Rehabilitation of Motor Function after Stroke: A Multiple Systematic Review Focused on Techniques to Stimulate Upper Extremity Recovery

Abstract

Stroke is one of the leading causes for disability worldwide. Motor function deficits due to stroke affect the patients' mobility, their limitation in daily life activities, their participation in society and their odds of returning to professional activities. All of these factors contribute to a low overall quality of life. Rehabilitation training is the most effective way to reduce motor impairments in stroke patients. This multiple systematic review focuses both on standard treatment methods and on innovating rehabilitation techniques used to promote upper extremity motor function in stroke patients. A total number of 5712 publications on stroke rehabilitation was systematically reviewed for relevance and quality with regards to upper extremity motor outcome. This procedure yielded 270 publications corresponding to the inclusion criteria of the systematic review. Recent technology-based interventions in stroke rehabilitation including non-invasive brain stimulation, robot-assisted training, and virtual reality immersion are addressed. Finally, a decisional tree based on evidence from the literature and characteristics of stroke patients is proposed. At present, the stroke rehabilitation field faces the challenge to tailor evidence-based treatment strategies to the needs of the individual stroke patient. Interventions can be combined in order to achieve the maximal motor function recovery for each patient. Though the efficacy of some interventions may be under debate, motor skill learning, and some new technological approaches give promising outcome prognosis in stroke motor rehabilitation.

Long-Term Improvements After Multimodal Rehabilitation in Late Phase After Stroke

“…Individually, or in combination, these components have all shown promise for treating individuals with brain disorders, including stroke, 10 and a recent meta-analyses provide evidence for positive effects of music-supported therapy and rhythmic auditory cueing in stroke rehabilitation. 7,9,14 There is an urgent unmet need to evaluate multimodal interventions applied to late-phase stroke survivors who often do not receive further rehabilitation after the subacute phase. We designed a 3-armed, single-blind, randomized controlled trial to evaluate whether a heterogeneous group of late-phase stroke survivors (10 months to 5 years post-stroke) benefit from 2 different multimodal group-based interventions: R-MT and H-RT.…”

Motor Imagery and Action Observation as Effective Tools for Physical Therapy

“…However, motor imagery and action observation are just tools for modulating brain states [48]. Therefore, it is important to choose the appropriate treatment strategy according to functional characteristics and recovery phases of patients in the clinical setting [49].…”

Hand Rehabilitation after Chronic Brain Damage: Effectiveness, Usability and Acceptance of Technological Devices: A Pilot Study

“…In the last 10 years, there has been increasing interest in the use of different technological devices for upper limb (UL) rehabilitation generally [5,9], and particularly hand rehabilitation for stroke patients [10]. These studies have approached the problem from different points of view: (1) on the one hand, by analysing the physiological and psychophysical characteristics of different devices [11], (2) on the other analysing the key aspects of design and usability [12] and (3) finally studying its effectiveness in therapy [13,14].…”

“…These impairments induce disabilities in common movements such as reaching, picking up or holding objects and difficult activities of daily living (ADLs) such as washing, eating or dressing, their participation in society, and their professional activities [5]. Most of people experiencing this upper limb impairment will still have problems chronically several years after the stroke.…”