The impact of physical therapy on functional outcomes after stroke: what's the evidence?

Peppen, R.P.S. van; Kwakkel, Gert; Wood-Dauphinée, Sharon; Hendriks, H. Jurgens; Wees, Ph. J. van der; Dekker, Joost

doi:10.1191/0269215504cr843oa

Cited by 782 publications

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“…There are few reports on physiotherapy techniques for patients with fluid in the subhumeral and subdeltoid bursae and for stroke patients with shoulder subluxation. The studies available describe physiotherapy methods used for restoring capacity of the upper limb on the paretic side [11,12]. As shown in the review by Morley et al, subluxation occurred in 16 to 66% of patients after a cerebrovascular accident [4].…”

Section: Discussionmentioning

confidence: 99%

“…We wcze śniej szych bada niach wła snych przy naj mniej jed no po wi kła nie wy stę po wa ło u 97,5%, a u 87,21% za ob ser wowa no więk szą licz bę po wi kłań [10]. Nie wie le jest do niesień na te mat sto so wa nych tech nik fizjo te ra pii w przypad ku wy stę po wa nia pły nu w ka let kach pod bar ko wej i pod na ramien nej oraz w przy pad ku pod wich nięć w sta wie ra mien nym u cho rych po prze by tym uda rze mó zgu a do stęp ne ba da nia do ty czą me tod fi zjo te ra pii sto so wa nych w ce lu po wro tu funk cji koń czy ny gór -nej po stro nie nie do wła du [11,12]. Z prze glą du badań na uko wych do ko na nych przez Mor ley i wsp.…”

Section: Dys Ku Sjaunclassified

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Subluxation of the shoulder joint in stroke patients and the influence of selected factors on the incidence of instability

Pop

2013

Ortop Traumatol Rehabil

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STRESZCZENIEWstęp. Ce lem ba dań by ła oce na czę sto ści wy stę po wa nia pod wich nię cia w sta wie ra mien nym u cho rych po przeby tym uda rze mó zgu oraz wpły wu re ha bi li ta cji i obec no ści lub bra ku pły nu w ka let kach pod bar ko wej i pod na ra miennej na wy stę po wa nie nie sta bil no ści.Materiał i metody. Gru pę ba da ną sta no wi ło 182 cho rych po prze by tym uda rze mó zgu. Wśród ba da nych było 108 mę żczyzn i 74 ko bie ty. U 156 cho rych udar miał cha rak ter nie do krwien ny, a u 26 ba da nych udar miał cha rakter krwo tocz ny, 90 osób mia ło nie do wład pra wo stron ny a 92 oso by mia ły nie do wład le wo stron ny. Dla oce ny ba danych zmien nych wy ko na no dwu krot ne ba da nie ul tra so no gra ficz ne bar ku oraz oce nę spraw no ści funk cjo nal nej koń -czy ny gór nej w ska li Brun nstrőm.W gru pie ba da nej, u 182 osób za sto so wa no pro gram ćwi czeń pro wa dzo nych według kon cep cji PNF.Wy ni ki. Pod wich nię cie po stro nie nie do wła du wy stę po wa ło u 25,3% ba da nych. Płyn w ka let kach wy stę po wał czę ściej po stro nie nie do wła du (12,6%). Po re ha bi li ta cji uzy ska no istot ną sta ty stycz nie zmniejszenie pod wich nię cia i re duk cję pły nu. Pod wich nię cie wy stę po wa ło czę ściej u osób ze stwier dzo ną obec no ścią pły nu w ka let kach, oraz u osób z gor szą spraw no ścią funk cjo nal ną koń czy ny gór nej.Wnio ski. 1. Ob ja wy kli nicz ne uda ru mó zgu są przy czy ną pod wich nię cia w sta wie ra mien nym. 2. Pod wich nię cie wy stę pu je czę ściej u cho rych ze stwier dzo ną obec no ścią pły nu w ka let kach pod bar ko wej i pod na ra mien nej oraz z obni żo ną spraw no ścią funk cjo nal ną. 3. Na zmniejszenie pod wich nię cia i pły nu w ka let kach ma ją wpływ pro gram ćwi -czeń i po pra wa spraw no ści funk cjo nal nej.Sło wa klu czo we: udar mó zgu, bark, re ha bi li ta cja SUMMARY Background. The aim of the study was to evaluate the incidence of shoulder subluxation in stroke patients and the impact of rehabilitation and presence/absence of fluid in the subhumeral and subdeltoid bursae on the occurrence of instability.Materials and methods. The study group was composed of 182 patients after stroke, with 108 men and 74 women. 156 of the patients had suffered an ischemic stroke whereas 26 had experienced a hemorrhagic stroke; 90 patients had right-sided paresis and 92 left-sided paresis.The study variables were evaluated by performing, on two occasions, an ultrasound examination of the shoulder and an assessment of upper limb functional capacity using the Brunnström scale. 182 patients of the study group participated in an exercise programme according to the PNF concept.Results. There was no subluxation of the shoulder on the healthy side, while on the paretic side, subluxation occurred in 25.3% of the patients. Bursal fluid was seen more frequently on the paretic side (12.6%). A sta tistically significant reduction of the subluxation and bursal fluid was achieved after the rehabilitation. Subluxation occurred more frequently in patients with a known pr...

