BIRMINGHAM, AL — An automated version of a revolutionary rehabilitation therapy for stroke patients has been shown to be as effective as the standard therapist-delivered therapy, with the potential of dramatically lowering costs of the therapy and making it more universally available to stroke patients, according to findings published May 25 in the American Heart Association journal, Stroke. Researchers found that AutoCITE, an automated version of Constraint-Induced Movement therapy (CI therapy), produced the same results in stroke patients as standard CI therapy.
“Standard CI therapy, while effective, is very labor-intensive,” said CI discoverer, Edward Taub, Ph.D., professor of psychology at the University of Alabama at Birmingham (UAB) and the Birmingham Veterans Administration (VA) Medical Center. “It requires a physical therapist to work exclusively with a single patient for an extended period of time, usually several weeks. By contrast, the AutoCITE device shows promise for allowing a single therapist to supervise and monitor several patients simultaneously, again with the same patient outcomes.”
Stroke patients often lose motor function on one side of the body. CI therapy consists of intensive, rigorous physical therapy for up to 6 hours a day for 2 or 3 weeks under the constant supervision of a therapist. A patient’s unaffected, or good, hand is restrained in a padded mitt. Patients must use the affected, or bad, hand and arm to carry out a variety of tasks. Taub’s previous research has shown that following CI therapy, patients regained substantial ability to use the affected arm or hand for the activities of daily life.
AutoCITE consists of the equipment for eight therapeutic tasks used in standard CI therapy arranged on a specially designed workstation, which automatically adjusts for height and distance from the patient using it. A computer screen prompts the patient through each task with the same frequency and intensity as standard CI therapy.
Positive feedback is provided by encouraging text messages that appear on the computer screen following successful completion of a task and by graphics that show previous best scores. Taub says patients seem to compete with themselves to do better, providing much needed reinforcement.
In the AutoCITE study, Taub’s research team worked with 27 stroke patients with mild to moderate disability. After learning how to use AutoCITE, patients were supervised during therapy 100 percent of the time, 50 percent of the time or 25 percent of the time.
“The therapy was just as effective for the 25 and 50 percent groups as it was for the 100 percent group,” said Taub. “Even more importantly, all the AutoCITE patients had the same beneficial effects in arm and hand function as we see in standard one-on-one CI therapy.”
The AutoCITE project was funded by the Office of Research and Development, Rehabilitation Service R & D, Department of Veterans Affairs and the research carried out at the Birmingham VA Medical Center. The workstation was designed by rehabilitation engineers at the VA Medical Center in Palo Alto, Calif. It is the first automated device to deliver motor function rehabilitation and potentially brings the already proven benefits of CI therapy to countless stroke patients with disabilities who cannot afford the cost of the therapy.
“CI therapy currently is not covered by most insurance carriers, and the price tag for the treatment is high since each therapist can usually only supervise one patient a day,” said Taub. “Since we found no loss of effectiveness in the treatment with 50 percent or 25 percent supervision, we feel that with the aid of several AutoCITE workstations, one therapist can provide effective rehabilitation to multiple patients, which will dramatically lower the costs associated with the therapy.”
Taub’s collaborators on the AutoCITE project include Peter Lum, Ph.D., Hunter Holmes McGuire VA Medical Center, who supervised building the device; Phillip Hardin, Birmingham VA Medical Center; Victor Mark, M.D., UAB Department of Physical Medicine and Rehabilitation; and Gitendra Uswatte, Ph.D., UAB Department of Psychology.
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