Interventions for improving upper limb function after stroke

Pollock, Alex; Farmer, Sybil E.; Brady, Marian; Langhorne, Peter; Mead, Gillian; Mehrholz, Jan; Wijck, Frederike van

doi:10.1002/14651858.cd010820

Cited by 139 publications

(210 citation statements)

References 107 publications

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“…Greater intensity of practice is generally associated with improved functional outcomes. [20][21][22] Current guidelines are pragmatic, recommending that 'people with stroke should accumulate at least 45 minutes of each appropriate therapy every day, at a frequency that enables them to meet their rehabilitation goals, and for as long as they are willing and capable of participating and showing measurable benefit from therapy'. 4 However, recent research suggests that the timing and intensity of early rehabilitation needs to be carefully considered.…”

Section: Rehabilitationmentioning

confidence: 99%

Stroke unit care, inpatient rehabilitation and early supported discharge

Rodgers

Price

2017

Clinical Medicine

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Stroke units reduce death and disability through the provision of specialist multidisciplinary care for diagnosis, emergency treatments, normalisation of homeostasis, prevention of complications, rehabilitation and secondary prevention. All stroke patients can benefit from provision of high-quality basic medical care and some need high impact specific treatments, such as thrombolysis, that are often time dependent. A standard patient pathway should include assessment of neurological impairment, vascular risk factors, swallowing, fluid balance and nutrition, cognitive function, communication, mood disorders, continence, activities of daily living and rehabilitation goals. Good communication and shared decision making with patients and their families are key to high-quality stroke care. Patients with mild or moderate disability, who are medically stable, can continue rehabilitation at home with early supported discharge teams rather than needing a prolonged stay in hospital. National clinical guidelines and prospective audits are integral to monitoring and developing stroke services in the UK. Stroke unitsEach year 152,000 people in the UK have a stroke.1 Randomised controlled trials and subsequent meta-analyses have clearly shown that care in a multidisciplinary stroke unit reduces death, disability and the need for institutionalisation when compared with general medical wards.2 These benefits are seen regardless of the patient's age, gender, stroke type (ie infarct or haemorrhage) or stroke severity (Fig 1 ).2 Based on a number needed to treat of 18, stroke units prevent death or dependency for 8,400 stroke patients per year.3 All acute stroke patients should be treated on a stroke unit (a ward that cares almost exclusively for stroke patients) throughout their inpatient stay unless stroke is not their predominant medical problem. Recently, stroke services in many areas have been reorganised to improve the quality and efficiency of care.5 Hyperacute stroke units (HASUs) provide > rapid specialist assessment and diagnosis on the HASU or in the associated accident and emergency department > hyperacute treatment, eg thrombolysis > physiological and neurological monitoring > early rehabilitation.Stroke patients usually remain on a HASU for up to 72 hours and are then transferred to an acute stroke unit or stroke rehabilitation unit. Some stroke services have a comprehensive

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Section: Rehabilitationmentioning

confidence: 99%

Stroke unit care, inpatient rehabilitation and early supported discharge

Rodgers

Price

2017

Clinical Medicine

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“…The systematic review that has been done by Pollock 10 explain that has done a lot of research, but none of rehabilitation approaches are most effective in recovery of function and mobility of patients after stroke. Assessment of compatibility problems of badly needed to formulate various problems the application of this motor learning.…”

Section: Introductionmentioning

confidence: 99%

Development of motor learning implementation for ischemic stroke: finding expert consensus

