Advancing the Evidence Base of Rehabilitation Treatments: A Developmental Approach

Whyte, John; Barrett, Anna M.

doi:10.1016/j.apmr.2011.11.040

Cited by 63 publications

(51 citation statements)

References 36 publications

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“…These events usually cause both cognitive and motor impairments, which interact (8). It is widely acknowledged that cognitive problems caused by stroke are strongly associated with later daily life disability such as limitations to community and social participation (9,10), and even minor strokes are associated with disabling hidden memory, spatial and mood disorders (11).…”

Section: Motor Function and Spatial Recoverymentioning

confidence: 99%

Spatial cognitive rehabilitation and motor recovery after stroke

Barrett

Muzaffar

2014

Current Opinion in Neurology

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Purpose of review Stroke rehabilitation needs to take major steps forward to reduce functional disability for survivors. In this article, we suggest that spatial retraining might greatly increase the efficiency and efficacy of motor rehabilitation, directly addressing the burden and cost of paralysis after stroke. Recent findings Combining motor and cognitive treatment may be practical, as well as addressing needs after moderate–to-severe stroke. Spatial neglect could suppress motor recovery and reduce motor learning, even when patients receive appropriate rehabilitation to build strength, dexterity, and endurance. Spatial neglect rehabilitation acts to promote motor as well as visual-perceptual recovery. These findings, and previous underemphasized studies, make a strong case for combining spatial neglect treatment with traditional exercise training. Spatial neglect therapies might also help people who cannot participate in intensive movement therapies because of limited strength and endurance after stroke. Summary Spatial retraining, currently used selectively after right brain stroke, may be broadly useful after stroke to promote rapid motor recovery.

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Section: Motor Function and Spatial Recoverymentioning

confidence: 99%

Spatial cognitive rehabilitation and motor recovery after stroke

Barrett

Muzaffar

2014

Current Opinion in Neurology

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“…Analysis of treatment outcomes might require simultaneous assessment in more than one setting: a failure to improve function could result from a treatment’s failure to act on the brain, a treatment’s failure to reduce impairment despite a decent brain effect, or an insensitive functional outcome measure that fails to demonstrate improvement despite reduction in clinical impairment. 102 …”

Section: Prism Adaptation Studiesmentioning

confidence: 99%

Prism adaptation for spatial neglect after stroke: translational practice gaps

2012

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Spatial neglect increases hospital morbidity and costs in around 50% of the 795,000 people per year in the USA who survive stroke, and an urgent need exists to reduce the care burden of this condition. However, effective acute treatment for neglect has been elusive. In this article, we review 48 studies of a treatment of intense neuroscience interest: prism adaptation training. Due to its effects on spatial motor ‘aiming’, prism adaptation training may act to reduce neglect-related disability. However, research failed, first, to suggest methods to identify the 50–75% of patients who respond to treatment; second, to measure short-term and long-term outcomes in both mechanism-specific and functionally valid ways; third, to confirm treatment utility during the critical first 8 weeks poststroke; and last, to base treatment protocols on systematic dose–response data. Thus, considerable investment in prism adaptation research has not yet touched the fundamentals needed for clinical implementation. We suggest improved standards and better spatial motor models for further research, so as to clarify when, how and for whom prism adaptation should be applied.

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“…4 Furthermore, sparse reporting on scientific methods (e.g., specification of active ingredients, manualization of procedures, definition and measurement of intervention fidelity, and development of valid and acceptable control or comparison conditions) impedes reproduction and weakens confidence in the robust nature of intervention in clinical practice. 4–7 To address these concerns, the Medical Research Council has published revised guidelines on the development and evaluation of complex interventions. 1 …”

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confidence: 99%

Developing complex interventions: lessons learned from a pilot study examining strategy training in acute stroke rehabilitation

et al. 2013

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Objective To examine the feasibility of a strategy training clinical trial in a small group of adults with stroke-related cognitive impairments in inpatient rehabilitation, and to explore the impact of strategy training on disability. Design Non-randomized two-group intervention pilot study Setting Two inpatient rehabilitation units within an academic health center Participants Individuals with a primary diagnosis of acute stroke, who were admitted to inpatient rehabilitation and demonstrated cognitive impairments were included. Individuals with severe aphasia; dementia; major depressive disorder, bipolar, or psychotic disorder; recent drug or alcohol abuse; and anticipated length of stay less than 5 days were excluded. Intervention Participants received strategy training or an attention control session in addition to usual rehabilitation care. Sessions in both groups were 30–40 minutes daily, 5 days per week, for the duration of inpatient rehabilitation. Main Outcome Measures We assessed feasibility through participants’ recruitment and retention; research intervention session number and duration; participants’ comprehension and engagement; intervention fidelity; and participants’ satisfaction. We assessed disability at study admission, inpatient rehabilitation discharge, 3 and 6 months using the Functional Independence Measure. Results Participants in both groups (5 per group) received the assigned intervention (>92% planned sessions; >94% fidelity) and completed follow-up testing. Strategy training participants in this small sample demonstrated significantly less disability at 6 months [M(SE)=117 (3)] than attention control participants [M(SE)=96 (14); t8=7.87, p=.02]. Conclusions It is feasible and acceptable to administer both intervention protocols as an adjunct to acute inpatient rehabilitation, and strategy training shows promise for reducing disability.

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Advancing the Evidence Base of Rehabilitation Treatments: A Developmental Approach

Cited by 63 publications

References 36 publications

Spatial cognitive rehabilitation and motor recovery after stroke

Spatial cognitive rehabilitation and motor recovery after stroke

Prism adaptation for spatial neglect after stroke: translational practice gaps

Developing complex interventions: lessons learned from a pilot study examining strategy training in acute stroke rehabilitation

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