Disability of the arm and hand often persists after stroke, and this is very problematic in post-stroke recovery. Diminished arm and hand function after stroke impacts almost every task of daily living. There are task-oriented approaches designed to improve arm and hand function, but they do not always produce satisfying results. Researchers are still on the look-out for new and better ways to improve use sooner after stroke impairment.
The search for effective therapy with faster results
Researchers from the US studied and compared a skill-directed investigational intervention called Accelerated Skill Acquisition Program (ASAP) with the standard care treatment for upper arm disability after stroke in the following categories:
- Body functions and structures
- Quality of Life Outcomes
Accelerated Skill Acquisition Program (ASAP)
The researchers of this study looked at the effects of an Accelerated Skill Acquisition Program (ASAP) on arm-hand function in stroke patients. The study included 361 individuals, with a mean age of 61 years. Fifty-six percent of participants were male, and all participants were an average of forty-six days post-stroke. The 361 participants were divided randomly into three outpatient therapy groups: a patient-centered Accelerated Skill Acquisition Program (ASAP), Dose Equivalent Usual Occupational Therapy (DEUCC), and Usual Therapy (UCC).
Physical or occupational therapists trained and standardized in ASAP intervention implemented the treatment. Participants received an orientation session and an evaluation session. Participants received thirty one-hour treatment sessions over a 16-week period. The DEUCC and UCC received the same number of treatments over the same period.
ASAP emphasizes building skillful goal-directed movements such as coordination, speed, and mobility. Researchers identified a “challenging threshold” every day for each task. The principles of frequency, duration and intensity were used as physiological overload principles to help progress tasks. The researchers “deconstructed” tasks to address specific movements (such as finger weakness). When possible, patients completed full tasks. Therapists and patients selected or added moves that were meaningful to them in strength, dexterity, and bimanual categories. Patients first had the opportunity to identify solutions or barriers in collaboration with therapist expertise.
Promising results from ASAP study
Researchers took baseline data and compared outcomes post-treatment, at six months, and again at one year. In all three groups, most improvements occurred during active treatment. After completion of active sessions, changes occurred more slowly but the ASAP group reported higher motor activity and quality of life an average of eight months before the other two therapies. The other two treatments were as effective at one-year post-treatment, but the earlier improvement is significant as it enhanced patient experience. Also, patients who improve faster had the added benefit of improved self-esteem and motivation and reduced economic and psychological burdens of stroke. Participants also rated higher gains in strength, mobility, physical function, self-efficacy, perceived health, reintegration, and patient-centeredness when compared to DEUCC and UCC treatment.
The results of this study reveal that customized task-oriented training can accelerate gains across of wide array of patient-reported outcomes. While the differences between therapies disappeared at one-year post-treatment, ASAP participants achieved these outcomes an average of eight months earlier than the other treatments.
The lead author of this study is Rebecca Lewthwaite, Ph.D., University of Southern California, Los Angeles, CA, USA.