Efficacy of interactive manual dexterity training after stroke: a pilot single-blinded randomized controlled trial

ObjectiveTo compare the efficacy of Dextrain Manipulandum & TRADE; training of dexterity components such as force control and independent finger movements, to dose-matched conventional therapy (CT) post-stroke.MethodsA prospective, single-blind, pilot randomized clinical trial was conducted. Chronic-phase post-stroke patients with mild-to-moderate dexterity impairment (Box and Block Test (BBT) > 1) received 12 sessions of Dextrain or CT. Blinded measures were obtained before and after training and at 3-months follow-up. Primary outcome was BBT-change (after-before training). Secondary outcomes included changes in motor impairments, activity limitations and dexterity components. Corticospinal excitability and short intracortical inhibition (SICI) were measured using transcranial magnetic stimulation.ResultsBBT-change after training did not differ between the Dextrain (N = 21) vs CT group (N = 21) (median [IQR] = 5[2-7] vs 4[2-7], respectively; P = 0.36). Gains in BBT were maintained at the 3-month post-training follow-up, with a non-significant trend for enhanced BBT-change in the Dextrain group (median [IQR] = 3[- 1-7.0], P = 0.06). Several secondary outcomes showed significantly larger changes in the Dextrain group: finger tracking precision (mean & PLUSMN; SD = 0.3 & PLUSMN; 0.3N vs - 0.1 & PLUSMN; 0.33N; P < 0.0018), independent finger movements (34.7 & PLUSMN; 25.1 ms vs 7.7 & PLUSMN; 18.5 ms, P = 0.02) and maximal finger tapping speed (8.4 & PLUSMN; 7.1 vs 4.5 & PLUSMN; 4.9, P = 0.045). At follow-up, Dextrain group showed significantly greater improvement in Motor Activity Log (median/IQR = 0.7/0.2-0.8 vs 0.2/0.1-0.6, P = 0.05). Across both groups SICI increased in patients with greater BBT-change (Rho = 0.80, P = 0.006). Comparing Dextrain subgroups with maximal grip force higher/lower than median (61.2%), BBT-change was significantly larger in patients with low vs high grip force (7.5 & PLUSMN; 5.6 vs 2.9 & PLUSMN; 2.8; respectively, P = 0.015).ConclusionsAlthough immediate improvements in gross dexterity post-stroke did not significantly differ between Dextrain training and CT, our findings suggest that Dextrain enhances recovery of several dexterity components and reported hand-use, particularly when motor impairment is moderate (low initial grip force). Findings need to be confirmed in a larger trial.Trial registration ClinicalTrials.gov NCT03934073 (retrospectively registered)

Automated summary

The efficacy of Dextrain Manipulandum training in post-stroke rehabilitation was compared to conventional therapy. Although there was no significant difference in gross dexterity improvement between the two treatments in the short term, Dextrain Manipulandum training enhanced recovery of multiple dexterity components and reported hand-use.