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Lin IH, Tsai HT, Wang CY, Hsu CY, Liou TH, Lin YN. Effectiveness and Superiority of Rehabilitative Treatments in Enhancing Motor Recovery Within 6 Months Poststroke: A Systemic Review. Arch Phys Med Rehabil 2018; 100:366-378. [PMID: 30686327 DOI: 10.1016/j.apmr.2018.09.123] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 08/19/2018] [Accepted: 09/21/2018] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To investigate the effects of various rehabilitative interventions aimed at enhancing poststroke motor recovery by assessing their effectiveness when compared with no treatment or placebo and their superiority when compared with conventional training program (CTP). DATA SOURCE A literature search was based on 19 Cochrane reviews and 26 other reviews. We also updated the searches in PubMed up to September 30, 2017. STUDY SELECTION Randomized controlled trials associated with 18 experimented training programs (ETP) were included if they evaluated the effects of the programs on either upper extremity (UE) or lower extremity (LE) motor recovery among adults within 6 months poststroke; included ≥10 participants in each arm; and had an intervention duration of ≥10 consecutive weekdays. DATA EXTRACTION Four reviewers evaluated the eligibility and quality of literature. Methodological quality was assessed using the PEDro scale. DATA SYNTHESIS Among the 178 included studies, 129 including 7450 participants were analyzed in this meta-analysis. Six ETPs were significantly effective in enhancing UE motor recovery, with the standard mean differences (SMDs) and 95% confidence intervals outlined as follow: constraint-induced movement therapy (0.82, 0.45-1.19), electrostimulation (ES)-motor (0.42, 0.22-0.63), mirror therapy (0.71, 0.22-1.20), mixed approach (0.21, 0.01-0.41), robot-assisted training (0.51, 0.22-0.80), and task-oriented training (0.57, 0.16-0.99). Six ETPs were significantly effective in enhancing LE motor recovery: body-weight-supported treadmill training (0.27, 0.01-0.52), caregiver-mediated training (0.64, 0.20-1.08), ES-motor (0.55, 0.27-0.83), mixed approach (0.35, 0.15-0.54), mirror therapy (0.56, 0.13-1.00), and virtual reality (0.60, 0.15-1.05). However, compared with CTPs, almost none of the ETPs exhibited significant SMDs for superiority. CONCLUSIONS Certain experimented interventions were effective in enhancing poststroke motor recovery, but little evidence supported the superiority of experimented interventions over conventional rehabilitation.
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Affiliation(s)
- I-Hsien Lin
- Department of Physical Medicine and Rehabilitation, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Han-Ting Tsai
- Department of Physical Medicine and Rehabilitation, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chien-Yung Wang
- Department of Physical Medicine and Rehabilitation, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chih-Yang Hsu
- Department of Physical Medicine and Rehabilitation, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Yen-Nung Lin
- Department of Physical Medicine and Rehabilitation, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan; Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan.
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Wu Q, Wang X, Chen B, Wu H. Patient-Active Control of a Powered Exoskeleton Targeting Upper Limb Rehabilitation Training. Front Neurol 2018; 9:817. [PMID: 30364274 PMCID: PMC6193099 DOI: 10.3389/fneur.2018.00817] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 09/10/2018] [Indexed: 12/22/2022] Open
Abstract
Robot-assisted therapy affords effective advantages to the rehabilitation training of patients with motion impairment problems. To meet the challenge of integrating the active participation of a patient in robotic training, this study presents an admittance-based patient-active control scheme for real-time intention-driven control of a powered upper limb exoskeleton. A comprehensive overview is proposed to introduce the major mechanical structure and the real-time control system of the developed therapeutic robot, which provides seven actuated degrees of freedom and achieves the natural ranges of human arm movement. Moreover, the dynamic characteristics of the human-exoskeleton system are studied via a Lagrangian method. The patient-active control strategy consisting of an admittance module and a virtual environment module is developed to regulate the robot configurations and interaction forces during rehabilitation training. An audiovisual game-like interface is integrated into the therapeutic system to encourage the voluntary efforts of the patient and recover the neural plasticity of the brain. Further experimental investigation, involving a position tracking experiment, a free arm training experiment, and a virtual airplane-game operation experiment, is conducted with three healthy subjects and eight hemiplegic patients with different motor abilities. Experimental results validate the feasibility of the proposed scheme in providing patient-active rehabilitation training.
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Affiliation(s)
- Qingcong Wu
- College of Mechanical and Electrical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Xingsong Wang
- College of Mechanical Engineering, Southeast University, Nanjing, China
| | - Bai Chen
- College of Mechanical and Electrical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Hongtao Wu
- College of Mechanical and Electrical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
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de Sousa DG, Harvey LA, Dorsch S, Glinsky JV. Interventions involving repetitive practice improve strength after stroke: a systematic review. J Physiother 2018; 64:210-221. [PMID: 30245180 DOI: 10.1016/j.jphys.2018.08.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 07/31/2018] [Accepted: 08/09/2018] [Indexed: 12/29/2022] Open
Abstract
QUESTIONS Do interventions involving repetitive practice improve strength after stroke? Are any improvements in strength accompanied by improvements in activity? DESIGN Systematic review of randomised trials with meta-analysis. PARTICIPANTS Adults who have had a stroke. INTERVENTION Any intervention involving repetitive practice compared with no intervention or a sham intervention. OUTCOME MEASURES The primary outcome was voluntary strength in muscles trained as part of the intervention. The secondary outcomes were measures of lower limb and upper limb activity. RESULTS Fifty-two studies were included. The overall SMD of repetitive practice on strength was examined by pooling post-intervention scores from 46 studies involving 1928 participants. The SMD of repetitive practice on strength when the upper and lower limb studies were combined was 0.25 (95% CI 0.16 to 0.34, I2=44%) in favour of repetitive practice. Twenty-four studies with a total of 912 participants investigated the effects of repetitive practice on upper limb activity after stroke. The SMD was 0.15 (95% CI 0.02 to 0.29, I2=50%) in favour of repetitive practice on upper limb activity. Twenty studies with a total of 952 participants investigated the effects of repetitive practice on lower limb activity after stroke. The SMD was 0.25 (95% CI 0.12 to 0.38, I2=36%) in favour of repetitive practice on lower limb activity. CONCLUSION Interventions involving repetitive practice improve strength after stroke, and these improvements are accompanied by improvements in activity. REVIEW REGISTRATION PROSPERO CRD42017068658. [de Sousa DG, Harvey LA, Dorsch S, Glinsky JV (2018) Interventions involving repetitive practice improve strength after stroke: a systematic review. Journal of Physiotherapy 64: 210-221].
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Affiliation(s)
- Davide G de Sousa
- Graythwaite Rehabilitation Centre, Ryde Hospital; John Walsh Centre for Rehabilitation Research, Kolling Institute; Sydney Medical School Northern, University of Sydney
| | - Lisa A Harvey
- John Walsh Centre for Rehabilitation Research, Kolling Institute; Sydney Medical School Northern, University of Sydney
| | - Simone Dorsch
- Faculty of Health Sciences, Australian Catholic University, Sydney, Australia
| | - Joanne V Glinsky
- John Walsh Centre for Rehabilitation Research, Kolling Institute; Sydney Medical School Northern, University of Sydney
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Khallaf ME. Effect of Gravity and Task Specific Training of Elbow Extensors on Upper Extremity Function after Stroke. Neurol Res Int 2018; 2018:4172454. [PMID: 30112205 PMCID: PMC6077607 DOI: 10.1155/2018/4172454] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 05/10/2018] [Accepted: 06/05/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND In individuals with hemiparetic stroke, reaching with the paretic arm can be impaired by abnormal muscle coactivation. Prior trails for improving upper extremity functions after stroke have underestimated the role of gravitational force in motor planning and execution. OBJECTIVE The aims this trial were to study the effect of gravity as a facilitator for elbow extension and to estimate the immediate and retention effects of task specific training of elbow extensors on upper extremity function after stroke. METHODS Twenty-six right handed patients with first ever stroke represented the sample of the study. The participants were randomly assigned into two equal groups. The study group received treatment through two phases. Phase one included training for the elbow extensors in an antigravity position. Phase two included a set of task specific exercise for 16 weeks. The control group received traditional passive stretch and range of motion exercises. Manual dexterity and upper limb function were assessed by Nine-Hole Peg Test and Fugl-Meyer upper extremity. Goniometry was used for measuring elbow extension and forearm supination active ranges of motion. RESULTS Significant improvements were observed in Nine-Hole Peg Test, Fugl-Meyer upper extremity, and ranges of motion at postintervention and follow-up compared to preintervention at P≤0.05. CONCLUSIONS The results of this study provide an evidence that antigravity positions can be used as a centrally presented facilitator of elbow extension. Additionally, task specific training was effective in improving upper extremity function and elbow extension range of motion.
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Affiliation(s)
- Mohamed E. Khallaf
- Department of Physical Therapy for Neuromuscular Disorders and Its Surgery, Faculty of Physical Therapy, Cairo University, Egypt
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Adebisi HI, Monikhe AS, Okey AE. Alterations in gait velocity and grip strength of stroke survivors following a 12-week structured therapeutic exercise programme. BIOMEDICAL HUMAN KINETICS 2018. [DOI: 10.1515/bhk-2018-0012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Summary
Study aim: This study investigated the alterations in gait velocity and grip strength of stroke survivors following a structured therapeutic exercise programme (STEP). Material and methods: This was a pre-test, post-test experimental study of the effectiveness of a 12-week STEP on gait velocity and grip strength of stroke survivors. A total of 30 hemiparetic stroke survivors participated in the study. The instrument for this study was an adaptation of a training protocol for the training and assessment of gait velocity and grip strength. The participants underwent a 12-week STEP of a frequency of 3 times per week and the training programme focused on exercises aimed at improving the gait velocity and grip strength of the participants. The gait velocity and grip strength were measured before and after the training. Data generated were analysed using descriptive statistics of mean and standard deviation to summarize the profile of the participants. The analysis of variance for repeated measures (ANOVA) was used to test the hypotheses. Statistical significance was accepted for a p value of <0.05. Results: The outcome of this study showed that the STEP had significant (p < 0.05) effects on the gait velocity and grip strength of stroke survivors. Meanwhile, there was no significant (p > 0.05) effect of haemorrhagic and ischaemic groups of stroke survivors on gait velocity and grip strength.
Conclusion: It was therefore concluded that the use of the STEP can substantially improve the gait velocity and grip strength of stroke survivors.
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Affiliation(s)
- Hammed I. Adebisi
- Department of Physiotherapy, University of Benin Teaching Hospital, Benin City , Nigeria
| | - Adodo S. Monikhe
- Department of Human Kinetics and Sports Science, University of Benin, Benin City , Nigeria
| | - Agwubike E. Okey
- Department of Human Kinetics and Sports Science, University of Benin, Benin City , Nigeria
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Sarkies MN, White J, Morris ME, Taylor NF, Williams C, O’Brien L, Martin J, Bardoel A, Holland AE, Carey L, Skinner EH, Bowles KA, Grant K, Philip K, Haines TP. Implementation of evidence-based weekend service recommendations for allied health managers: a cluster randomised controlled trial protocol. Implement Sci 2018; 13:60. [PMID: 29690882 PMCID: PMC5916715 DOI: 10.1186/s13012-018-0752-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 04/18/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND It is widely acknowledged that health policy and practice do not always reflect current research evidence. Whether knowledge transfer from research to practice is more successful when specific implementation approaches are used remains unclear. A model to assist engagement of allied health managers and clinicians with research implementation could involve disseminating evidence-based policy recommendations, along with the use of knowledge brokers. We developed such a model to aid decision-making for the provision of weekend allied health services. This protocol outlines the design and methods for a multi-centre cluster randomised controlled trial to evaluate the success of research implementation strategies to promote evidence-informed weekend allied health resource allocation decisions, especially in hospital managers. METHODS This multi-centre study will be a three-group parallel cluster randomised controlled trial. Allied health managers from Australian and New Zealand hospitals will be randomised to receive either (1) an evidence-based policy recommendation document to guide weekend allied health resource allocation decisions, (2) the same policy recommendation document with support from a knowledge broker to help implement weekend allied health policy recommendations, or (3) a usual practice control group. The primary outcome will be alignment of weekend allied health service provision with policy recommendations. This will be measured by the number of allied health service events (occasions of service) occurring on weekends as a proportion of total allied health service events for the relevant hospital wards at baseline and 12-month follow-up. DISCUSSION Evidence-based policy recommendation documents communicate key research findings in an accessible format. This comparatively low-cost research implementation strategy could be combined with using a knowledge broker to work collaboratively with decision-makers to promote knowledge transfer. The results will assist managers to make decisions on resource allocation, based on evidence. More generally, the findings will inform the development of an allied health model for translating research into practice. TRIAL REGISTRATION This trial is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) ( ACTRN12618000029291 ). Universal Trial Number (UTN): U1111-1205-2621.
