Interventions combined with task-specific training to improve upper limb motor recovery following stroke: a systematic review with meta-analyses

Valkenborghs, Sarah R.; Callister, Robin; Visser, Milanka M.; Nilsson, Michael; Vliet, Paulette van

doi:10.1080/10833196.2019.1597439

Cited by 10 publications

(8 citation statements)

References 144 publications

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“…[Table 7] The findings of this review are in broad agreement with conclusions seen in other reviews namely [8][9][10][11][12][13][14][15][16][17]. There appears an initial change in motor impairment in response to VR augmented exercise -based trainingtherapy delivered via virtual reality devices [8][9][10][11][12][13][14][15][16][17].…”

Section: Narrative Synthesis Of Findings In Relation To Review Questi...supporting

confidence: 86%

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Neurophysiological changes accompanying reduction in upper limb motor impairments in response to exercise-based virtual rehabilitation after stroke: systematic review

et al. 2021

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Section: Narrative Synthesis Of Findings In Relation To Review Questi...supporting

confidence: 86%

“…To date, clinical practice guidelines for delivering VR rehabilitation have not been developed. Perhaps due to the evidence-base isbeing limited by small sample sizes and the s; use of heterogeneous outcome measures s and protocols [8][9][10][11][12][13][14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Neurophysiological changes accompanying reduction in upper limb motor impairments in response to exercise-based virtual rehabilitation after stroke: systematic review

et al. 2021

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“…The forms of repetitive TMS (rTMS) examined most frequently in this context have been those in which either 1 Hz trains (usually 1200-2400 stimuli in each application), or the 'continuous' variant of theta burst stimulation (usually 600 stimuli in each application), have been applied. The meta-analyses reveal that, when compared to task-specific training alone, there is no additional benefit of 1 Hz rTMS applied over the contralesional M1 on upper limb impairment (Valkenborghs et al 2019). A similar conclusion may be drawn on the basis of studies in which the lower limb has been the focus of attention (Tung et al 2019).…”

Section: Effectiveness Of Interventions Based On the Inter-hemispherimentioning

confidence: 68%

“…The meta‐analyses reveal that, when compared to task‐specific training alone, there is no additional benefit of 1 Hz rTMS applied over the contralesional M1 on upper limb impairment (Valkenborghs et al . 2019). A similar conclusion may be drawn on the basis of studies in which the lower limb has been the focus of attention (Tung et al .…”

Section: Effectiveness Of Interventions Based On the Inter‐hemispherimentioning

confidence: 99%

Inter‐hemispheric inhibition sculpts the output of neural circuits by co‐opting the two cerebral hemispheres

Carson

2020

The Journal of Physiology

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‘Inter‐hemispheric inhibition’ is used frequently to describe the action of one hemisphere in suppressing or impeding processing in its counterpart. It is widely believed that this is required in order to prevent a bilateral cerebrum giving rise to simultaneous and potentially competing outputs. It is argued here that a fundamental role of inter‐hemispheric inhibition is to support contrast enhancing and integrative functions by co‐opting the capacities of the two cerebral hemispheres. Drawing upon an extensive body of empirical data, derived largely from animal models, and associated theoretical modelling, it is demonstrated that inter‐hemispheric projections act via mechanisms such as surround/lateral inhibition. The principal functional unit of callosal influence comprises a facilitatory centre and a depressing peripheral zone, which together shape the influence of converging inputs to pyramidal neurons. Inter‐hemispheric inhibition is an instance of a more general feature of mammalian neural systems, whereby inhibitory interneurons act not simply to prevent over‐excitation but to sculpt the output of specific circuits. The narrowing of the excitatory focus that occurs through crossed surround inhibition is a highly conserved motif of transcallosal interactions in mammalian sensory and motor cortices. A case is presented that the ‘inter‐hemispheric competition’ model has been sustained, and its clinical derivatives promoted, by erroneous assumptions concerning that revealed by investigative techniques such as transcranial magnetic stimulation (TMS). The alternative perspective offered here is also shown to be consistent with known associations between the structural integrity of callosal projections and the magnitude of the motor deficits that are exhibited following stroke.

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“…This is despite some evidence-based studies for more targeted interventions to retrain impaired tactile, proprioception, and other modalities [6,39,41,42]. If present, such forms of targeted exercise are typically combined with functional or task-specific activities to effectively stimulate and strengthen post-stroke motor recovery in patients with motor and somatosensory deficits [43][44][45][46].…”

Section: Discussionmentioning

confidence: 99%

Current clinical practice in managing somatosensory impairments and the use of technology in stroke rehabilitation

et al. 2022

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Stroke-induced somatosensory impairments seem to be clinically overlooked, despite their prevalence and influence on motor recovery post-stroke. Interest in technology has been gaining traction over the past few decades as a promising method to facilitate stroke rehabilitation. This questionnaire-based cross-sectional study aimed to identify current clinical practice and perspectives on the management of somatosensory impairments post-stroke and the use of technology in assessing outcome measures and providing intervention. Participants were 132 physiotherapists and occupational therapists currently working with stroke patients in public hospitals and rehabilitation centres in Singapore. It was found that the majority (64.4%) of the therapists spent no more than half of the time per week on somatosensory interventions. Functional or task-specific training was the primary form of intervention applied to retrain somatosensory functions in stroke survivors. Standardised assessments (43.2%) were used less frequently than non-standardised assessments (97.7%) in clinical practice, with the sensory subscale of the Fugl-Meyer Assessment being the most popular outcome measure, followed by the Nottingham Sensory Assessment. While the adoption of technology for assessment was relatively scarce, most therapists (87.1%) reported that they have integrated technology into intervention. There was a common agreement that proprioception is an essential component in stroke rehabilitation, and that robotic technology combined with conventional therapy is effective in enhancing stroke rehabilitation, particularly for retraining proprioception. Most therapists identified price, technology usability, and lack of available space as some of the biggest barriers to integrating robotic technology in stroke rehabilitation. Standardised assessments and interventions targeting somatosensory functions should be more clearly delineated in clinical guidelines. Although therapists were positive about technology-based rehabilitation, obstacles that make technology integration challenging ought to be addressed.

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Interventions combined with task-specific training to improve upper limb motor recovery following stroke: a systematic review with meta-analyses

Cited by 10 publications

References 144 publications

Neurophysiological changes accompanying reduction in upper limb motor impairments in response to exercise-based virtual rehabilitation after stroke: systematic review

Neurophysiological changes accompanying reduction in upper limb motor impairments in response to exercise-based virtual rehabilitation after stroke: systematic review

Inter‐hemispheric inhibition sculpts the output of neural circuits by co‐opting the two cerebral hemispheres

Current clinical practice in managing somatosensory impairments and the use of technology in stroke rehabilitation

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