Clinical Relevance for the Veteran

Purpose of the Work. At least 600,000 strokes occur every year in the United States, and stroke is the leading cause of disability. Stroke-related motor deficits and disabilities result in compromised quality of life, lost independence, and enormous healthcare costs. Numerous studies have shown that Constraint-Induced Movement therapy, or CI therapy, increases the amount of use of the moreaffected upper limb in activities of daily living in patients with mild to moderately severe chronic stroke. However, CI therapy is an intensive intervention that involves a great deal of one-on-one therapist time and is therefore too expensive to be available for many individuals who would benefit from it. We report progress in the development of AutoCITE, a workstation that delivers the task practice component of upper-limb CI therapy, which can potentially be used in the clinic or the home without the need for oneon-one supervision from a therapist. Subjects and Procedures. AutoCITE incorporates a computer and eight task devices arranged on a modified cabinet. Task performance is automatically recorded, and several types of feedback are provided. In preliminary testing, nine chronic stroke subjects with mild to moderate motor deficits practiced with AutoCITE for 3 h each weekday for 2 weeks. Subjects wore a padded mitt on the less-affected hand for a target of 90% of their waking hours. Results. In terms of effect sizes, gains were large and significant on the Motor Activity Log, and moderate to large on the Wolf Motor Function Test. These gains were comparable to the gains of a matched group of 12 subjects who received standard CI therapy. Relevance to the Veteran Population. Development of a workstation that delivers the task practice portion of CI therapy without the need for one-on-one supervision from a therapist would substantially reduce the cost of CI therapy because patients could perform the exercises at home, and one therapist could treat four or more patients simultaneously in the clinic. The reduced cost would provide access to CI therapy for many veterans who currently cannot afford the treatment but would benefit from it. Peter S. Lum, PhD The experience of time in the transition from hospital to home following stroke Maude Rittman, PhD; Christopher Faircloth, PhD; Craig Boylstein, PhD; Jaber F. Gubrium, PhD; Christine Williams, DNSc; Marieke Van Puymbroeck, MS; Charles Ellis, MA