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(Stroke. 2008;39:1800.)
© 2008 American Heart Association, Inc.

Original Contributions

Training of Reaching in Stroke Survivors With Severe and Chronic Upper Limb Paresis Using a Novel Nonrobotic Device

A Randomized Clinical Trial

Ruth N. Barker, PhD; Sandra G. Brauer, PhD Richard G. Carson, PhD

From the Division of Physiotherapy (R.N.B., S.G.B.), School of Health, and Rehabilitation Sciences, The University of Queensland, Queensland, Australia; the School of Public Health, Tropical Medicine and Rehabilitation Sciences (R.N.B.), James Cook University, Townsville, Australia; the Perception and Motor Systems Laboratory (R.G.C.), School of Human Movement Studies, The University of Queensland, Queensland, Australia; and the School of Psychology (R.G.C.), Queen’s University, Belfast, UK.

Correspondence to Sandra G. Brauer, PhD, Division of Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Queensland 4072, Australia. E-mail s.brauer{at}shrs.uq.edu.au

Background and Purpose— Severe upper limb paresis is a major contributor to disability after stroke. This study investigated the efficacy of a new nonrobotic training device, the Sensorimotor Active Rehabilitation Training (SMART) Arm, that was used with or without electromyography-triggered electrical stimulation of triceps brachii to augment elbow extension, permitting stroke survivors with severe paresis to practice a constrained reaching task.

Methods— A single-blind, randomized clinical trial was conducted with 42 stroke survivors with severe and chronic paresis. Thirty-three participants completed the study, of whom 10 received training using the SMART Arm with electromyography-triggered electrical stimulation, 13 received training using the SMART Arm alone, and 10 received no intervention (control). Training consisted of 12 1-hour sessions over 4 weeks. The primary outcome measure was "upper arm function," item 6 of the Motor Assessment Scale. Secondary outcome measures included impairment measures; triceps muscle strength, reaching force, modified Ashworth scale; and activity measures: reaching distance and Motor Assessment Scale. Assessments were administered before (0 weeks) and after training (4 weeks) and at 2 months follow-up (12 weeks).

Results— Both SMART Arm groups demonstrated significant improvements in all impairment and activity measures after training and at follow-up. There was no significant difference between these 2 groups. There was no change in the control group.

Conclusions— Our findings indicate that training of reaching using the SMART Arm can reduce impairment and improve activity in stroke survivors with severe and chronic upper limb paresis, highlighting the benefits of intensive task-oriented practice, even in the context of severe paresis.

Key Words: electrical stimulation • severe paresis • stroke • training • upper extremity

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