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Effects of Strength Training on
Upper-extremity Function in Post-stroke Hemiplegia
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Principal Investigator: Carolynn Patten, PhD, PT
Project Staff: Peter S. Lum, PhD, Kevin C. McGill, PhD; Heather E.
Brown, MSPT; Dhara Kothari, MS PT; Sara M. Northrop, MPT; and Ruth Yap, MS
Project Category: Stroke - 2003
Objective: The underlying premise of this study is that
upper-extremity rehabilitation for persons with post-stroke hemiparesis can be
significantly improved by increasing the intensity of rehabilitation
activities. We are conducting a controlled, randomized, double-blind clinical
trial to study the effects of shoulder and elbow strength training in subjects
in the subacute and chronic phases of recovery following stroke. Our
operational definition of subacute is completion of all outpatient therapy
programs, but less than 6 months post-CVA. For purposes of this study, chronic
describes subjects between 6 and 18 months post-CVA who have completed all
outpatient therapies. In the subacute arm of the study we compare this
experimental intervention of standard functional rehabilitation combined with
elbow and shoulder strength training against a control intervention of standard
functional rehabilitation alone. In the chronic arm of the study all subjects
receive both standard and experimental therapies in a cross-over design.
We hypothesize that subjects who receive resistance training in addition to
standard functional rehabilitation will demonstrate greater gains in elbow and
shoulder strength and greater improvements in functional performance than the
control group without experiencing increased hypertonia. We will study the
neuromuscular mechanisms underlying these improvements in strength and control
of movement resulting from these interventions.
Project Milestones to Date:
Experimental and therapeutic protocols were established in the first
project year.
Reliability testing for the trajectory-tracking task was completed
with11 hemiparetic adults. These data were analyzed and presented at the annual
VA RR&D Meeting (Feb, 2002) and a manuscript was published in the
Journal of Rehabilitation R&D in December, 2003.
Reliability testing for torque data has been completed with 10
hemiparetic adults. These data have been reduced and statistical analysis is
currently being performed.
A cross-sectional MRI study demonstrating activation impairment in 8
hemiparetic adults has been completed. These data have been analyzed and were
presented at the International Society for Magnetic Resonance in Medicine in
May, 2002. A manuscript is in preparation.
A cross-sectional analysis of the torque development deficit has been
conducted using data obtained from the baseline evaluation session. A
manuscript reporting these data was submitted to Muscle & Nerve in
Feburary, 2004,
17 subjects have been enrolled in the subacute arm of the study, 14 of
these subjects have completed the six-month follow up study. All subjects
demonstrated clinically and functionally significant improvements on the
clinical battery of outcome measures and on biomechanical assessments of
movement function.
Twenty subjects were enrolled in the chronic arm of the study,
seventeen of these subjects have completed the six month follow up evaluation.
All subjects demonstrated clinically and functionally significant improvements
on the clinical battery of outcome measures and on biomechanical assessments of
movement function.
This Phase I clinical trial of treatment efficacy closed in December,
2003. We have remaining follow up studies to conduct for a few subjects in both
the subacute and chronic cohorts. In the meantime, we are actively analyzing
the data and preparing manuscripts for submission to peer-reviewed journals.
Preliminary analysis of the biomechanical, kinematic and EMG data has
been conducted. Five presentations reporting our findings were made at the
recent American Physical Therapy Association Combined Sections Meeting (4-8
February, 2004). Abstracts were published in the Journal of Neurologic
Physical Therapy, December, 2003.
Definitive data analysis is proceeding for both the subacute and chronic
arms of the study.
Our immediate and short term publication plan is as follows:
Improved Reflex Modulation Following High Intensity Resistance Training
in Post-stroke Hemiparesis - Patten, C.; Condliffe, E.G.; Kothari, D.; Lum,
P.S. - submitted to Brain, Feb, 2004.
Development of a Standard Upper Extremity Rehabilitation Therapy for
Clinical Trials in Post-stroke Hemiparesis - Patten, C., Northrop, S. - in
preparation, to be submitted to JRRD, April, 2004.
Effects of Resistance Training on Upper-extremity Function in
Post-stroke Hemiparesis - (results of the chronic cohort) - Patten, C.,
Northrop, S., Kothari, D., Brown, H.E., Lum, P.S. - in preparation, to be
submitted to Brain, Summer, 2004.
Is there a link between improvements in upper-extremity strength and
function in post-stroke hemiparesis? - Brown, H.E., Kothari, D., Northrop, S.,
Patten, C. - in preparation, to be submitted to Journal of Neurological
Physical Therapy, Summer, 2004.
Improvements in Strength and Motor Activation Following High-Intensity
Resistance Training for Post-stroke Hemiparesis - Patten, C., Condliffe, E.G.,
Kothari, D., Yap, R., Northrop, S., Brown, H.E., and Lum, P.S. - in
preparation, to be submitted to Brain, Summer, 2004.
Efficacy of Resistance Training for Upper-extremity Rehabilitation in
Post-stroke Hemiparesis - (results of the subacute cohort) - Patten, C.,
Northrop, S., Kothari, D., Brown, H.E. and Lum, P.S. - in preparation, to be
submitted to JRRD, Fall, 2004.
There are additional aspects of the data set remaining for analysis and
publication. We intend to conduct analysis and prepare publications addressing
at least:
Reliability of Dynamic Upper-extremity Torque Data in Hemiparetic
Adults,
Improved Upper-extremity Control (Dexterity) following Rehabilitation
Adaptations in Kinematics of Upper-extremity Reaching following
Post-stroke Rehabilitation
A renewal application for this project is pending through VA RR&D
Merit Review.
Funding Source: VA RR&D Merit Review
Funding Status: Funded
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