Posts Tagged review

[Abstract] Home program practices for supporting and measuring adherence in post-stroke rehabilitation: a scoping review

ABSTRACT

Background

After stroke, individuals face a variety of impairments that impact function. Increasingly, rehabilitation for these impairments has moved into the community and home settings through the use of home programs. However, adherence to these programs is often low, limiting effectiveness.

Objective

This scoping review investigated home program implementation and measurement of adherence with persons post-stroke to identify commonly reported practices and determine areas for further research.

Methods

The electronic databases of PubMed, CINAHL, Scopus, Cochrane Database of Systematic Reviews, and PEDro were searched. Studies focused on post-stroke rehabilitation with an independent home program were selected. Qualitative studies, commentaries, and single-case studies were excluded. Title and abstract screenings were completed by two reviewers with a third for tie-breaking. The full-text review was completed by two reviewers using consensus to resolve any differences. Of the 1,197 articles initially found only 6% (n = 70) met criteria for data extraction. Elements for data extraction included: type of study, area of intervention, description of home program, presence of strategies to support adherence, methods to measure adherence and reported adherence.

Results

Most commonly reported strategies to support home practice were the use of technology, personalization, and written directions. Only 20 studies reported achieving adherence at or greater than 75% and 18 studies did not report adherence outcomes.

Conclusions

Future investigations that directly compare and identify the most effective strategies to support adherence to home programs for this population are warranted. The implementation of guidelines for reporting adherence to home programs is recommended.

Source: https://www.tandfonline.com/doi/full/10.1080/10749357.2019.1707950?scroll=top&needAccess=true

, , , , , ,

Leave a comment

[BOOK] Oxford Handbook of Rehabilitation Medicine – Review

Reviewed by: Stephen Halpin, Senior Clinical Research Fellow and Consultant in Rehabilitation Medicine, Academic Department of Rehabilitation Medicine, University of Leeds.


In the best tradition of Oxford Handbooks, this is a small book that packs a heavy punch. This third edition represents a significant expansion in scope and detail compared to the second edition of 2009. With over 650 pages miraculously compressed into less than two and a half centimetres, this edition adeptly fulfils its role in providing for jobbing clinicians a succinct, easily navigable overview of key clinical topics at their fingertips.

The volume is structured in two sections, the first of which ‘Common Clinical Approaches’ provides 25 chapters on cross-cutting areas from Communication, to Chronic Pain, Sexual Function and Mobility and Gait. Section 2 addresses ‘Condition-Specific Approaches’ in 16 chapters including Traumatic Brain Injury, Multiple Sclerosis, Prolonged Disorders of Consciousness and Amputee Rehabilitation. Where there is overlap, this is usefully signposted within the text, directing the reader to other relevant chapters. The text is helpfully presented, easy to scan and interspersed with many useful illustrations and diagrams.

The devotion of two chapters to musculoskeletal conditions, as well as the inclusion of Cancer Rehabilitation and Geriatric Rehabilitation reflects the editors’ timely desire to see the focus of rehabilitation as a medical specialty in the UK broaden to address conditions of greatest population burden. They will also be useful to rehabilitation practitioners in the traditional areas of neurological and spinal cord rehabilitation who find themselves working with increasingly complex conditions and co-morbidities.

Between the second and third editions the title has shifted from Clinical Rehabilitation to Rehabilitation Medicine, which is indicative of a change of emphasis towards greater rigorous pathophysiological detail and is accompanied by an authoritative, brisk editorial style. Medics, from students and junior doctors to specialists in Rehabilitation Medicine (but also Geriatrics, Neurology, Stroke Medicine and beyond) will be the main users of this handbook, but it also has much to offer to the whole multi-professional rehabilitation team.

The chapter authors are largely drawn from the UK and Australia, and sections on models of care and organisation of services reflect those settings. Inevitably, some details have already been superseded by new guidelines, for example that in TIA risk stratification, but in general this edition does an excellent job of succinctly bringing the reader up to date, and signposting further reading.

In its main aim of concisely presenting both the core principles and practical clinical details of Rehabilitation Medicine practice across an expanded scope of conditions, this handbook has certainly succeeded and it will undoubtedly become a familiar sight in MDT rooms and doctors’ offices across the rehabilitation landscape.

via Oxford Handbook of Rehabilitation Medicine. 3rd Edition – ACNR | Paper & Online Neurology Journal ACNR | Paper & Online Neurology Journal

, ,

Leave a comment

[ARTICLE] Effect of Specific Over Nonspecific VR-Based Rehabilitation on Poststroke Motor Recovery: A Systematic Meta-analysis – Full Text

Abstract

Background. Despite the rise of virtual reality (VR)-based interventions in stroke rehabilitation over the past decade, no consensus has been reached on its efficacy. This ostensibly puzzling outcome might not be that surprising given that VR is intrinsically neutral to its use—that is, an intervention is effective because of its ability to mobilize recovery mechanisms, not its technology. As VR systems specifically built for rehabilitation might capitalize better on the advantages of technology to implement neuroscientifically grounded protocols, they might be more effective than those designed for recreational gaming.

