Interlimb coupling in poststroke rehabilitation: a pilot randomized controlled trial

Arya, Kapil; Pandian, Shanta; Sharma, Abhishek; Kumar, Vikas; Kashyap, Varun Kumar

doi:10.1080/10749357.2019.1682368

Cited by 10 publications

(17 citation statements)

References 49 publications

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“…Two studies conducted by Arya included stroke survivors and the trial was conducted in a rehabilitation setting in Delhi. [ 21 , 22 ] One more trial was also conducted in New Delhi with children having cerebral palsy. [ 23 ] Two trials took place in Mumbai; one with Dequervain’s tenosynovitis participants and one with preterm infants.…”

Section: Resultsmentioning

confidence: 99%

Occupational Therapy for Reducing Disabilities in Persons with Disabilities in India

Kamalakannan

Chockalingam

Sethuraman

et al. 2021

The Indian Journal of Occupational Therapy

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Background The current evidence for occupational therapy practice, teaching, and research is replicated and implemented significantly from high-income countries in India. Therefore, a systematic review and an evaluation of existing evidence for occupational therapy (OT) to reduce disabilities including impairments, activity limitations, and participation restriction in persons with disabilities (PWD) in India are warranted. Objectives The objective of this review was to evaluate the effectiveness of OT interventions for reducing disabilities in PWD in India. Study Design Systematic review. Methods We searched the Cochrane CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, AMED, and Web of Science. A hand search was also carried out in selected Indian journals, OT-specific databases, and repositories, such as Indian Journal of Occupational Therapy , Indian Journal of Physiotherapy and Occupational Therapy , OT Seekers, World Federation of Occupational Therapy Bulletin, Asia Pacific Occupational Therapists Regional Group, and clinical trials registers. The search was restricted to published studies conducted in India during 2000–2021. We included randomized controlled trials (RCTs) of an occupational therapy intervention delivered by OTs for PWD, where the effects of the intervention were evaluated using any relevant disability outcome measure. Studies without access to full text were excluded. Two review authors independently completed screening, and one author reviewed the full text of the screened studies. Another pair of authors extracted data from included studies for prespecified disability outcomes, and two authors assessed the risk of bias in the included studies. Results We identified seven RCTs of occupational therapy interventions for PWD in India with 305 participants in total. All seven studies were very different in terms of their objective, participants, comparison, and outcomes. Allocation concealment and blinding and risk of bias were high in five trials. All the trials reported impairment outcomes with a statistically significant difference between the experimental arm and the control arm in terms of their primary outcomes except one. Given the sample size and the risk of bias in each of the included trials, the effect size has to be understood and interpreted with utmost caution. Conclusion Overall, this review establishes the paucity of evidence for occupational therapy for PWD in India. Building the capacity for rigorous and relevant scientific research in occupational therapy would enable bridging the gaps in evidence for occupational therapy in India.

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Section: Resultsmentioning

confidence: 99%

Occupational Therapy for Reducing Disabilities in Persons with Disabilities in India

Kamalakannan

Chockalingam

Sethuraman

et al. 2021

The Indian Journal of Occupational Therapy

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“…Individuals with severe paresis are likely to be able to use the contralesional arm only for gross assistance purposes, if at all. Previous research has indicated that bilateral movement training can be a useful tool to promote functional recovery in stroke survivors [1][2][3]. Different mechanisms of action of bilateral training have been hypothesized [4], with a focus on the idea that spatiotemporal coupling of the two arms can facilitate recovery of motor function by recruiting specialized neural circuitry [5].…”

Section: Introductionmentioning

confidence: 99%

Deficits in Performance on a Mechanically Coupled Asymmetrical Bilateral Task in Chronic Stroke Survivors with Mild Unilateral Paresis

et al. 2021

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Typical upper limb-mediated activities of daily living involve coordination of both arms, often requiring distributed contributions to mechanically coupled tasks, such as stabilizing a loaf of bread with one hand while slicing with the other. We sought to examine whether mild paresis in one arm results in deficits in performance on a bilateral mechanically coupled task. We designed a virtual reality-based task requiring one hand to stabilize against a spring load that varies with displacement of the other arm. We recruited 15 chronic stroke survivors with mild hemiparesis and 7 age-matched neurologically intact adults. We found that stroke survivors produced less linear reaching movements and larger initial direction errors compared to controls (p < 0.05), and that contralesional hand performance was less linear than that of ipsilesional hand. We found a hand × group interaction (p < 0.05) for peak acceleration of the stabilizing hand, such that the dominant right hand of controls stabilized less effectively than the nondominant left hand while stroke survivors showed no differences between the hands. Our results indicate that chronic stroke survivors with mild hemiparesis show significant deficits in reaching aspects of bilateral coordination, but no deficits in stabilizing against a movement-dependent spring load in this task.

