Didn't your competent? doctor train you on this years ago? Oh, that's right, you DON'T have a functioning stroke doctor, do you? S/he knows nothing about recovery, but to quote this fuckingly lazy saying: 'All strokes are different, all stroke recoveries are different'! If you hear that from anyone you need TO GET THEM FIRED!
Here's proof for how long your complete stroke hospital is INCOMPETENT!
Exercising the good side to recover the 'bad' side. December 2012)
The latest here:
Training the unimpaired arm improves the motion of the impaired arm and the sitting balance in chronic stroke survivors
A. De Luca, P. Giannoni, H. Vernetti, C. Capra, Robotics Rehabilitation Team, C. Lentino,
G. A. Checchia, M. Casadio*
Abstract -
Robot-assisted rehabilitation of stroke survivors
mainly focuses on the impaired side of the body while the role of
the unimpaired side in the recovery after stroke is still
controversial. The goal of this study is to investigate the influence
on sitting balance and paretic arm functions of a training
protocol based on movements of the unimpaired arm.
Sixteen chronic stroke survivors underwent nineteen training
sessions, in which they performed active movements with the
unimpaired arm supported by a passive exoskeleton.
Performance of the trunk and upper limbs was evaluated before
treatment, after treatment and at six months follow up with
clinical scales and an instrumented evaluation. A reaching test
executed with the exoskeleton was used to assess changes in
performance of both arms. The treatment based on the
unimpaired arm’s movements executed with a correct body
posture led to benefits in control of the trunk and of both the
trained and the untrained arm. The amount of impaired arm
improvement in the Fugl-Meyer score was comparable to the
outcome of robotic treatments focused directly on this arm.
Our results highlight the importance of taking into account all
body schema in the rehabilitation robotic program, instead of
focusing only on the impaired side of the body.
Index Terms— Rehabilitation, Reaching, Sitting posture,
Chronic stroke, Upper limb, Compensatory strategies
I. INTRODUCTION
Stroke is a cerebrovascular accident that often results in severe
motor impairment and disability on the side of the body
contralateral to the cerebral lesion. However, some studies
highlight that the ipsilateral side also has deficits in muscle
strength, coordination and dexterity [1-3] that are correlated
with the level of impairment of the more affected contralateral
side [4].
Paper submitted for review May 12th, 2016. This work was supported in part
by the FP7-PEOPLE-2012-CIG-334201 and by the kind contribution of the
Italian Ministry of foreign Affairs.
A.D. (alice.deluca@edu.unige.it ), P.G. (psiche.giannoni@dibris.unige.it ),
and M.C. *(maura.casadio@unige.it, corresponding author) are with the
University of Genova, Genova, Italy; MC is also with the Italian Institute of
Technology
A.D., H.V.(honore.vernetti@gmail.com ), C.C.(capracristina80@gmail.com ),
the robotics rehabilitation team (roboticarrf.pietra@asl2.liguria.it), C.L.
(c.lentino@asl2.liguria.it) and G.A.C. (g.checchia@asl2.liguria.it ), are with
the Recovery and Functional Reeducation Unit, Santa Corona Hospital, ASL2
Savonese, Pietra Ligure, Italy;
The members of the Rehabilitation Robotics Team are: H. Vernetti, C. Capra,
I. Pisu, C. Cassiano, F. Gaito, L. Barone, L. Loguercio and R. Carioti.
Research as well as rehabilitation, both traditional and robotic,
focuses mainly on the most impaired arm [5, 6]. The role of
the other arm in the recovery process is still controversial,
ranging from approaches that promote the ‘no use’ [7] to
methods that highlight a positive influence of the unimpaired
arm motion [8]. Constraint Induced Movement Therapy
(CIMT[9]) is based on limiting the movement of the
unimpaired arm to promote the use of the other arm. CIMT
seems to be effective at improving the most affected arm
functions in daily life activities, but positive changes are
observed mostly in stroke survivors with active wrist and
finger movements, good cognitive abilities and limited
spasticity [10]. Moreover these changes could be mainly due
to an adaptation process rather than to recovery of normal
functions and relearning upper arm use [11]. A recent review
[12] found that CIMT is associated with some degree of
recovery of motor functions, but does not reduce disability.
This method indeed may improve functional abilities by
increasing compensatory strategies along with a small
reduction in impairment [13].
Conversely, there are other approaches that highlight a
positive influence of the unimpaired arm motion on the more
impaired side, such as the “cross education” method [14]. A
recent review [15] examining the effects of cross-education in
the rehabilitation of post-stroke hemiplegic survivors
suggested that there is moderate evidence that cross-
education has positive effects on muscle strength. Few other
recent studies directly investigated if the training of the
unimpaired side can influence body posture and impaired arm
performance in stroke survivors. Exercises performed with the
unimpaired arm seem to have positive effects on reducing
spasticity [16] and enhancing balance and functions of the
more affected arm [17]. Pandian et al. [18] showed also that
this training could be effective not only for improving muscle
strength, dexterity and coordination of the less-affected side
directly involved in the training, but also for promoting the
motor recovery of the more affected side. However, the
evidence of the positive effects of this approach is still
controversial. Moreover, several studies [19-24] highlighted
limitations on the transfer of a learned skill from one arm to
the other in healthy subjects.
This work focuses on a training protocol based on active
movements of the unimpaired arm in a population of chronic
stroke survivors. We used a passive exoskeleton to facilitate a
correct sitting posture and to propose exercises that required
the recruitment of low back muscles with the goal of
improving core stability.
Training the unimpaired arm improves the
motion of the impaired arm and the sitting
balance in chronic stroke survivors
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