Catherine E Lang1,2,3, Michael J Strube4, Marghuretta D Bland5,6,7, Kimberly J Waddell5, Kendra M Cherry-Allen5, Randolph J Nudo8, Alexander W Dromerick9, Rebecca L Birkenmeier5,6,7. 1. Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO. langc@wustl.edu. 2. Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO. langc@wustl.edu. 3. Department of Neurology, Washington University School of Medicine, St. Louis, MO. langc@wustl.edu. 4. Department of Psychological and Brain Sciences, Washington University, St. Louis, MO. 5. Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO. 6. Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO. 7. Department of Neurology, Washington University School of Medicine, St. Louis, MO. 8. Department of Rehabilitation Medicine, Kansas University Medical Center, Kansas City, KS. 9. Department of Rehabilitation Medicine, Georgetown University and MedStar National Rehabilitation Hospital, Washington, DC.
Abstract
OBJECTIVE: The objectives of this work were to (1) determine whether higher doses of motor therapy in chronic poststroke hemiparesis result in better outcomes, compared to lower doses, and (2) evaluate potential modifiers of the dose-response relationship. METHODS: Eighty-five adults with upper extremity paresis ≥6 months poststroke were randomized to one of four dose groups in this single-blind, parallel, randomized, control trial. The dosing parameter manipulated was amount of task-specific training, as indexed by the number of task repetitions. Groups received 3,200, 6,400, 9,600, or individualized maximum (IM) repetitions, during 1-hour sessions, 4 days/week for 8 weeks. The intervention was an individualized, progressive, task-specific upper-limb training program designed to improve upper-limb functional motor capacity. The primary outcome was the slope of the Action Research Arm Test (ARAT) during the intervention. Effects of dose and potential modifiers of the dose-response relationship were evaluated with hierarchical linear models. RESULTS: ARAT scores for the 3,200, 9,600, and IM groups improved over time as indicated by slopes (ΔARAT/week, mean ± standard errors) of 0.40 ± 0.15, 0.31 ± 0.16, and 0.66 ± 0.14, respectively (p < 0.05). The slope of the 6,400 group was smaller (-0.05 ± 0.15) and significantly different from the 3,200 and IM groups (p < 0.001). Initial motor capacity, neglect, and other tested characteristics did not modify the dose-response relationship. INTERPRETATION: Overall, treatment effects were small. There was no evidence of a dose-response effect of task-specific training on functional capacity in people with long-standing upper-limb paresis poststroke. Ann Neurol 2016;80:342-354.
OBJECTIVE: The objectives of this work were to (1) determine whether higher doses of motor therapy in chronic poststroke hemiparesis result in better outcomes, compared to lower doses, and (2) evaluate potential modifiers of the dose-response relationship. METHODS: Eighty-five adults with upper extremity paresis ≥6 months poststroke were randomized to one of four dose groups in this single-blind, parallel, randomized, control trial. The dosing parameter manipulated was amount of task-specific training, as indexed by the number of task repetitions. Groups received 3,200, 6,400, 9,600, or individualized maximum (IM) repetitions, during 1-hour sessions, 4 days/week for 8 weeks. The intervention was an individualized, progressive, task-specific upper-limb training program designed to improve upper-limb functional motor capacity. The primary outcome was the slope of the Action Research Arm Test (ARAT) during the intervention. Effects of dose and potential modifiers of the dose-response relationship were evaluated with hierarchical linear models. RESULTS: ARAT scores for the 3,200, 9,600, and IM groups improved over time as indicated by slopes (ΔARAT/week, mean ± standard errors) of 0.40 ± 0.15, 0.31 ± 0.16, and 0.66 ± 0.14, respectively (p < 0.05). The slope of the 6,400 group was smaller (-0.05 ± 0.15) and significantly different from the 3,200 and IM groups (p < 0.001). Initial motor capacity, neglect, and other tested characteristics did not modify the dose-response relationship. INTERPRETATION: Overall, treatment effects were small. There was no evidence of a dose-response effect of task-specific training on functional capacity in people with long-standing upper-limb paresis poststroke. Ann Neurol 2016;80:342-354.
Authors: Pamela W Duncan; Katherine J Sullivan; Andrea L Behrman; Stanley P Azen; Samuel S Wu; Stephen E Nadeau; Bruce H Dobkin; Dorian K Rose; Julie K Tilson; Steven Cen; Sarah K Hayden Journal: N Engl J Med Date: 2011-05-26 Impact factor: 91.245
Authors: Steven L Wolf; Komal Sahu; R Curtis Bay; Sharon Buchanan; Aimee Reiss; Susan Linder; Anson Rosenfeldt; Jay Alberts Journal: Neurorehabil Neural Repair Date: 2015-03-17 Impact factor: 3.919
Authors: Cathy M Stinear; P Alan Barber; Peter R Smale; James P Coxon; Melanie K Fleming; Winston D Byblow Journal: Brain Date: 2007-01 Impact factor: 13.501
Authors: Justin B Rowe; Vicky Chan; Morgan L Ingemanson; Steven C Cramer; Eric T Wolbrecht; David J Reinkensmeyer Journal: Neurorehabil Neural Repair Date: 2017-08 Impact factor: 3.919
Authors: Rebecca Lewthwaite; Carolee J Winstein; Christianne J Lane; Sarah Blanton; Burl R Wagenheim; Monica A Nelsen; Alexander W Dromerick; Steven L Wolf Journal: Neurorehabil Neural Repair Date: 2018-02 Impact factor: 3.919
Authors: Jennifer Wu; Lucy Dodakian; Jill See; Erin Burke Quinlan; Lisa Meng; Jeby Abraham; Ellen C Wong; Vu Le; Alison McKenzie; Steven C Cramer Journal: Neurorehabil Neural Repair Date: 2020-10-21 Impact factor: 3.919