Combined Behavioral Approaches With Functional Electrical Therapy in Stroke Rehabilitation

• Movement time (MT) [ Time Frame: Baseline and change from baseline in MT at 4 weeks ] [ Designated as safety issue: No ]
  The movement time is collected by a 7-camera motion analysis system (VICON MX 3-D, Oxford Metrics Inc., Oxford, UK) from unilateral and bilateral reaching tasks of pressing the desk bell. MT is the interval between movement onset and offset.
  
  
• Total displacement (TD) [ Time Frame: Baseline and change from baseline in TD at 4 weeks ] [ Designated as safety issue: No ]
  The movement time is collected by a 7-camera motion analysis system (VICON MX 3-D, Oxford Metrics Inc., Oxford, UK) from unilateral and bilateral reaching tasks of pressing the desk bell. TD refers to the path of a hand in three-dimensional space and is a measure of trajectory smoothness.
  
  
• Percentage of peak velocity (PPV) [ Time Frame: Baseline and change from baseline in PPV at 4 weeks ] [ Designated as safety issue: No ]
  The movement time is collected by a 7-camera motion analysis system (VICON MX 3-D, Oxford Metrics Inc., Oxford, UK) from unilateral and bilateral reaching tasks of pressing the desk bell. The PPV reflects the duration of the acceleration phase relative to the deceleration phase and indicates the type of movement strategy selected for a motor action.
  
  

• Fugl-Meyer Assessment (FMA) [ Time Frame: Baseline, change from baseline in FMA at 2 weeks, and change from baseline in FMA at 4 weeks ] [ Designated as safety issue: No ]
  The UE subscale of the FMA (max. score 66) uses a 3-point ordinal scale to assess motor impairment.
  
  
• Medical Research Council scale (MRC) [ Time Frame: Baseline, change from baseline in MRC at 2 weeks, and change from baseline in MRC at 4 weeks ] [ Designated as safety issue: No ]
  The MRC scale examines the muscle strength of the affected arm and is reliable measurement with score ranged from 0 (no contraction) to 5 (normal power).
  
  
• Modified Ashworth Scale (MAS) [ Time Frame: Baseline, change from baseline in MAS at 2 weeks, and change from baseline in MAS at 4 weeks ] [ Designated as safety issue: No ]
  The MAS scale is an ordinal scale (0-5 points) assessing spasticity of skeletal muscle in UE. A higher score indicating more spasticity.
  
  
• MYOTON-3 [ Time Frame: Baseline, change from baseline in MYOTON-3 at two weeks, and change from baseline in MYOTON-3 at 4 weeks ] [ Designated as safety issue: No ]
  Assessment of the functional state of skeletal muscle was carried out using myometric measurements with the MYOTON-3 device.
  
  
• Motor Activity Log (MAL) [ Time Frame: Baseline, change of MAL at 2 weeks, and change of MAL at 4 weeks ] [ Designated as safety issue: No ]
  The MAL is a semi-structured interview of patients to assess the amount of use (AOU) and quality of movement (QOM) of the affected upper extremity in 30 important daily activities using a 6-point ordinal scale. Higher scores indicate better performance.
  
  
• ABILHAND Questionnaire [ Time Frame: Baseline, change of ABILHAND Questionnaire at 2 weeks, and change of ABILHAND Questionnaire at 4 weeks ] [ Designated as safety issue: No ]
  ABILHAND questionnaire is an inventory of 56 manual activities that uses a 3-point ordinal scale to measure subjectively perceived difficulty in performing everyday bimanual activity.
  
  
• Reintegration of Normal Living Index (RNL) [ Time Frame: Baseline, change of RNL at 2 weeks, and change of RNL at 4 weeks ] [ Designated as safety issue: No ]
  The RNL is used to measure the satisfaction with community reintegration. It scores on a 4-point ordinal scale, with higher scores indicating a higher level of satisfaction.
  
  

Two theory-based, task-oriented approaches are distributed CIT (dCIT) and robot-assisted Bilateral training(BAT). CIT/dCIT involves massed practice of the affected arm and restraint of the unaffected arm. BAT involves repetitive practice of symmetrical bilateral movements on robot. Both are evident to improve motor performance, motor control or daily function in high functioning patients. These dCIT and BAT have their own limitations for motor-deficit rehabilitation after stroke, i.e. only appropriate for high-functioning or mildly motor impaired patients. Functional electrical therapy, an innovative technology, is proposed as an adjunct to these behavioral approaches to assist in movement execution. Functional electrical therapy is used to increase the electric activity of muscles for movement and the active range of motion in low functioning patients. Combining functional electrical therapy into CIT or BAT may extend the utility of these two behavioral approaches beyond patients with mild motor deficits and could expedite the progress of motor recovery. This project attempts to perform a randomized controlled trial to verify the efficacy and motor control mechanism of the proposed combined functional electrical therapy with dCIT or with BAT.