8 years. What protocols did your hospital create as a result of this? NOTHING?
Do you prefer your incompetence NOT KNOWING? OR NOT DOING?
Their reasons for doing nothing? There is absolutely no excuse for doing nothing. They should all be keel-hauled.
Laziness? Incompetence? Or just don't care? No leadership? No strategy? Not my job?
The latest here.
A systematic review of bilateral upper limb training devices for poststroke rehabilitation
2012, Stroke research and treatment
A.(Lex)E.Q.vanDelden, 1
C.(Lieke)E.Peper, 1
GertKwakkel, 1,2
andPeterJ.Beek 1
1 Research Institute MOVE, Faculty of Human Movement Sciences, VU University Amsterdam, Van der Boechorststraat 9,1081 BT Amsterdam, The Netherlands
2 Research Institute MOVE, Department of Rehabilitation Medicine, VU University Medical Center, De Boelelaan 1117,1081 HV Amsterdam, The Netherlands
Correspondence should be addressed to A. (Lex) E. Q. van Delden, l.van.delden@vu.nlReceived 20 July 2012; Accepted 8 October 2012Academic Editor: Stefano PaolucciCopyright © 2012 A. (Lex) E. Q. van Delden et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Introduction In stroke rehabilitation, bilateral upper limb training is gaining ground. As a result, a growing number of mechanicaland robotic bilateral upper limb training devices have been proposed.
Objective
To provide an overview and qualitative evaluation of the clinical applicability of bilateral upper limb training devices.
Methods
A.(Lex)E.Q.vanDelden, 1
C.(Lieke)E.Peper, 1
GertKwakkel, 1,2
andPeterJ.Beek 1
1 Research Institute MOVE, Faculty of Human Movement Sciences, VU University Amsterdam, Van der Boechorststraat 9,1081 BT Amsterdam, The Netherlands
2 Research Institute MOVE, Department of Rehabilitation Medicine, VU University Medical Center, De Boelelaan 1117,1081 HV Amsterdam, The Netherlands
Correspondence should be addressed to A. (Lex) E. Q. van Delden, l.van.delden@vu.nlReceived 20 July 2012; Accepted 8 October 2012Academic Editor: Stefano PaolucciCopyright © 2012 A. (Lex) E. Q. van Delden et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Introduction In stroke rehabilitation, bilateral upper limb training is gaining ground. As a result, a growing number of mechanicaland robotic bilateral upper limb training devices have been proposed.
Objective
To provide an overview and qualitative evaluation of the clinical applicability of bilateral upper limb training devices.
Methods
Potentially relevant literature was searched in thePubMed, Web of Science, and Google Scholar databases from 1990 onwards. Devices were categorized as mechanical or robotic(according to the PubMed MeSH term of robotics).
Results
In total, 6 mechanical and 14 robotic bilateral upper limb training devices were evaluated in terms of mechanical and electromechanical characteristics, supported movement patterns, targeted part and active involvement of the upper limb, training protocols, outcomes of clinical trials, and commercial availability.
Conclusion
Initial clinical results are not yet of such caliber that the devices in question and the concepts on which they are based arefirmly established. However, the clinical outcomes do not rule out the possibility that the concept of bilateral training and the accompanied devices may provide a useful extension of currently available forms of therapy. To actually demonstrate their(surplus)value, more research with adequate experimental, dose-matched designs, and sufficient statistical power are required.
1.Introduction
As technology advances, a growing number of mechanical and robotic training devices (i.e., mechanical devices with electronic, computerized control systems) for upper limb training have been proposed for stroke rehabilitation. Compared to conventional therapies, these training devices have the advantage that they allow a self controlled increase in training intensity and frequency as well as the opportunity to train independently [1–4]. In recent years, a substantial number of these training devices have been designed specifically for bilateral upper limb training, but an integral overview and evaluation have thus far been lacking. The present study seeks to fill this lacuna.Bilateral upper limb training is by no means a new form of stroke rehabilitation. Since days long past, therapists have been creative in using appliances, such as pulleys, to move the most impaired upper limb simultaneously with the less impaired upper limb [5]. Nevertheless, the current upsurge in the interest in bilateral upper limb training hasa relatively short history and arose partly serendipitously [6, 7] and partly from insights gleaned from the motor control literature. In this literature, coupling (or interaction)effects between the two upper limbs have been investigated extensively in rhythmic interlimb coordination studies involving healthy subjects [8–12]. It is well established that healthy subjects show a basic tendency towards in phase(i.e., symmetrical movements) or anti-phase (i.e., alternating movements) coordination, with a prevalent 1:1 frequency-locking mode for upper limb bilateral movements [12]. These tendencies reflect the coupling between the upper limbs. Based on the assumption that this coupling facilitates the functional recovery of the paretic arm, it is exploited in bilateral upper limb training, usually by moving both arms.
