Using a bimanual lever-driven wheelchair for arm movement practice early after stroke: A pilot, randomized, controlled, single-blind trial.
Por:
Smith BW, Lobo-Prat J, Zondervan DK, Lew C, Chan V, Chou C, Toledo S, Reinkensmeyer DJ, Shaw S and Cramer SC
Publicada:
1 nov 2021
Ahead of Print:
24 may 2021
Resumen:
OBJECTIVE: Many patients with subacute stroke rely on the nonparetic arm and leg to propel manual wheelchairs. We designed a bimanual, lever-driven wheelchair (LARA) to promote overground mobility and hemiparetic arm exercise. This study measured the feasibility of using LARA to increase arm movement, achieve mobility, and improve arm motor recovery (clinicaltrials.gov/ct2/show/NCT02830893). DESIGN: Randomized, assessor-blind, controlled trial. SETTING: Two inpatient rehabilitation facilities. SUBJECTS: Nineteen patients with subacute stroke (1 week to 2 months post-stroke) received 30 minutes extra arm movement practice daily, while admitted to inpatient rehabilitation (n = 10) or before enrollment in outpatient therapy (n = 9). INTERVENTIONS: Patients were randomized to train with the LARA wheelchair (n = 11) or conventional exercises with a rehabilitation therapist (n = 8). MAIN MEASURES: Number of arm movements per training session; overground speed; Upper Extremity Fugl-Meyer score at three-month follow-up. RESULTS: Participants who trained with LARA completed 254 (median) arm movements with the paretic arm each session. For three participants, LARA enabled wheelchair mobility at practical indoor speeds (0.15-0.30 m/s). Fugl-Meyer score increased 19 ± 13 points for patients who trained with LARA compared to 14 ± 7 points with conventional exercises (P = 0.32). Secondary measures including shoulder pain and increased tone did not differ between groups. Mixed model analysis found significant interaction between LARA training and treatment duration (P = 0.037), informing power analysis for future investigation. CONCLUSIONS: Practising arm movement with a lever-driven wheelchair is a feasible method for increasing arm movement early after stroke. It enabled wheelchair mobility for a subset of patients and shows potential for improving arm motor recovery.
Filiaciones:
Smith BW:
Department of Mechanical Engineering, Loyola Marymount University, Los Angeles, CA, USA
Lobo-Prat J:
Institut de Robòtica i Informàtica Industrial, CSIC-UPC, Barcelona, Spain
Department of Mechanical and Aerospace Engineering, University of California at Irvine, Irvine, CA, USA
Zondervan DK:
Flint Rehabilitation Devices, LLC, Irvine, CA, USA
Lew C:
Department of Mechanical and Aerospace Engineering, University of California at Irvine, Irvine, CA, USA
Chan V:
Rehabilitation Services, UC Irvine Medical Center, Irvine, CA, USA
Chou C:
Rehabilitation Services, UC Irvine Medical Center, Irvine, CA, USA
Toledo S:
Rehabilitation Services, Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA
Reinkensmeyer DJ:
Department of Mechanical and Aerospace Engineering, University of California at Irvine, Irvine, CA, USA
Departments of Anatomy and Neurobiology, Biomedical Engineering, and Physical Medicine and Rehabilitation, University of California, Irvine, CA, USA
Shaw S:
Rehabilitation Services, Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA
Department of Neurology, University of Southern California, Los Angeles, CA, USA
Cramer SC:
Department of Neurology, University of California, Los Angeles, CA, USA
California Rehabilitation Institute, Los Angeles, CA, USA
Open Access
|