Invited Commentary on Comparison of Robotics, FES, and Motor Learning Methods for Treatment of Persistent Upper Extremity Dysfunction after Stroke

In this issue of Archives of Physical Medicine and Rehabilitation, Jessica McCabe and colleagues report findings from their methodologically sound dose-matched clinical trial in 39 patients beyond 6 months post stroke. In this phase II trial, the effects of 60 treatment sessions, each involving 3.5 hours of intensive practice plus either 1.5 hours of functional electrical stimulation (FES) or a shoulder-arm robotic therapy, were compared with 5 hours of intensive daily practice alone. While no significant between-group differences were found on the primary outcome measure of Arm Motor Ability Test (AMAT) and the secondary outcome measure of Fugl Meyer Arm (FMA) motor score, 10 to 15% within-group therapeutic gains were observed regarding AMAT and FMA. These gains are clinically meaningful for patients with stroke. However, the underlying mechanisms that drive these improvements are not yet well understood. The approximately 1000 dollar cost reduction per patient calculated for the use of motor learning (ML) methods alone or combined with FES, compared to the combination of ML and shoulder arm-robotics, further emphasizes the need for cost considerations when making clinical decisions regarding the selection of the most suitable therapy for the upper paretic limb in clients suffering from chronic stroke.