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Affiliation(s)
- Mitchell N. Sarkies
- Monash University and Monash Health Allied Health Research Unit, Kingston Centre, 400 Warrigal Road, Heatherton, Victoria 3192 Australia
| | - Jennifer White
- Monash University and Monash Health Allied Health Research Unit, Kingston Centre, 400 Warrigal Road, Heatherton, Victoria 3202 Australia
| | - Meg E. Morris
- La Trobe Centre for Sport and Exercise Medicine Research, La Trobe University, Bundoora, 3086 Australia
- North Eastern Rehabilitation Centre, Healthscope Australia, Melbourne, Australia
| | - Nicholas F. Taylor
- La Trobe Centre for Sport and Exercise Medicine Research, La Trobe University, Bundoora, 3086 Australia
- Allied Health Clinical Research Office, Eastern Health, Box Hill, 3128 Australia
| | - Cylie Williams
- Peninsula Health, 4 Hastings Rd, Frankston, Victoria 3199 Australia
| | - Lisa O’Brien
- Department of Occupational Therapy, Monash University, Building G, McMahons Road, Frankston, Victoria 3199 Australia
| | - Jenny Martin
- School of Arts, Social Sciences and Humanities, Swinburne University, Hawthorn Campus, John St, Hawthorn, Victoria 3122 Australia
| | - Anne Bardoel
- Department of Management and Marketing, Swinburne University, BA 1224 Hawthorn Campus, John St, Hawthorn, Victoria 3122 Australia
| | - Anne E. Holland
- Alfred Health and La Trobe University, 99 Commercial Rd, Melbourne, 3004 Australia
| | - Leeanne Carey
- Occupational Therapy, School of Allied Health, La Trobe University, Bundoora, Victoria 3086 Australia
- Florey Institute of Neuroscience and Mental Health, Neurorehabilitation and Recovery, Melbourne Brain Centre, 245 Burgundy Street, Heidelberg, Victoria 3084 Australia
| | - Elizabeth H. Skinner
- Monash University and Monash Health Allied Health Research Unit, Kingston Centre, 400 Warrigal Road, Heatherton, Victoria 3202 Australia
| | - Kelly-Ann Bowles
- Monash University and Monash Health Allied Health Research Unit, Kingston Centre, 400 Warrigal Road, Heatherton, Victoria 3192 Australia
| | - Kellie Grant
- Monash University and Monash Health Allied Health Research Unit, Kingston Centre, 400 Warrigal Road, Heatherton, Victoria 3192 Australia
| | - Kathleen Philip
- Department of Health and Human Services, Melbourne, Victoria Australia
| | - Terry P. Haines
- Monash University, Level 3, Building G, Peninsula Campus, McMahons Rd, Frankston, Victoria 3199 Australia
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Dorsch S, Ada L, Alloggia D. Progressive resistance training increases strength after stroke but this may not carry over to activity: a systematic review. J Physiother 2018; 64:84-90. [PMID: 29602748 DOI: 10.1016/j.jphys.2018.02.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 12/18/2017] [Accepted: 02/07/2018] [Indexed: 10/17/2022] Open
Abstract
QUESTION Does progressive resistance training improve strength and activity after stroke? Does any increase in strength carry over to activity? DESIGN Systematic review of randomised trials with meta-analysis. PARTICIPANTS Adults who have had a stroke. INTERVENTION Progressive resistance training compared with no intervention or placebo. OUTCOME MEASURES The primary outcome was change in strength. This measurement had to be of maximum voluntary force production and performed in muscles congruent with the muscles trained in the intervention. The secondary outcome was change in activity. This measurement had to be a direct measure of performance that produced continuous or ordinal data, or with scales that produced ordinal data. RESULTS Eleven studies involving 370 participants were included in this systematic review. The overall effect of progressive resistance training on strength was examined by pooling change scores from six studies with a mean PEDro score of 5.8, representing medium quality. The effect size of progressive resistance training on strength was 0.98 (95% CI 0.67 to 1.29, I2=0%). The overall effect of progressive resistance training on activity was examined by pooling change scores from the same six studies. The effect size of progressive resistance training on activity was 0.42 (95% CI -0.08 to 0.91, I2=54%). CONCLUSION After stroke, progressive resistance training has a large effect on strength compared with no intervention or placebo. There is uncertainty about whether these large increases in strength carry over to improvements in activity. REVIEW REGISTRATION PROSPERO CRD42015025401. [Dorsch S, Ada L, Alloggia D (2018) Progressive resistance training increases strength after stroke but this may not carry over to activity: a systematic review. Journal of Physiotherapy 64: 84-90].
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Affiliation(s)
- Simone Dorsch
- Faculty of Health Sciences, Australian Catholic University; Physiotherapy Department, Bankstown-Lidcombe Hospital
| | - Louise Ada
- Faculty of Health Sciences, The University of Sydney, Sydney, Australia
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Hunter SM, Johansen-Berg H, Ward N, Kennedy NC, Chandler E, Weir CJ, Rothwell J, Wing AM, Grey MJ, Barton G, Leavey NM, Havis C, Lemon RN, Burridge J, Dymond A, Pomeroy VM. Functional Strength Training and Movement Performance Therapy for Upper Limb Recovery Early Poststroke-Efficacy, Neural Correlates, Predictive Markers, and Cost-Effectiveness: FAST-INdiCATE Trial. Front Neurol 2018; 8:733. [PMID: 29472884 PMCID: PMC5810279 DOI: 10.3389/fneur.2017.00733] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 12/19/2017] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Variation in physiological deficits underlying upper limb paresis after stroke could influence how people recover and to which physical therapy they best respond. OBJECTIVES To determine whether functional strength training (FST) improves upper limb recovery more than movement performance therapy (MPT). To identify: (a) neural correlates of response and (b) whether pre-intervention neural characteristics predict response. DESIGN Explanatory investigations within a randomised, controlled, observer-blind, and multicentre trial. Randomisation was computer-generated and concealed by an independent facility until baseline measures were completed. Primary time point was outcome, after the 6-week intervention phase. Follow-up was at 6 months after stroke. PARTICIPANTS With some voluntary muscle contraction in the paretic upper limb, not full dexterity, when recruited up to 60 days after an anterior cerebral circulation territory stroke. INTERVENTIONS Conventional physical therapy (CPT) plus either MPT or FST for up to 90 min-a-day, 5 days-a-week for 6 weeks. FST was "hands-off" progressive resistive exercise cemented into functional task training. MPT was "hands-on" sensory/facilitation techniques for smooth and accurate movement. OUTCOMES The primary efficacy measure was the Action Research Arm Test (ARAT). Neural measures: fractional anisotropy (FA) corpus callosum midline; asymmetry of corticospinal tracts FA; and resting motor threshold (RMT) of motor-evoked potentials. ANALYSIS Covariance models tested ARAT change from baseline. At outcome: correlation coefficients assessed relationship between change in ARAT and neural measures; an interaction term assessed whether baseline neural characteristics predicted response. RESULTS 288 Participants had: mean age of 72.2 (SD 12.5) years and mean ARAT 25.5 (18.2). For 240 participants with ARAT at baseline and outcome the mean change was 9.70 (11.72) for FST + CPT and 7.90 (9.18) for MPT + CPT, which did not differ statistically (p = 0.298). Correlations between ARAT change scores and baseline neural values were between 0.199, p = 0.320 for MPT + CPT RMT (n = 27) and -0.147, p = 0.385 for asymmetry of corticospinal tracts FA (n = 37). Interaction effects between neural values and ARAT change between baseline and outcome were not statistically significant. CONCLUSIONS There was no significant difference in upper limb improvement between FST and MPT. Baseline neural measures did not correlate with upper limb recovery or predict therapy response. TRIAL REGISTRATION Current Controlled Trials: ISRCT 19090862, http://www.controlled-trials.com.
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Affiliation(s)
- Susan M. Hunter
- School of Health and Rehabilitation, Institute for Applied Clinical Sciences, Keele University, Keele, United Kingdom
| | - Heidi Johansen-Berg
- Wellcome Centre for Integrative Neuroimaging, Functional MRI of the Brain (FMRIB), University of Oxford, Nuffield Department of Clinical neurosciences, John Radcliffe Hospital, Oxford, United Kingdom
| | - Nick Ward
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, United Kingdom
| | - Niamh C. Kennedy
- School of Psychology, Ulster University, Coleraine, United Kingdom
| | - Elizabeth Chandler
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
| | - Christopher John Weir
- Edinburgh Clinical Trials Unit, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - John Rothwell
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, United Kingdom
| | - Alan M. Wing
- School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Michael J. Grey
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
| | - Garry Barton
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
| | - Nick Malachy Leavey
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
| | - Claire Havis
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
| | - Roger N. Lemon
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, United Kingdom
| | - Jane Burridge
- Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Amy Dymond
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
| | - Valerie M. Pomeroy
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
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Lin SH, Dionne TP. Interventions to Improve Movement and Functional Outcomes in Adult Stroke Rehabilitation: Review and Evidence Summary. J Particip Med 2018; 10:e3. [PMID: 33052128 PMCID: PMC7434068 DOI: 10.2196/jopm.8929] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 07/02/2017] [Indexed: 12/30/2022] Open
Abstract
Background Patients who have had a stroke may not be familiar with the terminology nor have the resources to efficiently search for evidence-based rehabilitation therapies to restore movement and functional outcomes. Recognizing that a thorough systematic review on this topic is beyond the scope of this article, we conducted a rapid review evidence summary to determine the level of evidence for common rehabilitation interventions to improve movement/motor and functional outcomes in adults who have had a stroke. Objective The objective of this study was to find evidence for common rehabilitation interventions to improve movement/motor and functional outcomes in adults who have had a stroke. Methods Medline Complete, PubMed, CINAHL Complete, Cochrane Database, Rehabilitation and Sports Medicine Source, Dissertation Abstracts International, and National Guideline Clearinghouse, from 1996 to April of 2016, were searched. From 348 articles, 173 met the following inclusion criteria: (1) published systematic reviews or meta-analyses, (2) outcomes target functional movement or motor skills of the upper and lower limbs, (3) non-pharmacological interventions that are commonly delivered to post-stroke population (acute and chronic), (4) human studies, and (5) English. Evidence tables were created to analyze the findings of systematic reviews and meta-analyses by category of interventions and outcomes. Results This rapid review found that the following interventions possess credible evidence to improve functional movement of persons with stroke: cardiorespiratory training, therapeutic exercise (ie, strengthening), task-oriented training (task-specific training), constraint-induced movement therapy (CIMT), mental practice, and mirror therapy. Neuromuscular electrical stimulation (NMES) (ie, functional electrical stimulation) shows promise as an intervention for stroke survivors. Conclusions Most commonly delivered therapeutic interventions to improve motor recovery after a stroke possess moderate quality evidence and are effective. Future research recommendations, such as optimal timing and dosage, would help rehabilitation professionals tailor interventions to achieve the best outcomes for stroke survivors.