Objective. We evaluate the efficacy of specific VR (SVR) and nonspecific VR (NSVR) systems for rehabilitating upper-limb function and activity after stroke. Methods. We conducted a systematic search for randomized controlled trials with adult stroke patients to analyze the effect of SVR or NSVR systems versus conventional therapy (CT).

Results. We identified 30 studies including 1473 patients. SVR showed a significant impact on body function (standardized mean difference [SMD] = 0.23; 95% CI = 0.10 to 0.36; P = .0007) versus CT, whereas NSVR did not (SMD = 0.16; 95% CI = −0.14 to 0.47; P = .30). This result was replicated in activity measures.

Conclusions. Our results suggest that SVR systems are more beneficial than CT for upper-limb recovery, whereas NSVR systems are not. Additionally, we identified 6 principles of neurorehabilitation that are shared across SVR systems and are possibly responsible for their positive effect. These findings may disambiguate the contradictory results found in the current literature.

Introduction

Better medical treatments in the acute phase after stroke have increased survival and with that the number of patients needing rehabilitation with an associated increased burden on the health care system. Novel technologies have sought to meet this increased rehabilitation demand and to potentially allow patients to continue rehabilitation at home after they leave the hospital. Also, technology has the potential to gather massive and detailed data (eg, kinematic and performance data) that might be useful in understanding recovery after stroke better, improving the quality of diagnostic tools and developing more successful treatment approaches. Given these promises, several studies and meta-analyses have evaluated the effectiveness of technologies that use virtual reality (VR) in stroke rehabilitation. In a first review, Crosbie et al analyzed 6 studies that used VR to provide upper-limb rehabilitation. Although they found a positive effect, they concluded that the evidence was only weak to moderate given the low quality of the research. A later meta-analysis analyzing 5 randomized controlled trials (RCTs) and 7 observational studies suggested a positive effect on a patient’s upper-limb function after training. Another meta-analysis of 26 studies by Lohse et al, which compared specific VR (SVR) systems with commercial VR games, found a significant benefit for SVR systems as compared with conventional therapy (CT) in both body function and activity but not between the 2 types of systems. This study, however, included a variety of systems that would treat upper-limb, lower-limb, and cognitive deficits. Saywell et al analyzed 30 “play-based” interventions, such as VR systems including commercial gaming consoles, rehabilitation tools, and robot-assisted systems. They found a significant effect of play-based versus control interventions in dose-matched studies in the Fugl-Meyer Assessment of the Upper Extremity (FM-UE). In contrast, a more recent large-scale analysis of a study with Nintendo Wii–based video games, including 121 patients concluded that recreational activities are as effective as VR. A later review evaluated 22 randomized and quasi–randomized controlled studies and concluded that there is no evidence that the use of VR and interactive video gaming is more beneficial in improving arm function than CT. In all, 31% of the included studies tested nonspecific VR (NSVR) systems (Nintendo Wii, Microsoft Xbox Kinect, Sony PlayStation EyeToy). Hence, although VR-based interventions have been in use for almost 2 decades, their benefit for functional recovery, especially for the upper limb, remains unknown. Possibly, these contradictory results indicate that, at present, studies are too few or too small and/or the recruited participants too variable to be conclusive. However, alternative conclusions can be drawn. First, VR is an umbrella term. Studies comparing its impact often include heterogeneous systems or technologies, customized or noncustomized for stroke treatment, addressing a broad range of disabilities. However, effectiveness can only be investigated if similar systems that rehabilitate the same impairment are contrasted. This has been achieved by meta-analyses that investigated VR-based interventions for the lower limb, concluding that VR systems are more effective in improving balance or gait than CT. Second, a clear understanding of the “active ingredients” that should make VR interventions effective in promoting recovery is missing. Therapeutic advantages of VR identified in current meta-analyses are that it might apply principles relevant to neuroplasticity,, such as providing goal-oriented tasks,, increasing repetition and dosage,, providing therapists and patients with additional feedback,,, and allowing to adjust task difficulty. In addition, it has been suggested that the use of VR increases patient motivation, enjoyment,, and engagement; makes intensive task-relevant training more interesting,; and offers enriched environments. Although motivational aspects are important in the rehabilitation process because they possibly increase adherence, their contribution to recovery is difficult to quantify because it relies on patients’ subjective evaluation., Rehabilitation methods, whether VR or not, however, need to be objectively beneficial in increasing the patient’s functional ability. Hence, an enormous effort has been expended to identify principles of neurorehabilitation that enhance motor learning and recovery. Consequently, an effective VR system should besides be motivating, also augment CT by applying these principles in the design. Following this argument, we advance the hypothesis that custom-made VR rehabilitation systems might have incorporated these principles, unlike off-the-shelf VR tools, because they were created for recreational purposes. Combining the effects of both approaches in one analysis might, thus, mask their real impact on recovery. Again, in the rehabilitation of the lower limb, this effect has been observed. Two meta-analyses investigating the effect of using commercial VR systems for gait and balance training did not find a superior effect, which contradicts the conclusions of the other systematic reviews. In upper-limb rehabilitation, this question has not been properly addressed until the most recent review by Aminov et al. However, there are several flaws in the method applied that could invalidate the results they found. Specifically, studies were included regardless of their quality, and it is not clear which outcome measurements were taken for the analysis according to the World Health Organization’s International Classification of Function, Disability, and Health (ICF-WHO). In addition, a specifically designed rehabilitation system (Interactive Rehabilitation Exercise [IREX]) was misclassified as an off-the-shelf VR tool. Because their search concluded in June 2017, the more recent evidence is missing. We decided to address these issues by conducting a well-controlled meta-analysis that focuses only on RCTs that use VR technologies for the recovery of the upper limb after stroke. We analyze the effect of VR systems specifically built for rehabilitation (ie, SVR systems) and off-the-shelf systems (ie, NSVR commercial systems) against CT according to the ICF-WHO categories. Also, we extracted 11 principles of motor learning and recovery from established literature that could act as “active ingredients” in the protocols of effective VR systems. Through a content analysis, we identified which principles are present in the included studies and compared their presence between SVR and NSVR systems. We hypothesized, first, that SVR systems might be more effective than NSVR systems as compared with CT in the recovery of upper-limb movement and, second, that this superior effect might be a result of the specific principles included in SVR systems.[…]

