Abstract
Rehabilitation training during the acute phase of stroke (<48 h) markedly improves impaired upper-limb movement. Hand-arm bimanual intensive training (HABIT) represents an intervention that promotes improvements in upper extremity function in children with cerebral palsy. This study repurposed HABIT in acute stroke patients and assessed recovery of upper extremity function when compared with a conventional rehabilitation program (CRP). In a randomized trial, 128 patients with acute stroke were assigned to the HABIT or the CRP groups. The primary endpoint was clinical motor functional assessment that was guided by the Fugl-Meyer motor assessment (FMA) and outcomes of the action research arm test (ARAT). The secondary endpoint was an improved neurophysiological evaluation according to the motor-evoked potential amplitude (AMP), resting motion threshold (RMT), and central motor conduction time (CMCT) scores over the 2-week course of therapy. In both groups, scores were evaluated at baseline, 1 week from commencing therapy, and post-therapy. After 2 weeks, the HABIT group showed improved scores as compared the CRP group for FMA (51.7 ± 6.44 vs. 43.5 ± 5.6, P < 0.001), ARAT (34.5 ± 6.2 vs. 33.3 ± 6.3, P = 0.022), and AMP (1.1 ± 0.1 vs. 1.0 ± 0.1, P < 0.001). However, CMCT (8.6 ± 1.0 vs. 9.1 ± 0.6, P = 0.054) and RMT (55.3 ± 4.2 vs. 57.5 ± 4.1, P = 0.088) were similar when comparing between groups. HABIT significantly improved motor functional and neuro-physiological outcomes in patients with acute stroke, which suggested that HABIT might represent an improved therapeutic strategy as compared CRP.
Highlights
Stroke is a common disabling health problem globally, and presentation of this condition is widely considered as one of the major causes of acquired adult disability (1–3)
The exclusion criteria were (1) presence of negligible or minimal aphasia that impeded the clear understanding of provided instructions; (2) severe cardiopulmonary complications; (3) evidence of prior stroke on the same side leading to impaired upper extremity function or intra-cerebral hemorrhage; (4) conditions that limited the use of the upper limb prior to presentation of stroke; (5) epilepsy; (6) presence of a pacemaker; (7) an intracranial implant; (8) presence of a cranial defect; or (9) a sudden worsening condition that prevented the patient from resuming rehabilitative training
No significant differences were observed between groups for Fugl-Meyer motor assessment (FMA), action research arm test (ARAT), AMP, central motor conduction time (CMCT), and resting motion threshold (RMT)
Summary
Stroke is a common disabling health problem globally, and presentation of this condition is widely considered as one of the major causes of acquired adult disability (1–3). In approximately 50% of acute stroke survivors, chronic functional impairment of the upper limbs and hands is seen (7). This impairment severely impacts the patients’ daily life and the therapeutic effect of rehabilitation training, which can dampen the quality of life of the patient following stroke (8, 9). Rehabilitation training during the acute phase of stroke (
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