Psychological Interventions to Improve Upper Limb Motor Dysfunction Post-stroke: A Scoping Review

 You wouldn't need psychological interventions if you had 100% RECOVERY PROTOCOLS! Do the correct research: 100% recovery and you don't need to waste time on all these secondary problems because your survivor didn't get 100% recovered! Do you people have two functioning neurons to rub together?

My conclusion is you don't understand ONE GODDAMN THING ABOUT SURVIVOR MOTIVATION, DO YOU? You create EXACT 100% recovery protocols and your survivor will be motivated to do the millions of reps needed because they are looking forward to 100% recovery. GET THERE!

There would be no need for this useless research.

Psychological Interventions to Improve Upper Limb Motor Dysfunction Post-stroke: A Scoping Review 

Published: January 02, 2025 >

DOI: 10.7759/cureus.76784

Peer-Reviewed

Cite this article as: Iwamoto Y, Imura T, Mitsutake T, et al. (January 02, 2025) Psychological Interventions to Improve Upper Limb Motor Dysfunction Post-stroke: A Scoping Review. Cureus 17(1): e76784. doi:10.7759/cureus.76784

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Abstract

Cognitive strategies in post-stroke patients significantly influence upper limb motor function recovery. Integrating upper extremity and psychological interventions may enhance rehabilitation outcomes. This scoping review aimed to summarize studies evaluating the effectiveness of combining these approaches to improve upper extremity motor dysfunction in patients with post-stroke syndrome. Randomized controlled trials (RCTs) comparing combined upper extremity and psychological interventions versus upper extremity interventions alone were included. Studies published between November 25, 2024, and the study’s conclusion were retrieved from PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Physiotherapy Evidence Database (PEDro), and Cumulative Index to Nursing and Allied Health Literature. Only English-language studies were reviewed. Three RCTs met the inclusion criteria. Two studies utilized cognitive orientation to daily occupational performance (CO-OP), while one employed cognitive-oriented strategy training augmented rehabilitation (COSTAR). The CO-OP studies demonstrated that combined psychological and physical interventions significantly improved motor function compared to physical interventions alone. However, the COSTAR-based study reported greater efficacy for upper extremity interventions alone. This review highlighted the mixed efficacy of combined interventions. While CO-OP showed potential benefits, the COSTAR findings suggest variability in the effectiveness of different cognitive strategies. Both approaches prioritized activity and goal setting rather than directly targeting motor recovery. Although the findings are inconclusive, this is the first review to explore the role of combined psychological and upper extremity interventions for post-stroke motor dysfunction, providing a foundation for further research.

Introduction & Background

Improving upper extremity motor dysfunction is crucial in post-stroke rehabilitation. Severe sequelae in the upper extremity affect 43%-69% of patients with post-stroke motor dysfunction [1,2]. Post-stroke upper extremity motor dysfunction limits activities of daily living [3] and social reintegration [4] and causes an economic burden [5]. Furthermore, post-stroke upper extremity dysfunction is correlated with anxiety, low quality of life, and a higher incidence of disability [6,7]. Only 5%-20% of patients achieve complete improvement in upper extremity motor dysfunction six months post-stroke despite the importance of improving upper extremity motor dysfunction [8,9]. Therefore, clinicians are required to select and provide patients with appropriate interventions to improve upper limb motor dysfunction.

Various upper limb interventions have improved upper limb motor dysfunction in stroke patients. Upper extremity motor dysfunction improvement, which requires sufficient physical activity and high-quality upper limb interventions, involves the basal ganglia, cerebellum, and cerebral cortex [10]. Upper limb interventions induce structural plasticity changes in the nervous system, which develops compensatory neural networks and improves motor dysfunction [11]. A previous guideline has determined constraint-induced movement therapy, electrical stimulation, and mirror therapy with a high evidence level to improve upper extremity motor dysfunction [12]. Therefore, interventions with a high evidence level aimed at enhancing upper limb motor dysfunction have already been determined.

Stroke patients often experience not only motor dysfunction but also mental status changes, such as post-stroke depression [13] and cerebrovascular dementia [14]. These mental status changes influence participation in rehabilitation and the overall recovery process [15-17]. Accordingly, it is hoped that improvements in mental state will lead to improvements in motor function and ADL, as well as improvements in the effectiveness of rehabilitation. Therefore, interventions addressing upper limb motor dysfunction also need to consider psychological aspects. Psychological interventions that use cognitive strategies have been recommended for improving skill transfer and subsequent functioning and participation [18-20]. Previous research on cognitive strategies has described them as goal-oriented, consciously controllable processes that facilitate or support performance as subjects develop internal procedures for them to perform desired skills [21]. Interventions using cognitive strategies have helped improve motor dysfunction [22,23]. However, evidence for psychological interventions to enhance post-stroke upper extremity motor dysfunction is inconsistent in previous guidelines [12]. Consistent evidence on psychological interventions remains lacking despite the importance of psychological interventions in improving motor dysfunction.

Previous systematic reviews revealed the effects of psychological interventions on improving mental health in patients with post-stroke syndrome, but not on improving motor dysfunction [24]. However, the usefulness of combining upper extremity interventions with psychological interventions for post-stroke upper extremity motor dysfunction remains unclear. Furthermore, various psychological intervention methods, including emotional [13], cognitive [25], motivation [26,27], planning and executing [28] aspects, are available, and summarizing the interventions that are effective when combined with upper extremity interventions is important. This scoping review aimed to comprehensively investigate and summarize the usefulness of a combination of upper extremity and psychological interventions for upper extremity motor dysfunction in stroke patients. Our overarching research questions were “Is it useful to combine upper extremity interventions with psychological interventions for upper extremity motor dysfunction post-stroke?” and “What psychological interventions are useful?”

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