Long-term rehabilitation for chronic stroke arm movements: a randomized controlled trial

Objective: We investigated the effect of long-term practice on motor improvements in chronic stroke patients. Design: Randomized parallel group controlled study. Setting: Motor Behavior Laboratory, University of Florida. Subjects: Eighteen individuals who experienced a stroke more than nine months prior to enrolling. Interventions: The treatment interventions were bilateral arm movements coupled with active neuromuscular stimulation on the impaired arm for both practice duration groups. The short-term group received one treatment protocol, whereas, over 16 months, the long-term practice group completed 10 treatment protocols. All protocol sessions were 6 hours long (90 minutes 1 day/week/4 weeks) and were separated by 22 days. Main outcome measures: Repeated data collection on three primary outcome measures (i.e. Box and Block test, fractionated reaction times, and sustained force production) evaluated motor capabilities across rehabilitation times. Results: Mixed design ANOVAs (Group x Retention Test: 2 x 4; Group x Retention Test x Arm Condition: 2 x 4 x 2) revealed improved motor capabilities for the long-term practice duration group on each primary measure. At the 16-month delayed retention test, when compared to the short-term group, the long-term group demonstrated: (a) more blocks moved (43 v 32), (b) faster premotor reaction times (158 v 208 ms), and (c) higher force production (75 v 45 N). Conclusion: Sixty hours of rehabilitation over 16 months provided by various bilateral arm movements and coupled active stimulation improved motor capabilities in chronic stroke.