 

Continue —->  Effect of Specific Over Nonspecific VR-Based Rehabilitation on Poststroke Motor Recovery: A Systematic Meta-analysis

, , , , , , , , , ,

Leave a comment

[ARTICLE] Effect of Specific Over Nonspecific VR-Based Rehabilitation on Poststroke Motor Recovery: A Systematic Meta-analysis – Full Text

Background. Despite the rise of virtual reality (VR)-based interventions in stroke rehabilitation over the past decade, no consensus has been reached on its efficacy. This ostensibly puzzling outcome might not be that surprising given that VR is intrinsically neutral to its use—that is, an intervention is effective because of its ability to mobilize recovery mechanisms, not its technology. As VR systems specifically built for rehabilitation might capitalize better on the advantages of technology to implement neuroscientifically grounded protocols, they might be more effective than those designed for recreational gaming.

Objective. We evaluate the efficacy of specific VR (SVR) and nonspecific VR (NSVR) systems for rehabilitating upper-limb function and activity after stroke. Methods. We conducted a systematic search for randomized controlled trials with adult stroke patients to analyze the effect of SVR or NSVR systems versus conventional therapy (CT).

Results. We identified 30 studies including 1473 patients. SVR showed a significant impact on body function (standardized mean difference [SMD] = 0.23; 95% CI = 0.10 to 0.36; P = .0007) versus CT, whereas NSVR did not (SMD = 0.16; 95% CI = −0.14 to 0.47; P = .30). This result was replicated in activity measures.

Conclusions. Our results suggest that SVR systems are more beneficial than CT for upper-limb recovery, whereas NSVR systems are not. Additionally, we identified 6 principles of neurorehabilitation that are shared across SVR systems and are possibly responsible for their positive effect. These findings may disambiguate the contradictory results found in the current literature.

