Effect of Self-empowered Upper Limb Repetitive Engagement (SURE) Program on Upper Limb Recovery After Stroke
Condition: Stroke
MeSH terms: Stroke
Study type: Interventional

Summary: 
      The aim of this study is to investigate the effect of SURE program on UL recovery during
      first few weeks post-stroke. A randomised blinded controlled pilot trial will be conducted.
      Twenty people with stroke will be randomly allocated to 4-weeks of SURE program or education
      program. This is to perform on top of their usual care. To determine the clinical benefit,
      all participants will be assessed pre-, 2 weeks during the training, post-training, 1-month
      and 3-month follow-up using a range of impairment and activity measures. To determine the
      cortical activation (fMRI), structural (FLAIR and DTI) and functional (resting state fcMRI)
      connectivity of cortical motor regions, all participants will undergo a 3T MRI pre-, post-
      and post-3 months after training.
    

Detailed description: 
      Background:

      UL recovery after stroke has been found to be limited. Efforts should be channelled into
      rehabilitation to improve UL recovery after stroke. First 4-weeks post-stroke is the period
      when neuroplasticity unfolds and when most rehabilitation occurs. This critical time window
      should be capitalized to interact with spontaneous biological recovery to facilitate UL
      recovery. There is growing evidence that shows that early increased UL practice after stroke
      improves the recovery of upper limb function. However, it has also been found that the level
      of early UL practice and use during early post-stroke is low. SURE program is a self-exercise
      program which aims to empower people with stroke and their caregivers to increase early UL
      practice outside therapy.

      Aim:

      To investigate the effect of SURE program on UL recovery during first few weeks post-stroke.

      Method:

      A randomised blinded controlled pilot trial will be conducted. Twenty people with stroke will
      be randomly allocated to 4-weeks of SURE program or education program.

      Intervention Group- SURE Program The intervention group will receive a SURE program booklet
      and will perform individualized daily self-exercise and functional use of the arm and hand on
      their own outside of therapy for 60 minutes/day, 6 days/week for 4 weeks. These
      self-exercises and upper limb functional use will be performed in addition to usual care.
      Three SURE program booklets have been developed which relate to the affected upper limb motor
      capability using individual Fugl Meyer (ULFM) score. Each SURE program booklet consists of
      warm-up exercises, strengthening exercises and motor tasks. The SURE program booklet also
      includes selected functional motor tasks to be performed by the participants using their
      affected upper limb. The performance of the exercises and functional motor tasks will be
      reviewed three times per week for the first 2 weeks, two times for the third week and one
      time for the fourth week of intervention period.

      Control Group- Education The control group will receive an education booklet with 10 modules.
      The education booklet will contain information on stroke, recovery and management strategies
      after stroke. Participants are to complete 2-3 modules per week and answer 1-2 simple
      questions after each module. Each module including answering questions takes approximately
      5-10 minutes to complete. CPI will review the information with the participants 3 times per
      week for the first 2 weeks, two times for the third week and one time for the fourth week of
      intervention period.The participants in the control group will continue with their usual care
      in the hospital.

      To determine the clinical benefit, all participants will be assessed pre-, 2 weeks during the
      training, post-training, 1-month and 3-month follow-up using a range of impairment and
      activity measures. To determine the cortical activation (fMRI), structural (FLAIR and DTI)
      and functional (resting state fcMRI) connectivity of cortical motor regions, all participants
      will undergo a 3T MRI pre-, post- and post-3 months after training.
    

Intervention name(s): SURE program
Intervention type(s): Behavioral
Intervention description(s): SURE program is a self-exercise program which aims to empower people with stroke and their caregivers to increase early UL practice outside therapy
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Randomised Blinded Controlled Pilot Trial
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Upper Limb; Self-exercise