Incidence, Time Course and Predictors of Impairments Relating to Caring for the Profoundly Affected arm After Stroke: A Systematic Review (original) (raw)
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Enhanced physical therapy for arm function after stroke: a one year follow up study
Journal of Neurology, Neurosurgery & Psychiatry, 1994
Ninety seven patients with stroke who had participated in a randomised trial of conventional physical therapy v an enhanced therapy for arm function were followed up at one year. Despite the emphasis of the enhanced therapy approach on continued use of the arm in everyday life, the advantage seen for some patients with enhanced therapy at six months after stroke had diminished to a non-significant trend by one year. This was due to some late improvement in the conventional therapy group whereas the enhanced therapy group remained static or fell back slightly. It is recommended that trials should be conducted comparing very intensive therapy for the arm with controls without treatment. This would provide a model of the effects of therapy on intrinsic neural recovery that would be relevant to all areas of neurological rehabilitation.
Clinical Rehabilitation, 2011
To test a study design and explore the feasibility and potential effects of conventional neurological therapy, constraint induced therapy and therapeutic climbing to improve minimal to moderate arm and hand function in patients after a stroke. A pilot study with six-month follow-up in patients after stroke with minimal to moderate arm and hand function admitted for inpatient rehabilitation was performed. Participants were randomly allocated to one of three treatment approaches. Main outcomes were improvement of arm and hand function and adverse effects. 283 patients with stroke were screened for inclusion over a two-year period, out of which fourtyfour were included. All patients could be treated according to the protocol. Improvement of arm and hand function was significantly higher in conventional neurological therapy and constraint induced therapy compared with therapeutic climbing at discharge, and at six months follow-up (P < 0.05, effect size = 0.56-0.76). No significant differences in arm and hand function were observed between constraint induced therapy and conventional neurological therapy. Constraint induced therapy participants were significantly less at risk of developing shoulder pain at six months follow-up compared with the other participants (P < 0.05, effect size = 0.82 and 1.79, respectively). The study design needs adaptation to accommodate the stringent inclusion criteria leading to prolonged study duration. Constraint induced therapy seems to be the optimal approach to improve arm and hand function and minimize the risk of shoulder pain for patients with minimal to moderate arm hand function after stroke in the intermediate term.
Assessment of post-stroke elbow flexor spasticity in different forearm positions
Somatosensory and Motor Research, 2018
Purpose/Aim: There have been conflicting results regarding which muscle contribute most to the elbow spastic flexion deformity. This study aimed to investigate whether flexor spasticity of the elbow changed according to the position of the forearm, and to determine the muscle or muscles that contributed most to the elbow spastic flexion deformity by clinical examination. Methods: This study is a single group, observational and cross-sectional study. Sixty patients were assessed for elbow flexor spasticity in different forearm positions (pronation, neutral and supination) with Modified Tardieu Scale. The primary outcome measure was a domain of the Modified Tardieu Scale, the dynamic component of spasticity (spasticity angle). Results: In general, there was a significant difference between forearm positions regarding spasticity angle (p < .001). In pairwise comparisons, median spasticity angles in pronation (70 degrees) and neutral position (60 degrees) were significantly higher than those in supination (57.5 degrees) (adjusted p < .001 and adjusted p ¼ .003, respectively). However, median spasticity angle in pronation did not differ significantly from those in neutral position in favour of pronation (adjusted p ¼ .274). Conclusions: The severity of spasticity changes according to the elbow position which suggests that the magnitude of contribution of each elbow flexor muscle to spastic elbow deformity is different. Reduction of spasticity from pronation to supination leads us to consider brachialis as the most spastic muscle. Since biceps was suggested to be the least spastic muscle in this study, and also to avoid spastic pronation deformity of the forearm, it should be rethought before performing chemodenervation into biceps muscle.
2016
SUMMARY Four short, simple measures of arm function, suitable for use with patients recovering from acute stroke, are described. These tests are: the Frenchay Arm Test, the Nine Hole Peg Test, finger tapping rate and grip strength. Good interobserver and test-retest reliability was demon-strated for all tests, and the Frenchay Arm Test was shown to be valid. Normal values for all tests were established on 63 controls. It was found that the limited sensitivity of the Frenchay Arm Test could be improved using the Nine Hole Peg Test and grip strength. Recovery of arm function has been studied in a sample of 56 patients seen regularly over the first 3 months after their stroke, using these standard measures. The results demonstrated a wide variation in recovery curves between patients. The use of the Nine Hole Peg Test enabled further recovery to be detected after patients achieved a top score on the Frenchay Arm Test. Failure to recover measureable grip strength before 24 days was asso...
