ICARE: Rehabilitation After a Stroke
Each year more than 700,000 Americans suffer from stroke, and approximately 85 percent of stroke survivors experience partial paralysis on one side of the body. The Center for Rehabilitation Medicine at Emory University is now enrolling patients in the ICARE study, geared toward improving the use of the hand and arm affected by the stroke.
Researcher: Dr. Steven Wolf
Study Participant: Joe Williams
Joe Williams suffered a stroke in early 2010 and afterward received the ICARE protocol.
Study Participant: Alvin Dunlop
Stroke victim Alvin Dunlop was in the study, but did not receive the ICARE therapy. His initial treatment was at the Marcus Stroke and Neuroscience Center at Grady Memorial Hospital, where his treatment was led by Emory neurologist Dr. Michael Frankel.
Each year more than 700,000 Americans suffer from stroke, and approximately 85 percent of stroke survivors experience partial paralysis on one side of the body. The annual health care cost for stroke care is approximately $45 billion.
Among stroke survivors, approximately 65 percent experience significant disability – including the potential loss of use of one arm. While such events can lead to a reduced quality of life and loss of independence, more options than ever before now
exist that, through intensive rehabilitation and clinical studies, may lessen the impact of the disability – improving the quality of life for both the patient and his or her caregiver.
The Center for Rehabilitation Medicine at Emory University is now enrolling patients in the ICARE study, geared toward improving the use of the hand and arm affected by the stroke.
“As part of the program, the ICARE study will test an experimental arm therapy called Accelerated Skill Acquisition Program (ASAP) which combines challenging, intensive and meaningful practice of tasks of the participant’s choice compared to two standard types of therapy, including occupational therapy totaling 30 hours, and occupational therapy for a duration indicated on the therapy prescription. A second objective of this study is to characterize current outpatient occupational for individuals who are eligible for ICARE,” explained Dr. Wolf. “Given the ongoing trend toward diminished time for stroke rehabilitation that is covered or reimbursed for the patient , the ultimate goal for the ICARE Trial is to provide evidence toward an optimal allocation of therapy services within the approved number of treatment sessions that will reduce disability, lessen the societal burden, and provide a standardized treatment useful for the rehabilitation in future trials.”
All participants, regardless of study group will receive comprehensive evaluations up to one year and will receive therapy in the outpatient setting provided by licensed/certified occupational therapists (OT), and physical therapists (PT). In addition, study participants are not precluded from receiving additionally prescribed outpatient therapies including physical therapy, speech therapy, or other services.
In order to be eligible for participation, patients must:
- Have sustained a stroke within the last 3 months, with resultant weakness in one arm/hand
- Be at least 21 years old
- Be able to attend outpatient therapy 3x/week for 10-16 weeks
- Be able to attend periodic follow-up evaluations up to 1 year afterwards
- Have no other medical conditions that affect their movement
- Not have dementia or pre-existing cognitive deficits
All enrolled participants will be randomly assigned to one of three study groups that will vary by therapy focus/content and dosage, including:
- The investigational intervention, Accelerated Skill Acquisition Program (ASAP):
- Thirty visits of an individualized therapy focused on the arm most affected by the stroke. This is an integrated and evidence-based intervention for upper extremity recovery that arose from diverse but converging and complementary and interdisciplinary literatures of basic and applied science as well as recent translational and clinical trials research of upper extremity recovery after stroke. Unique aspects include the structured framework by which intensity and progression of practice is managed and by which participant skills and confidence are fostered through therapist-patient dialogue.
- A dose-equivalent (30 visits) of usual and customary occupational therapy (DEUCC): 30 visits scheduled 3x/week over 10 – 16 weeks.
- Usual and customary occupational therapy care (UCC): delivered at the dosage common for that outpatient setting.
What do these interventions involve?
Accelerated Skill Acquisition Program (ASAP):
Participants randomized to ASAP will be given a customized package of therapy that includes challenging, intensive, and meaningful practice of participant chosen real-world tasks (e.g., carrying groceries, handwriting) that engage the arm most affected by the stroke. Participants will be offered a mitt to wear on their stronger arm during their time outside of therapy to promote use of the weaker arm; however, they will not be required to use the mitt if they so choose. Outside of therapy specific assignments (Action Plans) will be given to encourage self-managed, confident, safe, and effective arm use at home and in the community. Therapy sessions will be 1 hour in length and be scheduled 3x/week over 10 – 16 weeks. To prevent cross-contamination between study groups further details of the investigational intervention have been embargoed until after study completion.
Usual and Customary Occupational Therapy:
Participants assigned to one of the following other two study groups (DEUCC, UCC) will receive OT as it is typically practiced in the outpatient clinic. The scope of typical OT for patients with stroke may be more comprehensive than the focused package defined as ASAP. It may address issues or use interventions directed at other than the arm most affected by the stroke, including: perceptual deficits, splint and equipment fabrication, modalities (e.g., ice, heat), exercise, activities of daily living training, and vocation-related rehabilitation.
For More Information on ICARE
For more information, contact Sarah Blanton, PT, DPT, NCS at Sarah.Blanton@emory.edu or 404-712-2222.