Strength Training and Stroke

US Department of Veterans Affairs (VA)

Status and phase: Completed; Phase 2; Phase 1

Conditions: Stroke

Treatments: Behavioral: Constraint-Induced Movement Therapy + range of motion; Behavioral: Constraint-Induced Movement Therapy + strength training

Study type: Interventional

Funder types: Other U.S. Federal agency

Identifiers

NCT00629005

B5033-W

Details and patient eligibility

About

People with stroke experience weakness and incoordination. Studies have shown that with functional task practice, people can increase motor control and strength to a certain extent. This study will investigate whether adding progressive resistance strength training to functional task practice modeled after Constraint-Induced Movement Therapy results in greater motor function gains than functional task practice alone

Full description

To date most investigations of UE rehabilitation have examined single interventions. However, combining 2 efficacious interventions may enhance effectiveness. Both functional task training and strength training are beneficial for promoting improved upper extremity function, but they have seldom been studied as a coupled therapy. The research proposed in this project will examine the effect on UE function of adding UE resistive exercises to functional task training. Secondary aims are to examine the effect of stroke severity on the response to therapy, the interrelationship between therapy-induced neural changes and movement composition and functional changes with therapy, and test for retention of UE function gains over 6 months. Individuals with chronic hemiparesis from stroke will complete baseline testing and then be randomly assigned to either the functional task + strength training group or the functional task training alone group. Each group will train 4 hours/day, 3 days/week for 4 weeks. Each will perform 3 hours of functional task training per session. The strengthening group will then complete 1 hour of UE progressive resistance exercises while the functional task training alone group will complete gravity eliminated range of motion exercises for 1 hour. All subjects will be post-tested and then complete follow-up testing 6 months later.

Enrollment: 20 patients

Sex: All

Ages: 18 to 85 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

1. age 40-85;
2. a single unilateral middle cerebral artery ischemic stroke;
3. no history of drug/alcohol abuse;
4. ability to follow 3-step commands and provide informed consent;
5. no history of other neural disorder/dysfunction (including epilepsy), no serious medical illness or refractory depression;
6. at least 300 active upper extremity elevation in scapular plane (combination of flexion and abduction);
7. ability to extend the wrist 20 degrees, and two fingers and thumb 10 degrees three times in a minute;
8. permission of physician (BRRC medical director or BRRC neurologist) to participate in strength training.

Exclusion criteria

1. spasticity in elbow or hand (Modified Ashworth Scale > 2);
2. Motor Activity Log32 scores >3 (which would indicate relatively good use of the upper extremity);
3. ability to complete 135 degrees shoulder elevation easily with elbow straight (e.g., doesn't hold breath, movement is fluid, little to no effort tremor observed);
4. ataxia, major sensory deficits, or hemi-inattention/neglect;

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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20 participants in 2 patient groups

Arm 1

Experimental group

Description:

Constraint-Induced Movement Therapy (wear a mitt on non-paretic hand for 90% of waking hours + functional task practice for 3 hours) plus 1 hour of strength training for the arms and hands 3x/week

Treatment:

Behavioral: Constraint-Induced Movement Therapy + strength training

Arm 2

Active Comparator group

Description:

Constraint-Induced Movement Therapy (wear a mitt on non-paretic hand for 90% of waking hours + functional task practice for 3 hours) plus non-resisted arm and hand movements for 1 hour 3x/week

Treatment:

Behavioral: Constraint-Induced Movement Therapy + range of motion