The impact of physical therapy on functional outcomes after stroke: What’s the evidence?
ABSTRACT To determine the evidence for physical therapy interventions aimed at improving functional outcome after stroke.
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 best-research synthesis was performed. This best-research synthesis was based on methodological quality (PEDro score).
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 favour of task-oriented exercise training to restore balance and gait, and for strengthening the lower paretic limb. Summary effect sizes (SES) for functional outcomes ranged from 0.13 (95% Cl 0.03-0.23) for effects of high intensity of exercise training to 0.92 (95% Cl 0.54-1.29) for improving symmetry when moving from sitting to standing. Strong evidence was also found for therapies that were focused on functional training of the upper limb such as constraint-induced movement therapy (SES 0.46; 95% Cl 0.07-0.91), treadmill training with or without body weight support, respectively 0.70 (95% Cl 0.29-1.10) and 1.09 (95% Cl 0.56-1.61), aerobics (SES 0.39; 95% Cl 0.05-0.74), external auditory rhythms during gait (SES 0.91; 95% Cl 0.40-1.42) and neuromuscular stimulation for glenohumeral subluxation (SES 1.41; 95% Cl 0.76-2.06). No or insufficient evidence in terms of functional outcome was found for: traditional neurological treatment approaches; exercises for the upper limb; biofeedback; functional and neuromuscular electrical stimulation aimed at improving dexterity or gait performance; orthotics and assistive devices; and physical therapy interventions for reducing hemiplegic shoulder pain and hand oedema.
This review showed small to large effect sizes for task-oriented exercise training, in particular when applied intensively and early after stroke onset. In almost all high-quality RCTs, effects were mainly restricted to tasks directly trained in the exercise programme.
Full-textDOI: · Available from: Erik JM Hendriks, Nov 26, 2014
- SourceAvailable from: Philippe Marque
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- "First of all these different studies continuously backed-up the evidence of the effectiveness of rehabilitation on post-stroke motor recovery: today 467 controlled studies on this topic have been identified amounting to 25,373 patients . Rehabilitation care can improve the recovery of lower limb    and upper limb   impairments, gait  and balance  , as well as autonomy in activities of daily living    . "
ABSTRACT: La réadaptation des patients victimes d’AVC a connu une véritable révolution au cours des 3 dernières décennies. Les études de cohortes ont toujours souligné l’intérêt de la réadaptation après un AVC pour stimuler la récupération, mais les concepts des méthodes empiriques initialement proposées par les thérapeutes pour rééduquer ces patients n’ont pas résisté à l’analyse clinique critique. Parallèlement, les travaux de neuroimagerie fonctionnelle et les modèles animaux ont permis tout d’abord d’objectiver les mécanismes de la récupération fonctionnelle, puis d’en comprendre les limites ainsi que les modalités d’amélioration. Ces découvertes des neurosciences sont les bases sans lesquelles on ne peut pas comprendre l’apparition des nouvelles technologies : robotique et réalité virtuelle. Cette revue de la littérature se propose de faire une sélection de ces travaux clés qui permettent de mieux comprendre les propositions actuelles.Annals of Physical and Rehabilitation Medicine 08/2014; 57(8). DOI:10.1016/j.rehab.2014.08.004
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- "In our experience, RR for UL offers a positive result in neurorehabilitation training, particularly from severe to moderate impaired chronic stroke patients (Bovolenta et al., 2009, 2011). According to many papers, an efficient rehabilitative treatment must be intensive and specific, repetitive, functional, and motivating for the individual to allow a continuous enhancement in the process of learning, acquisition, and generalization (Fasoli et al., 2004; Van Peppen et al., 2004; Krakauer, 2006; Huang and Krakauer, 2009; Mehrholz et al., 2012). As a technology-based tool, RR devices have a number of inherent advantages over conventional, largely manually assisted therapy. "
ABSTRACT: The aim of this study was to determine short-term and long-term changes in motor function in patients with chronic hemiparesis who underwent robot training and to evaluate its long-term benefit after 6 months. This was a longitudinal study with a 6-month follow-up. The 15 patients included in this study underwent the Fugl-Meyer test, the Ashworth Scale test, the Frenchay Arm test, and the Box and Block test according to the following schedule: immediately before (T1, T3) and after each treatment (T2, T4), and 6 months after T4 (T5). There were statistically significant improvements in Fugl-Meyer test between T1 and T2 and between T1 and T4; the score increased in the Ashworth Scale test for Shoulder between T1 and T3 and between T1 and T5; a statistically significant decrease was found between T1 and T2 and between T1 and T4, in the Box and Block test between T1 and T4, and also between T1 and T5. This original rehabilitation treatment may contribute toward increasing upper limb motor recovery in stable chronic stroke patients. (C) 2014 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation 10/2013; 37(1). DOI:10.1097/MRR.0000000000000036 · 1.14 Impact Factor
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- "Indeed, following a rhythm has been proved to be an effective method to improve gait performance (especially walking speed) of patients affected by Parkinson's disease [McIntosh et al. 1997; Rubinstein et al. 2002; Lim et al. 2005], strokes [Thaut et al. 1993; Thaut et al.1997; Van Peppen et al. 2004; Hayden et al. 2009], multiple sclerosis [Conklyn et al. 2010], and cerebral palsy [Kwak 2007; Kim et al. 2011]. Similarly, there is a growing body of research exploring the effects of interactive auditory feedback while walking in the clinical population, although the study of such rehabilitation techniques in motor therapy is still in its infancy. "
ABSTRACT: This article investigates whether auditory feedback affects natural locomotion patterns. Individuals were provided with footstep sounds simulating different surface materials. The sounds were interactively generated using shoes with pressure sensors. Results showed that subjects' walking speed changed as a function of the type of simulated ground material. This effect may arise due to the presence of conflicting information between the auditory and foot-haptic modality, or because of an adjustment of locomotion to the physical properties evoked by the sounds simulating the ground materials. The results reported in this study suggest that auditory feedback may be more important in the regulation of walking in natural environments than has been acknowledged. Furthermore, auditory feedback could be used to develop novel approaches to the design of therapeutic and rehabilitation procedures for locomotion.ACM Transactions on Applied Perception 10/2013; 10(4-4):23:1-23:14. DOI:10.1145/2536764.2536770 · 1.05 Impact Factor