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Affiliation(s)
- Susan Hamady Lin
- Institute of Health Professions, Department of Occupational Therapy, Massachusetts General Hospital Institute of Health Professions, Boston, MA, United States
| | - Timothy P Dionne
- Department of Rehabilitation Sciences, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, NY, United States
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Gambassi BB, Coelho-Junior HJ, Schwingel PA, Almeida FDJF, Gaspar Novais TM, Lauande Oliveira PDL, Sauaia BA, Melo CD, Uchida MC, Rodrigues B. Resistance Training and Stroke: A Critical Analysis of Different Training Programs. Stroke Res Treat 2017; 2017:4830265. [PMID: 29423327 PMCID: PMC5750509 DOI: 10.1155/2017/4830265] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 11/29/2017] [Indexed: 01/01/2023] Open
Abstract
The aim of this study was to carry out a literature review on the overall benefits of resistance training (RT) after stroke and undertake a critical analysis of the resistance exercise programs surveyed (rest interval between sets and exercises, number of sets, number of repetitions, intensity, duration of training, and weekly frequency). To obtain articles for the review, we searched PubMed, Google Scholar, and Physiotherapy Evidence Database (PEDro). Inclusion criteria were considered using the PICO (population, intervention, control/comparison, and outcome variables) model. The following characteristics were recorded for all articles: type of study, author, year of publication, participants (time after stroke, sample size, and age), benefits of RT, and structured resistance exercise programs. Positive effects of training were found on anxiety status, quality of life, muscle hypertrophy, cognitive function, strength, and muscle power. Only 5 studies described the main variables of RT in detail. Lack of control of some variables of RT may negatively affect the results of this practice. The findings of the present study may further inform health and physical conditioning professionals on the importance and necessity of using the main variables in the search for benefits for individuals with stroke.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Bruno Rodrigues
- Faculty of Physical Education, University of Campinas, Campinas, SP, Brazil
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61
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Nam C, Rong W, Li W, Xie Y, Hu X, Zheng Y. The Effects of Upper-Limb Training Assisted with an Electromyography-Driven Neuromuscular Electrical Stimulation Robotic Hand on Chronic Stroke. Front Neurol 2017; 8:679. [PMID: 29312116 PMCID: PMC5735084 DOI: 10.3389/fneur.2017.00679] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 11/29/2017] [Indexed: 01/03/2023] Open
Abstract
Background Impaired hand dexterity is a major disability of the upper limb after stroke. An electromyography (EMG)-driven neuromuscular electrical stimulation (NMES) robotic hand was designed previously, whereas its rehabilitation effects were not investigated. Objectives This study aims to investigate the rehabilitation effectiveness of the EMG-driven NMES-robotic hand-assisted upper-limb training on persons with chronic stroke. Method A clinical trial with single-group design was conducted on chronic stroke participants (n = 15) who received 20 sessions of EMG-driven NMES-robotic hand-assisted upper-limb training. The training effects were evaluated by pretraining, posttraining, and 3-month follow-up assessments with the clinical scores of the Fugl-Meyer Assessment (FMA), the Action Research Arm Test (ARAT), the Wolf Motor Function Test, the Motor Functional Independence Measure, and the Modified Ashworth Scale (MAS). Improvements in the muscle coordination across the sessions were investigated by EMG parameters, including EMG activation level and Co-contraction Indexes (CIs) of the target muscles in the upper limb. Results Significant improvements in the FMA shoulder/elbow and wrist/hand scores (P < 0.05), the ARAT (P < 0.05), and in the MAS (P < 0.05) were observed after the training and sustained 3 months later. The EMG parameters indicated a significant decrease of the muscle activation level in flexor digitorum (FD) and biceps brachii (P < 0.05), as well as a significant reduction of CIs in the muscle pairs of FD and triceps brachii and biceps brachii and triceps brachii (P < 0.05). Conclusion The upper-limb training integrated with the assistance from the EMG-driven NMES-robotic hand is effective for the improvements of the voluntary motor functions and the muscle coordination in the proximal and distal joints. Furthermore, the motor improvement after the training could be maintained till 3 months later. Trial registration ClinicalTrials.gov. NCT02117089; date of registration: April 10, 2014.
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Affiliation(s)
- Chingyi Nam
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong
| | - Wei Rong
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong
| | - Waiming Li
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong
| | - Yunong Xie
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong
| | - Xiaoling Hu
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong
| | - Yongping Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong
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Qian Q, Hu X, Lai Q, Ng SC, Zheng Y, Poon W. Early Stroke Rehabilitation of the Upper Limb Assisted with an Electromyography-Driven Neuromuscular Electrical Stimulation-Robotic Arm. Front Neurol 2017; 8:447. [PMID: 28928706 PMCID: PMC5591334 DOI: 10.3389/fneur.2017.00447] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 08/14/2017] [Indexed: 11/13/2022] Open
Abstract
Background Effective poststroke motor rehabilitation depends on repeated limb practice with voluntary efforts. An electromyography (EMG)-driven neuromuscular electrical stimulation (NMES)-robot arm was designed for the multi-joint physical training on the elbow, the wrist, and the fingers. Objectives To investigate the training effects of the device-assisted approach on subacute stroke patients and to compare the effects with those achieved by the traditional physical treatments. Method This study was a pilot randomized controlled trial with a 3-month follow-up. Subacute stroke participants were randomly assigned into two groups, and then received 20-session upper limb training with the EMG-driven NMES-robotic arm (NMES-robot group, n = 14) or the time-matched traditional therapy (the control, n = 10). For the evaluation of the training effects, clinical assessments including Fugl-Meyer Assessment (FMA), Modified Ashworth Score (MAS), Action Research Arm Test (ARAT), and Function Independence Measurement (FIM) were conducted before, after the rehabilitation training, and 3 months later. Session-by-session EMG parameters in the NMES-robot group, including normalized co-contraction Indexes (CI) and EMG activation level of target muscles, were used to monitor the progress in muscular coordination patterns. Results Significant improvements were obtained in FMA (full score and shoulder/elbow), ARAT, and FIM [P < 0.001, effect sizes (EFs) > 0.279] for both groups. Significant improvement in FMA wrist/hand was only observed in the NMES-robot group (P < 0.001, EFs = 0.435) after the treatments. Significant reduction in MAS wrist was observed in the NMES-robot group after the training (P < 0.05, EFs = 0.145) and the effects were maintained for 3 months. MAS scores in the control group were elevated following training (P < 0.05, EFs > 0.24), and remained at an elevated level when assessed 3 months later. The EMG parameters indicated a release of muscle co-contraction in the muscle pairs of biceps brachii and flexor carpi radialis and biceps brachii and triceps brachii, as well as a reduction of muscle activation level in the wrist flexor in the NMES-robot group. Conclusion The NMES-robot-assisted training was effective for early stroke upper limb rehabilitation and promoted independence in the daily living comparable to the traditional physical therapy. It could achieve higher motor outcomes at the distal joints and more effective release in muscle tones than the traditional therapy. Clinical Trial Registration ClinicalTrials.gov, identifier NCT02117089; date of registration: April 10, 2014.
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Affiliation(s)
- Qiuyang Qian
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | - Xiaoling Hu
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | - Qian Lai
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | - Stephanie C Ng
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Yongping Zheng
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | - Waisang Poon
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
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Pasanen T, Tolvanen S, Heinonen A, Kujala UM. Exercise therapy for functional capacity in chronic diseases: an overview of meta-analyses of randomised controlled trials. Br J Sports Med 2017; 51:1459-1465. [PMID: 28500079 DOI: 10.1136/bjsports-2016-097132] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To summarise all meta-analyses of randomised controlled trials that have evaluated the effects of exercise therapy on functional capacity in patients with chronic diseases. DESIGN Umbrella review of meta-analyses of randomised controlled trials. DATA SOURCES We systematically searched the CENTRAL, CINAHL, DARE, Medline, OTSeeker, PEDro, SPORTDiscus, ProQuest Nursing & Allied Health Database, Web of Science, Scopus, OpenGrey and BMC Proceedings from database inception to 1 September 2016. ELIGIBILITY CRITERIA FOR SELECTING STUDIES We included meta-analyses that compared the effects of exercise therapy with no treatment or usual care in adults with non-communicable chronic diseases and included outcomes related to functional capacity. We excluded meta-analyses with less than 100 patients. RESULTS Eighty-five meta-analyses with 22 different chronic diseases were included. The exercise interventions resulted in statistically significant (p<0.05) improvements for 126 of 146 (86%) functional capacity outcomes, compared with the control group. The standardised mean differences were small in 64 (44%), moderate in 54 (37%) and large in 28 (19%) of the 146 functional capacity outcomes. The results were similar for aerobic exercise, resistance training, and aerobic and resistance training combined. There were no significant differences in serious adverse effects between the intervention and control groups in any of the meta-analyses. CONCLUSION Exercise therapy appears to be a safe way to improve functional capacity and reduce disability in individuals with chronic disease.
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Affiliation(s)
- Tero Pasanen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Samppa Tolvanen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Ari Heinonen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Urho M Kujala
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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Bilateral synergy as an index of force coordination in chronic stroke. Exp Brain Res 2017; 235:1501-1509. [DOI: 10.1007/s00221-017-4904-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 02/02/2017] [Indexed: 11/26/2022]
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Monaghan K, Horgan F, Blake C, Cornall C, Hickey PPM, Lyons BE, Langhorne P. Physical treatment interventions for managing spasticity after stroke. Cochrane Database Syst Rev 2017; 2017:CD009188. [PMCID: PMC6472515 DOI: 10.1002/14651858.cd009188.pub2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:
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Affiliation(s)
- Kenneth Monaghan
- St Angela's CollegeSchool of Nursing and Health StudiesLough GillSligoIreland
| | - Frances Horgan
- Royal College of Surgeons in IrelandSchool of Physiotherapy123 St Stephens GreenDublin 2Ireland
| | - Catherine Blake
- University College DublinSchool of Physiotherapy & Performance ScienceUCD Health Sciences CentreBelfieldDublin 4Ireland
| | - Catherine Cornall
- National Rehabilitation HospitalPhysiotherapy DepartmentRochestown AvenueDun LaoghaireIreland
| | - Paula PM Hickey
- Sligo General HospitalDepartment of MedicineThe MallSligoIreland
| | | | - Peter Langhorne
- University of GlasgowAcademic Section of Geriatric MedicineLevel 2, New Lister BuildingGlasgow Royal InfirmaryGlasgowUKG31 2ER
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Ivey FM, Prior SJ, Hafer-Macko CE, Katzel LI, Macko RF, Ryan AS. Strength Training for Skeletal Muscle Endurance after Stroke. J Stroke Cerebrovasc Dis 2016; 26:787-794. [PMID: 27865696 DOI: 10.1016/j.jstrokecerebrovasdis.2016.10.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 10/05/2016] [Accepted: 10/19/2016] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND AND PURPOSE Initial studies support the use of strength training (ST) as a safe and effective intervention after stroke. Our previous work shows that relatively aggressive, higher intensity ST translates into large effect sizes for paretic and non-paretic leg muscle volume, myostatin expression, and maximum strength post-stroke. An unanswered question pertains to how our unique ST model for stroke impacts skeletal muscle endurance (SME). Thus, we now report on ST-induced adaptation in the ability to sustain isotonic muscle contraction. METHODS Following screening and baseline testing, hemiparetic stroke participants were randomized to either ST or an attention-matched stretch control group (SC). Those in the ST group trained each leg individually to muscle failure (20 repetition sets, 3× per week for 3 months) on each of three pneumatic resistance machines (leg press, leg extension, and leg curl). Our primary outcome measure was SME, quantified as the number of submaximal weight leg press repetitions possible at a specified cadence. The secondary measures included one-repetition maximum strength, 6-minute walk distance (6MWD), 10-meter walk speeds, and peak aerobic capacity (VO2 peak). RESULTS ST participants (N = 14) had significantly greater SME gains compared with SC participants (N = 16) in both the paretic (178% versus 12%, P < .01) and non-paretic legs (161% versus 12%, P < .01). These gains were accompanied by group differences for 6MWD (P < .05) and VO2 peak (P < .05). CONCLUSION Our ST regimen had a large impact on the capacity to sustain submaximal muscle contraction, a metric that may carry more practical significance for stroke than the often reported measures of maximum strength.
