Article

Arm paresis remains a major impairment after stroke despite the best
conventional rehabilitation. Randomized, controlled trials of intensive exercise
programs have demonstrated improvements in arm function for patients with chronic
stroke. However, the gains achieved have been relatively modest for the large
investments in patient and therapist time. OBJECTIVE: To evaluate the safety,
acceptance, adherence, and effectiveness of a community-based exercise program
for upper limb paresis in patients with chronic stroke and the effects of
telerehabilitation monitoring in kiosks distributed through the community.
METHODS: Longitudinal cohort with geographic control group. The experimental
group received devices needed for a home exercise program based on the Carr and
Shepherd "Motor Learning Program" and were instructed to practice the exercises
at least twice a week at the kiosk and at least 3 more days a week at home. The
control group received usual care. RESULTS: Compared with the control group,
patients in the experimental group demonstrated significant gains in arm function
as measured by the Wolf Motor Function Test, 9-Hole Peg Test, Motricity Index,
and Nottingham Extended Activities of Daily Living Questionnaire. The
intervention received high satisfaction ratings and produced no adverse events.
Only 30% of the subjects attended kiosks regularly. Outcomes for this group did
not differ significantly from those who only practiced at home. CONCLUSIONS:
Home- and community-based exercise for arm paresis is safe and effective.
Telerehabilitation interventions will need additional enhancements to improve
effectiveness. The optimal upper extremity exercise prescription poststroke
remains to be established.
CI - (c) The Author(s) 2014.

Langue : ANGLAIS