TY - JOUR
T1 - Comparing a Novel Neuroanimation Experience to Conventional Therapy for High-Dose Intensive Upper-Limb Training in Subacute Stroke
T2 - The SMARTS2 Randomized Trial
AU - Krakauer, John W.
AU - Kitago, Tomoko
AU - Goldsmith, Jeff
AU - Ahmad, Omar
AU - Roy, Promit
AU - Stein, Joel
AU - Bishop, Lauri
AU - Casey, Kelly
AU - Valladares, Belen
AU - Harran, Michelle D.
AU - Cortés, Juan Camilo
AU - Forrence, Alexander
AU - Xu, Jing
AU - DeLuzio, Sandra
AU - Held, Jeremia P.
AU - Schwarz, Anne
AU - Steiner, Levke
AU - Widmer, Mario
AU - Jordan, Kelly
AU - Ludwig, Daniel
AU - Moore, Meghan
AU - Barbera, Marlena
AU - Vora, Isha
AU - Stockley, Rachel
AU - Celnik, Pablo
AU - Zeiler, Steven
AU - Branscheidt, Meret
AU - Kwakkel, Gert
AU - Luft, Andreas R.
N1 - Publisher Copyright: © The Author(s) 2021. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/5/1
Y1 - 2021/5/1
N2 - Background: Evidence from animal studies suggests that greater reductions in poststroke motor impairment can be attained with significantly higher doses and intensities of therapy focused on movement quality. These studies also indicate a dose-timing interaction, with more pronounced effects if high-intensity therapy is delivered in the acute/subacute, rather than chronic, poststroke period. Objective: To compare 2 approaches of delivering high-intensity, high-dose upper-limb therapy in patients with subacute stroke: a novel exploratory neuroanimation therapy (NAT) and modified conventional occupational therapy (COT). Methods: A total of 24 patients were randomized to NAT or COT and underwent 30 sessions of 60 minutes time-on-task in addition to standard care. The primary outcome was the Fugl-Meyer Upper Extremity motor score (FM-UE). Secondary outcomes included Action Research Arm Test (ARAT), grip strength, Stroke Impact Scale hand domain, and upper-limb kinematics. Outcomes were assessed at baseline, and days 3, 90, and 180 posttraining. Both groups were compared to a matched historical cohort (HC), which received only 30 minutes of upper-limb therapy per day. Results: There were no significant between-group differences in FM-UE change or any of the secondary outcomes at any timepoint. Both high-dose groups showed greater recovery on the ARAT (7.3 ± 2.9 points; P =.011) but not the FM-UE (1.4 ± 2.6 points; P =.564) when compared with the HC. Conclusions: Neuroanimation may offer a new, enjoyable, efficient, and scalable way to deliver high-dose and intensive upper-limb therapy.
AB - Background: Evidence from animal studies suggests that greater reductions in poststroke motor impairment can be attained with significantly higher doses and intensities of therapy focused on movement quality. These studies also indicate a dose-timing interaction, with more pronounced effects if high-intensity therapy is delivered in the acute/subacute, rather than chronic, poststroke period. Objective: To compare 2 approaches of delivering high-intensity, high-dose upper-limb therapy in patients with subacute stroke: a novel exploratory neuroanimation therapy (NAT) and modified conventional occupational therapy (COT). Methods: A total of 24 patients were randomized to NAT or COT and underwent 30 sessions of 60 minutes time-on-task in addition to standard care. The primary outcome was the Fugl-Meyer Upper Extremity motor score (FM-UE). Secondary outcomes included Action Research Arm Test (ARAT), grip strength, Stroke Impact Scale hand domain, and upper-limb kinematics. Outcomes were assessed at baseline, and days 3, 90, and 180 posttraining. Both groups were compared to a matched historical cohort (HC), which received only 30 minutes of upper-limb therapy per day. Results: There were no significant between-group differences in FM-UE change or any of the secondary outcomes at any timepoint. Both high-dose groups showed greater recovery on the ARAT (7.3 ± 2.9 points; P =.011) but not the FM-UE (1.4 ± 2.6 points; P =.564) when compared with the HC. Conclusions: Neuroanimation may offer a new, enjoyable, efficient, and scalable way to deliver high-dose and intensive upper-limb therapy.
KW - motor recovery
KW - neuroanimation
KW - rehabilitation
KW - stroke
KW - upper limb
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U2 - https://doi.org/10.1177/15459683211000730
DO - https://doi.org/10.1177/15459683211000730
M3 - Article
C2 - 33745372
SN - 1545-9683
VL - 35
SP - 393
EP - 405
JO - Neurorehabilitation and neural repair
JF - Neurorehabilitation and neural repair
IS - 5
ER -