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Affiliation(s)
- Frederick M Ivey
- Department of Veterans Affairs and Veterans Affairs Medical Center, Maryland Exercise and Robotics Center of Excellence (MERCE), Geriatric Research, Education and Clinical Center (GRECC), University of Maryland School of Medicine, Baltimore, Maryland; Department of Neurology.
| | - Steven J Prior
- Department of Veterans Affairs and Veterans Affairs Medical Center, Maryland Exercise and Robotics Center of Excellence (MERCE), Geriatric Research, Education and Clinical Center (GRECC), University of Maryland School of Medicine, Baltimore, Maryland; Department of Medicine, Division of Gerontology and Geriatric Medicine
| | - Charlene E Hafer-Macko
- Department of Veterans Affairs and Veterans Affairs Medical Center, Maryland Exercise and Robotics Center of Excellence (MERCE), Geriatric Research, Education and Clinical Center (GRECC), University of Maryland School of Medicine, Baltimore, Maryland; Department of Neurology
| | - Leslie I Katzel
- Department of Veterans Affairs and Veterans Affairs Medical Center, Maryland Exercise and Robotics Center of Excellence (MERCE), Geriatric Research, Education and Clinical Center (GRECC), University of Maryland School of Medicine, Baltimore, Maryland; Department of Medicine, Division of Gerontology and Geriatric Medicine
| | - Richard F Macko
- Department of Veterans Affairs and Veterans Affairs Medical Center, Maryland Exercise and Robotics Center of Excellence (MERCE), Geriatric Research, Education and Clinical Center (GRECC), University of Maryland School of Medicine, Baltimore, Maryland; Department of Neurology
| | - Alice S Ryan
- Department of Veterans Affairs and Veterans Affairs Medical Center, Maryland Exercise and Robotics Center of Excellence (MERCE), Geriatric Research, Education and Clinical Center (GRECC), University of Maryland School of Medicine, Baltimore, Maryland; Department of Medicine, Division of Gerontology and Geriatric Medicine
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67
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Sánchez-Sánchez ML, Ruescas-Nicolau MA, Pérez-Miralles JA, Marqués-Sulé E, Espí-López GV. Pilot randomized controlled trial to assess a physical therapy program on upper extremity function to counteract inactivity in chronic stroke. Top Stroke Rehabil 2016; 24:183-193. [DOI: 10.1080/10749357.2016.1245395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- M. Luz Sánchez-Sánchez
- Faculty of Physical Therapy, Department of Physical Therapy, University of Valencia, Valencia, Spain
| | | | - José-Antonio Pérez-Miralles
- Faculty of Physical Therapy, Department of Physical Therapy, University of Valencia, Valencia, Spain
- Nueva Opción – Brain Damage Association, Valencia, Spain
| | - Elena Marqués-Sulé
- Faculty of Physical Therapy, Department of Physical Therapy, University of Valencia, Valencia, Spain
| | - Gemma-Victoria Espí-López
- Faculty of Physical Therapy, Department of Physical Therapy, University of Valencia, Valencia, Spain
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68
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Graef P, Michaelsen SM, Dadalt MLR, Rodrigues DAMS, Pereira F, Pagnussat AS. Effects of functional and analytical strength training on upper-extremity activity after stroke: a randomized controlled trial. Braz J Phys Ther 2016; 20:543-552. [PMID: 27683837 PMCID: PMC5176200 DOI: 10.1590/bjpt-rbf.2014.0187] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 03/14/2016] [Indexed: 11/25/2022] Open
Abstract
Objective To investigate the effects of functional strengthening (using functional movements) and analytical strengthening (using repetitive movements) on level of activity and muscular strength gain in patients with chronic hemiparesis after stroke. Method A randomized, assessor-blinded trial was conducted in a therapist-supervised home rehabilitation program. Twenty-seven patients with chronic stroke were randomly allocated one of two groups: functional strengthening (FS) (n=13) and analytical strengthening (AS) (n=14). Each group received a five-week muscle strengthening protocol (30 minutes per day, three times per week) including functional movements or analytical movements, respectively. Pre-, post-, and ten-month follow-up outcomes included the Upper-Extremity Performance Test (primary outcome), Shoulder and Grip Strength, Active Shoulder Range of Motion (ROM), the Fugl-Meyer Assessment, and the Modified Ashworth Scale (MAS) (secondary outcomes). Results There was significant improvement in the Upper-Extremity Performance Test for the combined unilateral and bilateral task scores in the FS Group (mean difference 2.4; 95% CI=0.14 to 4.6) in the 10-month follow-up. No significant difference was observed between groups in the other outcomes (p>0.05). Conclusion A five-week home-based functional muscle strengthening induced positive results for the upper-extremity level of activity of patients with moderate impairment after chronic stroke.
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Affiliation(s)
- Patrícia Graef
- Programa de Pós-graduação em Ciências da Reabilitação, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil.,Escola da Saúde, Centro Universitário Ritter dos Reis (UNIRITTER), Porto Alegre, RS, Brazil.,Programa de Pós-graduação em Ciências da Saúde, UFCSPA, Porto Alegre, RS, Brazil
| | - Stella M Michaelsen
- Programa de Pós-graduação em Fisioterapia, Universidade do Estado de Santa Catarina (UDESC), Florianópolis, SC, Brazil
| | | | | | - Franciele Pereira
- Programa de Pós-graduação em Ciências da Reabilitação, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Aline S Pagnussat
- Programa de Pós-graduação em Ciências da Reabilitação, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil.,Programa de Pós-graduação em Ciências da Saúde, UFCSPA, Porto Alegre, RS, Brazil.,Departamento de Fisioterapia, UFCSPA, Porto Alegre, RS, Brazil
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69
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Dias CP, Freire B, Goulart NBA, Onzi ES, Becker J, Gomes I, Arampatzis A, Vaz MA. Muscle architecture and torque production in stroke survivors: an observational study. Top Stroke Rehabil 2016; 24:206-213. [PMID: 27449490 DOI: 10.1080/10749357.2016.1210873] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Spasticity poststroke leads to muscle weakness and soft tissue contracture, however, it is not clear how muscle properties change due this motor neural disorder. The purpose was to compare medial gastrocnemius muscle architecture and mechanical properties of the plantarflexor muscles between stroke survivors with spasticity and healthy subjects. METHODS The study included 15 stroke survivors with ankle spasticity and 15 healthy subjects. An isokinetic dynamometer was used for the evaluation of maximal isometric plantarflexor torque and images of the medial gastrocnemius muscle were obtained using ultrasonography. Images were collected at rest and during a maximum voluntary contraction. RESULTS The affected limb showed reduced fascicle excursion (0.9 ± 0.7 cm), shorter fascicle length, and reduced muscle thickness (0.095 ± 0.010% of leg length and 1.18 ± 0.20 cm, at rest) compared to contralateral (1.6 ± 0.4 cm, 0.106 ± 0.015% of leg length and 1.29 ± 0.24 cm, respectively) and to healthy participants (1.8 ± 0.7 cm, 0.121 ± 0.019% of leg length and 1.43 ± 0.22 cm, respectively). The contralateral limb showed lower force (between 32 and 40%) and similar architecture parameters compared to healthy participants. CONCLUSION The affected limb had a different muscle architecture that appears to result in lower force production. The contralateral limb showed a decrease in force compared to healthy participants due to the other neural impairments than muscle morphology. Spasticity likely leds to adaptations of muscle architecture in the affected limb and in force reductions in both limbs of stroke survivors.
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Affiliation(s)
- Caroline P Dias
- a Exercise Research Laboratory , School of Physical Education, Federal University of Rio Grande do Sul , Porto Alegre , Brazil.,b Physical Education Course, Faculty of Serra Gaúcha , Caxias do Sul , Brazil
| | - Bruno Freire
- a Exercise Research Laboratory , School of Physical Education, Federal University of Rio Grande do Sul , Porto Alegre , Brazil.,c Postgraduate Program of Medicine and Health Sciences , Pontifical Catholic University of Rio Grande do Sul , Porto Alegre , Brazil
| | - Natália B A Goulart
- a Exercise Research Laboratory , School of Physical Education, Federal University of Rio Grande do Sul , Porto Alegre , Brazil
| | - Eduardo S Onzi
- a Exercise Research Laboratory , School of Physical Education, Federal University of Rio Grande do Sul , Porto Alegre , Brazil
| | - Jefferson Becker
- d Neurology Service, São Lucas Hospital , Pontifical Catholic University of Rio Grande do Sul , Porto Alegre , Brazil
| | - Irenio Gomes
- c Postgraduate Program of Medicine and Health Sciences , Pontifical Catholic University of Rio Grande do Sul , Porto Alegre , Brazil.,e Biomedical Gerontology and Neurology Department , Pontifical Catholic University of Rio Grande do Sul , Porto Alegre , Brazil
| | - Adamantios Arampatzis
- f Department of Training and Movement Sciences , Centre of Sports Science and Sports Medicine, Humboldt-Univesität zu Berlin , Berlin , Germany
| | - Marco A Vaz
- a Exercise Research Laboratory , School of Physical Education, Federal University of Rio Grande do Sul , Porto Alegre , Brazil
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van Vliet P, Hunter SM, Donaldson C, Pomeroy V. Using the TIDieR Checklist to Standardize the Description of a Functional Strength Training Intervention for the Upper Limb After Stroke. J Neurol Phys Ther 2016; 40:203-8. [PMID: 27187925 PMCID: PMC4915727 DOI: 10.1097/npt.0000000000000133] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND PURPOSE Published reports of intervention in randomized controlled trials are often poorly described. The Template for Intervention Description and Replication (TIDieR) checklist has been recently developed to improve the reporting of interventions. The aim of this article is to describe a therapy intervention used in the stroke rehabilitation trial, "Clinical Efficacy of Functional Strength Training for Upper Limb Motor Recovery Early After Stroke: Neural Correlates and Prognostic Indicators" (FAST-INdICATE), using TIDieR. METHODS The functional strength training intervention used in the FAST-INdICATE trial was described using TIDieR so that intervention can be replicated by both clinicians, who may implement it in practice, and researchers, who may deliver it in future research. The usefulness of TIDieR in the context of a complex stroke rehabilitation intervention was then discussed. RESULTS AND DISCUSSION The TIDieR checklist provided a systematic way of describing a treatment intervention used in a clinical trial of stroke rehabilitation. Clarification is needed regarding several aspects of the TIDieR checklist, including in which section to report about the development of the intervention in pilot studies, results of feasibility studies; overlap between training and procedures for assessing fidelity; and where to publish supplementary material so that it remains in the public domain. CONCLUSIONS TIDieR is a systematic way of reporting the intervention delivered in a clinical trial of a complex intervention such as stroke rehabilitation. This approach may also have value for standardizing intervention in clinical practice.Video abstract available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A131).
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Affiliation(s)
- Paulette van Vliet
- School of Health Sciences (P.v.V.), Faculty of Health and Medicine, The University of Newcastle, Australia; School of Health and Rehabilitation (S.U.M.), and Institute for Science and Technology in Medicine, Keele University, Staffordshire, UK; St George's, University of London (C.D.), London, UK; and Acquired Brain Injury Rehabilitation Alliance (V.P.), School of Health Sciences, University of East Anglia, Norwich, Norfolk, UK
| | - Susan M. Hunter
- School of Health Sciences (P.v.V.), Faculty of Health and Medicine, The University of Newcastle, Australia; School of Health and Rehabilitation (S.U.M.), and Institute for Science and Technology in Medicine, Keele University, Staffordshire, UK; St George's, University of London (C.D.), London, UK; and Acquired Brain Injury Rehabilitation Alliance (V.P.), School of Health Sciences, University of East Anglia, Norwich, Norfolk, UK
| | - Catherine Donaldson
- School of Health Sciences (P.v.V.), Faculty of Health and Medicine, The University of Newcastle, Australia; School of Health and Rehabilitation (S.U.M.), and Institute for Science and Technology in Medicine, Keele University, Staffordshire, UK; St George's, University of London (C.D.), London, UK; and Acquired Brain Injury Rehabilitation Alliance (V.P.), School of Health Sciences, University of East Anglia, Norwich, Norfolk, UK
| | - Valerie Pomeroy
- School of Health Sciences (P.v.V.), Faculty of Health and Medicine, The University of Newcastle, Australia; School of Health and Rehabilitation (S.U.M.), and Institute for Science and Technology in Medicine, Keele University, Staffordshire, UK; St George's, University of London (C.D.), London, UK; and Acquired Brain Injury Rehabilitation Alliance (V.P.), School of Health Sciences, University of East Anglia, Norwich, Norfolk, UK
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71
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Carvalho-Pinto BPB, Faria CDCM. Health, function and disability in stroke patients in the community. Braz J Phys Ther 2016; 20:355-66. [PMID: 27556392 PMCID: PMC5015678 DOI: 10.1590/bjpt-rbf.2014.0171] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 12/01/2015] [Accepted: 02/10/2016] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Stroke patients commonly have impairments associated with reduction in functionality. Among these impairments, the motor impairments are the most prevalent. The functional profile of these patients living in the community who are users of the primary health-care services in Brazil has not yet been established. OBJECTIVE To describe the functional profile of stroke patients who are users of the primary health-care services in Brazil, looking at one health-care unit in the city of Belo Horizonte, Brazil. METHOD From medical records and home visits, data were collected regarding health status, assistance received following the stroke, personal and environmental contextual factors, function and disability, organized according to the conceptual framework of the International Classification of Functioning, Disability and Health (ICF). Test and instruments commonly applied in the assessment of stroke patients were used. RESULTS Demographic data from all stroke patients who were users of the health-care unit (n=44, age: 69.23±13.12 years and 67±66.52 months since the stroke) participated of this study. Most subjects presented with disabilities, as changes in emotional function, muscle strength, and mobility, risks of falling during functional activities, negative self-perception of quality of life, and perception of the environment factors were perceived as obstacles. The majority of the patients used the health-care unit to renew drug prescriptions, and did not receive any information on stroke from health professionals, even though patients believed it was important for patients to receive information and to provide clarifications. CONCLUSION Stroke patients who used primary health-care services in Brazil have chronic disabilities and health needs that require continuous health attention from rehabilitation professionals. All of these health needs should be considered by health professionals to provide better management as part of the integral care of stroke patients, as recommended by the clinical practice guidelines for stroke rehabilitation.