2 Stroke Research and Treatment and/or hands in either in-phase or anti-phase coordination.However, whether one pattern is to be preferred over the other is currently not evident.Recent systematic reviews produced mixed results on the superiority or inferiority of bilateral upper limb training over other interventions in post stroke rehabilitation. Two such reviews found strong evidence in support of bilateral upperlimb training after stroke [13, 14]. Another review was more reticent in its conclusions than the previous two [15], and three systematic reviews concluded that bilateral training isat best similarly effective as other treatments but certainly not better [16–18]. These mixed results may be related to the heterogeneity of types of bilateral upper limb training and the devices used in clinical trials. Therefore, an overview and evaluation of clinical applicability of bilateral upper limb training devices may be helpful in directing future research in this regard.The present systematic review evaluates bilateral training devices designed for post stroke upper limb training in terms of (1) mechanical and electromechanical characteristics, (2)supported movement patterns, (3) targeted part and active involvement of the upper limb, (4) training protocols, (5)outcomes of clinical trials, and (6) commercial availability.The aim of the paper is to evaluate these aspects in a qualitative manner because not sufficient randomized clinical trials are available on the devices in question to evaluate or compare clinical outcomes statistically. We therefore aim at comparing and integrating concepts, findings, and insights from largely qualitative studies, culminating in an overview of training devices for post stroke rehabilitation, an assessment of their clinical applicability, and some general conclusions and recommendations for future developments and research.
Results
In total, 6 mechanical and 14 robotic bilateral upper limb training devices were evaluated in terms of mechanical and electromechanical characteristics, supported movement patterns, targeted part and active involvement of the upper limb, training protocols, outcomes of clinical trials, and commercial availability.
Conclusion
Initial clinical results are not yet of such caliber that the devices in question and the concepts on which they are based arefirmly established. However, the clinical outcomes do not rule out the possibility that the concept of bilateral training and the accompanied devices may provide a useful extension of currently available forms of therapy. To actually demonstrate their(surplus)value, more research with adequate experimental, dose-matched designs, and sufficient statistical power are required.
1.Introduction
As technology advances, a growing number of mechanical and robotic training devices (i.e., mechanical devices with electronic, computerized control systems) for upper limb training have been proposed for stroke rehabilitation. Compared to conventional therapies, these training devices have the advantage that they allow a self controlled increase in training intensity and frequency as well as the opportunity to train independently [1–4]. In recent years, a substantial number of these training devices have been designed specifically for bilateral upper limb training, but an integral overview and evaluation have thus far been lacking. The present study seeks to fill this lacuna.Bilateral upper limb training is by no means a new form of stroke rehabilitation. Since days long past, therapists have been creative in using appliances, such as pulleys, to move the most impaired upper limb simultaneously with the less impaired upper limb [5]. Nevertheless, the current upsurge in the interest in bilateral upper limb training hasa relatively short history and arose partly serendipitously [6, 7] and partly from insights gleaned from the motor control literature. In this literature, coupling (or interaction)effects between the two upper limbs have been investigated extensively in rhythmic interlimb coordination studies involving healthy subjects [8–12]. It is well established that healthy subjects show a basic tendency towards in phase(i.e., symmetrical movements) or anti-phase (i.e., alternating movements) coordination, with a prevalent 1:1 frequency-locking mode for upper limb bilateral movements [12]. These tendencies reflect the coupling between the upper limbs. Based on the assumption that this coupling facilitates the functional recovery of the paretic arm, it is exploited in bilateral upper limb training, usually by moving both arms.
2 Stroke Research and Treatment and/or hands in either in-phase or anti-phase coordination.However, whether one pattern is to be preferred over the other is currently not evident.Recent systematic reviews produced mixed results on the superiority or inferiority of bilateral upper limb training over other interventions in post stroke rehabilitation. Two such reviews found strong evidence in support of bilateral upperlimb training after stroke [13, 14]. Another review was more reticent in its conclusions than the previous two [15], and three systematic reviews concluded that bilateral training isat best similarly effective as other treatments but certainly not better [16–18]. These mixed results may be related to the heterogeneity of types of bilateral upper limb training and the devices used in clinical trials. Therefore, an overview and evaluation of clinical applicability of bilateral upper limb training devices may be helpful in directing future research in this regard.The present systematic review evaluates bilateral training devices designed for post stroke upper limb training in terms of (1) mechanical and electromechanical characteristics, (2)supported movement patterns, (3) targeted part and active involvement of the upper limb, (4) training protocols, (5)outcomes of clinical trials, and (6) commercial availability.The aim of the paper is to evaluate these aspects in a qualitative manner because not sufficient randomized clinical trials are available on the devices in question to evaluate or compare clinical outcomes statistically. We therefore aim at comparing and integrating concepts, findings, and insights from largely qualitative studies, culminating in an overview of training devices for post stroke rehabilitation, an assessment of their clinical applicability, and some general conclusions and recommendations for future developments and research.
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