Better medical treatments in the acute phase after stroke have increased survival and with that the number of patients needing rehabilitation with an associated increased burden on the health care system.1 Novel technologies have sought to meet this increased rehabilitation demand and to potentially allow patients to continue rehabilitation at home after they leave the hospital.2 Also, technology has the potential to gather massive and detailed data (eg, kinematic and performance data) that might be useful in understanding recovery after stroke better, improving the quality of diagnostic tools and developing more successful treatment approaches.3 Given these promises, several studies and meta-analyses have evaluated the effectiveness of technologies that use virtual reality (VR) in stroke rehabilitation. In a first review, Crosbie et al4 analyzed 6 studies that used VR to provide upper-limb rehabilitation. Although they found a positive effect, they concluded that the evidence was only weak to moderate given the low quality of the research. A later meta-analysis analyzing 5 randomized controlled trials (RCTs) and 7 observational studies suggested a positive effect on a patient’s upper-limb function after training.5 Another meta-analysis of 26 studies by Lohse et al,6 which compared specific VR (SVR) systems with commercial VR games, found a significant benefit for SVR systems as compared with conventional therapy (CT) in both body function and activity but not between the 2 types of systems. This study, however, included a variety of systems that would treat upper-limb, lower-limb, and cognitive deficits. Saywell et al7 analyzed 30 “play-based” interventions, such as VR systems including commercial gaming consoles, rehabilitation tools, and robot-assisted systems. They found a significant effect of play-based versus control interventions in dose-matched studies in the Fugl-Meyer Assessment of the Upper Extremity (FM-UE).7 In contrast, a more recent large-scale analysis of a study with Nintendo Wii–based video games, including 121 patients concluded that recreational activities are as effective as VR.8A later review evaluated 22 randomized and quasi–randomized controlled studies and concluded that there is no evidence that the use of VR and interactive video gaming is more beneficial in improving arm function than CT.9 In all, 31% of the included studies tested nonspecific VR (NSVR) systems (Nintendo Wii, Microsoft Xbox Kinect, Sony PlayStation EyeToy). Hence, although VR-based interventions have been in use for almost 2 decades, their benefit for functional recovery, especially for the upper limb, remains unknown. Possibly, these contradictory results indicate that, at present, studies are too few or too small and/or the recruited participants too variable to be conclusive.10 However, alternative conclusions can be drawn. First, VR is an umbrella term. Studies comparing its impact often include heterogeneous systems or technologies, customized or noncustomized for stroke treatment, addressing a broad range of disabilities. However, effectiveness can only be investigated if similar systems that rehabilitate the same impairment are contrasted. This has been achieved by meta-analyses that investigated VR-based interventions for the lower limb, concluding that VR systems are more effective in improving balance or gait than CT.11Second, a clear understanding of the “active ingredients”3 that should make VR interventions effective in promoting recovery is missing. Therapeutic advantages of VR identified in current meta-analyses are that it might apply principles relevant to neuroplasticity,5,9 such as providing goal-oriented tasks,5,9 increasing repetition and dosage,5,9 providing therapists and patients with additional feedback,5,6,9 and allowing to adjust task difficulty.6 In addition, it has been suggested that the use of VR increases patient motivation,6 enjoyment,8,9 and engagement7; makes intensive task-relevant training more interesting4,7; and offers enriched environments.9 Although motivational aspects are important in the rehabilitation process because they possibly increase adherence,3 their contribution to recovery is difficult to quantify because it relies on patients’ subjective evaluation.7,1215 Rehabilitation methods, whether VR or not, however, need to be objectively beneficial in increasing the patient’s functional ability. Hence, an enormous effort has been expended to identify principles of neurorehabilitation that enhance motor learning and recovery.1624 Consequently, an effective VR system should besides be motivating, also augment CT by applying these principles in the design.23 Following this argument, we advance the hypothesis that custom-made VR rehabilitation systems might have incorporated these principles, unlike off-the-shelf VR tools, because they were created for recreational purposes. Combining the effects of both approaches in one analysis might, thus, mask their real impact on recovery. Again, in the rehabilitation of the lower limb, this effect has been observed. Two meta-analyses investigating the effect of using commercial VR systems for gait and balance training did not find a superior effect, which contradicts the conclusions of the other systematic reviews.11 In upper-limb rehabilitation, this question has not been properly addressed until the most recent review by Aminov et al.25 However, there are several flaws in the method applied that could invalidate the results they found. Specifically, studies were included regardless of their quality, and it is not clear which outcome measurements were taken for the analysis according to the World Health Organization’s International Classification of Function, Disability, and Health (ICF-WHO).26 In addition, a specifically designed rehabilitation system (Interactive Rehabilitation Exercise [IREX])27 was misclassified as an off-the-shelf VR tool. Because their search concluded in June 2017, the more recent evidence is missing. We decided to address these issues by conducting a well-controlled meta-analysis that focuses only on RCTs that use VR technologies for the recovery of the upper limb after stroke. We analyze the effect of VR systems specifically built for rehabilitation (ie, SVR systems) and off-the-shelf systems (ie, NSVR commercial systems) against CT according to the ICF-WHO categories. Also, we extracted 11 principles of motor learning and recovery from established literature that could act as “active ingredients” in the protocols of effective VR systems. Through a content analysis, we identified which principles are present in the included studies and compared their presence between SVR and NSVR systems. We hypothesized, first, that SVR systems might be more effective than NSVR systems as compared with CT in the recovery of upper-limb movement and, second, that this superior effect might be a result of the specific principles included in SVR systems.

