The University of Southern California is taking the lead to address rehabilitation therapy and how it can improve the quality of life for stroke survivors. Each year, about 700,000 people in the United States experience first or recurrent attacks of stroke.
About 65 percent of stroke survivors experience significant disability, such as the loss of use of one arm. This can lead to a reduced quality of life and loss of independence, says Carolee Winstein, director of the Motor Behavior and Neurorehabilitation Laboratory at USC.
"More effective rehabilitation treatments could lessen the disability, caregiver burden and economic impact of stroke," says Winstein, a professor of biokinesiology and physical therapy.
To address the problem, the NIH-National Institute of Neurological Disorders and Stroke and the NIH-National Institute of Child Health and Human Development awarded Winstein $12.4 million for a five-year study of a promising physical therapy program for stroke patients who have lost movement in their upper limbs.
The trial will investigate the effectiveness of the Accelerated Skill Acquisition Program (ASAP), an "intense and focused" outpatient rehabilitation program that emphasizes activities-based training and resistance exercises, and includes 30 hours of one-on-one therapy early in the rehab process, within the first three months of the stroke. The ASAP program also uses motivational techniques to encourage patients to self-manage their therapy.
Patients in the study will be divided into three groups; the ASAP therapy group, an outpatient group receiving a similar amount of PT and a monitoring only out-patient therapy group. The ASAP and outpatient group will attend a one hour therapy session, three times a week for 10 weeks. Meanwhile, the monitoring only group will receive out-patient therapy for a frequency and duration prescribed by their referring physician.
Winstein's study is named I-CARE, for Interdisciplinary Comprehensive Arm Rehabilitation Evaluation (I-CARE) Stroke Initiative.
The I-CARE trial will link the USC School of Dentistry's Division of Biokinesiology and Physical Therapy with two other academic clinical research centers in the U.S.: the National Rehabilitation Hospital in Washington, D.C., led by co-principal investigator Alexander Dromerick, and the Emory University Center for Rehabilitation Medicine in Atlanta, Ga., led by co-principal investigator Steven Wolf. USC will serve as the primary project site and data management center.
I-CARE will also involve five Southern California physical rehabilitation sites: Cedars-Sinai Medical Center in Los Angeles, Casa Colina Centers for Rehabilitation in Pomona, Huntington Rehabilitation Medicine Associates in Pasadena, Long Beach Memorial Medical Center in Long Beach and Rancho Los Amigos National Rehabilitation Center in Downey.
The extensive study is expected to generate a wealth of useful data about stroke rehabilitation that "could find use in trials of current and future experimental interventions such as pharmacological agents, gene therapy, stem cell implants and robot-assisted and direct cortical stimulation programs," Winstein says.