Deans' stroke musings

Changing stroke rehab and research worldwide now.Time is Brain!Just think of all the trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 493 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It's quite disgusting that this information is not available from every stroke association and doctors group.
My back ground story is here:http://oc1dean.blogspot.com/2010/11/my-background-story_8.html

Tuesday, September 6, 2016

Effects of Robot-Assisted Therapy for the Upper Limb After Stroke A Systematic Review and Meta-analysis

And yet we still have no one writing up a stroke protocol on this. A great stroke association president would be making sure at the very least a draft protocol would be written up. It could then be critiqued and updated as necessary. But since we have fucking failures of stroke associations something as simple as this will never occur under current lack of leadership. We don't have stroke leaders because leaders actually tackle the difficult problems, they don't run away and just produce press releases.
http://nnr.sagepub.com/content/early/2016/09/03/1545968316666957.abstract?&

  1. Janne M. Veerbeek, PhD1,2,3
  2. Anneli C. Langbroek-Amersfoort, MSc4
  3. Erwin E. H. van Wegen, PhD1,2,3
  4. Carel G. M. Meskers, PhD, MD1,2,3,5
  5. Gert Kwakkel, PhD1,2,3,5,6
  1. 1MOVE Research Institute Amsterdam, VU University Amsterdam, Amsterdam, the Netherlands
  2. 2Neuroscience Campus Amsterdam, Amsterdam, the Netherlands
  3. 3VU University Medical Center, Amsterdam, the Netherlands
  4. 4Centrum voor Fysiotherapie, Eerstelijns Centrum Beatrixpark, Ede, the Netherlands
  5. 5Northwestern University, Evanston, IL, USA
  6. 6Amsterdam Rehabilitation Research Center, Reade, Amsterdam, the Netherlands
  1. Janne M. Veerbeek, Department of Rehabilitation Medicine, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, the Netherlands. Email: j.veerbeek@vumc.nl

Abstract

Background. Robot technology for poststroke rehabilitation is developing rapidly. A number of new randomized controlled trials (RCTs) have investigated the effects of robot-assisted therapy for the paretic upper limb (RT-UL).  
Objective. To systematically review the effects of poststroke RT-UL on measures of motor control of the paretic arm, muscle strength and tone, upper limb capacity, and basic activities of daily living (ADL) in comparison with nonrobotic treatment.  
Methods. Relevant RCTs were identified in electronic searches. Meta-analyses were performed for measures of motor control (eg, Fugl-Meyer Assessment of the arm; FMA arm), muscle strength and tone, upper limb capacity, and basic ADL. Subgroup analyses were applied for the number of joints involved, robot type, timing poststroke, and treatment contrast.  
Results. Forty-four RCTs (N = 1362) were included. No serious adverse events were reported. Meta-analyses of 38 trials (N = 1206) showed significant but small improvements in motor control (~2 points FMA arm) and muscle strength of the paretic arm and a negative effect on muscle tone. No effects were found for upper limb capacity and basic ADL. Shoulder/elbow robotics showed small but significant effects on motor control and muscle strength, while elbow/wrist robotics had small but significant effects on motor control.  
Conclusions. RT-UL allows patients to increase the number of repetitions and hence intensity of practice poststroke, and appears to be a safe therapy. Effects on motor control are small and specific to the joints targeted by RT-UL, whereas no generalization is found to improvements in upper limb capacity. The impact of RT-UL started in the first weeks poststroke remains unclear. These limited findings could mainly be related to poor understanding of robot-induced motor learning as well as inadequate designing of RT-UL trials, by not applying an appropriate selection of stroke patients with a potential to recovery at baseline as well as the lack of fixed timing of baseline assessments and using an insufficient treatment contrast early poststroke.

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