Additional therapy promotes a continued pattern of improvement in upper-limb function and independence post-stroke

Abstract

BackgroundUpper-limb motor impairment after stroke is common and disabling. Growing evidence suggests that rehabilitation is effective in the chronic period. However, there is limited knowledge on the effects of ongoing targeted rehabilitation programs on patient outcomes. ObjectivesThis study investigated the effects of delivering two programs of dose-matched evidence-based upper-limb rehabilitation to community-dwelling post-acute stroke patients with low, moderate and high motor-function. Materials and methods12 patients (2 female) aged 50.5±18.2 years and 13.8±10.8 months post-stroke completed 2-weeks of modified-Constraint-Induced Movement Therapy followed by 2-weeks of Wii-based Movement Therapy after a mean interval of 9.6±1.1 months (range 6-19months). Function was assessed at 6 time points (i.e. before and after each therapy program and 6-month follow-up after each program). Primary outcome measures were the Wolf Motor Function Test timed-tasks (WMFT-tt), upper-limb Fugl-Meyer Assessment (F-M) and the Motor Activity Log Quality of Movement Scale (MALQOM). Improvement and maintenance was analyzed using Paired T-Tests and Wilcoxon Signed Rank Tests. ResultsUpper-limb function significantly improved on all primary outcome measures with the first therapy program (WMFT-tt p=0.008, F-M p=0.007 and MALQOM p<0.0001). All scores continued to improve with the second therapy program with significant improvements in the F-M (p=0.048) and the MALQOM (p=0.001). ConclusionsAll patients showed a pattern of continued improvement in upper-limb motor-function and independence in activities of daily living. These improvements demonstrate the benefit of ongoing post-stroke rehabilitation for community-dwelling stroke survivors for individuals of varying baseline functional status.