2017

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The main purpose of this study was to investigate motor learning implementation for ischemic stroke from experts on the field of motor learning in stroke patients including the neurologist, medical rehabilitation specialists and physiotherapists. To collect the data and answer the research questions, statements were made on the basis of the study of literature and the grains exploration of the statements in the questionnaire using the Delphi Method. Formulation development model was based iteration or judgment of experts. Validation assessment statement grain tested by the Content Validity Ratio (CVR) and Content Validity Index (CVI) was used to analyze the data. The finding clear up that CVR value of each item statement was 1 and the value of CVI also 1. There were 6 indicators in a 26-point declaration on the implementation of the development model of motor learning intervention for ischemic stroke. Six indicators included basic theories that support the importance of intervention motor learning, motor learning stages, principles of motor learning, dosage, timing of and kinds of motor learning interventions that can be provided as well as application development intervention model motor learning, allowing given for ischemic stroke. In conclusion, based on the content validity of the results of the consensus expert judgments are six indicators of the importance of motor learning application for ischemic stroke. ABSTRAKTujuan penelitian ini adalah mengembangkan model intervensi pembelajaran motorik untuk strok iskemik dengan cara mencari konsensus dari beberapa ahli, yaitu dokter spesialis saraf, dokter spesialis keterapian fisik dan fisioterapis. Pengumpulan data yang berupa butir-butir pernyataan dibuat atas dasar kajian pustaka terdahulu. Eksplorasi mengenai butir-butir pernyataan dalam kuesioner menggunakan Metode Delphi. Perumusan pengembangan model didasarkan penilaian dari para ahli. Validasi penilaian butir-butir pernyataan diuji dengan Content Validity Ratio (CVR) dan Content Validity Index (CVI). Nilai CVR masing-masing butir pernyataan adalah 1 dan nilai CVI juga 1. Terdapat 6 indikator dalam 26 butir pernyataan tentang pengembangan model intervensi penerapan pembelajaran motorik untuk strok iskemik. Enam indikator itu meliputi dasar teori yang mendukung tentang pentingnya intervensi pembelajaran motorik, tahapan pembelajaran motorik, prinsip-prinsip pembelajaran motorik, dosis, waktu pelaksanaan dan macam J Med Sci, Volume 49, No. 4, 2017 October: 199-215 200 intervensi pembelajaran motorik yang bisa diberikan. Dapat disimpulkan, berdasarkan validitas isi dari hasil konsensus penilaian para ahli terdapat 6 indikator pentingnya penerapan pembelajaran motorik untuk strok iskemik.

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“…There is now unambiguous evidence that rehabilitation is essential to facilitate recovery after stroke [18,27,28,29] but this does not tell us exactly who will or will not benefit from rehabilitation or in what way. However, it appears that the right of entry to rehabilitation may be becoming more challenging as decisions regarding access to active rehabilitation services need to be taken more quickly.…”

Section: Introductionmentioning

confidence: 99%

Accessing rehabilitation after stroke – a guessing game?

Enderby

Pandyan

Bowen

et al. 2016

Disability and Rehabilitation

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Aim: To explore the use, meaning and value of the term ''rehabilitation potential''. Method: The authors of this commentary met to discuss concerns relating to the pressure on health service staff created by reduced length of stay in acute settings of those who have suffered a stroke and the need to determine the potential of a patient for rehabilitation in order to inform discharge arrangements. Points raised at this meeting were shared with an email group who over a 12-month period contributed to this paper. Results: The group agreed that: (a) Given that there is very limited evidence to guide judgements regarding rehabilitation potential following stroke at an early stage the need for rehabilitation needs to be reviewed on a regular basis over a long period and that this needs to be reflected in clinical guidelines. (b) Rehabilitation needs to be available in a broad range of care settings, in order that discharge from hospital is not equated with a lack of rehabilitation potential. (c) Research related to rehabilitation potential needs to be conducted. This should examine influences of decision-making and the algorithms associated with recovery and local policy on rehabilitation potential. (d) The economic benefits of rehabilitation needs further exploration. (e) Assessment of rehabilitation potential should be made more explicit and supported by appropriate evidence. Conclusion: Whilst further research is required to assist in determining the right time for people to benefit from formal rehabilitation this gives the impression that one dose of rehabilitation at a specific time will meet all needs. It is likely that a rehabilitation pathway identifying features required in the early stages following stroke as well as that required over many years in order to prevent readmission, maintain fitness and prevent secondary sequelae such as depression and social isolation would be beneficial. ä IMPLICATIONS FOR REHABILITATION

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Interventions for improving upper limb function after stroke

Cited by 139 publications

References 107 publications

Stroke unit care, inpatient rehabilitation and early supported discharge

Stroke unit care, inpatient rehabilitation and early supported discharge

Development of motor learning implementation for ischemic stroke: finding expert consensus

Accessing rehabilitation after stroke – a guessing game?

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