Purpose of reviewMuch of neurorehabilitation rests on the assumption that patients can improve with practice. This review will focus on arm movements and address the following questions: (i) What is motor learning? (ii) Do patients with hemiparesis have a learning deficit? (iii) Is recovery after in

https://www.jsmf.org/meetings/2008/may/Krakauer_COIN(2006).pdf

Motor learning: its relevance to stroke recovery and neurorehabilitation.

Stroke patients have impaired physical fitness and this may exacerbate their disability. It is not known whether improving physical fitness after stroke reduces disability. Objectives The primary aims were to establish whether physical fitness training reduces death, dependence and disability after stroke. The secondary aims included an investigation of the effects of fitness training on secondary outcome measures (including, physical fitness, mobility, physical function, health and quality of life, mood and the incidence of adverse events). Randomised controlled trials were included when an intervention represented a clear attempt to improve either muscle strength and/or cardiorespiratory fitness, and whose control groups comprised either usual care or a non-exercise intervention. A total of 12 trials were included in the review. No trials reported death and dependence data. Two small trials reporting disability showed no evidence of benefit. The remaining available secondary outcome data suggest that cardiorespiratory training improves walking ability (mobility). Observed benefits appear to be associated with specific or 'task-related' training.

/pdf/physical-fitness-training-for-stroke-patients-29s61ki4l4.pdf

Physical fitness training for stroke patients

Graeme J. Hankey MD, FRCP Section Editor 

The inclusion of active practice of task-specific motor activities is popular in therapy approaches to stroke rehabilitation.

The objective of this review was to determine if repetitive task training after stroke improves global, upper, or lower limb function and if treatment effects are influenced by the amount, type, or timing of practice.

We searched the Cochrane Stroke Trials Register (to October 2006); The Cochrane Library, MEDLINE, EMBASE, CINAHL, AMED, SportDiscus, Science Citation Index, Index to Theses, ZETOC, PEDro, and OT Seeker (all to September 2006); and OT search (to March 2006). We also searched for unpublished/non-English language trials; combed conference proceedings and reference lists; requested information on bulletin boards; and contacted trial authors.

Selection …

/pdf/repetitive-task-training-for-improving-functional-ability-27q1d8zshw.pdf

Repetitive task training for improving functional ability after stroke

Purpose. There is little guidance on using extrinsic feedback to enhance motor learning after stroke. This narrative review synthesises research findings and identifies questions remaining to be answered. Method. A summary is given relating to the use of extrinsic feedback in healthy subjects. Then, research concerning content of feedback, feedback scheduling, and attentional focus is discussed in relation to patients with stroke. Results. Though research is scarce, preliminary key findings were as follows: Patients’ balance performance can improve from receiving visual feedback about weight distribution during practice; auditory feedback of force production may improve performance of sit-to-stand; providing feedback on less than 100% of trials, and giving summary or average feedback may enhance learning; instructions or feedback inducing an external focus may be more effective than those with an internal focus. Further research is needed concerning the relative benefits of verbal, visual, video and kinematic feedback; reduced feedback frequencies and summary feedback schedules; feedback delays, error estimation, and self-controlled feedback; and attentional focus of feedback. Conclusions. Although there are some indications that feedback might enhance motor learning after stroke, there are many areas as yet not examined and there is clearly a need for considerable research in this area.

/pdf/extrinsic-feedback-for-motor-learning-after-stroke-what-is-4bmsyie16q.pdf

Extrinsic feedback for motor learning after stroke: What is the evidence?

Background and Purpose— Occupational therapy (OT) is an important aspect of stroke rehabilitation. The objective of this study was to determine from the available literature whether OT interventions improve outcome for stroke patients. Methods— An extensive search in MEDLINE, CINAHL, EMBASE, AMED, and SCISEARCH was performed. Studies with controlled and uncontrolled designs were included. Seven intervention categories were distinguished and separately analyzed. If a quantitative approach (meta-analysis) of data analysis was not appropriate, a qualitative approach (best-evidence synthesis), based on the type of design, methodological quality, and significant findings of outcome and/or process measures, was performed. Results— Thirty-two studies were included in this review, of which 18 were randomized controlled trials. Ten randomized controlled trials had a high methodological quality. For the comprehensive OT intervention, the pooled standardized mean difference for primary activities of daily living (AD...

/pdf/occupational-therapy-for-stroke-patients-a-systematic-review-3rx6jrs76u.pdf

Occupational Therapy for Stroke Patients A Systematic Review

https://www.archives-pmr.org/article/S0003-9993(01)02885-4/pdf

Thomas Winter

Papers

Arm ability training for stroke and traumatic brain injury patients with mild arm paresis: A single-blind, randomized, controlled trial