JSU-Diagram: A Guideline for Treatment of the Upper Limb in Stroke Patients

Michielsen, Marc

doi:10.4172/2329-9096.1000280

Cited by 2 publications

(4 citation statements)

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“…In 2015, the rehabilitation team in Jessa Hospital, Belgium developed the JSU (Jessa Sint Ursula)-diagram, with the objective to stimulate the early start of rehabilitation of the arm and hand post stroke (10). The diagram offers a guideline to work on the objectives needed to shape the rehabilitation of the upper limb at various stages of recovery.…”

Section: Introductionmentioning

confidence: 99%

“…The diagram offers a guideline to work on the objectives needed to shape the rehabilitation of the upper limb at various stages of recovery. The diagram also highlights the importance of stratification of patients toward different training objectives, based on the levels of trunk control and arm function that are reached (10). A focused therapy program for the upper limb needs to be further delineated by knowledge of neurophysiological recovery post stroke to ensure that specific therapy goals are set for the correct patient at each stage in recovery (11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

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Arm-Hand Boost Therapy During Inpatient Stroke Rehabilitation: A Pilot Randomized Controlled Trial

et al. 2021

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Objective: It was the aim to assess feasibility, safety, and potential efficacy of a new intensive, focused arm-hand BOOST program and to investigate whether there is a difference between early vs. late delivery of the program in the sub-acute phase post stroke.Methods: In this pilot RCT, patients with stroke were randomized to the immediate group (IG): 4 weeks (4 w) BOOST +4 w CONTROL or the delayed group (DG): 4 w CONTROL +4 w BOOST, on top of their usual inpatient care program. The focused arm-hand BOOST program (1 h/day, 5x/week, 4 weeks) consisted of group exercises with focus on scapula-setting, core-stability, manipulation and complex ADL tasks. Additionally, 1 h per week the Armeo®Power (Hocoma AG, Switzerland) was used. The CONTROL intervention comprised a dose-matched program (24 one-hour sessions in 4 w) of lower limb strengthening exercises and general reconditioning. At baseline, after 4 and 8 weeks of training, the Fugl-Meyer assessment upper extremity (FMA-UE), action research arm test (ARAT), and stroke upper limb capacity scale (SULCS) were administered.Results: Eighteen participants (IG: n = 10, DG: n = 8) were included, with a median (IQR) time post stroke of 8.6 weeks (5–12). No adverse events were experienced. After 4 weeks of training, significant between-group differences were found for FMA-UE (p = 0.003) and SULCS (p = 0.033) and a trend for ARAT (p = 0.075) with median (IQR) change scores for the IG of 9 (7–16), 2 (1–3), and 12.5 (1–18), respectively, and for the DG of 0.5 (−3 to 3), 1 (0–1), and 1.5 (−1 to 9), respectively. In the IG, 80% of patients improved beyond the minimal clinical important difference of FMA-UE after 4 weeks, compared to none of the DG patients. Between 4 and 8 weeks of training, patients in the DG tend to show larger improvements when compared to the IG, however, between-group comparisons did not reach significance.Conclusions: Results of this pilot RCT showed that an intensive, specific arm-hand BOOST program, on top of usual care, is feasible and safe in the sub-acute phase post stroke and suggests positive, clinical meaningful effects on upper limb function, especially when delivered in the early sub-acute phase post stroke.Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT04584177

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Arm-Hand Boost Therapy During Inpatient Stroke Rehabilitation: A Pilot Randomized Controlled Trial