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Affiliation(s)
- Bárbara P. B. Carvalho-Pinto
- Escola de Educação Física, Fisioterapia e
Terapia OcupacionalUniversidade Federal de Minas
GeraisUniversidade Federal de Minas
GeraisBelo HorizonteMGBrazilDepartamento de Fisioterapia, Escola de
Educação Física, Fisioterapia e Terapia Ocupacional, Universidade Federal de
Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Christina D. C. M. Faria
- Escola de Educação Física, Fisioterapia e
Terapia OcupacionalUniversidade Federal de Minas
GeraisUniversidade Federal de Minas
GeraisBelo HorizonteMGBrazilDepartamento de Fisioterapia, Escola de
Educação Física, Fisioterapia e Terapia Ocupacional, Universidade Federal de
Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
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72
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Winstein CJ, Stein J, Arena R, Bates B, Cherney LR, Cramer SC, Deruyter F, Eng JJ, Fisher B, Harvey RL, Lang CE, MacKay-Lyons M, Ottenbacher KJ, Pugh S, Reeves MJ, Richards LG, Stiers W, Zorowitz RD. Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2016; 47:e98-e169. [PMID: 27145936 DOI: 10.1161/str.0000000000000098] [Citation(s) in RCA: 1538] [Impact Index Per Article: 192.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE The aim of this guideline is to provide a synopsis of best clinical practices in the rehabilitative care of adults recovering from stroke. METHODS Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council's Scientific Statement Oversight Committee and the AHA's Manuscript Oversight Committee. The panel reviewed relevant articles on adults using computerized searches of the medical literature through 2014. The evidence is organized within the context of the AHA framework and is classified according to the joint AHA/American College of Cardiology and supplementary AHA methods of classifying the level of certainty and the class and level of evidence. The document underwent extensive AHA internal and external peer review, Stroke Council Leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the AHA Science Advisory and Coordinating Committee. RESULTS Stroke rehabilitation requires a sustained and coordinated effort from a large team, including the patient and his or her goals, family and friends, other caregivers (eg, personal care attendants), physicians, nurses, physical and occupational therapists, speech-language pathologists, recreation therapists, psychologists, nutritionists, social workers, and others. Communication and coordination among these team members are paramount in maximizing the effectiveness and efficiency of rehabilitation and underlie this entire guideline. Without communication and coordination, isolated efforts to rehabilitate the stroke survivor are unlikely to achieve their full potential. CONCLUSIONS As systems of care evolve in response to healthcare reform efforts, postacute care and rehabilitation are often considered a costly area of care to be trimmed but without recognition of their clinical impact and ability to reduce the risk of downstream medical morbidity resulting from immobility, depression, loss of autonomy, and reduced functional independence. The provision of comprehensive rehabilitation programs with adequate resources, dose, and duration is an essential aspect of stroke care and should be a priority in these redesign efforts. (Stroke.2016;47:e98-e169. DOI: 10.1161/STR.0000000000000098.).
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Dorsch S, Ada L, Canning CG. Lower Limb Strength Is Significantly Impaired in All Muscle Groups in Ambulatory People With Chronic Stroke: A Cross-Sectional Study. Arch Phys Med Rehabil 2016; 97:522-527. [DOI: 10.1016/j.apmr.2015.10.106] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 07/31/2015] [Accepted: 10/28/2015] [Indexed: 11/26/2022]
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Salter K, Musovic A, F. Taylor N. In the first 3 months after stroke is progressive resistance training safe and does it improve activity? A systematic review. Top Stroke Rehabil 2016; 23:366-75. [DOI: 10.1080/10749357.2016.1160656] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Gray VL, Ivanova TD, Garland SJ. A single session of open kinetic chain movements emphasizing speed improves speed of movement and modifies postural control in stroke. Physiother Theory Pract 2016; 32:113-23. [DOI: 10.3109/09593985.2015.1110848] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Nilsen DM, Gillen G, Geller D, Hreha K, Osei E, Saleem GT. Effectiveness of interventions to improve occupational performance of people with motor impairments after stroke: an evidence-based review. Am J Occup Ther 2015; 69:6901180030p1-9. [PMID: 25553742 DOI: 10.5014/ajot.2015.011965] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We conducted a review to determine the effectiveness of interventions to improve occupational performance in people with motor impairments after stroke as part of the American Occupational Therapy Association's Evidence-Based Practice Project. One hundred forty-nine studies met inclusion criteria. Findings related to key outcomes from select interventions are presented. Results suggest that a variety of effective interventions are available to improve occupational performance after stroke. Evidence suggests that repetitive task practice, constraint-induced or modified constraint-induced movement therapy, strengthening and exercise, mental practice, virtual reality, mirror therapy, and action observation can improve upper-extremity function, balance and mobility, and/or activity and participation. Commonalities among several of the effective interventions include the use of goal-directed, individualized tasks that promote frequent repetitions of task-related or task-specific movements.
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Affiliation(s)
- Dawn M Nilsen
- Dawn M. Nilsen, EdD, OTL, is Assistant Professor of Rehabilitation and Regenerative Medicine (Occupational Therapy), Columbia University, New York, NY;
| | - Glen Gillen
- Glen Gillen, EdD, OTR/L, FAOTA, is Associate Professor of Rehabilitation and Regenerative Medicine (Occupational Therapy), Columbia University, New York, NY
| | - Daniel Geller
- Daniel Geller, MS, MPH, OTR/L, Kimberly Hreha, OTR/L, Ellen Osei, MS, OTR/L, and Ghazala T. Saleem, MS, OTR/L, are Doctoral Students, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Kimberly Hreha
- Daniel Geller, MS, MPH, OTR/L, Kimberly Hreha, OTR/L, Ellen Osei, MS, OTR/L, and Ghazala T. Saleem, MS, OTR/L, are Doctoral Students, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Ellen Osei
- Daniel Geller, MS, MPH, OTR/L, Kimberly Hreha, OTR/L, Ellen Osei, MS, OTR/L, and Ghazala T. Saleem, MS, OTR/L, are Doctoral Students, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Ghazala T Saleem
- Daniel Geller, MS, MPH, OTR/L, Kimberly Hreha, OTR/L, Ellen Osei, MS, OTR/L, and Ghazala T. Saleem, MS, OTR/L, are Doctoral Students, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
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Diermayr G, Schachner H, Eidenberger M, Lohkamp M, Salbach NM. Evidence-based practice in physical therapy in Austria: current state and factors associated with EBP engagement. J Eval Clin Pract 2015. [PMID: 26200235 DOI: 10.1111/jep.12415] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Research examining the use of evidence-based practice (EBP) in physical therapy in many countries has revealed positive attitudes, varying degrees of EBP use and barriers at practitioner, patient and organizational levels. In contrast to these countries, Austria does not have an academic or research tradition in physical therapy. Engagement in EBP in countries such as Austria is unknown. The objectives of the study were to describe the current state of EBP engagement and identify factors associated with EBP engagement among Austrian physical therapists (PTs). METHODS A cross-sectional online survey was conducted. Existing questionnaires and the theory of planned behaviour guided questionnaire development. Face and content validity and ease of use of the questionnaire were evaluated in pilot tests. Item-level response frequencies and percentages were determined. Simple and multiple regressions were used to identify factors associated with EBP engagement. RESULTS The final sample size was 588 (response rate: 17.5%). Ten percent of participants fully agreed that they regularly use guidelines and standardized assessment tools in clinical practice. While 49.9% reported not using electronic databases for literature searching, 41.9% reported reading research articles 2-5 times per month. Most frequently cited barriers to EBP engagement were lack of scientific skills, lack of time and insufficient organizational support. Research awareness, attitude, behavioural control, involvement in research and degree level were final correlates of EBP engagement. CONCLUSION Austrian PTs show a low level of engagement in EBP. Initiatives to advance EBP in Austria and other countries with no academic or research tradition should primarily target practitioner-level factors.
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Affiliation(s)
- Gudrun Diermayr
- Physical Therapy Program, Department of Therapeutic Sciences, SRH Hochschule Heidelberg, Heidelberg, Germany.,Universitätsklinik für Neurologie, Medizinische Universität Wien, Wien, Austria
| | - Herbert Schachner
- Physical Therapy Program, Fachhochschule für Gesundheitsberufe Oberösterreich, Linz, Austria
| | - Margit Eidenberger
- Physical Therapy Program, Fachhochschule für Gesundheitsberufe Oberösterreich, Linz, Austria
| | - Monika Lohkamp
- Physical Therapy Program, Department of Therapeutic Sciences, SRH Hochschule Heidelberg, Heidelberg, Germany
| | - Nancy M Salbach
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
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Martins JC, Aguiar LT, Lara EM, Teixeira-Salmela LF, Faria CDCM. Assessment of grip strength with the modified sphygmomanometer test: association between upper limb global strength and motor function. Braz J Phys Ther 2015; 19:498-506. [PMID: 26647752 PMCID: PMC4668344 DOI: 10.1590/bjpt-rbf.2014.0118] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 05/28/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Grip strength, commonly evaluated with the handgrip dynamometer, is a good indicator of upper limb (UL) function in stroke subjects and may reflect the global strength deficits of the whole paretic UL. The Modified Sphygmomanometer Test (MST) also provides objective and adequate measures at low-cost. OBJECTIVE To assess whether grip strength values obtained by using the MST and those obtained by using a handgrip dynamometer would present similar correlations with the global strength and motor function of the paretic UL in subjects with stroke, both in the subacute and chronic phases. METHOD Measures of grip strength (MST and handgrip dynamometer), UL global strength (MST and hand-held dynamometer), and UL motor function (Fugl-Meyer motor assessment scale) were obtained with 33 subacute and 44 chronic stroke subjects. Pearson and Spearman correlation coefficients were calculated and Stepwise multiple regression analyses were performed to investigate predictor variables of grip strength (α=0.05). RESULTS Significant correlations of similar magnitude were found between measures of global strength of the paretic UL and grip strength assessed with both the MST (0.66≤r≤0.78) and handgrip dynamometer (0.66≤r≤0.78) and between UL motor function and grip strength assessed with both the MST (0.50≤rs≤0.51) and hand-held dynamometer (0.50≤rs≤0.63) in subacute and chronic stroke subjects. Only global strength remained as a significant predictor variable of grip strength for the MST (0.43≤R2≤0.61) and for the handgrip dynamometer (0.44≤R2≤0.61) for both stroke subgroups. CONCLUSION Grip strength assessed with the MST could be used to report paretic UL global strength.
