Poster 31: Value of a fitness program after completion of rehabilitation therapy poststroke

Objective: To assess the value of a fitness program after completion of formal stroke rehabilitation. Design: Randomized, controlled, prospective study. Setting: Community wellness center. Participants: 39 subjects with stroke randomly assigned to immediate (n=20) versus deferred treatment (n=19). Interventions: The immediate group (IG) was enrolled in a 12-week exercise program. The deferred group (DG) was deferred from the exercise program for 12 weeks. Main Outcome Measures: Fugl-Meyer motor and balance subscores, 2- and 6-minute timed walk tests, FIM™ instrument, number of falls, number of hospitalizations, Mini-Mental State Examination, Beck Depression Scale, Community Integration Questionnaire, and Burke Handicap Scores were obtained at baseline and at 12 weeks postenrollment. Results: Preliminary analysis showed that the change in Fugl-Meyer motor score from baseline to 12 weeks was the only significant outcome variable (IG score ± SEM, 5.3±1.5 vs DG score, −1.7±2.1; P=.01). Subject dropouts differed significantly between the 2 groups (1 in IG, 6 in DG; χ²=4.0, P=.04). Conclusions: Structured exercise after completion of formal stroke rehabilitation has a significant effect on impairment. Subject dropouts in the DG indicated the strength of patient demand for a structured exercise program.     

Poster 9: Motivating, game-based stroke rehabilitation: a pilot study

Objective: To determine the efficacy and reactions of stroke patient to a game-based rehabilitation modality for more affected upper limbs. Design: Case series. Setting: Outpatient rehabilitation clinic. Participants: 4 persons with stroke (3 men; mean age, 60.0±4.9y; age range, 56-66y; mean time since stroke, 84.3mo; range, 10-264mo). Interventions: Each patient received thirteen 30-minute training sessions using the gaming device. Each session required participation in electronic table tennis using the more affected hand as the joystick, thus forcing use of the more affected limb. Instantaneous kinesthetic and force feedback was available via participation. Main Outcome Measures: Wolf Motor Function Test (WMFT) and patient interviews before and after intervention. Results: After the intervention, patients exhibited decreased median time to complete WMFT tasks (−5.3s), decreased mean time to perform WMFT tasks (−19.7s), and improved performance ratings as assessed by an objective rater. Interviews revealed high satisfaction and motivation; they also revealed that motor improvement had a high carryover to valued activities. Conclusions: This approach appears to be an efficacious, motivating, and enjoyable modality deserving of additional research. A larger, multicenter trial is planned.     

Poster 39: Total body reciprocal training improves hand function in chronic stroke survivors

Objective: To examine changes in hand function of chronic stroke survivors participating in exercise using a total body recumbent stepper (TBRS). Design: Case series. Setting: University medical school. Participants: 11 participants (8 men; age, 61.3±11.0y) >6 months poststroke with mild to moderate hemiparesis (6 with right side involvement). Intervention: An 8-week exercise program using TBRS 3 times a week for 30 minutes per session. Main Outcome Measures: Functional Rating Score (FRS) from the Wolf Motor Function Test and bilateral grip strength measured by dynamometry. Results: Statistical analyses were conducted using a repeated-measures 2×2×4 factorial analysis of variance for factors of gender and the more affected side along with time. Results indicated a significant interaction of the intervention with left grip strength. Left grip strength increased from 13.44±8.92lb to 16.72±7.23lb after intervention. Values were significant at P<.05. The average for right grip strength did not demonstrate significance after intervention. FRS improved, but not significantly. Conclusion: Improvements in function and strength are possible for chronic stroke survivors participating in exercise involving a TBRS.