Pushing the Rehabilitation Boundaries: Hand Motor Impairment Can Be Reduced in Chronic Stroke.
Firas Mawase, Kendra Cherry-Allen, Jing Xu and 3 others
PMID 32845230WHAT IT FOUND
Intensive multi-finger pressing training improved finger independence and hand function in 18 adults with chronic stroke, especially pinch, with gains still present at 6 months, though there was no control group.
Key findings
01The primary finger individuation measure improved after training, with increases of 10.3% ± 4.55% at post 1-training, 12.9% ± 5.80% at post 2-training, and 11.71% ± 9.31% at post 3-training.
02ARAT scores improved by 5.60 ± 0.8 points at post 1-training, 6.0 ± 0.90 points at post 2-training, and 4.54 ± 1.14 points at post 3-training, with most improvement in pinch precision (48%, 53%, and 49%); the post 1 and post 2 changes exceeded the reported minimal clinically important difference of 5.7 points.
03Training generalized to untrained chords and improved nonparetic hand individuation by 6% at post 1-training and 8.5% at post 2-training, but not at post 3-training.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
There was no control group, so time, motivation, repeated assessment, or other nonspecific factors could have contributed to the improvements. The study was single-group and nonrandomized, so it cannot determine whether the training caused the gains. Only 13 of 18 participants had 6-month follow-up data, so long-term conclusions rest on a smaller group. Motor Activity Log data were incomplete, with only 10 or 11 participants at some time points. Fugl-Meyer improvement did not reach the reported minimal clinically important difference. The task used a specialized force-sensing keyboard and very high repetition load (2100 trials over 5 days), which may be hard to deliver in routine clinics. Participants were selected for ability to extend fingers at least 5 degrees and no severe neglect or cognitive impairment, so results may not apply to more impaired stroke survivors.
Declared interests
The authors declared no potential conflicts of interest. The study was supported by NIH/NICHD grants R01HD053793 and R01HD073147.
The easy way to misread this
Do not conclude that this training is proven to reduce chronic stroke hand impairment. The study had no control group, was nonrandomized, and the authors state it cannot determine whether gains were due to training rather than time or participation.