What is it about?

Stroke survivors with severe upper limb disability need opportunities to engage in task-oriented practice to achieve meaningful recovery. The SMART Arm offers one such opportunity. This study looks at the impact of SMART Arm training with usual therapy to usual therapy alone on arm function for stroke survivors with severe upper limb disability undergoing inpatient rehabilitation. A prospective, multicenter, randomized controlled trial was conducted with 50 inpatients within 4 months of stroke with severe upper limb disability. participants received 60 min/d, 5 days a week for 4 weeks of (1) SMART Arm with outcome-triggered electrical stimulation and usual therapy, (2) SMART Arm alone and usual therapy, or (3) usual therapy. All groups demonstrated a statistically and clinically significant improvement in arm function at posttraining and at 52 weeks. There were no differences in improvement in arm function between groups however there were greater odds of better arm function in SMART Arm groups as compared with usual therapy alone at posttraining. In conclusion, SMART Arm training supported a clinically significant improvement in arm function, which was similar to usual therapy. All groups maintained gains at 12 months.

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Why is it important?

All participants in the current study engaged in repetitive upper limb practice, despite presence of severe and multiple impairments across sensory, cognitive, and/or linguistic domains. Contrary to oft-held views, participants were able to demonstrate improvements in arm function that were maintained at 12-month follow-up.


To demonstrate the full recovery potential of SMART Arm training, future studies need to identify those most likely to respond. To shift the recovery profile for stroke survivors with severe paresis, over and above the spontaneous recovery profile, consideration must be given to timing, dose, and duration of training required to fully exploit the “sensitive period” in which therapy-mediated recovery is heightened. In addition, SMART Arm training needs to be individualized to achieve the optimal challenge point and to include real-world use.

Ruth Barker
James Cook University

Read the Original

This page is a summary of: SMART Arm Training With Outcome-Triggered Electrical Stimulation in Subacute Stroke Survivors With Severe Arm Disability: A Randomized Controlled Trial, Neurorehabilitation and Neural Repair, December 2017, SAGE Publications,
DOI: 10.1177/1545968317744276.
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