Review of the randomized clinical stroke rehabilitation trials in 2009

Department of Neurology, Veterans Affairs Medical Center, Oklahoma University, Oklahoma City, OK 73104, USA.
Medical science monitor: international medical journal of experimental and clinical research (Impact Factor: 1.43). 02/2011; 17(2):RA25-43. DOI: 10.12659/MSM.881382
Source: PubMed


Recent review of the available evidence on interventions for motor recovery after stroke, showed that improvements in recovery of arm function were seen for constraint-induced movement therapy, electromyographic biofeedback, mental practice with motor imagery, and robotics. Similar improvement in transfer ability or balance were seen with repetitive task training, biofeedback, and training with a moving platform. Walking speed was improved by physical fitness training, high-intensity physiotherapy and repetitive task training. However, most of these trials were small and had design limitations.
In this article, randomized control trials (RCT's) published in 2009 of rehabilitation therapies for acute (≤ 2 weeks), sub-acute (2 to 12 weeks) and chronic (≥ 12 weeks) stroke was reviewed. A Medline search was performed to identify all RCT's in stroke rehabilitation in the year 2009. The search strategy that was used for PubMed is presented in the Appendix 1. The objective was to examine the effectiveness of these treatment modalities in stroke rehabilitation.
This generated 35 RCT's under 5 categories which were found and analyzed. The methodological quality was assessed by using the PEDro scale for external and internal validity.
These trials were primarily efficacy studies. Most of these studies enrolled small numbers of patient which precluded their clinical applicability (limited external validity). However, the constraint induced movement therapy (CIT), regularly used in chronic stroke patients did not improve affected arm-hand function when used in acute stroke patients at ≤ 4 weeks. Intensive CIT did not lead to motor improvement in arm-hand function. Robotic arm treatment helped decrease motor impairment and improved function in chronic stroke patients only. Therapist provided exercise programs (when self-administered by patients during their off-therapy time in a rehabilitation setting) did improve arm-hand function. Tai Chi exercises helped improve balance and weight bearing. Exercise programs for community dwelling stroke patient helped maintain and even improve their functional state.

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Available from: Meheroz H Rabadi, Sep 23, 2014
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    • "Presumably, if the use of the peroneal nerve stimulator has a therapeutic effect on functional performance , physiological changes should also be observed. Yet, research on investigating the physiological changes and the associated functional changes is scarce [5]. Further clinical trials are thus necessary to investigate the physiological changes occurring in the motor cortex, muscle function, and improvement in gait. "
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    ABSTRACT: Objective: The aim of this study was to evaluate the effectiveness of Cognitive Sensory Motor Training Therapy (Perfetti's method) vis-à-vis conventional occupational therapy in the recovery of arm function after acute stroke.Design: Prospective randomized controlled trial.Setting: Two rehabilitation centers in Bangkok, Thailand.Subjects: Forty first-time acute stroke patients without severe cognitive or language impairment.Intervention: All subjects were randomly divided into two groups; one was treated using Perfetti's method and the other using conventional occupational therapy. Each group underwent therapy for 30 minutes, five times a week for four weeks.Main measures: The primary variable was arm function as assessed by the Action Research Arm Test; secondary variables were the extended Barthel Index and the box and block test score.Results: The intention-to-treat analysis revealed no statistically significant differences between the two groups at the end of treatment for any variable.Conclusions: There was no evidence of a difference between Cognitive Sensory Motor Training Therapy of Perfetti's method and conventional occupational therapy with respect to the restoration of hand and arm function after a stroke.
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