Ask your competent? doctor if ANYTHING AT ALL FOUND IN THE LAST 13 YEARS GETS SURVIVORS ARMS/HAND FULLY RECOVERED! If nothing, what the hell has your incompetent doctor been doing for 13 years to get survivors recovered?
Send me hate mail on this: oc1dean@gmail.com. I'll print your complete statement with your name and my response in my blog. Or are you afraid to engage with my stroke-addled mind? I need an explanation of your incompetence on stroke research and why you're not solving stroke.
Wow, more blithering idiots saying spasticity is not a major problem. Well, hope schadenfreude hits you hard when you are the 1 in 4 per WHO that has a stroke and you just happen to get spasticity. You could have solved it when still working!
Potential effectiveness of three different treatment approaches to improve minimal to moderate arm and hand function after stroke - a pilot randomized clinical trial
2011, Clinical Rehabilitation
4 Pages
2 Files ▾
To
test a study design and explore the feasibility and potential effects
of conventional neurological therapy, constraint induced therapy and
therapeutic climbing to improve minimal to moderate arm and hand
function in patients after a stroke. A pilot study with six-month
follow-up in patients after stroke with minimal to moderate arm and hand
function admitted for inpatient rehabilitation was performed.
Participants were randomly allocated to one of three treatment
approaches. Main outcomes were improvement of arm and hand function and
adverse effects. 283 patients with stroke were screened for inclusion
over a two-year period, out of which fourtyfour were included. All
patients could be treated according to the protocol. Improvement of arm
and hand function was significantly higher in conventional neurological
therapy and constraint induced therapy compared with therapeutic
climbing at discharge, and at six months follow-up
(P < 0.05, effect size = 0.56-0.76). No significant
differences in arm and hand function were observed between constraint
induced therapy and conventional neurological therapy. Constraint
induced therapy participants were significantly less at risk of
developing shoulder pain at six months follow-up compared with the other
participants (P < 0.05, effect size = 0.82 and 1.79,
respectively). The study design needs adaptation to accommodate the
stringent inclusion criteria leading to prolonged study duration.
Constraint induced therapy seems to be the optimal approach to improve
arm and hand function and minimize the risk of shoulder pain for
patients with minimal to moderate arm hand function after stroke in the
intermediate term.
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 mes-
sage 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 function 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
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? Task-oriented exercises are shown to be effective
to regain independence and motor control in the
early stages of acute stroke. Task-oriented exercises
are even more important in the late stages of stroke,
since now it is a way to maintain function! Nowhere
is ‘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’ shown to be crucial for
motor control or maintaining function. Could we, as
therapists, please refrain from this reborn Bobath
approach and move on?
Birgitta Langhammer
Faculty of Health Sciences, Oslo and Akershus
University, Oslo, Norway
Email: Birgitta.Langhammer@hioa.no
Johan K Stanghelle
Sunnaas Rehabilitation Hospital and Faculty of
Medicine, University of Oslo, Norway
Katharina Stibrant Sunnerhagen
Institute of Neuroscience and Physiology,
The Sahlgrenska Academy,
University of Gothenburg, Sweden
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