et al. 2021

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“…Participants were recruited consecutively from the inpatient rehabilitation unit of Jessa Hospital, Rehabilitation Campus Sint-Ursula in Belgium between May 2019 and March 2020. patients were eligible for the study if they (1) experienced a first-ever unilateral, supra-tentorial stroke as defined by the World Health Organization (35), (2) were minimally 18 years old, (3) had a residual inpatient stay of minimally 4 weeks, (4) had the ability to sit independently, as defined as a maximal score of 25 on item 3 of the trunk control test (36), and (5) experienced motor impairment in the upper limb, as defined, based on the JSU diagram (10), as a score of 8-17 on stage 2 (synergies) of the FMA-UE (37), or a score of <8 on stage 2 of the FMA-UE, combined with a score of >6 on stage 5 (hand) of the FMA-UE. The exclusion criteria were: (1) musculoskeletal and/or other neurological conditions with permanent damage that may interfere with the study procedures or assessments, (2) subdural hematoma, tumor, encephalitis or trauma, with stroke-like symptoms, and (3) severe communication or cognitive deficits which could hamper the assessment.…”

Section: Methodsmentioning

confidence: 99%

“…The diagram offers a guideline to work on the objectives needed to shape the rehabilitation of the upper limb at various stages of recovery. The diagram also highlights the importance of stratification of patients towards different training objectives, based on the levels of trunk control and arm function that are reached (10). A focused therapy program for the upper limb needs to be further delineated by knowledge of neurophysiological recovery post stroke to ensure that specific therapy goals are set for the correct patient at each stage in recovery (11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

Arm-hand boost therapy during inpatient stroke rehabilitation: a pilot randomized controlled trial

Meyer

Verheyden

Kempeneers

et al. 2021

Preprint

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ObjectiveIt was the aim to assess feasibility, safety and potential efficacy of a new intensive, focused arm-hand BOOST program and to investigate whether there is a difference between early versus late delivery of the program in the sub-acute phase post stroke.MethodsIn this pilot RCT, patients with stroke were randomized to the immediate group (IG): 4 weeks (4w) BOOST +4w CONTROL or the delayed group (DG): 4w CONTROL +4w BOOST, on top of their usual inpatient care program. The focused arm-hand BOOST program (1 hour/day, 5x/week, 4 weeks) consisted of group exercises with focus on scapula-setting, core-stability, manipulation and complex ADL tasks. Additionally, one hour per week the Armeo®Power (Hocoma AG, Switzerland) was used. The CONTROL intervention comprised a dose-matched program (24 one-hour sessions in 4w) of lower limb strengthening exercises and general reconditioning. At baseline, after 4 and 8 weeks of training, the Fugl-Meyer assessment upper extremity (FMA-UE), action research arm test (ARAT) and stroke upper limb capacity scale (SULCS) were administered.ResultsEighteen participants (IG: n=10, DG: n=8) were included, with a median (IQR) time post stroke of 8.6 weeks (5-12). No adverse events were experienced. After 4 weeks of training, significant between-group differences were found for FMA-UE (p=0.003) and SULCS (p=0.033) and a trend for ARAT (p=0.075) with median (IQR) change scores for the IG of 9 (7-16), 2 (1-3) and 12.5 (1-18) respectively, and for the DG of 0.5 (−3-3), 1 (0-1) and 1.5 (−1-9), respectively. In the IG, 80% of patients improved beyond the minimal clinical important difference of FMA-UE after 4 weeks, compared to none of the DG patients. Between 4 and 8 weeks of training, patients in the DG tend to show larger improvements when compared to the IG, however, between-group comparisons did not reach significance.ConclusionsResults of this pilot RCT showed that an intensive, specific arm-hand BOOST program, on top of usual care, is feasible and safe in the sub-acute phase post stroke and suggests positive, clinical meaningful effects on upper limb function, especially when delivered in the early sub-acute phase post stroke.Clinical Trial Registrationwww.ClinicalTrials.gov, identifier NCT04584177

show abstract

JSU-Diagram: A Guideline for Treatment of the Upper Limb in Stroke Patients

Cited by 2 publications

References 24 publications

Arm-Hand Boost Therapy During Inpatient Stroke Rehabilitation: A Pilot Randomized Controlled Trial

Arm-Hand Boost Therapy During Inpatient Stroke Rehabilitation: A Pilot Randomized Controlled Trial

Arm-hand boost therapy during inpatient stroke rehabilitation: a pilot randomized controlled trial

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