 

This meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.28

Identification of RCTs

We define VR as a computer-based technology that provides the user with a sense of presence in a virtual environment,29 which is induced by exposing the user to computer-generated sources of sensory stimulation that satisfy their perceptual predictions and expected sensorimotor contingencies.30 The studies included aimed at training the upper extremity of stroke patients through active participation, without assistive robotic devices (eg, exoskeleton, end-effector devices) or exogenous stimulation. We compared the impact on body function and activity of 2 kinds of VR systems with CT: SVR and NSVR systems. SVR systems were developed exclusively for neurorehabilitation purposes. NSVR systems, on the other hand, are recreational and/or off-the-shelf video games (eg, Nintendo Wii, Microsoft Xbox). As CT, we considered occupational therapy and physical therapy. To identify all RCTs in these 2 categories, we performed a computerized search in the bibliographic databases MEDLINE (OVID), Cochrane Library Plus (including EMBASE), CINAHL, APA PsycNET, DARE, and PEDro for studies that were published in English from inception until August 7, 2018, the day of the conclusion of the search. The search strategy (Supplementary Table 1) included only RCTs that tested the efficacy of SVR or NSVR systems in recovering the upper limbs of stroke patients who were either in the acute (up to 21 days poststroke), subacute (between 3 weeks and 3 months poststroke), or chronic (after 3 months poststroke) stage. We combined the effects of various chronicity bands because the current literature suggests that principles of motor learning interact constantly with the biological processes of recovery,31 and therefore, no differential effect between SVR and NSVR systems resulting from chronicity should be expected. This notion has also been confirmed by the latest meta-analysis.25 In addition, splitting the identified literature into VR type, ICF-WHO category, and chronicity reduces statistical power because of the small number of studies remaining in each band. Two reviewers (BRB and MM) assessed the studies for eligibility. We excluded studies that were not carried out on humans, lacked a control group, included less than 5 participants per experimental condition, did not target upper-extremity rehabilitation, used exoskeletons as interfaces, used exogenous stimulation (such as transcranial stimulation), or did not provide information on standard clinical scales (Figure 1). Exoskeletons and exogenous stimulation protocol where excluded for the passive or active support provided in the rehabilitation process that might lead to different outcomes.

                        figure

Figure 1. Study flow diagram (PRISMA). The selection process of identified randomized controlled trials.

[…]

 

Continue —>  Effect of Specific Over Nonspecific VR-Based Rehabilitation on Poststroke Motor Recovery: A Systematic Meta-analysis – Martina Maier, Belén Rubio Ballester, Armin Duff, Esther Duarte Oller, Paul F. M. J. Verschure, 2019

, , , , , , , , , , ,

Leave a comment

[ARTICLE] Rehabilitation of Motor Function after Stroke: A Multiple Systematic Review Focused on Techniques to Stimulate Upper Extremity Recovery – Full Text

Associated Data

Supplementary Materials

Abstract

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.

Introduction

The World Health Organization (WHO) estimates that stroke events in EU countries are likely to increase by 30% between 2000 and 2025 (Truelsen et al., ). The most common deficit after stroke is hemiparesis of the contralateral upper limb, with more than 80% of stroke patients experiencing this condition acutely and more than 40% chronically (Cramer et al., ). Common manifestations of upper extremity motor impairment include muscle weakness or contracture, changes in muscle tone, joint laxity, and impaired motor control. These impairments induce disabilities in common activities such as reaching, picking up objects, and holding onto objects (for a review on precision grip deficits, see Bleyenheuft and Gordon, ).

Motor paresis of the upper extremity may be associated with other neurological manifestations that affect the recovery of motor function and thus require focused therapeutic intervention. Deficits in somatic sensations (body senses such as touch, temperature, pain, and proprioception) after stroke are common with prevalence rates variously reported to be 11–85% (Carey et al., ; Yekutiel, ; Hunter, ). Functionally, the motor problems resulting from sensory deficits after stroke can be summarized as (1) impaired detection of sensory information, (2) disturbed motor tasks performance requiring somatosensory information, and (3) diminished upper extremity rehabilitation outcomes (Hunter, ). Sensation is essential for safety even if there is adequate motor recovery (Yekutiel, ). Also, up to 50% of patients experience pain of the upper extremity during the first year after stroke, especially shoulder pain and complex regional pain syndrome-type I (CRPS-type I), which may impede adequate early rehabilitation (Jönsson et al., ; Kocabas et al., ; Sackley et al., ; Lundström et al., ). Furthermore, joint subluxation and muscle contractures can lead to nociceptive musculoskeletal pain (de Oliveira et al., ). Among other complications of stroke the neglect syndrome (Ringman et al., ) and spasticity (Sommerfeld et al., ; Welmer et al., ) affect motor and functional outcomes.