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“…The coordination of four-limb motion has been coined “interlimb coordination”, where all four limbs move in coordination to accomplish a task, and this has been recently proposed to enhance limb movement control through an increase of neural coupling between arms and legs [ 23 ]. Examples of interlimb-coordinated tasks are the use of a rowing machine, elliptical machine, and bicycle ergometer [ 24 ]. A recently published study that included healthy participants reported that upper limb muscles drive lower-limb muscle activity during a specific gait phase via the subcortical and cortical pathways to achieve intermuscular coherence between the upper and lower limbs [ 25 ].…”

Section: Introductionmentioning

confidence: 99%

“…Rhythmic arm cycling training in patients with chronic stroke was reported to promote a significant improvement in gait, balance, lower limb motor function, and enhanced activity in the dorsiflexion muscle during the swing phase of walking [ 26 ]. The most recently published preliminary randomized controlled trial investigated the effect of the interlimb coordinated protocol in patients with chronic stroke [ 24 ]. A range of interlimb coordinated tasks were provided to chronic stroke patients for 2 months (3 h per week) in an outpatient setting.…”

Section: Introductionmentioning

confidence: 99%

“…The majority of everyday activities require the coordinated use of both hands [ 31 ]. It is common that one of the upper limb stabilizes a trunk or an object itself in order to allow manipulation by the other limb, or both of the upper limbs may be needed to manipulate the object for a task to be completed [ 24 ]. The impairment of bimanual coordination in patients with stroke have been reported in several studies, and impairments in coordination are not related to the lateral deviation of the impaired limb [ 32 , 33 ].…”

Section: Introductionmentioning

confidence: 99%

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The Efficacy of Interlimb-Coordinated Intervention on Gait and Motor Function Recovery in Patients with Acute Stroke: A Multi-Center Randomized Controlled Trial Study Protocol

Chen

Zhao

et al. 2021

Brain Sciences

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Background: The efficacy of interlimb-coordinated training on gait and upper limb functional improvement remains unclear. The latest published randomized controlled trials have supported the potential benefits of interlimb-coordinated training to enhance gait function. Upper limb functional recovery may also benefit from interlimb-coordinated training since most everyday activities require the coordinated use of both hands to complete a task. This study investigates the efficacy of interlimb-coordinated training on gait and upper limb functional recovery over a short-medium term period. Methods: A total of 226 acute stroke patients will be recruited from four centres over four years. Patients will be randomly allocated to either conventional therapy or conventional therapy plus interlimb-coordinated training. Outcomes will be recorded at baseline, after 2 weeks of intervention, and at 3- and 6-months post-intervention. Gait speed is the primary outcome measure. Secondary outcome measures include Fugl–Meyer Assessment of Motor Recovery, Berg Balance Scale, Timed Up and Go test, Action Research Arm Test, electroencephalography, and magnetic resonance imaging. Conclusion: The results of this trial will provide an in-depth understanding of the efficacy of early interlimb-coordinated intervention on gait and upper functional rehabilitation and how it may relate to the neural plasticity process.

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Interlimb coupling in poststroke rehabilitation: a pilot randomized controlled trial

Cited by 10 publications

References 49 publications

Occupational Therapy for Reducing Disabilities in Persons with Disabilities in India

Occupational Therapy for Reducing Disabilities in Persons with Disabilities in India

Deficits in Performance on a Mechanically Coupled Asymmetrical Bilateral Task in Chronic Stroke Survivors with Mild Unilateral Paresis

The Efficacy of Interlimb-Coordinated Intervention on Gait and Motor Function Recovery in Patients with Acute Stroke: A Multi-Center Randomized Controlled Trial Study Protocol

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