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McDonnell M.1, Serrada I.1, Nes R.2, Stanley M.2, Williams L.2, Hillier S.1
1University of South Australia, Sansom Institute for Health Research, Adelaide, Australia, 2University of South Australia, School of Health Sciences, Adelaide, Australia
Background: Recovery of early voluntary finger extension is an important predictor of recovery of upper extremity (UE) function, but the amount of UE rehab is reported to be low during the acute stage post stroke. This may be the period of greatest neuroplasticity, where intensive rehabilitation may have greater gains.
Purpose: The purpose of this study was to examine the feasibility of implementing an intensive evidence-based UE rehabilitation program in the first four weeks post stroke, assisted by carers.
Methods: Twenty participants were recruited to the study 5 ± 4 days after a first-ever stroke. All participants received usual physical and occupational therapy. Those randomly allocated to the intervention group received a supplementary program based on an evidence-based algorithm, which was monitored and progressed weekly by an experienced physiotherapist. Participants were asked to perform this for 60 mins/day for four weeks, supervised and assisted as necessary by their carer, or therapy assistant when no carer was available. Accelerometers were used to measure changes in real-world use of the affected UE, in addition to the Action Research Arm Test (ARAT) and Motor Activity Log (MAL) to record arm activity. Semi-structured, in-depth interviews were conducted to explore acceptability for participants´ carers and were analysed using thematic analysis.
Results: Two patients were withdrawn due to medical issues, but there were no adverse events from the intervention. All measures improved significantly over time (ARAT P = 0.002 for time for both groups, MAL amount of use P 0.001) with no group by time interactions. Four main themes emerged from the interviews with carers: extra therapy and better results, individually tailored and monitored therapy, the support of therapists to carry through the unfamiliar, and the issue of tensions between carers and the stroke survivor.
Conclusion(s): Additional evidence-based therapy was feasible and acceptable in the acute setting, but there was no superior effect in this pilot group. Carers perceived that the experience was beneficial with regard to the therapy itself, and support for their role in early rehabilitation.
Implications: We have established the safety and feasibility of providing additional evidence-based therapy to address UE impairments following stroke. While there was no significant difference in functional outcomes post-intervention, carers may benefit from this approach in the future.
Funding acknowledgements: This study was supported by the Ian Potter Foundation
Topic: Neurology
Ethics approval: This research was approved by the Human Research Ethics Committees of the Royal Adelaide Hospital, and University of South Australia
All authors, affiliations and abstracts have been published as submitted.
