Hopefully you can train your doctor and therapists into what bilateral priming is.
Bilateral Priming Accelerates Recovery of Upper Limb Function After Stroke: A Randomized Controlled Trial
Cathy M. Stinear, PhD; Matthew A. Petoe, PhD; Samir Anwar, FAFRM (RACP); Peter Alan Barber, FRACP; Winston D. Byblow, PhD205
The ability to live independently after stroke depends on the recovery of motor function, particularly of the upper limb.
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The potential for recovery is related to the extent of cerebral damage that creates a ceiling effect,
2,3
with a plateau usually reached within 6 months after stroke.(Plateau doesn't exist, get with the up-to-date program.)
4
There are no treatments available that can repair the stroke lesion and raise the recovery ceiling.(Then you haven't been following research.) An alternative strategy could be the development of adjuvant techniques that accelerate recovery and help patients more efficiently reach a plateau of best possible function.Techniques that prime the brain for a more plastic response to therapy may accelerate motor recovery after stroke. Increasing excitability and reducing inhibition are important precursors for neural plasticity,
5
which may allow surviving neural elements to more easily reorganize in response to therapy.
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Active–passive bilateral priming (APBP) is a pattern of coordinated movement that disinhibits the M1 contralateral to the assisted (paretic) limb
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and facilitates its excitability for≥30 minutes after a 15-minute session.
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In patients with≥6 months after stroke, daily APBP followed by motor practice led to increased ipsile-sional corticomotor excitability and a greater improvement in upper limb function compared with motor practice alone.
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The aim of this study was to determine the immediate and longer term effects of bilateral priming with patients with stroke at the subacute stage. We hypothesized that APBP before upper limb therapy would accelerate the recovery of hand and arm function, with a greater proportion of PRIMED participants reaching maximum recovery by 12 weeks.
Methods
Participants
Consecutive patients aged
≥
18 years admitted with first-ever mono-hemispheric ischemic stroke were screened between November 2009
Background and Purpose
—The ability to live independently after stroke depends on the recovery of upper limb function. We hypothesized that bilateral priming with active–passive movements before upper limb physiotherapy would promote rebalancing of corticomotor excitability and would accelerate upper limb recovery at the subacute stage.
Methods
—A single-center randomized controlled trial of bilateral priming was conducted with 57 patients randomized at the subacute stage after first-ever ischemic stroke. The PRIMED group made device-assisted mirror symmetrical bimanual movements before upper limb physiotherapy, every weekday for 4 weeks. The CONTROL group was given intermittent cutaneous electric stimulation of the paretic forearm before physiotherapy. Assessments were made at baseline, 6, 12, and 26 weeks. The primary end point was the proportion of patients who reached their plateau for upper limb function at 12 weeks, measured with the Action Research Arm Test.
Results
—Odds ratios indicated that PRIMED participants were 3× more likely than controls to reach their recovery plateau by 12 weeks. Intention-to-treat and per-protocol analyses showed a greater proportion of PRIMED participants achieved their plateau by 12 weeks (intention to treat,χ2=4.25;
P=0.039 and per protocol,χ2=3.99;P=0.046). ANOVA of per-protocol data showed PRIMED participants had greater rebalancing of corticomotor excitability than controls at 12 and 26 weeks and interhemispheric inhibition at 26 weeks (all P<0.05).
Conclusions
—Bilateral priming accelerated recovery of upper limb function in the initial weeks after stroke.
Clinical Trial Registration
—URL: http://www.anzctr.org.au. Unique identifier: ANZCTR1260900046822.
(
Stroke
. 2014;45:205-210.)
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