The Critical Period After Stroke Study (CPASS) Upper Extremity Treatment Protocol

Area of Science:

• Neuroscience
• Rehabilitation Medicine
• Clinical Trials

Background:

• Stroke frequently causes upper extremity (UE) motor impairments, significantly impacting patient independence and quality of life.
• Current rehabilitation strategies often lack personalization, potentially limiting functional recovery in the critical periods after stroke.
• Standardized treatments may not address the unique, meaningful activities prioritized by individual stroke survivors.

Purpose of the Study:

• To introduce a novel, personalized upper extremity (UE) treatment developed for the Critical Periods After Stroke Study (CPASS).
• To evaluate the feasibility and delivery of this UE treatment within a phase II randomized controlled trial (RCT).
• To explore contextual factors influencing treatment adherence among stroke survivors.

Main Methods:

• A secondary analysis of data from the CPASS phase II RCT was conducted.
• The intervention involved 20 hours of UE treatment, with goals identified using the Activity Card Sort (ACS) for personalized activity selection.
• Treatment activities were standardized into smaller components based on the protocol's essential elements.

Main Results:

• The novel UE treatment was delivered in inpatient and outpatient settings within the first year post-stroke.
• High adherence was observed, with 49 out of 53 eligible participants (92.5%) fully adhering to the treatment protocol.
• Feasibility was assessed by examining treatment duration, location, and practiced UE activities, with contextual factors influencing adherence.

Conclusions:

• The CPASS treatment successfully integrated participant-identified meaningful activities via the ACS, enabling customized UE motor therapy.
• This approach demonstrated flexibility in tailoring therapy without compromising standardization or data quantification.
• The study confirms the feasibility of delivering personalized UE motor therapy within the first year post-stroke, adaptable to diverse settings and participant impairments.