Abstract
Stroke is a leading cause of death and disability in the USA. Up to 60% of patients do not fully recover despite intensive physical therapy treatment. N-Methyl-D-aspartate receptors (NMDA-R) have been shown to play a role in synaptic plasticity when activated. D-Cycloserine promotes NMDA receptor function by binding to receptors with unoccupied glycine sites. These receptors are involved in learning and memory. We hypothesized that D-cycloserine, when combined with robotic-assisted physiotherapy (RAP), would result in greater gains compared with placebo + RAP in stroke survivors. Participants (n = 14) were randomized to D-cycloserine plus RAP or placebo plus RAP. Functional, cognitive, and quality-of-life measures were used to assess recovery. There was significant improvement in grip strength of the affected hand within both groups from baseline to 3 weeks (95% confidence interval for mean change, 3.95 ± 2.96 to 4.90 ± 3.56 N for D-cycloserine and 5.72 ± 3.98 to 8.44 ± 4.90 N for control). SIS mood domain showed improvement for both groups (95% confidence interval for mean change, 72.6 ± 16.3 to 82.9 ± 10.9 for D-cycloserine and 82.9 ± 13.5 to 90.3 ± 9.9 for control). This preliminary study does not provide evidence that D-cycloserine can provide greater gains in learning compared with placebo for stroke survivors.
Highlights
An estimated 750,000 Americans suffer a stroke annually, incurring estimated costs related to their care of approximately $56.8 billion [1]
Of the 14 patients that completed testing, one participant in the placebo + robotic-assisted physiotherapy (RAP) group was excluded from the analyses because Tukey’s schematic box plot analysis [49] identified her as an outlier; subsequent analyses were performed on 13 participants (3 men, 10 women; 3 Caucasian, 10 African American)
At baseline, subjects were well matched across the 2 treatment groups, more women were enrolled than men (Table 1)
Summary
An estimated 750,000 Americans suffer a stroke annually, incurring estimated costs related to their care of approximately $56.8 billion [1]. Stroke is a leading cause of serious long-term disability and the long-term effects of stroke affect an estimated 6.4 million Americans [2]. 50–60% of stroke survivors exhibit some degree of motor impairment and require at least partial assistance in activities of daily living [3, 4]. The most common impairments that limit functional status after stroke are upper limb motor dysfunction, hand function [5] and gait [6]. The burden of stroke-related disability is predicted to increase in the coming decades in proportion to the expansion of the elderly population [7]. Stroke case fatality has declined, stroke incidence has not, leading to rising numbers of stroke survivors
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