Arm Training in Standing After Stroke

Study Overview
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Brief Summary
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This study will examine the feasibility of providing task-oriented arm training in standing or during walking in individuals with movement deficits due to stroke. Participants will received 24 sessions of arm training in standing over an 8-week period that focus on arm and hand function.

Detailed Description
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Residual motor deficits are common after stroke and often have a negative impact on the performance of functional activities and overall quality of life. A frequently reported contribution to these functional limitations is an inability to incorporate the weaker arm and hand into daily activities. While rehabilitation interventions can improve arm functional capacity, these improvements often do not translate into increased real-world arm use which is often reduced after stroke. The performance of skilled arm and hand movements in standing requires precise coordination between upper extremity movement and balance control. Many everyday functional tasks that require the arm are performed in standing (e.g. opening a door or meal preparation at the kitchen counter), however, training of arm function in rehabilitation is often done in sitting. An important rehabilitation approach may be to create a training environment that resembles the way the arm is used in everyday life (i.e. standing). This study will examine the feasibility of providing task-oriented, functional arm training in standing and during walking in individuals with motor deficits due to stroke.

Official Title
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Task-oriented Training of Arm Function in Standing After Stroke: a Pilot Study

Conditions
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Stroke

Intervention / Treatment
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* Behavioral: Arm training in standing


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: At least 18 years old Had a stroke at least 6 months prior to enrollment Show evidence of continued arm and hand weakness Have some ability to move the arm and hand that is weaker from the stroke Be able to stand with minimal assistance or less without support of the weaker arm for at least 2 minutes Be able to follow two-step commands. Exclusion Criteria: Acute medical issues that would interfere with participation Another neurologic diagnosis that may impact movement (e.g. Parkinson's Disease) Severe apraxia or hemispatial neglect Pain that interferes with arm movement or standing

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Arm Training in Standing<br>Task-oriented, functional arm training completed in standing or during walking. All participants receive the same arm training intervention. | Behavioral: Arm training in standing<br>* Arm training will be provided in one hour sessions, 3 time per week for 8 weeks. In each session, you will practice functional tasks with your weaker arm and hand in standing or during walking. Practice will be scaled to match your current level of function and progressed over time as able.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Sessions Completed | Total number of treatment sessions completed | 8 weeks | 
| Fatigue | Mean change in self-reported fatigue from the start to the end of each intervention session | 8 weeks | 
| Treatment intensity | Total number of arm repetitions per session and the percent of arm repetitions completed in standing or walking | 8 weeks | 
| Action Research Arm Test | Clinical measure of arm and hand function | Change from Baseline to 8 weeks | 
| Arm Use Measured with Accelerometers | Arm use measured during a typical day using accelerometers worn on the wrist | Change from Baseline to 8 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Upper Extremity Fugl-Meyer | Clinical Measure of arm and hand impairment | Change from Baseline to 8 weeks | 
| Box & Blocks Test | Clinical measure of hand function | Change from Baseline to 8 weeks | 
| Nine-Hole Peg Test | Clinical measure of hand dexterity | Change from Baseline to 8 weeks | 
| Stroke Impact Scale Hand Domain Subscale | Patient-reported measure of hand related quality-of-life. Score ranges from 0 to 100 with higher being better. | Change from Baseline to 8 weeks | 
| Timed Up and Go | Clinical measure of mobility and balance | Change from Baseline to 8 weeks | 
| Activities Specific Balance Confidence Scale | Patient-reported measure of balance confidence. Score ranges from 0 to 100 with higher being better | Change from Baseline to 8 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Rehabilitation, Upper Extremity