Interventions for improving upper limb function after stroke

Abstract

Large numbers of overlapping reviews related to interventions to improve upper limb function following stroke have been identified, and this overview serves to signpost clinicians and policy makers toward relevant systematic reviews to support clinical decisions, providing one accessible, comprehensive document, which should support clinicians and policy makers in clinical decision making for stroke rehabilitation.Currently, no high-quality evidence can be found for any interventions that are currently used as part of routine practice, and evidence is insufficient to enable comparison of the relative effectiveness of interventions. Effective collaboration is urgently needed to support large, robust RCTs of interventions currently used routinely within clinical practice. Evidence related to dose of interventions is particularly needed, as this information has widespread clinical and research implications.

Deficits of reach-to-grasp coordination following stroke: Comparison of instructed and natural movements

“…A further limitation of the current study relates to the fixed task order (subjects were tested first in context E and thereafter in context L), which was used to avoid the Hawthorne effect (Wickstrom and Bendix, 2000) according to which the knowledge to participate in a grasping study might affect the grasping responses in context E. Especially for intervention studies (Elsner et al, 2013;Pollock et al, 2014), a randomized task order would be desirable. Fortunately, the putative effects of task order on the observed context-dependent kinematic differences were specifically investigated in a recent study (Baak and Bock, 2014).…”

Closed-Loop Task Difficulty Adaptation during Virtual Reality Reach-to-Grasp Training Assisted with an Exoskeleton for Stroke Rehabilitation

“…Different, mutually non-exclusive reasons might be responsible for the current limited functional gain: Since the dose of stroke rehabilitation therapy has been shown to correlate positively with clinically meaningful improvements (Lohse et al, 2014; Pollock et al, 2014), the approximately 3000 movement attempts, i.e., exercise trials, performed in the course of 20 sessions during this 4-week study might have been insufficient to induce functionally more relevant improvements. On the other hand, even higher doses of motor therapy (i.e., 6400 or 9600 repetitions in the course of 8 weeks and 32 sessions, 4 days/week) in chronic stroke patients with long-standing (>6 months) upper limb paresis, did not result in a larger functional improvements than in patients who received a therapy dose (3200 repetitions) similar to the one applied here (Lang et al, 2016).…”

“…In the first weeks and months after stroke, a positive relationship between the dose of therapy and clinically meaningful improvements has been demonstrated (Lohse et al, 2014; Pollock et al, 2014). In stroke patients with long-standing (>6 months) upper limb paresis, however, treatment effects were small, with no evidence of a dose-response effect of task-specific training on the functional capacity (Lang et al, 2016).…”

Interfacing brain with computer to improve communication and rehabilitation after brain damage

“…Technology-based approaches, ranging from telemedicine to virtual reality approaches and robotics, are constantly gaining attraction in poststroke rehabilitation (Chang and Kim, 2013;Laver et al, 2013Laver et al, , 2015 in gait rehabilitation (Mehrholz et al, 2013) and upper limb motor recovery (Pollock et al, 2014). Technologyassisted therapy offers the possibility to increase exercise repetition and intensity while reducing the workload of therapists.…”