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Affiliation(s)
- Júlia C Martins
- Departamento de Fisioterapia, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Larissa T Aguiar
- Departamento de Fisioterapia, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Eliza M Lara
- Departamento de Fisioterapia, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Luci F Teixeira-Salmela
- Departamento de Fisioterapia, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Christina D C M Faria
- Departamento de Fisioterapia, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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Strength training associated with task-oriented training to enhance upper-limb motor function in elderly patients with mild impairment after stroke: a randomized controlled trial. Am J Phys Med Rehabil 2015; 94:11-9. [PMID: 25122097 DOI: 10.1097/phm.0000000000000135] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to verify the effects of loaded exercises associated with a task-oriented training (TOT) program in the recovery of upper-limb function in individuals with chronic hemiparesis after stroke. DESIGN This study used a single-blinded, randomized controlled trial. Patients were included into two TOT groups: one that performed the task-oriented therapy without load (TOT group, n = 10) and another one that performed task-oriented therapy with personalized resistance (TOT_ST group, n = 10) for 6 wks, for a total of 12 sessions. Main measures included The Upper Extremity Performance Test, shoulder flexor and handgrip strength, shoulder active range of motion, motor impairment (Fugl-Meyer Scale), and muscle tone. RESULTS The TOT_ST group demonstrated better scores relating to unilateral tasks and in the quality aspects of bilateral movements (The Upper Extremity Performance Test, P = 0.04) at the end of rehabilitation protocol. The highest muscle force gain was reached by the TOT_ST group for the shoulder flexors (P = 0.001). Similarly, the active range of motion (P = 0.01) and Fugl-Meyer scores (P = 0.001) were higher in the TOT_ST group compared with the TOT group. Both groups showed improvement after training. CONCLUSIONS Strength training was able to intensify the upper-limb rehabilitation, as demonstrated by the superior scores achieved by the TOT_ST group in most of the evaluated parameters. Muscle strength training might be a pivotal element of the task-oriented rehabilitation program of chronic patients with mild impairment after stroke.
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Cleveland S, Driver S, Swank C, Macklin S. Classifying physical activity research following stroke using the behavioral epidemiologic framework. Top Stroke Rehabil 2015; 22:289-98. [PMID: 26258454 DOI: 10.1179/1074935714z.0000000043] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Stroke is a significant public health issue in the USA and a need emerges to better understand how to reduce an individual's co-morbidity risk. Physical activity is one approach to improving the health of individuals and comprehensive literature supports increased activity as a means to reduce risk of morbidity and mortality. One approach to examining whether research in a field is addressing a public health issue is through application of the behavioral epidemiological framework. OBJECTIVE To classify physical activity research for individuals following stroke into distinct phases so that efforts can be made to systematically address gaps and disseminate evidence-based practice. METHODS Specific key words were identified and then searched through EBSCO host, PubMed, and Google Scholar. Physical activity and stroke literature from 2000-2014 was categorized into one of five discrete phases. Research in Phase 1 identified associations between activity and health; Phase 2 established valid measures of activity; Phase 3 examined determinants of behavior; Phase 4 evaluated activity interventions; and Phase 5 disseminated evidence-based practice. RESULTS A comprehensive review of literature identified 202 articles with 70% categorized in Phase 1 (n = 141), 11% in Phase 2 (n = 23), 10% in Phase 3 (n = 20), 8% in Phase 4 (n = 15), and 1% in Phase 5 (n = 3). CONCLUSION Findings suggest that physical activity research for individuals following stroke is in the early stages of development with less than 10% of research evaluating or disseminating interventions.
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Pulman J, Buckley E. Assessing the Efficacy of Different Upper Limb Hemiparesis Interventions on Improving Health-Related Quality of Life in Stroke Patients: A Systematic Review. Top Stroke Rehabil 2015; 20:171-88. [DOI: 10.1310/tsr2002-171] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Cruickshank TM, Reyes AR, Ziman MR. A systematic review and meta-analysis of strength training in individuals with multiple sclerosis or Parkinson disease. Medicine (Baltimore) 2015; 94:e411. [PMID: 25634170 PMCID: PMC4602948 DOI: 10.1097/md.0000000000000411] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Strength training has, in recent years, been shown to be beneficial for people with Parkinson disease and multiple sclerosis. Consensus regarding its utility for these disorders nevertheless remains contentious among healthcare professionals. Greater clarity is required, especially in regards to the type and magnitude of effects as well as the response differences to strength training between individuals with Parkinson disease or multiple sclerosis. This study examines the effects, magnitude of those effects, and response differences to strength training between patients with Parkinson disease or multiple sclerosis. A comprehensive search of electronic databases including Physiotherapy Evidence Database scale, PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and CINAHL was conducted from inception to July 2014. English articles investigating the effect of strength training for individuals with neurodegenerative disorders were selected. Strength training trials that met the inclusion criteria were found for individuals with Parkinson disease or multiple sclerosis. Individuals with Parkinson disease or multiple sclerosis were included in the study. Strength training interventions included traditional (free weights/machine exercises) and nontraditional programs (eccentric cycling). Included articles were critically appraised using the Physiotherapy Evidence Database scale. Of the 507 articles retrieved, only 20 articles met the inclusion criteria. Of these, 14 were randomized and 6 were nonrandomized controlled articles in Parkinson disease or multiple sclerosis. Six randomized and 2 nonrandomized controlled articles originated from 3 trials and were subsequently pooled for systematic analysis. Strength training was found to significantly improve muscle strength in people with Parkinson disease (15%-83.2%) and multiple sclerosis (4.5%-36%). Significant improvements in mobility (11.4%) and disease progression were also reported in people with Parkinson disease after strength training. Furthermore, significant improvements in fatigue (8.2%), functional capacity (21.5%), quality of life (8.3%), power (17.6%), and electromyography activity (24.4%) were found in individuals with multiple sclerosis after strength training. The limitations of the study were the heterogeneity of interventions and study outcomes in Parkinson disease and multiple sclerosis trials. Strength training is useful for increasing muscle strength in Parkinson disease and to a lesser extent multiple sclerosis.
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Affiliation(s)
- Travis M Cruickshank
- From the School of Medical Sciences (TMC, ARR, MRZ), Edith Cowan University; and School of Pathology and Laboratory Medicine (MRZ), University of Western Australia, Perth, Australia
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Hu XL, Tong RKY, Ho NSK, Xue JJ, Rong W, Li LSW. Wrist Rehabilitation Assisted by an Electromyography-Driven Neuromuscular Electrical Stimulation Robot After Stroke. Neurorehabil Neural Repair 2014; 29:767-76. [PMID: 25549656 DOI: 10.1177/1545968314565510] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Augmented physical training with assistance from robot and neuromuscular electrical stimulation (NMES) may introduce intensive motor improvement in chronic stroke. OBJECTIVE To compare the rehabilitation effectiveness achieved by NMES robot-assisted wrist training and that by robot-assisted training. METHODS This study was a single-blinded randomized controlled trial with a 3-month follow-up. Twenty-six hemiplegic subjects with chronic stroke were randomly assigned to receive 20-session wrist training with an electromyography (EMG)-driven NMES robot (NMES robot group, n = 11) and with an EMG-driven robot (robot group, n = 15), completed within 7 consecutive weeks. Clinical scores, Fugl-Meyer Assessment (FMA), Modified Ashworth Score (MAS), and Action Research Arm Test (ARAT) were used to evaluate the training effects before and after the training, as well as 3 months later. An EMG parameter, muscle co-contraction index, was also applied to investigate the session-by-session variation in muscular coordination patterns during the training. RESULTS The improvement in FMA (shoulder/elbow, wrist/hand) obtained in the NMES robot group was more significant than the robot group (P < .05). Significant improvement in ARAT was achieved in the NMES robot group (P < .05) but absent in the robot group. NMES robot-assisted training showed better performance in releasing muscle co-contraction than the robot-assisted across the training sessions (P < .05). CONCLUSIONS The NMES robot-assisted wrist training was more effective than the pure robot. The additional NMES application in the treatment could bring more improvements in the distal motor functions and faster rehabilitation progress.
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Affiliation(s)
- Xiao-Ling Hu
- Interdisciplinary Division of Biomedical Engineering, the Hong Kong Polytechnic University, Hong Kong, SAR
| | - Raymond Kai-yu Tong
- Interdisciplinary Division of Biomedical Engineering, the Hong Kong Polytechnic University, Hong Kong, SAR Department of Electronic Engineering, the Chinese University of Hong Kong, Hong Kong, SAR
| | - Newmen S K Ho
- Interdisciplinary Division of Biomedical Engineering, the Hong Kong Polytechnic University, Hong Kong, SAR
| | - Jing-jing Xue
- The Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Wei Rong
- Interdisciplinary Division of Biomedical Engineering, the Hong Kong Polytechnic University, Hong Kong, SAR
| | - Leonard S W Li
- Tung Wah Hospital, the University of Hong Kong, Hong Kong, SAR
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Pollock A, Farmer SE, Brady MC, Langhorne P, Mead GE, Mehrholz J, van Wijck F. Interventions for improving upper limb function after stroke. Cochrane Database Syst Rev 2014; 2014:CD010820. [PMID: 25387001 PMCID: PMC6469541 DOI: 10.1002/14651858.cd010820.pub2] [Citation(s) in RCA: 341] [Impact Index Per Article: 34.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Improving upper limb function is a core element of stroke rehabilitation needed to maximise patient outcomes and reduce disability. Evidence about effects of individual treatment techniques and modalities is synthesised within many reviews. For selection of effective rehabilitation treatment, the relative effectiveness of interventions must be known. However, a comprehensive overview of systematic reviews in this area is currently lacking. OBJECTIVES To carry out a Cochrane overview by synthesising systematic reviews of interventions provided to improve upper limb function after stroke. METHODS SEARCH METHODS We comprehensively searched the Cochrane Database of Systematic Reviews; the Database of Reviews of Effects; and PROSPERO (an international prospective register of systematic reviews) (June 2013). We also contacted review authors in an effort to identify further relevant reviews. SELECTION CRITERIA We included Cochrane and non-Cochrane reviews of randomised controlled trials (RCTs) of patients with stroke comparing upper limb interventions with no treatment, usual care or alternative treatments. Our primary outcome of interest was upper limb function; secondary outcomes included motor impairment and performance of activities of daily living. When we identified overlapping reviews, we systematically identified the most up-to-date and comprehensive review and excluded reviews that overlapped with this. DATA COLLECTION AND ANALYSIS Two overview authors independently applied the selection criteria, excluding reviews that were superseded by more up-to-date reviews including the same (or similar) studies. Two overview authors independently assessed the methodological quality of reviews (using a modified version of the AMSTAR tool) and extracted data. Quality of evidence within each comparison in each review was determined using objective criteria (based on numbers of participants, risk of bias, heterogeneity and review quality) to apply GRADE (Grades of Recommendation, Assessment, Development and Evaluation) levels of evidence. We resolved disagreements through discussion. We systematically tabulated the effects of interventions and used quality of evidence to determine implications for clinical practice and to make recommendations for future research. MAIN RESULTS Our searches identified 1840 records, from which we included 40 completed reviews (19 Cochrane; 21 non-Cochrane), covering 18 individual interventions and dose and setting of interventions. The 40 reviews contain 503 studies (18,078 participants). We extracted pooled data from 31 reviews related to 127 comparisons. We judged the quality of evidence to be high for 1/127 comparisons (transcranial direct current stimulation (tDCS) demonstrating no benefit for outcomes of activities of daily living (ADLs)); moderate for 49/127 comparisons (covering seven individual interventions) and low or very low for 77/127 comparisons.Moderate-quality evidence showed a beneficial effect of constraint-induced movement therapy (CIMT), mental practice, mirror therapy, interventions for sensory impairment, virtual reality and a relatively high dose of repetitive task practice, suggesting that these may be effective interventions; moderate-quality evidence also indicated that unilateral arm training may be more effective than bilateral arm training. Information was insufficient to reveal the relative effectiveness of different interventions.Moderate-quality evidence from subgroup analyses comparing greater and lesser doses of mental practice, repetitive task training and virtual reality demonstrates a beneficial effect for the group given the greater dose, although not for the group given the smaller dose; however tests for subgroup differences do not suggest a statistically significant difference between these groups. Future research related to dose is essential.Specific recommendations for future research are derived from current evidence. These recommendations include but are not limited to adequately powered, high-quality RCTs to confirm the benefit of CIMT, mental practice, mirror therapy, virtual reality and a relatively high dose of repetitive task practice; high-quality RCTs to explore the effects of repetitive transcranial magnetic stimulation (rTMS), tDCS, hands-on therapy, music therapy, pharmacological interventions and interventions for sensory impairment; and up-to-date reviews related to biofeedback, Bobath therapy, electrical stimulation, reach-to-grasp exercise, repetitive task training, strength training and stretching and positioning. AUTHORS' CONCLUSIONS Large numbers of overlapping reviews related to interventions to improve upper limb function following stroke have been identified, and this overview serves to signpost clinicians and policy makers toward relevant systematic reviews to support clinical decisions, providing one accessible, comprehensive document, which should support clinicians and policy makers in clinical decision making for stroke rehabilitation.Currently, no high-quality evidence can be found for any interventions that are currently used as part of routine practice, and evidence is insufficient to enable comparison of the relative effectiveness of interventions. Effective collaboration is urgently needed to support large, robust RCTs of interventions currently used routinely within clinical practice. Evidence related to dose of interventions is particularly needed, as this information has widespread clinical and research implications.
