Objective: To determine the evidence for physical therapy interventions aimed at improving functional outcome after stroke.Methods: MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, DARE, PEDro, EMBASE and DocOnline were searched for controlled studies. Physical therapy was divided into 10 intervention categories, which were analysed separately. If statistical pooling (weighted summary effect sizes) was not possible due to lack of comparability between interventions, patient characteristics and measures of outcome, a bestresearch synthesis was performed. This best-research synthesis was based on methodological quality (PEDro score).Results: In total, 151 studies were included in this systematic review; 123 were randomized controlled trials (RCTs) and 28 controlled clinical trials (CCTs). Methodological quality of all RCTs had a median of 5 points on the 10-point PEDro scale (range 2–8 points). Based on high-quality RCTs strong evidence was found in f...

The impact of physical therapy on functional outcomes after stroke: what's the evidence?

Background and Purpose—Of all stroke survivors, 30% to 66% are unable to use their affected arm in performing activities of daily living. Although forced use therapy appears to improve arm function in chronic stroke patients, there is no conclusive evidence. This study evaluates the effectiveness of forced use therapy. Methods—In an observer-blinded randomized clinical trial, 66 chronic stroke patients were allocated to either forced use therapy (immobilization of the unaffected arm combined with intensive training) or a reference therapy of equally intensive bimanual training, based on Neuro-Developmental Treatment, for a period of 2 weeks. Outcomes were evaluated on the basis of the Rehabilitation Activities Profile (activities), the Action Research Arm (ARA) test (dexterity), the upper extremity section of the Fugl-Meyer Assessment scale, the Motor Activity Log (MAL), and a Problem Score. The minimal clinically important difference (MCID) was determined at the onset of the study. Results—One week after...

Forced Use of the Upper Extremity in Chronic Stroke Patients: Results From a Single-Blind Randomized Clinical Trial

https://www.archives-pmr.org/article/S0003-9993(00)66077-X/pdf

Task-related circuit training improves performance of locomotor tasks in chronic stroke: A randomized, controlled pilot trial ☆ ☆☆ ★ ★★

Stroke is one of the leading causes for disability worldwide. Motor function deficits due to stroke affect the patients’ mobility, their limitation in daily life activities, their participation in society and their odds of returning to professional activities. All of these factors contribute to a low overall quality of life. Rehabilitation training is the most effective way to reduce motor impairments in stroke patients. This multiple systematic review focuses both on standard treatment methods and on innovating rehabilitation techniques used to promote upper extremity motor function in stroke patients. A total number of 5712 publications on stroke rehabilitation was systematically reviewed for relevance and quality with regards to upper extremity motor outcome. This procedure yielded 270 publications corresponding to the inclusion criteria of the systematic review. Recent technology-based interventions in stroke rehabilitation including non-invasive brain stimulation, robot-assisted training and virtual reality immersion are addressed. Finally, a decisional tree based on evidence from the literature and characteristics of stroke patients is proposed. At present, the stroke rehabilitation field faces the challenge to tailor evidence-based treatment strategies to the needs of the individual stroke patient. Interventions can be combined in order to achieve the maximal motor function recovery for each patient. Though the efficacy of some interventions may be under debate, motor skill learning and some new technological approaches give promising outcome prognosis in stroke motor rehabilitation.

/pdf/rehabilitation-of-motor-function-after-stroke-a-multiple-5abvu0mwtg.pdf

Rehabilitation of Motor Function after Stroke: A Multiple Systematic Review Focused on Techniques to Stimulate Upper Extremity Recovery.

https://www.uni-bamberg.de/fileadmin/uni/fakultaeten/ppp_professuren/physiologische_psychologie/Publikation/Electrified_minds_Transcranial_direct_current_stimulation.pdf

Electrified minds: transcranial direct current stimulation (tDCS) and galvanic vestibular stimulation (GVS) as methods of non-invasive brain stimulation in neuropsychology--a review of current data and future implications.

A controlled trial of retraining of the sensory function of the hand was undertaken in hemiplegic patients after the period of spontaneous recovery. Twenty hemiplegic patients with sensory deficit in the hand, two or more years after stroke, received systematic retraining three times a week for six weeks. Sensation in the plegic hand was tested before and after this period in these patients and in 19 untreated control patients. The treated group showed large and significant gains on all sensory tests (P < 0.001), while no change occurred in the control group. It is concluded that somatosensory deficit can be alleviated even years after stroke and that rehabilitation for stroke patients should include sensory retraining for those with sensory deficit.

https://jnnp.bmj.com/content/jnnp/56/3/241.full.pdf

M Yekutiel

Papers

A controlled trial of the retraining of the sensory function of the hand in stroke patients.