SAN ANTONIO — Regular sessions of arm and hand movement rehabilitation exercises helped chronic stroke patients significantly improve their motor capacity, motor skills, and ability to perform daily activities in a randomized study with 127 Veterans Affairs patients.
“High-intensity, repetitive movement can help individuals with stroke-related impairment despite high severity, chronicity, and multiple strokes,” Dr. Albert C. Lo said at the International Stroke Conference.
The exercises “result in modest improvement. The findings are small but consistent, and significant because little is [currently] available for chronic stroke patients,” said Dr. Lo, a neurologist at the VA Medical Center and at Brown University in Providence, R.I. “Compared with what's out there, I think this is better.”
Especially notable about the movement and activity gains achieved with both robot-assisted therapy and intensive conventional physical therapy was that the patients were enrolled an average of 5 years post stroke, with a range of 0.5-24 years since their initial stroke.
“These are exciting findings. Intensive treatment can give patients hope for continued improvement months or even years later, when many thought they could no longer improve,” commented Dr. Philip B. Gorelick, professor of neurology and rehabilitation and director of the Center for Stroke Research at the University of Illinois in Chicago.
The study enrolled 127 patients (96% men) at four VA centers with an average age of 65 years (range, 28-95 years). Overall, 78% were white and 19% African American; 85% had ischemic strokes, and a third had multiple strokes.
Dr. Lo and his associates randomized the patients into three study groups:
▸ Forty-nine patients underwent robot-assisted, upper-extremity physical therapy three times a week for 12 weeks. The robots guided each patient through a series of movements of the fingers, hands, wrists, and elbows, with more than 1,000 movements per session.
▸ Fifty patients participated in an “intensive comparison therapy” (ICT) that also involved three sessions per week for 12 weeks. Patients did arm and hand exercises using conventional physical therapy equipment, such as hand ergometers.
▸ Twenty-eight patients entered a “usual care” control group that did not undergo structured upper-extremity exercise.
The study's primary end point was change in the patients' mean score on the Fugl-Meyer Assessment, which measures motor capacity, at the end of 12 weeks. At entry, the average score was 18.9 out of a possible 66.
After 12 weeks, the average score rose by slightly more than 1 point in the robot-assisted group and fell by slightly more than 1 point in the usual care group, a difference that just missed statistical significance. The robot and ICT groups had similar score changes after treatment.
Dr. Lo and his associates also presented preliminary economic data. The average cost per patient over 12 weeks was $9,977 for robot-assisted, $8,269 for ICT, and $0 for usual care. The higher cost for robot therapy largely derived from an amortized portion of the robot's cost, about $200,000 per machine, with several different machines used in the physical therapy sessions, Dr. Lo said at the conference, which was sponsored by the American Heart Association.