Stroke Structured Abstract - S #17
Enjoyable activities may be more effective than traditional motor function exercises in improving stroke clients' physical ability and psychosocial well-being
CITATION: Smedley, R. R., Fiorino, A. J, Soucar, E., Reynolds, D., Smedley, W. P., & Aronica, M. J. (1986). Slot machines: Their use in rehabilitation after stroke. Archives of Physical Medicine and Rehabilitaion, 67, 546-549.
LEVEL OF EVIDENCE: IIB3b
What is the effectiveness of a novel and entertaining motor function exercise compared with that of traditional motor function exercises?
Subjects designated as the control group were inpatients at the John Heinz Institute of Rehabilitation Medicine. Subjects designated as the experimental group were inpatients at the George T. Walters Institute of Rehabilitation Medicine. The two sites were reported to be identical in size, staff, policies, and procedures.
SAMPLING PROCEDURE/INCLUSION CRITERIA
N = 50
Male = NR
Female = NR
Age range = 40-85
LCVA = 37
RCVA = 13
Attrition = NR
NR = Not Reported
(R = Reliability established; V = Validity established)
PULSES Profile (Reliability not reported)
Range of motion (ROM)
Gross Motor Coordination
Fine Motor Coordination
Beck Depression Inventory - R
Experimental Group: Slot machines (as in a gambling casino) were adapted to operate with ordinary washers instead of coins and to allow graded resistive exercises that accomplish the same muscle strengthening goals of traditional therapeutic devices.
Control Group: Tasks and activities commonly used by therapists to improve sensorimotor functioning with the use of machines and devices such as pulleys, peg boards, suspension devices, shoulder bars, push boxes, etc.
WHO DELIVERED INTERVENTION
Clinics of two different hospitals
FREQUENCY & DURATION
NR; Experiment lasted 1 month
Beck Depression Inventory E > C (p = .03, r = .26)
ROM (p = .37, r = .05)
Muscle strength E > C (p = .009, r = .33)
Gross coordination (p = .32, r = .07)
Fine coordination E > C (p = .0000006, r = .62)
90% of all subjects improved
Beck Depression Inventory: E (t = 3.42, p < .0005, r = .45); C (t = 2.57, p < .01, r = .35)
PULSES Profile: E (p < .003 for 4 out of 4 tests, r = .50); C (p < .01 for 3 out of 4 tests, r = .31).
THREATS TO VALIDITY
Possible selection bias because groups were treated in two different facilities.
Expectation: Unclear whether the therapists at the two hosptitals were blind to the research hypothesis.
Unequal amount of therapy between groups: Both groups received traditional OT, the Experimental Group received slot-machine therapy in addition.
Multivariate analysis of the results showed significantly greater progress in the five dependent variables among patients in the Experimental Group.
This study suggests that novel and entertaining motor function may be incorporated into therapy with positive results. However, more controlled research is needed to further examine the effect of this type of intervention.
Terminology used in this document is based on two systems of classification current at the time the evidence-based literature reviews were completed: Uniform Terminology for Occupational Therapy Practice-Third Edition (AOTA, 1994) and International Classification of Functioning, Disability and Health (ICIDH-2) (World Health Organization [WHO], 1999). More recently, the Uniform Terminology document was replaced by Occupational Therapy Practice Framework: Domain and Process (AOTA, 2002), and modifications to ICIDH-2 were finalized in the International Classification of Functioning, Disability and Health (WHO, 2001).
This work is based on the evidence-based literature review completed by Hui-ing Ma, ScD, OTR, and Catherine A. Trombly, ScD, OTR/L, FAOTA.
For more information about the Evidence-Based Literature Review Project, contact the Practice Department at the American Occupational Therapy Association, 301-652-6611, x 2040.
Copyright 2003 American Occupational Therapy Association, Inc. All rights reserved. This material may be reproduced and distributed without prior written consent.