The neurological recovery after stroke displays a nonlinear, logarithmic pattern (Figure (Figure1;1; Kwakkel et al., ; Langhorne et al., ). The greater part of recovery is reported to take place in the first 3 months following stroke (Wade et al., ). However, there is evidence that recovery is not limited to this time period; hand and upper extremity recovery has been reported many years after stroke (Carey et al., ; Yekutiel and Guttman, ). Improvement probably occurs through a complex combination of spontaneous and learning-dependent processes including: restitution, substitution, and compensation (Kwakkel et al., ; Langhorne et al., ). Until the third month after stroke onset, a variable spontaneous neurological recovery can be considered a confounder of rehabilitation intervention (Kwakkel et al., ). In the past, the observation of spontaneous recovery after stroke has misled some authors to believe that recovery of upper extremity function is intrinsic and that little can be done by therapists to influence it (Wade et al., ; Heller et al., ). Progresses in functional outcome appearing after 3 months seem largely dependent on learning adaptation strategies (Kwakkel et al., ). Evidence suggests that neurological repair through brain reorganization supporting true recovery or, alternatively through compensation, may also take place in the subacute and chronic phase after stroke (Krakauer, ).

An external file that holds a picture, illustration, etc.Object name is fnhum-10-00442-g0001.jpg

Figure 1
Hypothetical pattern of recovery after stroke with timing of intervention strategies. The neurological recovery after stroke displays a nonlinear, logarithmic pattern. The greater part of recovery is reported to take place in the first three months following stroke. Rehabilitation interventions targeting at improving a stroke patients’ performance should be implemented according to the phase of neurological recovery. Reprinted from Langhorne et al. (), Copyright [2011] by Elsevier. Reprinted with permission.

[…]

 

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

, , , , , , , ,

Leave a comment

[Abstract] How is sexuality after stroke experienced by stroke survivors and partners of stroke survivors? A systematic review of qualitative studies

To synthesise how post-stroke sexuality is experienced by stroke survivors and partners of stroke survivors.

MEDLINE, PubMed, SCOPUS, CINAHL and PsycINFO were searched from inception to May 2018 using a combination of relevant Medical Subject Headings and Free Text Terms. Only papers published in English reporting original qualitative research were included. Methodological quality was assessed using the Critical Appraisal Skills Programme Qualitative Research Checklist. All text presented as ‘results’ or ‘findings’ in the included studies was extracted and subjected to a thematic analysis and synthesis which was discussed and agreed by the research team.

The initial search yielded 136 unique papers with a further 8 papers identified through reference checking. Following full-text review, 43 papers were included in the final synthesis. Two analytical themes were identified: sexuality is silenced and sexuality is muted and sometimes changed, but not forgotten. These themes were made up of six descriptive themes: struggle to communicate within relationships, health professionals don’t talk about sexuality, sexuality and disability is a taboo topic, changes to pre-stroke relationships, changed relationship with the stroke survivor’s own body and resuming sexual intimacy – adaptation and loss.

Stroke has a profound impact on how sexuality is experienced by both stroke survivors and partners of stroke survivors. Despite this, post-stroke sexuality is rarely discussed openly. Stroke survivors and partners value sexuality and may benefit from strategies to support adjustment to post-stroke sexuality.

via How is sexuality after stroke experienced by stroke survivors and partners of stroke survivors? A systematic review of qualitative studies – Margaret McGrath, Sandra Lever, Annie McCluskey, Emma Power, 2018

, , , , , ,

Leave a comment

[Abstract] Additional physical therapy services reduce length of stay and improve health outcomes in people with acute and sub-acute conditions: an updated systematic review and meta-analysis

Abstract

Objective

To update a previous review on whether additional physical therapy services reduce length of stay, improve health outcomes, are safe and cost effective for patients with acute or sub-acute conditions.

Data sources

Electronic database (AMED, CINAHL, EMBASE, MEDLINE, PEDro, PubMed) searches were updated from 2010 through June 2017.

