Article Dans Une Revue Stroke Année : 2021

Additional, Mechanized Upper Limb Self-Rehabilitation in Patients With Subacute Stroke

Jean-Marie Beis
Djamel Bensmaïl
  • Fonction : Auteur
Charles Benaim
  • Fonction : Auteur
Jacques Luaute
Isabelle Bonan
  • Fonction : Auteur
François Boyer
Emmanuel Coudeyre
Patrick Dehail
  • Fonction : Auteur
Anne-Laure Ferrapie
  • Fonction : Auteur
Jean-Luc Isambert
  • Fonction : Auteur
Jacques Kerdraon
  • Fonction : Auteur
Philippe Marque
  • Fonction : Auteur
  • PersonId : 955472
  • IdRef : 10886300X
Jerome Froger
Etienne Allart
  • Fonction : Auteur
Raphaël Gross
  • Fonction : Auteur
Alain Yelnik
  • Fonction : Auteur
Laurent Bensoussan
  • Fonction : Auteur

Résumé

Background and Purpose: Additional therapy may improve poststroke outcomes. Self-rehabilitation is a useful means to increase rehabilitation time. Mechanized systems are usual means to extend time for motor training. The primary aim was to compare the effects of self-rehabilitation using a mechanized device with control self-exercises on upper extremity impairment in patients with stroke. Methods: Phase III, parallel, concealed allocation, randomized controlled, multicenter trial, with 12-month follow-up. Patients aged 18 to 80 years, 3 weeks to 3 months poststroke with a Fugl-Meyer Assessment score of 10 to 40 points, were randomized to the Exo or control groups. All undertook two 30-minute self-rehabilitation sessions/day, 5 days/wk for 4 weeks in addition to usual rehabilitation. The Exo group performed games-based exercises using a gravity-supported mechanical exoskeleton (Armeo Spring). The control group performed stretching plus basic active exercises. Primary outcome was change in upper extremity Fugl-Meyer Assessment score at 4 weeks. Results: Two hundred fifteen participants were randomly allocated to the Exo group (107) or the control group (108). Mean age (SD), 58.3 (13.6) years; mean time poststroke, 54.8 (22.1) days; and mean baseline Fugl-Meyer Assessment score, 26.1 (9.5). There was no between-group difference in mean change in Fugl-Meyer Assessment score following the intervention: 13.3 (9.0) in the Exo group and 11.8 (8.8) in the control group ( P =0.22). There were no significant between-group differences in changes for any of the other outcomes at any time point (except for perception of the self-rehabilitation). There was no between-group difference in cost utility at 12 months. Conclusions: In patients with moderate-to-severe impairment in the subacute phase of stroke, the purchase and use of complex devices to provide additional upper limb training may not be necessary: simply educating patients to regularly move and stretch their limbs appears sufficient. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01383512.

Dates et versions

hal-03226599 , version 1 (14-05-2021)

Identifiants

Citer

Olivier Rémy-Néris, Anaïs Le Jeannic, Angelina Dion, Béatrice Médée, Emmanuel Nowak, et al.. Additional, Mechanized Upper Limb Self-Rehabilitation in Patients With Subacute Stroke. Stroke, 2021, 52 (6), pp.1938-1947. ⟨10.1161/STROKEAHA.120.032545⟩. ⟨hal-03226599⟩
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