Deans' stroke musings: Intensive upper limb neurorehabilitation in chronic stroke: outcomes from the Queen Square programme

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

Nick S Ward1,2,3,
Fran Brander2,3,
Kate Kelly2,3

Author affiliations

Department of Clinical and Motor Neuroscience, UCL Institute of Neurology, London, UK
The National Hospital for Neurology and Neurosurgery, London, UK
UCLP Centre for Neurorehabilitation, London, UK

Correspondence to Professor Nick S Ward, Department of Clinical and Motor Neuroscience, UCL Institute of Neurology, London WC1N 3BG, UK; n.ward@ucl.ac.uk

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.

http://dx.doi.org/10.1136/jnnp-2018-319954