Date Published: April 12, 2019
Publisher: Public Library of Science
Author(s): Jessica P. McCabe, Dennyse Henniger, Jessica Perkins, Margaret Skelly, Curtis Tatsuoka, Svetlana Pundik, Masahiko Sumitani.
Individuals with stroke are often left with persistent upper limb dysfunction, even after treatment with traditional rehabilitation methods. The purpose of this retrospective study is to demonstrate feasibility of the implementation of an upper limb myoelectric orthosis for the treatment of persistent moderate upper limb impairment following stroke (>6 months). Methods: Nine patients (>6 months post stroke) participated in treatment at an outpatient Occupational Therapy department utilizing the MyoPro myoelectric orthotic device. Group therapy was provided at a frequency of 1–2 sessions per week (60–90 minutes per session). Patients were instructed to perform training with the device at home on non-therapy days and to continue with use of the device after completion of the group training period. Outcome measures included Fugl-Meyer Upper Limb Assessment (FM) and modified Ashworth Scale (MAS). Results: Patients demonstrated clinically important and statistically significant improvement of 9.0±4.8 points (p = 0.0005) on a measure of motor control impairment (FM) during participation in group training. It was feasible to administer the training in a group setting with the MyoPro, using a 1:4 ratio (therapist to patients). Muscle tone improved for muscles with MAS >1.5 at baseline. Discussion: Myoelectric orthosis use is feasible in a group clinic setting and in home-use structure for chronic stroke survivors. Clinically important motor control gains were observed on FM in 7 of 9 patients who participated in training.
Stroke is a leading cause of long term disability in the United States. Traditional rehabilitation does not restore normal motor control for all stroke survivors, and upwards of 50% live with persistent upper limb dysfunction. This leads to diminished functional independence and quality of life. Motor learning-based interventions have shown promise. However in today’s health care milieu, for those with chronic motor deficits, provision of the intensive rehabilitation necessary to provide motor learning-based interventions is challenging. Therefore, new treatment methods are needed under these constraints.
This is a retrospective analysis of data collected longitudinally while chronic stroke patients participated in group training with a MyoPro in our clinic. Training was provided by OT staff. This study was approved by the IRB of the Louis Stokes Cleveland Department of Veterans Affairs Medical Center (IRB #17030-H23). Approval was obtained to review and analyze patient data.
Table 2 provides patient characteristics (n = 9). Fig 2 provides information regarding the change in FM score over time along with individual patient participation patterns in the group training sessions. Patients were moderately impaired at initial data collection according to FM (Table 3). Four of 9 patients had their dominant arm affected by stroke (patients 1,2,3 and 9, Table 3).
This study provides evidence that it is feasible to utilize a myoelectric upper limb orthosis using a group training paradigm for the rehabilitation of moderately impaired chronic stroke survivors. The main finding is that clinically important changes on a motor control performance measure were observed in individuals with chronic stroke who participated in group training. Of note, these patients were deemed plateaued with traditional OT services and were being discharged from standard care. There was a trend toward decreased flexor tone in individuals presenting with elevated flexor tone.
In a group clinical setting, it was feasible to implement a myoelectric upper limb orthosis with chronic stroke survivors. Clinically important and statistically significant gains were made on a measure of upper limb motor control. The results may be explained by the motor learning based functionality of the device. Further study is warranted in a larger cohort.