Best Conventional Therapy Versus Modular Impairment-Oriented Training for Arm Paresis After Stroke: A Single-Blind, Multicenter Randomized Controlled Trial

Platz, Thomas; Kaick, S. van; Mehrholz, Jan; Leidner, Ottmar; Eickhof, Christel; Pohl, Marcus

doi:10.1177/1545968309335974

Cited by 102 publications

(81 citation statements)

References 31 publications

(41 reference statements)

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“…Positive effects of a specific training have been demonstrated for healthy participants not only on the trained but also on the non-trained extremity [24][25][26][27] as well as for performing another not specifically trained motor task with the same extremity [28]. Furthermore, similar findings have also been reported after stroke resulting in mild arm paresis for learning transfer on non-trained tasks [29,30] as well as from the healthy to the paretic hand [31]. In fact, training time in a range of weeks to months is essential to understand the effects observed in motor rehabilitation.…”

Section: Introductionmentioning

confidence: 60%

Changes in cortical, cerebellar and basal ganglia representation after comprehensive long term unilateral hand motor training

Walz

Doppl

Kaza

et al. 2015

Behavioural Brain Research

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Section: Introductionmentioning

confidence: 60%

Changes in cortical, cerebellar and basal ganglia representation after comprehensive long term unilateral hand motor training

Walz

Doppl

Kaza

et al. 2015

Behavioural Brain Research

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“…We performed task-related fMRI assessment immediately before and after a four-week impairment-oriented training period (1080 repetitions of a reach-tograsp task executed with the paretic arm) [33][34][35][36]. The short-and longterm effects of this type of training has been investigated previously by us [33,34] and others [35,36] and found this training to be associated with a moderate improvement of the arm motor control and a decrease in the alternative (compensatory) movement strategy (i.e., the use of the trunk) used. Trunk compensation has been widely studied by us [32,37,38] during tasks executed with the paretic arm.…”

Section: International Journal Of Physical Medicine and Rehabilitationmentioning

confidence: 99%

Primary Motor Cortex Ipsilateral to the Paretic Arm - A Potential Neural Substrate for Compensatory Trunk Use in Chronic Stroke

Bani-Ahmed¹,

Savage²,

Nudo³

et al. 2017

Int J Phys Med Rehabil

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Objective: Arm motor recovery after stroke is primarily attributed to the primary motor cortex (M1) plasticity. While the M1 contralateral to the paretic arm (cM1) is undoubtedly critical for recovery, the role of the ipsilateral M1 (iM1) is still inconclusive. For instance, an abnormally increased activity in the iM1 is reported immediately after stroke and normalizes at the chronic stage in recovered patients. Whether persistent iM1 hyperactivity in chronic stroke reflects a less efficient type of plasticity (so-called maladaptive) is still far from settled. We investigated the functional significance of the iM1 hyperactivity with respect to compensatory behavioral strategies employed by patients suffering from chronic arm paresis. Methods:Functional MRI and trunk kinematics data were collected during paretic arm movements in 11 patients before and after a four-week training specifically designed to improve the motor control of the paretic arm and diminish the behavioral (trunk) compensation comprising of variable practice of a reach-to-grasp task with feedback given as knowledge-of-performance. Eight age-matched healthy controls underwent similar evaluations and training. Magnitude of iM1 (and cM1) activation and anterior trunk displacement were analysed. Results:Before training, patients exhibited significantly stronger iM1 activation, increased trunk motion, and significant positive correlations between these two variables compared to controls. After training, patients significantly decreased iM1 activation and displayed a trend toward decreased trunk use. The correlations between iM1 activation and trunk motion persisted and were different from those in controls. Conclusion:Our preliminary data provide evidence that functional iM1 plasticity is related to behavioral compensation, suggesting a maladaptive role of the iM1 in chronic subcortical stroke. We however recommend caution in interpreting these results until more work is completed.

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“…[65]. "Arm-Basis-Training", entwickelt zur gezielten Behandlung von Patienten mit hochgradigen Armparesen, und "Arm-Ability-Training" zur Therapie bei Patienten mit schon bestehenden motorischen Teilfunktionen wurden mit der jeweils besten konventionellen Therapie bei 148 subakuten Schlaganfall-Patienten verglichen [66]. Die Verfahren waren den anderen Therapieansätzen überlegen, was rasche, innerhalb der 3-bis 4-wöchigen Interventionsphase auftretende Effekte anging.…”

Section: Constraint-induced Movementunclassified

Evidenzbasierte Verfahren in der motorischen Rehabilitation nach Schlaganfall

Liepert

2012

Fortschr Neurol Psychiatr

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In this review, treatments for motor rehabilitation after stroke will be presented. In particular, randomised, controlled trials, meta-analyses and systematic reviews, mainly from the years 2009 - 2011, were taken into consideration. In summary, evidence is best for constraint-induced movement therapy and Botulinum toxin type A in patients with focal spasticity. Superiority has been demonstrated for the administration of drugs (serotonin re-uptake inhibitors and L-dopa), mirror therapy, the use of virtual reality, electromechanical devices to restore independent walking, and fitness and circuit training. Other therapies (bilateral arm training, treadmill therapy, robot-assisted arm therapy) did not show superiority. For sensory training and repetitive transcranial magnetic stimulation large clinical studies still need to be done.

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Best Conventional Therapy Versus Modular Impairment-Oriented Training for Arm Paresis After Stroke: A Single-Blind, Multicenter Randomized Controlled Trial

Abstract: Specificity of active training seemed more important for motor recovery than intensity (therapy time). The comprehensive modular IOT approach promoted motor recovery in patients with either severe or mild arm paresis.

Cited by 102 publications

References 31 publications

Changes in cortical, cerebellar and basal ganglia representation after comprehensive long term unilateral hand motor training

Changes in cortical, cerebellar and basal ganglia representation after comprehensive long term unilateral hand motor training

Primary Motor Cortex Ipsilateral to the Paretic Arm - A Potential Neural Substrate for Compensatory Trunk Use in Chronic Stroke

Evidenzbasierte Verfahren in der motorischen Rehabilitation nach Schlaganfall

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