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An Opportunity for Our Stroke Patients

Stroke Rehabilitation in Pomona

The ICARE study is about arm and hand recovery after a stroke. We are testing an experimental arm therapy called Accelerated Skill Acquisition Program (ASAP), which combines challenging, intensive and meaningful practice of tasks compared to two standard types of therapy (traditional arm therapy totaling 30 hours and traditional arm therapy for a duration indicated on the therapy prescription). A second objective is to characterize current outpatient arm therapy (dosage and content) for individuals who are eligible for ICARE.

The ICARE study is headquartered at University of Southern California. Evaluations and treatment will occur at multiple clinical sites with centers in Atlanta, GA; Southern California; and Washington, DC. ICARE Clinical Sites include:
  • Casa Colina Centers for Rehabilitation (Pomona, CA)
  • Cedars Sinai Medical Center (Los Angeles, CA)
  • Emory University (Atlanta, GA)
  • Huntington Medical Rehabilitation Associates (Pasadena, CA)
  • Long Beach Memorial Medical Center (Long Beach, CA)
  • National Rehabilitation Hospital (Washington, D.C.)
  • Rancho Los Amigos National Rehabilitation Center (Downey, CA)
The ICARE study is sponsored by the National Institute of Neurological Disorders and Stroke (NINDS) and the Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD).

Why is this study being done?

This study is about arm and hand recovery after a stroke. We are testing an experimental arm therapy called Accelerated Skill Acquisition Program (ASAP) which combines challenging, intensive and meaningful practice of tasks of the participant's choice compared to two standard types of therapy (traditional arm therapy totaling 30 hours and traditional arm therapy for a duration indicated on the therapy prescription). A second objective is to characterize current outpatient arm therapy (dosage and content) for individuals who are eligible for ICARE.

For complete details about the study, please visit http://clinicaltrials.gov/ct2/show/NCT00871715

Who may be eligible to participate?

A total of 360 individuals from multiple sites within three Centers (Atlanta GA, Los Angeles, CA, and Washington DC) who:
  • sustained a stroke within the last 3 months
  • are at least 21 years old
  • could attend outpatient therapy 3x/week for 10 weeks
  • could attend periodic follow-up evaluations up to 1 year afterwards
  • have no other medical conditions that affect their movement
  • have hemiparesis (weakness) in one arm/hand affected by the index stroke
  • do not have a recent history of drug or alcohol abuse
  • do not have dementia or pre-existing cognitive deficits
What is involved in the study?

All participants, regardless of study group will receive comprehensive evaluations up to 1-year and may receive therapy in the outpatient setting provided by licensed/certified occupational therapists (OT), and physical therapists (PT). In addition, study participants are not precluded from receiving additionally prescribed outpatient therapies including physical therapy, speech therapy, or other services. All enrolled participants will be randomly assigned to one of three study groups that will vary by therapy focus/content and dosage. They are:
  • The investigational intervention, Accelerated Skill Acquisition Program (ASAP): 30 visits of an individualized therapy focused on the arm most affected by the stroke. This is an integrated and evidence-based intervention for upper extremity recovery that arose from diverse but converging and complementary and interdisciplinary literatures of basic and applied science as well as recent translational and clinical trials research of upper extremity recovery after stroke. Unique aspects include the structured framework by which intensity and progression of practice is managed and by which participant skills and confidence are fostered through therapist-patient dialogue sustained a stroke within the last 3 months
  • A dose-equivalent (30 visits) of usual and customary outpatient arm therapy (DEUCC): 30 visits scheduled 3x/week over 10 weeks
  • Usual and customary outpatient arm therapy care (UCC): delivered at the dosage common for that outpatient setting. This will vary by site but is likely to be less than 30 visits, and in some cases, may be no therapy
What do these interventions involve?

Accelerated Skill Acquisition Program (ASAP):
Participants randomized to ASAP will be given a customized package of therapy that includes challenging, intensive, and meaningful practice of participant chosen real-world tasks (e.g., carrying groceries, handwriting) that engage the arm most affected by the stroke. Participants will be offered a mitt to wear on their stronger arm during their time outside of therapy to promote use of the weaker arm; however, they will not be required to use the mitt if they so choose. Outside of therapy specific assignments (Action Plans) will be given to encourage self-managed, confident, safe, and effective arm use at home and in the community. Therapy sessions will be 1 hour in length and be scheduled 3 x a week over 10 weeks. To prevent cross-contamination between study groups further details of the investigational intervention have been embargoed until after study completion.

Usual and Customary Outpatient Arm Therapy:
Participants assigned to one of the following other two study groups (DEUCC, UCC) will receive traditional outpatient arm therapy as it is typically practiced in the outpatient clinic. The scope of typical therapy for patients with stroke may be more comprehensive than the focused package defined as ASAP. It may address issues or use interventions directed at other than the arm most affected by the stroke, including: perceptual deficits, splint and equipment fabrication, modalities (e.g., ice, heat), exercise, activities of daily living training, and vocation-related rehabilitation.

Who do I contact for consideration in the ICARE study?

If you believe you are or you know an eligible participant, please contact:

Stephanie Kaplan, PT, DPT, ATP
ICARE Clincal Site Coordinator
Casa Colina Centers for Rehabilitation
255 E. Bonita Ave.
Pomona, CA 91769
909/596-7733, ext. 3074
skaplan@cassacolina.org