Kathryn S. Hayward, Bridee A. Neibling, Ruth N. Barker; Self-Administered, Home-Based SMART (Sensorimotor Active Rehabilitation Training) Arm Training: A Single-Case Report. Am J Occup Ther 2015;69(4):6904210020. https://doi.org/10.5014/ajot.2015.016055
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This single-case, mixed-method study explored the feasibility of self-administered, home-based SMART (sensorimotor active rehabilitation training) Arm training for a 57-yr-old man with severe upper-limb disability after a right frontoparietal hemorrhagic stroke 9 mo earlier. Over 4 wk of self-administered, home-based SMART Arm training, the participant completed 2,100 repetitions unassisted. His wife provided support for equipment set-up and training progressions. Clinically meaningful improvements in arm impairment (strength), activity (arm and hand tasks), and participation (use of arm in everyday tasks) occurred after training (at 4 wk) and at follow-up (at 16 wk). Areas for refinement of SMART Arm training derived from thematic analysis of the participant’s and researchers’ journals focused on enabling independence, ensuring home and user friendliness, maintaining the motivation to persevere, progressing toward everyday tasks, and integrating practice into daily routine. These findings suggest that further investigation of self-administered, home-based SMART Arm training is warranted for people with stroke who have severe upper-limb disability.
I’ve had people ask me, did the SMART Arm do you any good? And I say bloody oath it did. It got my arm moving and in turn got my confidence going, which started to allow me to do things that I hadn’t been able to do in a long time.
SMART Arm training may offer a feasible option for people with stroke with severe paresis to undertake self-administered upper-limb rehabilitation within the home, once recommended changes have been implemented.
The feasibility of home-based, self-administered training may be influenced by the extent to which training fits into the daily routine of the person with stroke and the availability of coaching sessions to refine and make progress on task practice.
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