Since this is for chronic you are completely on your own to find the protocol and tools used. You hospital will do nothing since you were long ago kicked out for plateauing and thus your insurance quit paying. Our fucking failures of stroke associations do nothing and will have nothing on this.
Your doctor and hospital should have tested BATRAC years ago.
BATRAC (2 posts to October 2020)
Repetitive Bilateral Arm Training and Motor Cortex Activation in Chronic Stroke
Andreas R. Luft, MDSandy McCombe-Waller, PT, PhDJill Whitall, PhDLarry W. Forrester, PhDRichard Macko, MDJohn D. Sorkin, MD, PhDJörg B. Schulz, MD Andrew P. Goldberg, MDDaniel F. Hanley, MD
H
EMIPARESIS REPRESENTS THE
dominant functionally limiting symptom in 80% of patients with acute stroke.1
Within 2 to 5 months after a stroke,patients recover a variable degree of function, depending on the magnitude of the initial deficit.1
Several studies have demonstrated that recovery is associated with reorganization of central nervous system networks.2,3
Functional brain imaging of paretic movement during the recovery period has shown recruitment of cortex immediately adjacent to the stroke cavity along with intact cortical areas within the lesioned and in the uninjured contralesional hemisphere.4,5
The pattern of recruitment depends on the severity of impairment,6 lesion location,7 and time since stroke.8
The factors that initiate and maintain cortical reorganization are not known. Imaging data suggest that circuitry in motor cortices on both sides of the brain is modified during recovery.2
Author Affiliations:
Division of Gerontology, Department of Medicine (Drs Luft, Macko, Sorkin, Gold-berg, and Hanley), Department of Physical Therapy and Rehabilitation Science (Drs McCombe-Waller,Whitall, and Forrester), and Department of Neurology (Drs Forrester and Macko), University of Mary-land School of Medicine, Baltimore; Division of Brain Injury Outcome, Department of Neurology, Johns Hop-kins University,Baltimore,Md(Drs. Luft and Hanley);Department of General Neurology, HertieInstitutefor Clinical Brain Research,University of Tübingen,Tübingen, Germany (Drs Luft and Schulz); and Baltimore Veterans Affairs Maryland Health Care System,Geriatric Research, Education and Clinical Center, Baltimore (Drs McCombe-Waller, Whitall, Forrester,Macko, Sorkin, Goldberg, and Hanley).
Corresponding Author:
Jill Whitall, PhD, Department of Physical Therapy and Rehabilitation Science, University of Maryland, School of Medicine,100PennSt,Baltimore, MD 21201 (Jwhitall@som.umaryland.edu).
H
EMIPARESIS REPRESENTS THE
dominant functionally limiting symptom in 80% of patients with acute stroke.1
Within 2 to 5 months after a stroke,patients recover a variable degree of function, depending on the magnitude of the initial deficit.1
Several studies have demonstrated that recovery is associated with reorganization of central nervous system networks.2,3
Functional brain imaging of paretic movement during the recovery period has shown recruitment of cortex immediately adjacent to the stroke cavity along with intact cortical areas within the lesioned and in the uninjured contralesional hemisphere.4,5
The pattern of recruitment depends on the severity of impairment,6 lesion location,7 and time since stroke.8
The factors that initiate and maintain cortical reorganization are not known. Imaging data suggest that circuitry in motor cortices on both sides of the brain is modified during recovery.2
Author Affiliations:
Division of Gerontology, Department of Medicine (Drs Luft, Macko, Sorkin, Gold-berg, and Hanley), Department of Physical Therapy and Rehabilitation Science (Drs McCombe-Waller,Whitall, and Forrester), and Department of Neurology (Drs Forrester and Macko), University of Mary-land School of Medicine, Baltimore; Division of Brain Injury Outcome, Department of Neurology, Johns Hop-kins University,Baltimore,Md(Drs. Luft and Hanley);Department of General Neurology, HertieInstitutefor Clinical Brain Research,University of Tübingen,Tübingen, Germany (Drs Luft and Schulz); and Baltimore Veterans Affairs Maryland Health Care System,Geriatric Research, Education and Clinical Center, Baltimore (Drs McCombe-Waller, Whitall, Forrester,Macko, Sorkin, Goldberg, and Hanley).
Corresponding Author:
Jill Whitall, PhD, Department of Physical Therapy and Rehabilitation Science, University of Maryland, School of Medicine,100PennSt,Baltimore, MD 21201 (Jwhitall@som.umaryland.edu).
Context
Reorganization in central motor networks occurs during early recovery from hemiparetic stroke. In chronic stroke survivors, specific rehabilitation therapy can improve upper extremity function.
Objective
To test the hypothesis that in patients who have chronic motor impairment following stroke, specific rehabilitation therapy that improves arm function is associated with reorganization of cortical networks.
Design, Setting, and Patients
A randomized controlled clinical trial conducted in a US ambulatory rehabilitation program with 21 patients (median [IQR], 50.3[34.8-77.3] months after unilateral stroke). Data were collected between 2001 and2004.
Interventions
Patients were randomly assigned to bilateral arm training with rhythmic auditory cueing (BATRAC) (n=9) or standardized dose-matched therapeutic exercises (DMTE) (n=12). Both were conducted for 1 hour, 3 times a week, for 6weeks.
Main Outcome Measures
Within2weeksbeforeandaftertheintervention,brain activation during elbow movement assessed by functional magnetic resonance imaging (fMRI) and functional outcome assessed using arm function scores.
Results
Patients in the BATRAC group but not in the DMTE group increased hemispheric activation during paretic arm movement (P=.03). Changes in activation were observed in the contralesional cerebrum and ipsilesional cerebellum(P=.009). BATRAC was associated with significant increases in activation in precentral (P<.001) and post central gyri (P=.03) and the cerebellum (<P.001), although3 BATRAC patients showed no fMRI changes. Considering all patients, there were no differences in functional outcome between groups. When only BATRAC patients with fMRI response were included (n=6), BATRAC improved arm function more than DMTE did (P=.02).
Conclusions
These preliminary findings suggest that BATRAC induces reorganization in contralesional motor networks and provide biological plausibility for repetitive bilateral training as a potential therapy for upper extremity rehabilitation in hemiparetic stroke.
No comments:
Post a Comment