The efficacy of SMART Arm training early after stroke for stroke survivors with severe upper limb disability a protocol for a randomised controlled trial

Sandra G Brauer, Kathryn S Hayward, Richard G Carson, Andrew G Cresswell, Ruth N Barker

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Recovery of upper limb function after stroke is poor. The acute to subacutephase after stroke is the optimal time window to promote the recovery ofupper limb function. The dose and content of training providedconventionally during this phase is however, unlikely to be adequate todrive functional recovery, especially in the presence of severe motordisability. The current study concerns an approach to address thisshortcoming, through evaluation of the SMART Arm, a non-robotic device thatenables intensive and repetitive practice of reaching by stroke survivorswith severe upper limb disability, with the aim of improving upper limbfunction. The outcomes of SMART Arm training with or withoutoutcome-triggered electrical stimulation (OT-stim) to augment movement andusual therapy will be compared to usual therapy alone.

A prospective, assessor-blinded parallel, three-group randomised controlledtrial is being conducted. Seventy-five participants with a first-everunilateral stroke less than 4 months previously, who present with severe armdisability (three or fewer out of a possible six points on the MotorAssessment Scale [MAS] Item 6), will be recruited from inpatientrehabilitation facilities. Participants will be randomly allocated to one ofthree dose-matched groups: SMART Arm training with OT-stim andusual therapy; SMART Arm training without OT-stim and usualtherapy; or usual therapy alone. All participants will receive 20 hours ofupper limb training over four weeks. Blinded assessors will conduct fourassessments: pre intervention (0-weeks), post intervention (4-weeks), 26weeks and 52 weeks follow-up. The primary outcome measure is MAS item 6. Allanalyses will be based on an intention-to-treat principle.

By enabling intensive and repetitive practice of a functional upper limb taskduring inpatient rehabilitation, SMART Arm training with or without OT-stimin combination with usual therapy, has the potential to improve recovery ofupper limb function in those with severe motor disability. The immediate andlong-term effects of SMART Arm training on upper limb impairment, activityand participation will be explored, in addition to the benefit of trainingwith or without OT-stim to augment movement when compared to usual therapyalone.
Original languageEnglish
JournalBMC Neurology
Publication statusPublished - 02 Jul 2013


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