Upper Extremity Interventions post stroke

Not much hope here. But with the 163 pages and 37 pages of references I'm sure your doctor has this all covered already. But maybe you want to give a quiz.

Everything here should be publicly available with corresponding stroke protocols to accomplish them. But that won't occur because we have NO stroke leadership.  You'll just have to hope that your doctor/therapist knows how to competently reproduce the interventions that were done in the research cited. With no link from this summary to the research this is actually pretty useless.

HAH! You're fucking screwed.

Upper Extremity Interventions post stroke

I'm only including the summary here.

10.11

Summary

1. There is consensus (Level 3) opinion that in severely impaired upper extremities (less than stage

4) the focus of treatment should be on palliation and compensation. For those upper extremities

with signs of some recovery (stage 4 or better) there is consensus (Level 3) opinion that

attempts to restore function through therapy should be made.

2. There is strong (Level 1a) evidence that neurodevelopmental techniques such as Bobath are not

superior to other therapeutic approaches. There is moderate (level 1b) evidence that indicates

compared to Bobath, motor relearning programs may result in improved short-term motor

functioning and shorter lengths of hospital stay.

3. There is moderate (Level 1b) evidence that both functional and neuropsychological approaches

both help to improve dressing performance.

4. There is conflicting (Level 4) evidence that enhanced therapies improve short-term upper

extremity function. There is evidence that results may not be long lasting. There is moderate

(Level 1b) evidence that a program of daily stretch regimens does not prevent the development

of contractures.

5. There is strong (Level 1a) evidence that repetitive task-specific training techniques improve

measures of upper extremity function.

6. There is conflicting (Level 4) evidence that sensorimotor treatments improve upper extremity

function.

7. There is conflicting (Level 4) evidence that bilateral arm training is superior to unilateral

training.

8. There is conflicting (Level 4) evidence that specialized programs improve reaching.

9. There is conflicting (level 4) evidence that mental practice may improve upper-extremity motor

and ADL performance following stroke.

10. There is strong (Level 1a) evidence that hand splinting does not improve impairment or reduce

disability.

11. There is conflicting (Level 4) evidence of benefit of CIMT in the acute stage of stroke.

12. There is strong (Level 1a) evidence of benefit of mCIMT in the acute/subacute stage of stroke.

Benefits appear to be confined to stroke patients with some active wrist and hand movements,

particularly those with sensory loss and neglect.

There is moderate (Level 1b) evidence that any intensity of CIMT will provide benefit.

13. There is conflicting (Level 4) evidence that mirror therapy improves motor function following

stroke and moderate (Level 1b) evidence that it does not reduce spasticity.

14. There is moderate (Level 1b) evidence that action observation improves performance on the Box

& Block test.

15.  There is strong (Level 1a) evidence that extrinsic feedback helps to improve motor learning

following stroke.

16. There is strong (Level 1a) evidence that sensorimotor training with robotic devices improves

upper extremity functional outcomes, and motor outcomes of the shoulder and elbow.

There is strong (Level 1a) evidence that robotic devices do not improve motor outcomes of the wrist and hand.

17. There is strong (Level 1a) evidence that virtual reality treatment can improve locomotor

function in the chronic stages of stroke.

18. There is strong (Level 1a) evidence that hand splinting does not reduce the development of

contracture or reduce spasticity.

19. There is moderate (Level 1a) evidence that a nurse-led stretching program can help to increase

range of motion in the upper extremity and reduce pain in the chronic stage of stroke.

20. There is strong (Level Ia) that treatment with BTX alone or in combination with therapy

significantly decreases spasticity in the upper extremity in stroke survivors.

21. There is conflicting (Level 4) evidence that treatment with BTX alone or in combination with

therapy significantly improves upper limb function or quality of life.

22. There is moderate (Level 1b) evidence that electrical stimulation combined with botulinum toxin

injection is associated with reductions in muscle tone.

23. There is moderate (Level 1b) evidence that electrical stimulation can reduce spasticity and

improve motor function in the upper extremity.

24. There is limited (Level 2) evidence that treatment with ethyl alcohol improves elbow and finger

PROM and can decrease spasticity in the upper extremity in stroke survivors.

25. There is strong (Level 1a) evidence that physical therapy does not reduce spasticity in the upper

extremity.

26. There is limited (Level 2) evidence that shock wave therapy can reduce tone in the upper

extremity.

27. There is moderate (Level 1b) evidence that tolperisone can reduce spasticity following stroke.

28. There is strong (Level 1a) evidence that EMG/Biofeedback therapy is not superior to other forms

of treatment.

29. There is conflicting (Level 4) evidence that treatment with TENS in the upper extremity improves

a variety of outcomes, including motor recovery, spasticity and ADLs.

30. There is strong (Level 1a) evidence that FES treatment improves upper extremity function in

chronic stroke.

31. There is moderate (Level 1b) evidence that EMG-triggered FES is not superior to cyclic FES.

32. There is conflicting (Level 4) evidence that stimulants can improve upper extremity impairment

following stroke.

33. There is conflicting (Level 4) evidence that levodopa can improve upper extremity motor

function following stroke.

34. There is strong (Level 1a) evidence that a single dose of either a SSRI or NARI can enhance short-term manual dexterity in the affected hand following stroke.

35. There is moderate (Level 1b) evidence that a 90-day course of SSRIs initiated acutely following

stroke improves motor recovery of the upper extremity.

36. There is moderate (Level 1b) evidence that intermittent pneumatic compression does not reduce

hand edema following stroke. There is limited (Level 2) evidence that both neuromuscular nerve

stimulation and continuous passive motion help to reduce hand edema compared to limb

elevation