Efficacy of tele-CPASS, a telerehabilitation intervention using Critical Periods After Stroke (CPASS), compared to in-person CPASS therapy for upper extremity motor recovery. - Nearly two-thirds of the 800,000 annual stroke survivors experience persistent upper extremity (UE) motor impairments. In the Critical Periods After Stroke Study (CPASS), we demonstrated that rehabilitation is time-sensitive—patients receiving therapy within 0–4 months post-stroke recover significantly better than those starting at 6 months. Despite this, rehabilitation dose declines sharply after inpatient discharge at 1 month, not due to full recovery but logistical barriers. Significance: Access to intensive stroke rehabilitation is particularly limited in medically underserved areas (MUAs), where geographic, financial, and transportation barriers prevent timely intervention. El Paso, TX, a predominantly Hispanic/Latino MUA, exemplifies this challenge. Telerehabilitation offers a scalable solution by delivering therapy directly to patients in their homes. Goals & Approach: We propose a longitudinal, single-blind, randomized controlled, non-inferiority trial to evaluate tele-CPASS, a telerehabilitation adaptation of CPASS, against in-person CPASS during the critical recovery window. Thirty-eight patients will be randomized within <40 days post-stroke to receive 20 hours of therapy over 30 days via tele-CPASS or in-person CPASS. Outcomes include the Action Research Arm Test (ARAT), and accelerometry-based arm use in daily life, tested at Baseline, post-intervention and six-months post stroke. Collaborations: Key partners include Texas Tech University Health Sciences Center El Paso (TTUHSC-EP) and University Medical Center of El Paso (UMC) for patient recruitment, and Dr. Lum (Catholic University of America) for accelerometry analysis. Expected Outcomes & Impact: If successful, tele-CPASS can be integrated into standard care using existing CPT codes for telerehabilitation, ensuring equitable access to high-quality stroke rehabilitation, particularly in underserved communities. This scalable, patient-centered model has national implications for improving stroke recovery outcomes.
