Combined Behavioral Approaches with Functional Electrical Therapy in Stroke Rehabilitation---Effects on Motor Control, Motor Impairment, Daily Function and Community Reintegration

Project: National Science and Technology CouncilNational Science and Technology Council Academic Grants

Project Details


Abstract Following a stroke, 30–66% of patients experience persistent neurological motor deficits in their affected arm and hand, resulting in activity limitations and restrictions. Training the affected upper extremity has been a mainstay of neurorehabilitation. Successful stroke rehabilitation requires theory-based approaches, evidence-based practice, repetitive practice, functional oriented training, and the application of modern technologies to facilitate the daily work of therapists. Two theory-based, task-oriented approaches are distributed CIT (dCIT) and bilateral arm training (BAT). CIT/dCIT involves massed practice of the affected arm and restraint of the unaffected arm. BAT involves repetitive practice of symmetrical bilateral movements. Both are evident to improve motor performance, motor control or daily function in high functioning patients. These dCIT and BAT (at least one form of it-bilateral isokinematic training) have their own limitations for motor-deficit rehabilitation after stroke, i.e. only appropriate for high-functioning or mildly motor impaired patients. Functional electrical therapy, an innovative technology, is proposed as an adjunct to these behavioral approaches to assist in movement execution. Functional electrical therapy is used to increase the electric activity of muscles for movement and the active range of motion in low functioning patients. Combining functional electrical therapy into CIT or bilateral isokinematic training (one type of BAT) may extend the utility of these two behavioral approaches beyond patients with mild motor deficits and could expedite the progress of motor recovery. This project attempts to perform a randomized controlled trial to verify the efficacy and motor control mechanism of the proposed combined functional electrical therapy with dCIT or with BAT. This project will be implemented in two stages. The first stage(the first four months)designs the mode of functional electrical therapy and evaluates the feasibility of the functional electrical therapy. The second stage (the rest of the research duration) conducts a rigorous randomized controlled trial to investigate the midterm and after-treatment outcomes and mechanisms of the protocols. The outcome measures are motor control, motor impairment, functional ability, and community reintegration. We will recruit sixty stroke patients after first-ever stroke. These patients will be randomly assigned to one of three groups, which are dCIT coupled with functional electrical therapy, BAT coupled with functional electrical therapy, and control intervention. The treatment programs will be administered for 1.5 hours per day on each weekday of the 4-week treatment period. Before, at midterm of and immediately after the 4-week intervention period, the kinematic analyses of unilateral and bimanual tasks and the clinical assessment (motor impairment, functional performance and community reintegration) will be administered. Administering this comparative efficacy research may advance biomechanical application in rehabilitation science, enhance intervention techniques, strengthen evidence-based practices advocated by academia, and add knowledge to neurorehabilitation. The proposed combined protocols (integration of the functional electrical therapy with the dCIT or BAT approaches) that are theoretically grounded might be recognized as one of the mainstream regimens for stroke rehabilitation. Research outcomes will lay the foundation for evidence-based stroke rehabilitation.

Project IDs

Project ID:PC9907-2115
External Project ID:NSC99-2314-B182-014-MY3
Effective start/end date01/08/1031/07/11


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