LAUSR

Research Objectives To investigate the potential benefits of supplemental training for the upper extremity on patient's arm and hand function during subacute stroke recovery. Design Retrospective cohort study over 6 month duration. Setting Inpatient Rehabilitation Hospital. Participants All participants received conventional occupational therapy (COT) during their inpatient rehabilitation for an admitting diagnosis of stroke. The control group consisted of 34 participants that were not referred to a specialty therapist. The 33 patients in the study group were referred by primary therapist to a specialty therapist for upper extremity motor recovery. Interventions Patients treated 1-3x weekly, 60 minute sessions. - Clinical consultation including plan of care recommendations specific to upper extremity impairments. - Treatment by specialty therapist including: 1. Upper extremity robotics 2. Gravity eliminated motor retraining 3. Virtual reality 4. Functional electrical stimulation 5. Constraint induced movement therapy Main Outcome Measures Fugl Meyer Assessment - Upper Extremity (FMA-UE), Box and Blocks Test (BBT). Results Patients in both groups were stratified into severe, moderate and mild impairment categories using the FMA-UE score collected at inpatient admission. Patients in control group with a severe impairment had an average change score of 8 on FMA-UE and 2 on BBT. Comparatively, the severe experimental group achieved an average change score of 21.9 on FMA-UE and 13.7 on BBT. Effects of supplemental training on mild impairment groups were not seen in FMA-UE. However, the BBT change score for mild control group was 8 versus 16.8 for experimental group. The supplemental training failed to show a significant increase for moderate group in FMA-UE or BBT. Conclusions Supplemental upper extremity training along with COT in the subacute phase of stroke recovery may improve gross and fine motor functioning for patients with severe impairment. For patients with mild impairment, supplemental training may serve to improve fine motor function. The effect of specialty therapist intervention on upper extremity function warrants further study due to current small sample size and interaction of selection bias due to reliance on therapist's referral for consultation. Author(s) Disclosures None.