平均时间为 8.8±5.6 年。所有参与者的上肢严重偏瘫，Fugl-Meyer 上肢评估（FMA-U）评分为 21.3±8.5。参与者被随机分配到 A 组或 B 组。A 组接受 3 个月的 PA-EST（第 1 阶段），然后进行 3 个月的标准拉伸和锻炼（第 2 阶段），而 B 组的治疗顺序相反。为避免遗留效应，在第 1 阶段和第 2 阶段之间提供了 1 个月的清除期。使用重复测量的双向方差分析 (ANOVA) 进行分析。主要结果是 FMA-U，次要结果是运动活动日志（MAL；使用量 [AOU] 和运动质量 [QOM]），

结果：

重复测量-方差分析显示干预类型与 FMA-U (F = 16.303, P = 0.005)、MAL AOU (F = 7.966, P = 0.026) 和 QOM (F = 6.408, P = 0.039) 的时间之间存在显着的交互作用和 GAS-light (F = 6.905, P = 0.034)，其中与标准拉伸相比​​，PA-EST 与运动功能和目标实现的显着改善有关。

结论：

在 FMA-U、MAL 和 GAS-light 中反映的手部功能恢复方面，PA-EST 可能比拉伸/锻炼具有更大的效果。我们的研究结果表明，PA-EST 是一项重要且有用的家庭康复计划，可促进慢性中风幸存者对严重偏瘫上肢的使用。