Wrong objective: it should have been; Create protocols based on this study. This is useless.
Effects of Intensive Impairment-Oriented Arm Rehabilitation for Chronic Stroke Survivors: An Observational Cohort Study
1
Neurorehabilitation Research Group, University Medical Centre, 17475 Greifswald, Germany
2
BDH-Klinik
Greifswald, Institute for Neurorehabilitation and Evidence-Based
Practice, “An-Institut”, University of Greifswald, 17491 Greifswald,
Germany
3
Hand and Occupational Therapy Outpatient Service Laborn, 80802 München, Germany
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2025, 14(1), 176; https://doi.org/10.3390/jcm14010176
Submission received: 28 November 2024
/
Revised: 15 December 2024
/
Accepted: 21 December 2024
/
Published: 31 December 2024
(This article belongs to the Special Issue Rehabilitation and Management of Stroke)
Abstract
Objective:
To assess the effects
of a two-week course of intensive impairment-oriented arm rehabilitation
for chronic stroke survivors on motor function.
Methods:
An
observational cohort study that enrolled chronic stroke survivors (≥6
months after stroke) with mild to severe arm paresis, who received a
two-week course of impairment-oriented and technology-supported arm
rehabilitation (1:1 participant–therapist setting), which was carried
out daily (five days a week) for four hours. The outcome measures were
as follows: the primary outcome was the arm motor function of the
affected arm (mild paresis: BBT, NHPT; severe paresis: Fugl-Meyer arm
motor score). The secondary outcomes were measures of finger strength,
active ROM, spasticity, joint mobility/pain, somatosensation, emotional
distress, quality of life, acceptability, and adverse events.
Results:
One hundred chronic stroke survivors (≥6 months after stroke) with mild
to severe arm paresis were recruited. The training was acceptable
(drop-out rate 3%; 3/100). The clinical assessment indicated improved
motor function (SMD 0.42, 95% CI 0.36–0.49; n = 97), reduced
spasticity/resistance to passive movement, and slightly improved joint
mobility/pain and somatosensation. The technology-based objective
measures corroborated the improved active range of motion for arm and
finger joints, reduced finger spasticity/resistance to passive movement,
and the increased amount of use in daily life, but there was no effect
on finger strength. The patient’s emotional well-being and quality of
life were positively influenced. Adverse events were reported by the
majority of participants (51%, 49/97) and were mild.
Conclusions:
Structured intensive impairment-oriented and technology-supported arm
rehabilitation can promote(NOT GOOD ENOUGH! Exact protocols need to be created to get survivors recovered! This would be cause for firing in the business world! Namby-pamby shit like this would never fly!) motor function among chronic stroke survivors
with mild to severe arm paresis and is an acceptable and tolerable form
of treatment when supervised and adjusted by therapists.
1. Introduction
Stroke
is the third leading cause of death and disability, combined, in the
world, and the burden it places on the healthcare system has increased
substantially over the last few decades [1].
As a major cause of chronic impaired arm function, it frequently
affects many activities of daily living. Between forty to seventy
percent of those affected by stroke suffer from arm paresis initially [2,3]. Among those, two thirds have severe arm paresis [3].
Six months after stroke, the affected arm of approximately half of all
stroke survivors, who initially had severe arm paresis, still remains
without function [4]. Different training- and technology-based interventions have been shown to improve arm function after stroke [5,6] and are recommended for stroke rehabilitation [7].
Most spontaneous recovery and the best course of treatment in terms of
improvements can be expected early after stroke, i.e., within the first
three months, and when arm paresis is not severe [8,9]. And, while there is the potential for stroke survivors in the chronic phase to improve their motor function [10],
it remains controversial how improvements to arm motor function can
still be gained through training and whether improvements at this stage
are related to the recovery of function, the enhancement of compensatory
strategies, or a reversal of learnt non-use (only) [11].
This
study followed the rationale (and hypothesis) that motor recovery,
i.e., the improvement of motor control, such as selective movement
control (rather than improved function due to compensatory behaviour),
is still achievable by stroke survivors in the chronic stage when
therapy offers training that explicitly, specifically, intensively, and
comprehensively addresses the motor control to be regained, i.e., the
ability to move the arm in regard to its various segments selectively
for stroke survivors with moderate to severe arm paresis, or the level
of performance related to different sensorimotor abilities for stroke
survivors with mild arm paresis [12].
This
cohort study aimed to investigate whether stroke survivors in the
chronic stage of their condition (i.e., ≥6 months post-stroke) with
various degrees of arm paresis, i.e., from mild to severe, could benefit
from a two-week course of intensive impairment-oriented arm
rehabilitation. For this purpose, the participants received daily
therapy as either Arm Basis Training (moderate to severe arm paresis) or
Arm Ability Training (mild arm paresis) [12],
combined with individually selected technology-based arm
rehabilitation, for a total of 4 h per weekday, for two consecutive
weeks (ten sessions). Both standardised clinical assessments and
technology-based measures were used to evaluate to what degree the
patient’s motor function improved and whether other body functions
(strength, spasticity/resistance to passive movement, somatosensation,
or passive joint mobility) were affected in parallel, whether more use
of the affected limb in the community was promoted, and whether the
patient-reported emotional well-being and quality of life changed. In
addition, acceptability in terms of the drop-out rate and safety, based
on documented adverse events, were addressed.
More at link.
No comments:
Post a Comment