Relative Effects and Predictive Models of Contemporary Upper Limb Training Programs in Stroke Patients Delivered in Hospital-Based and Home-Based Settings

The purpose of this project is threefold. The first purpose is to investigate the relative effects of modified constraint-induced therapy (mCIT) vs. bilateral isokinematic training (BIT) on movement reorganization, motor performance, functional ability, and quality of life (QoL) immediately and six months later after treatment delivered at hospitals. Movement reorganization will be evaluated by kinematic instrument. Motor performance, functional ability, and QoL will be assessed using clinical assessment tools. By the same token, we also investigate the relative effects of these two approaches delivered at home. The second purpose is to study whether home-based mCIT is efficacious in various aspects of outcomes described above immediately and six months later following treatment, compared to home-based traditional rehabilitation (TR), and hospital-based mCIT and TR.We also study the same question regarding home-based BIT efficacy. The third purpose is to establish predictive models to predict functional and QoL outcomes immediately and six months later following mCIT and BIT. Whitall (2004) suggested that formulation of specific questions should pertain to maximization of the benefits from training and moving us more quickly to efficient and effective rehabilitation of stroke patients. The critical questions, for example, included (1) what are the relative effects of different research-supported training programs; (2) whether home-based treatment programs can be successfully implemented and effective; (3) whether the treatment benefits can be maintained; and (4) who can benefit most from which type of the training programs. mCIT and BIT, one type of bilateral movement training, share similar treatment principles: (1) massed practice; (2) the incorporation of functional activities into therapeutic tasks; and (3) targeting patients with moderate-to-high motor ability. There is a need to compare these two approaches to understand which aspect of healthy status can be improved more by which one of these two approaches. Current home-based rehabilitation allows the patient to compensate by using the unaffected upper limb (UL) to perform day-to-day functional activities. However, the recovery of affected UL plays an important role in the functional independence after stroke. Emphasis on the remediation of affected UL in the home-based rehabilitation should further enhance the efficacy of home-based rehabilitation. We will test this possibility by applying home-based mCIT and BIT. Finally, the efficacy study should further find out one may be better than another for a certain type of patient. The most appropriate types of stroke patients obtaining benefits from mCIT and BIT will be examined by exploring potential predictors to predict functional and QoL outcomes following mCIT and BIT immediately and six months later. We will recruit one hundred and eighty stroke patients after first-ever stroke. Ninety stroke patients will stay at hospitals for rehabilitation and will be randomly assigned to one of the following three groups: hospital-based mCIT, BIT, and TR. Another ninety should be discharged without receiving outpatient rehabilitation at hospitals and will be randomly assigned to receive one of the following treatment groups: home-based mCIT, BIT, and TR. The treatment program will be administered for 2 hours per day on each weekday of the 3-week treatment period. The training will include 3 visits a week for 3 weeks in the home-based treatment groups and 3 individual-based intervention a week for 3 weeks in the hospital-based treatment groups. The treatment program of the other two days will be preplanned by the therapist and administered by patients themselves. Before, immediately and six months after the 3-week intervention period, the kinematic analysis of unilateral and bimanual tasks and the clinical assessment (motor performance, functional ability, and quality of life) will be administered. The findings of this study will advance movement reorganization mechanism underlying treatment approaches and clinical intervention techniques. These findings may inform rehabilitation professionals about which treatment approach is superior to another one in certain aspect of outcome and who can benefit most from certain treatment approach. Accordingly, the results of this project may help us move quickly to design and develop efficient and effective rehabilitation programs for individualized patients.

Project ID:PC9709-0110
External Project ID:NSC97-2314-B182-004-MY3