Potential effectiveness of three different treatment approaches to improve minimal to moderate arm and hand function after stroke - a pilot randomized clinical trial

 This letter to the editor should have referenced that Bobath should have been shitcanned since 2003! Physiotherapy Based on the Bobath Concept for Adults with Post-Stroke Hemiplegia: A Review of Effectiveness Studies 2003 

And the idiotic reference to the ridiculous opinion of Dr. William M. Landau?

Spasticity After Stroke: Why Bother? Aug. 2004)

The latest here:

Potential effectiveness of three different treatment approaches to improve minimal to moderate arm and hand function after stroke - a pilot randomized clinical trial

Clinical Rehabilitation 26(8) 758–760 © The Author(s) 2012 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0269215512441758 cre.sagepub.com

 

Re: ‘Potential effectiveness of three different treatment approaches to improve minimal to moderate arm and hand function after stroke-a pilot randomized controlled clinical trial’ We read with interest the article of three different approaches to improve arm and hand function. 1 The study confirms the difficulty in doing clinical studies on conditions in stroke rehabilitation. It is not easy to get samples big enough to do research on specific problems in treatment. On the other hand, the study is also an example of trying to prove too many things in one sample. As we understand it the authors wanted to see if the treatment approaches were feasible within this patient group. Why? Two of the treatment methods are used regularly (conventional and constraint-induced movement therapy) and have been explored in other studies. Having two main outcomes and three arms makes it difficult to power, and it is not clear if a power analysis was performed beforehand. A pilot with two arms would probably have greater power to show change between groups. One of the new and exciting treatment approaches in this study was therapeutic climbing which actually was the one of interest. This could have preferably been investigated in a two-arm study. The study would probably have gained more power to conclude on possible effects if this approach had been chosen. The message in this pilot study is that any therapy is better than no therapy in maintaining arm and hand function. And since one of the criteria for including patients in the study was ‘no shoulder pain’ one can assume that constraint-induced movement therapy was the therapy that imposed least shoulder pain. This is in contrast to the clinical message presented on p. 1040. However, when reading the article we were once again surprised by the notion that conventional neurological therapy is presented as a form of synthesized Bobath methodology: ‘spasticity prevents economic and effective movement and therefore must be controlled. The classical aspects of symmetry, posture and inhibition of ineffective synergistic movements characterize this treatment approach’. 1 And to make it more accepted it is stated that ‘this is complemented by functional task- oriented treatment strategies’, as if this is the optional way to treat stroke patients. It seems as if things are back to normal and that we have not moved an inch from the days before our study Bobath or Motor Relearning. In a comparison of two different approaches of physiotherapy in stroke rehabilitation – a randomized controlled study 2 – we showed that it was not necessary to pay so much attention to ‘the classical aspects of symmetry, posture and inhibition of ineffective synergistic movements’ but that you could actually go straight to task-oriented exercises. It seems as if this conventional approach is accepted in some clinics, although it is not the optimal approach. The described approach contains all the old-fashioned ways that are not necessary to enhance motor func- tion and it seems an awful waste of therapy time to do all this preparations for something that is not necessary. And little time is left to do the effective part of treatment, namely task-oriented exercises! Furthermore, other studies have shown that spasticity is not a major problem in therapy for stroke(WHAT A BUNCH OF FUCKING BULLSHIT! You'll change your mind when you have spasticity from your stroke!) and when it is spasticity rarely increases with exercises, rather the contrary. 3–5 So how is it that this Bobath method has now been reborn as ‘conventional therapy approaches’ and that meta-analyses such as the one by Kollen et al. 6 are used to sanctify these standpoints?