Study selection

Randomized controlled trials evaluating additional physical therapy services on patient health outcomes, length of stay or cost effectiveness were eligible. Searching identified 1524 potentially relevant articles, of which 11 new articles from 8 new randomized controlled trials with 1563 participants were selected. In total, 24 randomized controlled trials with 3262 participants are included in this review.

Data extraction

Data were extracted using the form used in the original systematic review. Methodological quality was assessed using the PEDro scale and The Grading of Recommendation Assessment, Development and Evaluation (GRADE) approach was applied to each meta-analysis.

Data synthesis

Post intervention data were pooled with an inverse variance, random effects model to calculate standardized mean differences (SMDs) and 95% confidence intervals (CIs). There is moderate quality evidence that additional physical therapy services reduced length of stay by 3 days in sub-acute settings (MD-2.8, 95%CI -4.6 to -0.9, I20%) and low quality evidence that it reduced length of stay by 0.6 days in acute settings (MD -0.6, 95%CI -1.1 to 0.0, I2 65%). Additional physical therapy led to small improvements in self-care (SMD 0.11, 95%CI 0.03 to 0.19, I2 0%), activities of daily living (SMD 0.13, 95%CI 0.02 to 0.25, I2 15%) and health-related quality of life (SMD 0.12, 95%CI 0.03 to 0.21, I2 0%), with no increases in adverse events. There was no significant change in walking ability. One trial reported that additional physical therapy was likely to be cost-effective in sub-acute rehabilitation.

Conclusions

Additional physical therapy services improve patient activity and participation outcomes, while reducing hospital length of stay for adults. These benefits are likely safe and there is preliminary evidence to suggest they may be cost effective.

via Additional physical therapy services reduce length of stay and improve health outcomes in people with acute and sub-acute conditions: an updated systematic review and meta-analysis – Archives of Physical Medicine and Rehabilitation

, , , , , ,

Leave a comment

[Abstract] Rehabilitation Interventions for Upper Limb Function in the First Four Weeks Following Stroke: A Systematic Review and Meta-Analysis of the Evidence

Abstract

Objective

To investigate the therapeutic interventions reported in the research literature and synthesize their effectiveness in improving upper limb (UL) function in the first 4 weeks poststroke.

Data Sources

Electronic databases and trial registries were searched from inception until June 2016, in addition to searching systematic reviews by hand.

Study Selection

Randomized controlled trials (RCTs), controlled trials, and interventional studies with pre/posttest design were included for adults within 4 weeks of any type of stroke with UL impairment. Participants all received an intervention of any physiotherapeutic or occupational therapeutic technique designed to address impairment or activity of the affected UL, which could be compared with usual care, sham, or another technique.

Data Extraction

Two reviewers independently assessed eligibility of full texts, and methodological quality of included studies was assessed using the Cochrane Risk of Bias Tool.

Data Synthesis

A total of 104 trials (83 RCTs, 21 nonrandomized studies) were included (N=5225 participants). Meta-analyses of RCTs only (20 comparisons) and narrative syntheses were completed. Key findings included significant positive effects for modified constraint-induced movement therapy (mCIMT) (standardized mean difference [SMD]=1.09; 95% confidence interval [CI], .21–1.97) and task-specific training (SMD=.37; 95% CI, .05–.68). Evidence was found to support supplementary use of biofeedback and electrical stimulation. Use of Bobath therapy was not supported.

Conclusions

Use of mCIMT and task-specific training was supported, as was supplementary use of biofeedback and electrical simulation, within the acute phase poststroke. Further high-quality studies into the initial 4 weeks poststroke are needed to determine therapies for targeted functional UL outcomes.

 

via Rehabilitation Interventions for Upper Limb Function in the First Four Weeks Following Stroke: A Systematic Review and Meta-Analysis of the Evidence – Archives of Physical Medicine and Rehabilitation

, , , , , , , , ,

Leave a comment

[ARTICLE] Systematic Review of Appropriate Robotic Intervention for Gait Function in Subacute Stroke Patients – Full Text

Abstract

The purpose of this study was to critically evaluate the effects of robot-assisted gait training (RAGT) on gait-related function in patients with acute/subacute stroke. We conducted a systematic review of randomized controlled trials published between May 2012 and April 2016. This search included 334 articles (Cochrane, 51 articles; Embase, 175 articles; PubMed, 108 articles). Based on the inclusion and exclusion criteria, 7 studies were selected for this review. We performed a quality evaluation using the PEDro scale. In this review, 3 studies used an exoskeletal robot, and 4 studies used an end-effector robot as interventions. As a result, RAGT was found to be effective in improving walking ability in subacute stroke patients. Significant improvements in gait speed, functional ambulatory category, and Rivermead mobility index were found with RAGT compared with conventional physical therapy . Therefore, aggressive weight support and gait training at an early stage using a robotic device are helpful, and robotic intervention should be applied according to the patient’s functional level and onset time of stroke.

