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Abstract Background We previously characterized hemisphere-specific motor control deficits in the ipsilesional, less-impaired arm of unilaterally lesioned stroke survivors. Our preliminary data indicate these deficits are substantial and functionally limiting in patients with severe paresis. Methods We have designed an intervention (“IPSI”) to remediate the hemisphere-specific deficits in the ipsilesional arm, using a virtual-reality platform, followed by manipulation training with a variety of real objects, designed to facilitate generalization and transfer to functional behaviors encountered in the natural environment. This is a 2-site (primary site – Penn State College of Medicine, secondary site – University of Southern California), two-group randomized intervention with an experimental group, which receives unilateral training of the ipsilesional arm throughout 3 one-hour sessions per week for 5 weeks, through our Virtual Reality and Manipulation Training (VRMT) protocol. Our control group receives a conventional intervention on the contralesional arm, 3 one-hour sessions per week for 5 weeks, guided by recently released practice guidelines for upper limb rehabilitation in adult stroke. The study aims to include a total of 120 stroke survivors (60 per group) whose stroke was in the territory of the middle cerebral artery (MCA) resulting in severe upper-extremity motor impairments. Outcome measures (Primary: Jebsen-Taylor Hand Function Test, Fugl-Meyer Assessment, Abilhand, Barthel Index) are assessed at five evaluation points: Baseline 1, Baseline 2, immediate post-intervention (primary endpoint), and 3-weeks (short-term retention) and 6-months post-intervention (long-term retention). We hypothesize that both groups will improve performance of the targeted arm, but that the ipsilesional arm remediation group will show greater improvements in functional independence. Discussion The results of this study are expected to inform upper limb evaluation and treatment to consider ipsilesional arm function, as part of a comprehensive physical rehabilitation strategy that includes evaluation and remediation of both arms. Trial Registration This study is registered with ClinicalTrials.gov (Registration ID: NCT03634397 ; date of registration: 08/16/2018).

The study explored the acceptability of high repetition arm training as part of a randomised controlled trial, early after stroke, when fatigue levels and emotional strain are often high. 36 sub-acute stroke survivors (61 years+/-15) attended for assessment sessions at 3, 6, and 12 weeks after stroke. Individuals were randomised to receive 6 high repetition arm training sessions between 3 and 6 weeks (intervention) or the control group. Semi-structured interviews were conducted at trial completion. Interview transcripts were analysed through framework analysis conducted independently by 2 researchers. Stroke survivors participated despite high levels of fatigue because they hoped for personal benefit or to potentially benefit future patients. Benefits reported from participation included physical improvements, psychological benefit, improved understanding of their condition as well as a feeling of hope and distraction. The arm training at three weeks after stroke, aiming for 420 movement repetitions was not considered to be too intensive or too early, and most individuals felt lucky to have been, or would have preferred to be in the early training group. High repetition arm training early after stroke was acceptable to participants. Study participation was generally viewed as a positive experience, suggesting that early intervention may not only be physically beneficial but also psychologically. Stroke survivors report that high repetition arm training early after stroke is acceptable. Participation in rehabilitation research early after stroke provides stroke survivors with hope and meaning despite the high prevalence of fatigue. Complex information needs to be repeated and provided in a number of formats early after stroke. [ABSTRACT FROM AUTHOR]

Background: We previously characterized hemisphere-specific motor control deficits in the ipsilesional, lessimpaired arm of unilaterally lesioned stroke survivors. Our preliminary data indicate these deficits are substantial and functionally limiting in patients with severe paresis. Methods: We have designed an intervention ("IPSI") to remediate the hemisphere-specific deficits in the ipsilesional arm, using a virtual-reality platform, followed by manipulation training with a variety of real objects, designed to facilitate generalization and transfer to functional behaviors encountered in the natural environment. This is a 2-site (primary site - Penn State College of Medicine, secondary site - University of Southern California), two-group randomized intervention with an experimental group, which receives unilateral training of the ipsilesional arm throughout 3 one-hour sessions per week for 5 weeks, through our Virtual Reality and Manipulation Training (VRMT) protocol. Our control group receives a conventional intervention on the contralesional arm, 3 one-hour sessions per week for 5 weeks, guided by recently released practice guidelines for upper limb rehabilitation in adult stroke. The study aims to include a total of 120 stroke survivors (60 per group) whose stroke was in the territory of the middle cerebral artery (MCA) resulting in severe upper-extremity motor impairments. Outcome measures (Primary: Jebsen-Taylor Hand Function Test, Fugl-Meyer Assessment, Abilhand, Barthel Index) are assessed at five evaluation points: Baseline 1, Baseline 2, immediate post-intervention (primary endpoint), and 3-weeks (short-term retention) and 6-months postintervention (long-term retention). We hypothesize that both groups will improve performance of the targeted arm, but that the ipsilesional arm remediation group will show greater improvements in functional independence. Discussion: The results of this study are expected to inform upper limb evaluation and treatment to consider ipsilesional arm function, as part of a comprehensive physical rehabilitation strategy that includes evaluation and remediation of both arms. [ABSTRACT FROM AUTHOR]

In the last few years, novel robotic technology has been developed that has the potential to improve upper extremity function after spinal cord injury (SCI), stroke, and other neurological diseases. Three generations of the arm therapy robot ARMin were developed and clinically evaluated on many patients. Key focus was on the training of functional tasks incorporating activities of daily living (ADL) with large range of motion of the entire arm in order to enhance transfer to daily life and improve quality of life. Encouraged by the promising results in first single-case studies performed with ARMin I and ARMin II, an optimized ARMin III was developed and duplicated and is currently being used within a 4-center randomized clinical trial. A fourth generation of ARMin is currently under development that will have further functional benefits with respect to patient-cooperative control and therapy assessment. Intellectual property has been identified for technology transfer and commercial exploitation. The continuation of the clinical research and the future product development and commercialization may satisfy the pressing socioeconomic need to improve quality of life of the disabled subjects. [ABSTRACT FROM AUTHOR]

Objective: Exercise training in people with chronic obstructive pulmonary disease (COPD) is widely accepted as the cornerstone to pulmonary rehabilitation. Traditionally, exercise for people with COPD has focused on leg training, such as walking and cycling. However, the recognition that there is greater limitation for daily arm activities has attracted interest in the effectiveness of arm training. This review was undertaken to examine the literature for the effectiveness of arm endurance and strength training on arm exercise capacity in people with COPD. Methods: Trials relating to arm endurance and strength training in COPD were located by searching electronic databases and screening the reference lists of pertinent articles. Where possible, effect sizes and 95% CI were determined and meta-analysis used. Results: The search strategy yielded 24 articles. Unsupported arm training improved arm endurance capacity (standard mean difference [SMD]=1·25; 95% CI=–0·16 to 2·66) and was the optimal mode of arm endurance training. Combined unsupported and supported arm training was also found to have a large positive effect on peak arm exercise capacity (SMD=1·27; 95% CI=0·59 to 1·94). In addition arm strength training produced moderate improvements in arm strength (SMD=0·46; 95% CI=0·10 to 0·81). Conclusion: This review suggests that in the short term, arm endurance training improves arm exercise capacity and arm strength training improves arm strength. Further research is required, in people with COPD, to investigate the long-term effects of arm training and to determine the optimal training routine for improving arm tasks important for daily living. [ABSTRACT FROM AUTHOR]

The article presents a study on arm exercise and hyperinflation in patients with COPD. Pulmonary rehabilitation programs improve exercise capacity by reducing both dynamic hyperinflation and dyspnea in patients with COPD. An arm-training program leads to reduction in ventilatory requirements for simple arm elevation. A variable percentage of COPD patients stop leg exercise because of both dyspnea and leg effort, while others mostly stop because of either one or the other. The present results showing in each subject a similar amount of both dyspnea and arm effort are consistent with the neural motor output being balanced between respiratory muscles, and arm and torso muscles.

Exercise performance in patients with impaired ventricular function does not correlate well with the severity of dysfunction. Patients with ventricular dysfunction can achieve a fairly high work capacity, and the physiological variables respond in a similar way, regardless of whether or not the patients do or do not have impaired function. Furthermore, patients with pump dysfunction can benefit from a supervised physical training programme by improving their functional capacity and thus, their quality of life. The absolute contraindications for exercise therapy in this group of patients with coronary artery disease should therefore be identical to those who have normal ventricular function.In our opinion, special attention should be exercised in patients who have chronotropic incompetence, lack of an elevation or decrease in blood pressure during exercise performance and in those whose stroke volume is not elevated during even low to moderate work-loads. Recommendations as to the implication of exercise therapy as a therapeutic modality in patients with ventricular impairment must be accepted with caution. The reason for this is that our observations are based on historical, anecdotal trials, most of which included only a modest number of patients. Future research and a prolonged follow-up is needed in order to obtain both a more exact analysis and eventually scientifically based evidence on the benefits and hazards involved. [ABSTRACT FROM PUBLISHER]