Journal of Neurology, Neurosurgery & Psychiatry, 1992
Previous research on stroke rehabilitation has not established whether increase in physical therapy lead to better intrinsic recovery from hemiplegia. A detailed study was carried out of recovery of arm function after acute stroke, and compares orthodox physiotherapy with an enhanced therapy regime which increased the amount of treatment as well as using behavioural methods to encourage motor learning. In a single-blind randomised trial, 132 consecutive stroke patients were assigned to orthodox or enhanced therapy groups. At six months after stroke the enhanced therapy group showed a small but statistically significant advantage in recovery of strength, range and speed of movement. This effect seemed concentrated amongst those who had a milder initial impairment. More work is needed to discover the reasons for this improved recovery, and whether further development of this therapeutic approach might offer clinically significant gains for some patients. first three months after stroke appeared to lead to better recovery of the range of active movement in the arm and leg. However, the patient groups in this study were not well matched at initial assessment which complicated statistical evaluation of results. Previous research from this Unit 15-18 has shown that under a typical therapy regime, prognosis for recovery of arm function is particularly poor. Approximately half of all acute stroke patients starting rehabilitation will have marked impairment of function of one arm, and only about 15% of these will eventually regain useful function. A number of small scale studies have, however, suggested that recovery of the arm may be improved by various techniques including encouragement of home-based exercise,"9 avoidance of learned non-use,20 and biofeedback therapy.2" In this study, orthodox therapy was compared with an enhanced therapeutic regime which increased the amount of therapy for the arm and used behavioural methods to encourage active learning during treatment sessions and also through self-directed exercises.
Forced Use of the Upper Extremity in Chronic Stroke Patients
Stroke
Background and Purpose-Of all stroke survivors, 30% to 66% are unable to use their affected arm in performing activities of daily living. Although forced use therapy appears to improve arm function in chronic stroke patients, there is no conclusive evidence. This study evaluates the effectiveness of forced use therapy. Methods-In an observer-blinded randomized clinical trial, 66 chronic stroke patients were allocated to either forced use therapy (immobilization of the unaffected arm combined with intensive training) or a reference therapy of equally intensive bimanual training, based on Neuro-Developmental Treatment, for a period of 2 weeks. Outcomes were evaluated on the basis of the Rehabilitation Activities Profile (activities), the Action Research Arm (ARA) test (dexterity), the upper extremity section of the Fugl-Meyer Assessment scale, the Motor Activity Log (MAL), and a Problem Score. The minimal clinically important difference (MCID) was determined at the onset of the study. Results-One week after the last treatment session, a significant difference in effectiveness in favor of the forced use group compared with the bimanual group (corrected for baseline differences) was found for the ARA score (3.0 points; 95% CI, 1.3 to 4.8; MCID, 5.7 points) and the MAL amount of use score (0.52 points; 95% CI, 0.11 to 0.93; MCID, 0.50).
Validity and Reliability of the Spasticity-Associated Arm Pain Scale
Journal of Pain Management & Medicine
Objective: Validated, reliable instruments to assess spasticity-related arm pain are not available. Non-specific pain-assessment scales have not been validated in this condition either and may be unsuitable for nursing-home patients. Without such validated scales, the effects of botulinum toxin on this condition cannot be investigated in a scientifically robust manner. The objective of this study was to evaluate the internal consistency, reliability, and validity of the Spasticity-Associated Arm Pain Scale (SAAPS) for adults with post-stroke upper-limb spasticity, and its sensitivity for detecting pain reduction following incobotulinumtoxinA treatment. Methods: Psychometric evaluation of a five-item pain-assessment tool was conducted in this prospective, multicenter, open-label, observational study, involving adults with post-stroke upper-limb spasticity (inter-rater reliability, n=25; all other measures, n=61). Internal consistency was analyzed using Cronbach's alpha coefficients. Test-retest reliability was assessed using intraclass correlations, Spearman's rho, polychoric correlation, and Kendall's Tau-b coefficients. Inter-rater reliability was assessed using weighted kappa. SAAPS validity was assessed using correlations with patient/investigator ratings on an 11-point numerical rating scale. Sensitivity of SAAPS was investigated 4-6 weeks after an incobotulinumtoxinA injection. Results: Test-retest reliability was high (all measured coefficients>0.70) and weighted kappa for inter-rater reliability (0.45-0.69) indicated good/fair agreement. SAAPS scores were reduced by 3.7 points (mean) 4-6 weeks post-treatment (p<0.0001), and indicated pain reduction in 79.7% of patients. SAAPS scores and numerical rating scale pain ratings were significantly correlated (p<0.001). Conclusion: SAAPS is a reliable, valid tool for assessing pain reduction after incobotulinumtoxin A treatment in adults with post-stroke upper-limb spasticity.