1. Introduction

Stroke is a common disease [1]. In most patients, disabilities remain after stroke, and long-lasting disability requires continuous management and intensive rehabilitation [12]. Furthermore, the economic burden on the patient increases because of the prolonged rehabilitation period. Therefore, the application of intensive and efficient rehabilitation programs and techniques is an urgent need after stroke [3].

Gait impairment is one of the most important problems after stroke and is associated with activities of daily living and mobility issues [4]. Therefore, recovery of gait function is an important goal of rehabilitation for independent living [5]. Interventions to enhance gait function require repetitive task training with high intensity, and extensive effort by physical therapists is essential [5]. Moreover, the most effective rehabilitation intervention, including gait training, must be performed shortly after stroke and in an intensive and task-oriented manner and should include multisensory stimulation [3].

Robot-assisted gait training (RAGT) for patients in the acute/subacute stage who are nonambulatory is effective at reeducating motor control function through repetitive training of a specific task [6]; RAGT provides intensive therapy, which reduces the burden on therapists, and enhances motor reeducation with multisensory stimulation [3]. Several previous studies reported that gait training using robotic devices is effective at enhancing muscular activity patterns [7], muscle tone, joint range of motion [8], gait speed, functional gait capability [79], gait independence, and mobility in the community [1011]. Moreover, patients who received RAGT and conventional physical therapy had a higher chance of regaining independent gait function than those who received only conventional gait training [12]. However, owing to studies that suggested RAGT is ineffective [13], the effect on gait and gait-related function in subacute stroke remains unclear. In a previous review of effectiveness in stroke patients, the RAGT group showed significant improvement in balance and balance-related activity function, but the comparison between the groups was not significant [14]. These results show that RAGT is effective, but whether it is more effective than other gait-related rehabilitation interventions is still unclear. In this context, the effect of RAGT is still not clearly demonstrated, and reviews that have recently demonstrated the effect of RAGT on gait-related outcome measures in patients with acute/subacute stroke are also limited.

Therefore, the aim of this systematic review was to investigate the effects of RAGT on acute/subacute stroke. The specific goals included identifying the effects of RAGT using assessment tools associated with gait and gait-related function in patients with acute/subacute stroke.[…]

Continue —>  Systematic Review of Appropriate Robotic Intervention for Gait Function in Subacute Stroke Patients

, , , , , , ,

Leave a comment

[ARTICLE] Cannabinoids in the Treatment of Epilepsy: Hard Evidence at Last? – Full Text PDF

The interest in cannabis-based products for the treatment of refractory epilepsy has skyrocketed in recent years. Marijuana and other cannabis products with high content in Δ(9) –tetrahydrocannabinol (THC), utilized primarily for recreational purposes, are generally unsuitable for this indication, primarily because THC is associated with many undesired effects. Compared with THC, cannabidiol (CBD) shows a better defined anticonvulsant profile in animal models and is largely devoid of adverse psychoactive effects and abuse liability. Over the years, this has led to an increasing use of CBD-enriched extracts in seizure disorders, particularly in children. Although improvement in seizure control and other benefits on sleep and behavior have been often reported, interpretation of the data is made difficult by the uncontrolled nature of these observations. Evidence concerning the potential anti-seizure efficacy of cannabinoids reached a turning point in the last 12 months, with the completion of three high-quality placebo-controlled adjunctive-therapy trials of a purified CBD product in patients with Dravet syndrome and Lennox-Gastaut syndrome. In these studies, CBD was found to be superior to placebo in reducing the frequency of convulsive (tonic-clonic, tonic, clonic, and atonic) seizures in patients with Dravet syndrome, and the frequency of drop seizures in patients with Lennox-Gastaut syndrome. For the first time, there is now class 1 evidence that adjunctive use of CBD improves seizure control in patients with specific epilepsy syndromes. Based on currently available information, however, it is unclear whether the improved seizure control described in these trials was related to a direct action of CBD, or was mediated by drug interactions with concomitant medications, particularly a marked increased in plasma levels of N-desmethylclobazam, the active metabolite of clobazam. Clarification of the relative contribution of CBD to improved seizure outcome requires re-assessment of trial data for the subgroup of patients not comedicated with clobazam, or the conduction of further studies controlling for the confounding effect of this interaction. (2017;7:61-76) […]

Full Text PDF 

, , , , , , , , ,

Leave a comment

%d bloggers like this: