STROKE-UPPER LIMB INTERVENTIONS, THERAPIES

SUMMARY

1. Most investigators agree that post-stroke rehabilitation enhances motor reorganization, however no study has systematically looked at the critical threshold of therapy intensity.
2. Technology (video games, robotics) may be necessary to achieve the maximum number of reps (Saposnik et al. 2010).

EFFECTIVE

3. Task specific training: yields longer-lasting cortical reorganization of specific areas involved than traditional rehab.
4. Action observation: may be beneficial for improving dexterity and spasticity.
5. Strength training: strong evidence that strength training increases grip strength following stroke.

6. Repetitive task practice: may be superior to conventional training at improving UL function.

7. CIMT: after 2 weeks of stroke onset; designed to overcome learned non-use by promoting cortical reorganization.
8. Mirror box therapy: effective for improving UL function, ADL & pain, at least as an adjunct to normal rehab.
9. Mental practice/motor imagery: strong evidence that mental practice improves UL function.

10. FES: improves UL function in acute & chronic strokes when used alone or in combination with conventional therapy.
11. Robotic devices: sensorimotor training with robotic devices improves UL functional & motor outcomes of the shoulder and elbow but not the wrist & hand.

12. Repetitive transcranial magnetic stimulation: beneficial for arm, hand motor function, grasp & pinch but not ROM of the wrist.

INEFFECTIVE

13. Sensorimotor training: conflicting evidence that this improves UL function.
14. Bilateral arm training: not superior to unilateral training.
15. EMG/Bio-feedback therapy: not superior to other treatments.
16. Acupuncture: there is strong evidence that traditional acupuncture and electroacupuncture may not improve upper extremity function, but do improve spasticity.
17. Mobilizing within 24 hours: the AVERT study showed negative outcome.

18. Music therapy: overall literature is mixed.
19. Transcranial direct current stimulation (anodal/cathodal): The literature is mixed for anodal, cathodal or dual (bilateral) tDCS, alone or in combination with other therapy approaches, for UL rehabilitation post stroke.
20. VR: Virtual reality therapy may not be more beneficial than conventional therapy for improving motor function and stroke severity.

Ref: Saikaley, M., Pauli, G., Iruthayarajah, J., Mirkowski, M., Iliescu, A., Caughlin, S., Fragis, N., Alam, R., Harris, J., Dukelow, S., Chae, J., Knutson, J., Miller, T. and Teasell, R. (2018). Upper Extremity Interventions | EBRSR: Evidence-Based Review of Stroke Rehabilitation. [online] Ebrsr.com. Available at: http://www.ebrsr.com/evidence-review/10-upper-extremity-interventions [Accessed 6 Dec. 2019]

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].