Best practice for arm recovery post stroke: an international application

Even with all these experienced therapists involved they still don't have any protocols about stroke recovery. And I see nothing on using a lever wheelchair.

Best practice for arm recovery post stroke: an international application

S.L. Wolf

,

G. Kwakkel

,

M. Bayley

,

M.N. McDonnell

, for the Upper Extremity Stroke Algorithm Working Group¹

¹The Upper Extremity Stroke Algorithm Working Group: Carolyn Baum (Professor, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA), Sarah Blanton (Associate Professor, Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University School of Medicine, Atlanta, GA, USA), Leeanne Carey (Department of Occupational Therapy, School of Allied Health, La Trobe University, Bundoora, Victoria, Australia), Judith Deutsch (Professor, Department of Rehabilitation and Movement Science, School of Health Related Sciences, Rutgers University, Newark, NJ, USA), Janice Eng (Professor, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada), Charlotte Hager (Professor, Department of Community Medicine and Rehabilitation, Physiotherapy Umeå University, SE-901 87 Umeå, Sweden), Catherine Lang (Professor, Program in Physical Therapy, Program in Occupational Therapy, Dept. Neurology, Washington University School of Medicine, St. Louis, MO, USA), Mindy F. Levin (Professor, School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada H3G 1Y5), Marilyn MacKay-Lyons (Professor, School of Physiotherapy, Dalhousie University Halifax, Nova Scotia, Canada), Valery Pomeroy (Professor of Neurorehabilitation, Associate Director of Research, School of Health Sciences, Queen's Building, University of East Anglia, Norwich, England), Carol L. Richards (Professor, Department of Rehabilitation Senior Researcher, Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada), Nancy Salbach (Associate Professor, Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada), Katherine Salter (Aging, Rehabilitation & Geriatric Care Program, Lawson Health Research Institute, Parkwood Hospital, London, Ontario, Canada), Cathy Stinear (Associate Professor, Department of Medicine, University of Auckland, Auckland, New Zealand), Bob Teasell (Professor, Department of Physical Medicine and Rehabilitation, Lawson Health Research Institute and Western University, Parkwood Institute, London, Ontario, Canada), Paulette Van Vliet (ARC Future Fellow, Professor of Stroke Rehabilitation, University of Newcastle, Newcastle, NSW, Australia), Carolee J. Winstein (Professor, Department of Biokinesiology and Physical Therapy, Director, Motor Behaviour and Neurorehabilitation Laboratory, University of Southern California, Los Angeles, CA 90089, USA).

DOI: http://dx.doi.org/10.1016/j.physio.2015.08.007

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Abstract

Objective

To develop an evidence-based application (‘app’) for post-stroke upper extremity rehabilitation that can be used globally by therapists.

Participants

Twenty-three experienced neurorehabilitation therapists, applied scientists and physicians, and 10 consultants dedicated to the provision of best practice to stroke survivors.

Design

This team evaluated the evidence to support the timely and appropriate provision of interventions and the most defensible outcome measures during a 4-year voluntary information gathering and assimilation effort, as a basis for the sequencing of an algorithm informed by the data and directed by changes in impairment and chronicity.

Outcome measures

The primary outcome was the formulation of a testable app that will be available for minimal user cost. The app is for a smartphone, and the comments of a focus group (audience at a World Confederation for Physical Therapy 2015 presentation, approximate n = 175) during a 30-minute ‘Questions and Answers’ session were assessed.

Results

Analysis of documented, extensive input offered by the audience indicated a highly favourable disposition towards this novel tool, with provision of concrete suggestions prior to launching the final version. Suggestions centred on: inclusion of instructions; visuals and demonstrations; monitoring of adverse responses; availability of updates; autonomous use by patients; and potential to characterise practice.

Conclusions

A simple, user-friendly app for decision making in the treatment of upper extremity impairments following stroke is feasible and welcomed.