Previous lower limb dominance does not affect measures of impairment and activity after stroke

Constraint-induced movement therapy protocols using the number of repetitions of task practice: a systematic review of feasibility and effects

BACKGROUND

High repetitions of task practice is required for the recovery of the motor function during constraint-induced movement therapy (CIMT). This can be achieved into ways: when the task practice is measured in hours of practice or when the number of repetitions is counted. However, it has been argued that using hours of task practice as a measure of practice does not provide a clear instruction on the dose of practice.

AIM

The aim of this study is to determine the feasibility and effects of the CIMT protocol that uses the number of repetitions of task practice.

MATERIALS/METHOD

The study was a systematic review registered in PROSPERO (CRD42020142140). Five databases, PubMED, CENTRAL, PEDro, OTSeeker and Web of Science, were searched. Studies of any designs in adults with stroke were included if they used the number of repetitions of task practice as a measure of dose. The methodological quality of the included studies was assessed using Modified McMaster critical review form. The results were analysed using qualitative synthesis.

RESULTS

Eight studies (n = 205) were included in the study. The number of task repetitions in the studies ranges between 45 and 1280 per day. The results showed that CIMT protocol using the number of repetitions of task practice was feasible and improved outcomes such as motor function, quality of life, functional mobility and spasticity.

CONCLUSION

The number of repetitions of task practice as a measure of CIMT dose can be used in place of the existing protocol that uses the number of hours of task practice.

Deficits in motor coordination of the paretic lower limb limit the ability to immediately increase walking speed in individuals with chronic stroke

OBJECTIVE

To explore the relationships between clinical measures and the ability to increase walking speed in ambulatory people with chronic stroke and to identify which measures would best predict walking speed reserve.

METHODS

An exploratory, cross-sectional study was conducted with 114 individuals with chronic stroke. The outcome of interest was walking speed reserve, defined as the difference between individuals' comfortable and maximal walking speeds. Predictors were characteristics of the participants (age, sex, time since stroke, relative lower-limb dominance) and motor impairments (tonus, strength, and motor coordination).

RESULTS

The characteristics of the participants did not significantly correlate with walking speed reserve. All measures of motor impairments, i.e., tonus, strength, and motor coordination, were significantly correlated with walking speed reserve (p < 0.01), but only motor coordination was kept in the regression model. Motor coordination alone explained 35% (F = 61.5; p < 0.001) of the variance in walking speed reserve.

CONCLUSIONS

The level of motor coordination of the paretic lower limb is associated with the walking speed reserve of individuals with stroke. Interventions aimed at improving motor coordination may have the potential to improve everyday situations that require immediate increases in walking speed.