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Affiliation(s)
- Alex Pollock
- Glasgow Caledonian UniversityNursing, Midwifery and Allied Health Professions Research UnitBuchanan HouseCowcaddens RoadGlasgowUKG4 0BA
| | - Sybil E Farmer
- Glasgow Caledonian UniversityNursing, Midwifery and Allied Health Professions Research UnitBuchanan HouseCowcaddens RoadGlasgowUKG4 0BA
| | - Marian C Brady
- Glasgow Caledonian UniversityNursing, Midwifery and Allied Health Professions Research UnitBuchanan HouseCowcaddens RoadGlasgowUKG4 0BA
| | - Peter Langhorne
- University of GlasgowAcademic Section of Geriatric MedicineLevel 2, New Lister BuildingGlasgow Royal InfirmaryGlasgowUKG31 2ER
| | - Gillian E Mead
- University of EdinburghCentre for Clinical Brain SciencesRoom S1642, Royal InfirmaryLittle France CrescentEdinburghUKEH16 4SA
| | - Jan Mehrholz
- Private Europäische Medizinische Akademie der Klinik Bavaria in Kreischa GmbHWissenschaftliches InstitutAn der Wolfsschlucht 1‐2KreischaGermany01731
| | - Frederike van Wijck
- Glasgow Caledonian UniversityInstitute for Applied Health Research and the School of Health and Life SciencesGlasgowUK
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Saunders DH, Greig CA, Mead GE. Physical activity and exercise after stroke: review of multiple meaningful benefits. Stroke 2014; 45:3742-7. [PMID: 25370588 DOI: 10.1161/strokeaha.114.004311] [Citation(s) in RCA: 136] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- David H Saunders
- From the Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, United Kingdom (D.H.S.); School of Sport, Exercise and Rehabilitation Sciences, MRC-Arthritis Research UK Centre, University of Birmingham, Birmingham, United Kingdom (C.A.G.); and Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (G.E.M.).
| | - Carolyn A Greig
- From the Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, United Kingdom (D.H.S.); School of Sport, Exercise and Rehabilitation Sciences, MRC-Arthritis Research UK Centre, University of Birmingham, Birmingham, United Kingdom (C.A.G.); and Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (G.E.M.)
| | - Gillian E Mead
- From the Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, United Kingdom (D.H.S.); School of Sport, Exercise and Rehabilitation Sciences, MRC-Arthritis Research UK Centre, University of Birmingham, Birmingham, United Kingdom (C.A.G.); and Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (G.E.M.)
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Schmid AA, Miller KK, Van Puymbroeck M, DeBaun-Sprague E. Yoga leads to multiple physical improvements after stroke, a pilot study. Complement Ther Med 2014; 22:994-1000. [PMID: 25453519 DOI: 10.1016/j.ctim.2014.09.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 07/03/2014] [Accepted: 09/21/2014] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE To assess change in physical functioning (pain, range of motion (ROM), strength, and endurance) after 8 weeks of therapeutic-yoga. DESIGN Planned analyses of data from a randomized pilot study of yoga after stroke. SETTING University-based research laboratory. PARTICIPANTS People with chronic stroke (N=47) randomized to therapeutic-yoga (n=37) or wait-list control (n=10). INTERVENTIONS 16 sessions of therapeutic yoga (twice a week/8 weeks). Yoga was delivered in a standardized and progressive format with postures, breathing, and meditation, and relaxation in sitting, standing, and supine. MAIN MEASURES Pain was assessed with the PEG, a 3-item functional measure of the interference of pain. ROM included neck and hip active and passive ROM measurements). Upper and lower extremity strength were assessed with the arm curl test and chair-to-stand test, respectively. Endurance was assessed with the 6-minute walk and modified 2-min step test. RESULTS After a Bonferroni Correction, pain, neck ROM, hip passive ROM, upper extremity strength, and the 6-min walk scores all significantly improved after 8 weeks of engaging in yoga. No changes occurred in the wait-list control group. CONCLUSIONS A group therapeutic-yoga intervention may improve multiple aspects of physical functioning after stroke. Such an intervention may be complementary to traditional rehabilitation.
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Affiliation(s)
- Arlene A Schmid
- Colorado State University, College of Health and Human Sciences, Department of Occupational Therapy, Fort Collins, CO, United States.
| | - Kristine K Miller
- Indiana University School of Health and Rehabilitation Sciences, Department of Physical Therapy, Indianapolis, IN, United States; Roudebush Veterans Administration (VA) Medical Center; Health Services Research and Development (HSR&D) Center of Innovation, Indianapolis, IN, United States
| | - Marieke Van Puymbroeck
- Clemson University, College of Health and Human Development, Department of Parks, Recreation and Tourism Management, Clemson, SC, United States
| | - Erin DeBaun-Sprague
- Indiana University School of Health and Rehabilitation Sciences, Department of Occupational Therapy, Indianapolis, IN, United States
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87
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Ammann BC, Knols RH, Baschung P, de Bie RA, de Bruin ED. Application of principles of exercise training in sub-acute and chronic stroke survivors: a systematic review. BMC Neurol 2014; 14:167. [PMID: 25162455 PMCID: PMC4236657 DOI: 10.1186/s12883-014-0167-2] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 08/18/2014] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND There is increasing evidence for the beneficial effects of exercise training in stroke survivors. In order to reach the desired training effects, exercise training principles must be considered as this ensures the prescription of adequate exercises at an adequate dose. Moreover, exercise training interventions must be designed in a way that maximizes patients' adherence to the prescribed exercise regimen. The objectives of this systematic review were (1) to investigate whether training principles for physical exercise interventions are reported in RCTs for sub-acute and chronic stroke survivors, (2) to evaluate whether the RCTs reported the prescription of the FITT components of the exercise interventions as well as (3) patients' adherence to this prescription, and (4) to assess the risk of bias of the included studies. METHODS We performed a systematic review of RCTs with exercise training as the primary intervention and muscular strength and/or endurance as primary outcomes. The Cochrane library's risk of bias (ROB) tool was used to judge the methodological quality of RCTs. RESULTS Thirty-seven RCTs were included in this systematic review. Eighteen studies (48.7%) focused on aerobic, 8 (21.6%) on resistance and 11 (29.7%) on combined interventions of aerobic and resistive strength exercise. Twenty-nine studies (78.4%) included only chronic stroke survivors, 5 studies (13.5%) only sub-acute stroke survivors whilst 3 studies (8.1%) included both. In terms of principle of exercise training, 89% reported specificity, 75.7% progression, 48.7% overload, 37.8% initial values, 32.4% reversibility and 13.5% diminishing returns. One RCT described all principles of physical exercise training and 19 (51.4%) all FITT components. Patients' adherence to exercise prescription was accounted for in 3 studies (8.1%). Failure to report blinding in patients and participants and failure to report allocation concealment were the most prevalent methodological shortcomings. CONCLUSIONS Incomplete and inconsistent reporting of (1) training components, (2) underlying exercise training principles and (3) patient adherence together with (4) a broad variation in the methodological quality of the included RCTs limit both the utility and reproducibility of physical exercise programs in stroke patients.
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Affiliation(s)
| | | | | | | | - Eling D de Bruin
- Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, 6200 MD, the Netherlands.
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Mares K, Cross J, Clark A, Vaughan S, Barton GR, Poland F, McGlashan K, Watson M, Myint PK, O’Driscoll ML, Pomeroy VM. Feasibility of a randomized controlled trial of functional strength training for people between six months and five years after stroke: FeSTivaLS trial. Trials 2014; 15:322. [PMID: 25118156 PMCID: PMC4138387 DOI: 10.1186/1745-6215-15-322] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 07/23/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Functional Strength Training (FST) could enhance recovery late after stroke. The aim of this study was to evaluate the feasibility of a subsequent fully powered, randomized controlled trial. METHODS The study was designed as a randomized, observer-blind trial. Both interventions were provided for up to one hour a day, four days a week, for six weeks. Evaluation points were before randomization (baseline), after six weeks intervention (outcome), and six weeks thereafter (follow-up). The study took place in participants' own homes. Participants (n = 52) were a mean of 24.4 months after stroke with a mean age of 68.3 years with 67.3% male. All had difficulty using their paretic upper (UL) and lower limb (LL). Participants were allocated to FST-UL or FST-LL by an independent randomization service. The outcome measures were recruitment rate, attrition rate, practicality of recruitment strategies, occurrence of adverse reactions, acceptability of FST, and estimation of sample size for a subsequent trial. Primary clinical efficacy outcomes were the Action Research Arm Test (ARAT) and the Functional Ambulation Categories (FAC). Analysis was conducted using descriptive statistics and thematic analysis of participants' views of FST. A power calculation used estimates of clinical efficacy variance to estimate sample size for a subsequent trial. RESULTS The screening process identified 1,127 stroke survivors of whom 52 (4.6%) were recruited. The recruitment rate was higher for referral from community therapists than for systematic identification of people discharged from an acute stroke unit. The attrition rate was 15.5% at the outcome and follow-up time-points. None of the participants experienced an adverse reaction. The participants who remained in the study at outcome had received 68% of the total possible amount of therapy. Participants reported that their experience of FST provided a sense of purpose and involvement and increased their confidence in performing activities. The power calculation provides estimation that 150 participants in each group will be required for a subsequent clinical trial. CONCLUSIONS This study found that a subsequent clinical trial was feasible with modifications to the recruitment strategy to be used. TRIAL REGISTRATION Controlled-trials.com ISCTN71632550, 30 January 2009.
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Affiliation(s)
- Kathryn Mares
- />School of Rehabilitation Sciences, University of East Anglia, Norwich Research Park, Queen’s Building, Norwich, NR4 7TJ UK
| | - Jane Cross
- />School of Rehabilitation Sciences, University of East Anglia, Norwich Research Park, Queen’s Building, Norwich, NR4 7TJ UK
| | - Allan Clark
- />Norwich Medical School and Norwich Clinical Trials Unit, University of East Anglia, Norwich, NR4 7TJ UK
| | - Susan Vaughan
- />School of Rehabilitation Sciences, University of East Anglia, Norwich Research Park, Queen’s Building, Norwich, NR4 7TJ UK
| | - Garry R Barton
- />Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ UK
| | - Fiona Poland
- />School of Rehabilitation Sciences, University of East Anglia, Norwich Research Park, Queen’s Building, Norwich, NR4 7TJ UK
| | - Kate McGlashan
- />Colman Centre for Specialist Rehabilitation Services, Unthank Road, Norwich, NR2 2PJ UK
| | - Martin Watson
- />School of Rehabilitation Sciences, University of East Anglia, Norwich Research Park, Queen’s Building, Norwich, NR4 7TJ UK
| | - Phyo K Myint
- />School of Medicine & Dentistry, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD UK
- />UK and Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ UK
| | - Marie-Luce O’Driscoll
- />Department of Sports Therapy and Physiotherapy, Faculty of Health and Social Sciences, University of Bedfordshire, Park Square, Luton, LU1 3JU UK
| | - Valerie M Pomeroy
- />School of Rehabilitation Sciences, University of East Anglia, Norwich Research Park, Queen’s Building, Norwich, NR4 7TJ UK
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Motamed Vaziri P, Bahrpeyma F, Firoozabadi M, Forough B, Hatef B, Sheikhhoseini R, Shamili A. Low frequency repetitive transcranial magnetic stimulation to improve motor function and grip force of upper limbs of patients with hemiplegia. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e13579. [PMID: 25389476 PMCID: PMC4222002 DOI: 10.5812/ircmj.13579] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Revised: 01/12/2014] [Accepted: 02/09/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Stroke is the most common and debilitating neurological disorder among adults, and is a sudden onset of neurological signs caused by brain blood vessels impairments. OBJECTIVES Some new therapeutic methods focus on the use of magnetic stimulation to produce therapeutic effects by inducing the currents. The aim of this study is to determine the effects of rTMS plus routine rehabilitation on hand grip and wrist motor functions in patients with hemiplegia, and compare with pure routine rehabilitation programs. PATIENTS AND METHODS In this study, 12 patients with hemiplegia were randomly divided in two groups. Control group, received the rehabilitation program with placebo magnetic stimulation, and the experimental group, received magnetic stimulation with routine rehabilitation program for 10 sessions for three times per week. Pre and post evaluations of treatment performed using Barthel and Fugl-Meyer indices and dynamometers. RESULTS In the control group, Barthel and Fugl-Meyer indices showed significant improvement (P = 0.01, P = 0.00), while in the experimental group, significant improvement in Barthel and Fugl-Meyer indices and dynamometers has been observed (P = 0.01, P = 0.00, P = 0.007). CONCLUSIONS rTMS can improve hand muscle force and functions of patients with chronic hemiplegia, while conventional treatment is not effective.
