Now we just need this written into a protocol, including the objective diagnosis needed to use the protocol, and distributed to all the stroke hospitals in the world. If your hospital doesn't get this in a month then have them go after it. We need to light fires under our stroke medical professionals or they will sit on their asses doing nothing. I can't tell from this if patients with spasticity were included or they just cherry picked less disabled survivors. So if not, then 30% of survivors that have spasticity won't be helped.
Intensive upper limb neurorehabilitation in chronic stroke: outcomes from the Queen Square programme
Abstract
Objective
Persistent difficulty in using the upper limb remains a major
contributor to physical disability post-stroke. There is a nihilistic
view about what clinically relevant changes are possible after the early
post-stroke phase. The Queen Square Upper Limb Neurorehabilitation
programme delivers high-quality, high-dose, high-intensity upper limb
neurorehabilitation during a 3-week (90 hours) programme. Here, we
report clinical changes made by the chronic stroke patients treated on
the programme, factors that might predict responsiveness to therapy and
the relationship between changes in impairment and activity.
Methods
Upper limb impairment and activity were assessed on admission,
discharge, 6 weeks and 6 months after treatment, with modified upper
limb Fugl-Meyer (FM-UL, max-54), Action Research Arm Test (ARAT, max-57)
and Chedoke Arm and Hand Activity Inventory (CAHAI, max-91).
Patient-reported outcome measures were recorded with the Arm Activity
Measure (ArmA) parts A (0–32) and B (0–52), where lower scores are
better.
Results
224 patients (median time post-stroke 18 months) completed the 6-month
programme. Median scores on admission were as follows: FM-UL = 26 (IQR
16–37), ARAT=18 (IQR 7–33), CAHAI=40 (28-55), ArmA-A=8 (IQR 4.5–12) and
ArmA-B=38 (IQR 24–46). The median scores 6 months after the programme
were as follows: FM-UL=37 (IQR 24–48), ARAT=27 (IQR 12–45), CAHAI=52
(IQR 35–77), ArmA-A=3 (IQR 1–6.5) and ArmA-B=19 (IQR 8.5–32). We found
no predictors of treatment response beyond admission scores.
Conclusion
With intensive upper limb rehabilitation, chronic stroke patients can
change by clinically important differences in measures of impairment and
activity. Crucially, clinical gains continued during the 6-month
follow-up period.
From your keyboard to the medical gods' ears!
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