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Affiliation(s)
| | - Farid Bahrpeyma
- Faculty of Medical Sciences, Tarbiat Modares University, Tehran, IR Iran
| | | | - Bijan Forough
- School of Medicine, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Boshra Hatef
- Neuroscience Research Center, Baghiyatallah University on Medical Sciences, Tehran, IR Iran
| | - Rahman Sheikhhoseini
- Department of Physical Education and Sport Sciences, University of Tehran, Tehran, IR Iran
- Corresponding Author: Rahman Sheikhhoseini, Department of Physical Education and Sport Sciences, University of Tehran, Tehran, IR Iran. Tel: +98-2122790724, +98-9188668284, E-mail:
| | - Aryan Shamili
- Neuroscience Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran
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90
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Billinger SA, Arena R, Bernhardt J, Eng JJ, Franklin BA, Johnson CM, MacKay-Lyons M, Macko RF, Mead GE, Roth EJ, Shaughnessy M, Tang A. Physical Activity and Exercise Recommendations for Stroke Survivors. Stroke 2014; 45:2532-53. [PMID: 24846875 DOI: 10.1161/str.0000000000000022] [Citation(s) in RCA: 838] [Impact Index Per Article: 83.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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91
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Body symmetry and physical strength in human males. Am J Hum Biol 2014; 26:697-700. [DOI: 10.1002/ajhb.22584] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 06/20/2014] [Accepted: 06/22/2014] [Indexed: 11/07/2022] Open
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92
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Bleyenheuft Y, Gordon AM. Precision grip in congenital and acquired hemiparesis: similarities in impairments and implications for neurorehabilitation. Front Hum Neurosci 2014; 8:459. [PMID: 25071502 PMCID: PMC4074995 DOI: 10.3389/fnhum.2014.00459] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 06/05/2014] [Indexed: 12/02/2022] Open
Abstract
Background: Patients with congenital and acquired hemiparesis incur long-term functional deficits, among which the loss of prehension that may impact their functional independence. Identifying, understanding, and comparing the underlying mechanisms of prehension impairments represent an opportunity to better adapt neurorehabilitation. Objective: The present review aims to provide a better understanding of precision grip deficits in congenital and acquired hemiparesis and to determine whether the severity and type of fine motor control impairments depend on whether or not the lesions are congenital or acquired in adulthood. Methods: Using combinations of the following key words: fingertip force, grip force, precision grip, cerebral palsy, stroke, PubMed, and Scopus databases were used to search studies from 1984 to 2013. Results: Individuals with both congenital and acquired hemiparesis were able to some extent to use anticipatory motor control in precision grip tasks, even if this control was impaired in the paretic hand. In both congenital and acquired hemiparesis, the ability to plan efficient anticipatory motor control when the less-affected hand is used provides a possibility to remediate impairments in anticipatory motor control of the paretic hand. Conclusion: Surprisingly, we observed very few differences between the results of studies in children with congenital hemiplegia and stroke patients. We suggest that the underlying specific strategies of neurorehabilitation developed for each one could benefit the other.
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Affiliation(s)
- Yannick Bleyenheuft
- Institute of Neuroscience, Université Catholique de Louvain , Brussels , Belgium
| | - Andrew M Gordon
- Department of Biobehavioral Sciences, Teachers College, Columbia University , New York, NY , USA
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93
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Li X, Liu J, Li S, Wang YC, Zhou P. Examination of hand muscle activation and motor unit indices derived from surface EMG in chronic stroke. IEEE Trans Biomed Eng 2014; 61:2891-8. [PMID: 24967982 DOI: 10.1109/tbme.2014.2333034] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
In this study, we used muscle and motor unit indices, derived from convenient surface electromyography (EMG) measurements, for examination of paretic muscle changes post stroke. For 12 stroke subjects, compound muscle action potential and voluntary surface EMG signals were recorded from paretic and contralateral first dorsal interosseous, abductor pollicis brevis, and abductor digiti minimi muscles. Muscle activation index (AI), motor unit number index (MUNIX), and motor unit size index (MUSIX) were then calculated for each muscle. There was a significant AI reduction for all the three muscles in paretic side compared with contralateral side, providing an evidence of muscle activation deficiency after stroke. The hand MUNIX (defined by summing the values from the three muscles) was significantly reduced in paretic side compared with contralateral side, whereas the hand MUSIX was not significantly different. Furthermore, diverse changes in MUNIX and MUSIX were observed from the three muscles. A major feature of the present examinations is the primary reliance on surface EMG, which offers practical benefits because it is noninvasive, induces minimal discomfort and can be performed quickly.
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94
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Armentano R, Kun L. Multidisciplinary, holistic and patient specific approach to follow up elderly adults. HEALTH AND TECHNOLOGY 2014. [DOI: 10.1007/s12553-014-0080-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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95
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96
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Scherbakov N, von Haehling S, Anker SD, Dirnagl U, Doehner W. Stroke induced Sarcopenia: Muscle wasting and disability after stroke. Int J Cardiol 2013; 170:89-94. [DOI: 10.1016/j.ijcard.2013.10.031] [Citation(s) in RCA: 130] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 09/30/2013] [Accepted: 10/07/2013] [Indexed: 12/25/2022]
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97
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Pollock A, Farmer SE, Brady MC, Langhorne P, Mead GE, Mehrholz J, van Wijck F. Interventions for improving upper limb function after stroke. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2013. [DOI: 10.1002/14651858.cd010820] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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98
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Dorsch S, Ada L, Canning CG. EMG-triggered electrical stimulation is a feasible intervention to apply to multiple arm muscles in people early after stroke, but does not improve strength and activity more than usual therapy: a randomized feasibility trial. Clin Rehabil 2013; 28:482-90. [PMID: 24198342 DOI: 10.1177/0269215513510011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine whether EMG-triggered electrical stimulation applied to multiple muscles daily is a feasible intervention and to determine its effect on strength and activity in very weak stroke patients. DESIGN A prospective, randomized trial with blinded assessment. SETTING Metropolitan mixed acute and rehabilitation units. PARTICIPANTS Thirty-three people within four weeks of a stroke with less than Grade 3 strength in three out of four muscle groups (shoulder flexors, elbow extensors, wrist and finger extensors and thumb abductors) of the affected arm. INTERVENTIONS Participants were randomly allocated to receive EMG-triggered electrical stimulation to the four muscle groups of the affected arm plus usual therapy five times a week for four weeks, or usual therapy only. MAIN MEASURES Feasibility of the intervention was measured by examining compliance with the trial protocol. Strength was measured using manual muscle testing summed across muscle groups (0-20). Activity was measured using the Motor Assessment Scale, summed upper limb items (0-18). RESULTS The experimental group received 87% of the intervention. Following the intervention period, there was no difference between the groups for strength (mean between-group difference, 0 out of 20, 95% confidence interval (CI) -3 to 3, p = 0.91) or activity (mean between-group difference 1 out of 18, 95% CI -2 to 4, p = 0.44). CONCLUSIONS It is feasible to apply EMG-triggered electrical stimulation to multiple muscles of the upper limb in very weak people early after stroke. However, it does not appear to improve strength or activity beyond usual arm therapy that contains strengthening.
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Affiliation(s)
- Simone Dorsch
- 1Faculty of Health Sciences, Australian Catholic University, Sydney, NSW, Australia
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Sin M, Kim WS, Park D, Min YS, Kim WJ, Cho K, Paik NJ. Electromyographic analysis of upper limb muscles during standardized isotonic and isokinetic robotic exercise of spastic elbow in patients with stroke. J Electromyogr Kinesiol 2013; 24:11-7. [PMID: 24290983 DOI: 10.1016/j.jelekin.2013.10.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 09/03/2013] [Accepted: 10/04/2013] [Indexed: 11/17/2022] Open
Abstract
Although it has been reported that strengthening exercise in stroke patients is beneficial for their motor recovery, there is little evidence about which exercise method is the better option. The purpose of this study was to compare isotonic and isokinetic exercise by surface electromyography (EMG) analysis using standardized methods. Nine stroke patients performed three sets of isotonic elbow extensions at 30% of their maximal voluntary isometric torque followed by three sets of maximal isokinetic elbow extensions with standardization of mean angular velocity and the total amount of work for each matched set in two strengthening modes. All exercises were done by using 1-DoF planner robot to regulate exact resistive torque and speed. Surface electromyographic activity of eight muscles in the hemiplegic shoulder and elbow was recorded. Normalized root mean square (RMS) values and co-contraction index (CCI) were used for the analysis. The isokinetic mode was shown to activate the agonists of elbow extension more efficiently than the isotonic mode (normalized RMS for pooled triceps: 96.0±17.0 (2nd), 87.8±14.4 (3rd) in isokinetic, 80.9±11.0 (2nd), 81.6±12.4 (3rd) in isotonic contraction, F[1,8]=11.168; P=0.010) without increasing the co-contraction of muscle pairs, implicating spasticity or synergy.
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Affiliation(s)
- Minki Sin
- School of Mechanical and Aerospace Engineering, Seoul National University/IAMD, Seoul, Republic of Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Daegeun Park
- School of Mechanical and Aerospace Engineering, Seoul National University/IAMD, Seoul, Republic of Korea
| | - Yu-Sun Min
- Department of Rehabilitation Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Woo Jin Kim
- Department of Physical Medicine and Rehabilitation, Haeundae Paik Hospital, Inje University of Medicine, Busan, Republic of Korea
| | - Kyujin Cho
- School of Mechanical and Aerospace Engineering, Seoul National University/IAMD, Seoul, Republic of Korea.
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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Hayward KS, Barker RN, Carson RG, Brauer SG. The effect of altering a single component of a rehabilitation programme on the functional recovery of stroke patients: a systematic review and meta-analysis. Clin Rehabil 2013; 28:107-17. [PMID: 23922265 DOI: 10.1177/0269215513497601] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the effect of altering a single component of a rehabilitation programme (e.g. adding bilateral practice alone) on functional recovery after stroke, defined using a measure of activity. DATA SOURCES A search was conducted of Medline/Pubmed, CINAHL and Web of Science. REVIEW METHODS Two reviewers independently assessed eligibility. Randomized controlled trials were included if all participants received the same base intervention, and the experimental group experienced alteration of a single component of the training programme. This could be manipulation of an intrinsic component of training (e.g. intensity) or the addition of a discretionary component (e.g. augmented feedback). One reviewer extracted the data and another independently checked a subsample (20%). Quality was appraised according to the PEDro scale. RESULTS Thirty-six studies (n = 1724 participants) were included. These evaluated nine training components: mechanical degrees of freedom, intensity of practice, load, practice schedule, augmented feedback, bilateral movements, constraint of the unimpaired limb, mental practice and mirrored-visual feedback. Manipulation of the mechanical degrees of freedom of the trunk during reaching and the addition of mental practice during upper limb training were the only single components found to independently enhance recovery of function after stroke. CONCLUSION This review provides limited evidence to support the supposition that altering a single component of a rehabilitation programme realises greater functional recovery for stroke survivors. Further investigations are required to determine the most effective single components of rehabilitation programmes, and the combinations that may enhance functional recovery.
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Affiliation(s)
- Kathryn S Hayward
- 1Division of Physiotherapy, The University of Queensland Brisbane, Brisbane, Australia
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