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Section: Discussionmentioning

confidence: 99%

Section: Dys Ku Sjaunclassified

Subluxation of the shoulder joint in stroke patients and the influence of selected factors on the incidence of instability

Pop

2013

Ortop Traumatol Rehabil

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“…Two thirds of stroke survivors achieve independent ambulation after stroke, but less than half recover upper limb function at six months 2 . Best evidence for improving functional recovery after stroke suggests rehabilitation should consist of high intensity repetitive task-specific practice [3][4][5][6] . However despite this, the amount of therapy time dedicated to upper limb rehabilitation remains low 7 and upper limb exercises, when prescribed, are often of low intensity 8 .…”

Section: Introductionmentioning

confidence: 99%

Investigating Measures of Intensity During a Structured Upper Limb Exercise Program in Stroke Rehabilitation: An Exploratory Study

Connell

McMahon

Simpson

et al. 2014

Archives of Physical Medicine and Rehabilitation

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Objectives-To use three measures of intensity (i) time, (ii) observed repetitions and (iii) wrist accelerometer activity counts to describe the intensity of exercise carried out when completing a structured upper limb exercise programme. To explore if a relationship exists between wrist accelerometer activity counts and observed repetitions. Design-Observational study design. Setting-Rehabilitation centre research laboratory.Participants-Thirteen community dwelling stroke survivors with upper limb hemiparesis. Intervention-Not applicable.Main Outcome Measures-Time engaged in exercise, total repetitions and accelerometer activity counts for the affected upper limb.Results-Mean session time was 48.5 minutes (SD 7.8 minutes). Participants were observed to be engaged in exercises for 63.8% (SD 7.5%) of the total session time. The median number of observed repetitions per session was 340 of which 251 (IQR 80-309) were purposeful repetitions. Wrist accelerometers showed the stroke survivors' upper limbs to be moving for 75.7% (SD 15.9%) of the total session time. Purposeful repetitions and activity counts were found to be significantly correlated (r s =0.627, p<0.05).Correspondence: Louise Connell, Senior Research Fellow, Brook 426, Clinical Practice Research Unit, School of Health, University of Central, Lancashire, Preston, PR1 2HE, Phone: 01772 893725, laconnell@uclan.ac.uk. Conflicts of interest None declared SUPPLIER'S LIST CIHR Author Manuscript CIHR Author Manuscript CIHR Author ManuscriptConclusions-Stroke survivors were not actively engaged in exercises for approximately one third of each exercise session. Overall session time may not be the most accurate measure of intensity. Counting repetitions was feasible when using a structured exercise programme and provides a clinically meaningful way of monitoring intensity and progression. Wrist accelerometers provided an objective measure for how much the arm moves, which correlated with purposeful repetitions. Further research using repetitions and accelerometers as measures of intensity is warranted. KeywordsStroke; rehabilitation; time; repetitions; accelerometer Every year, 15 million people worldwide suffer a stroke 1 . Two thirds of stroke survivors achieve independent ambulation after stroke, but less than half recover upper limb function at six months 2 . Best evidence for improving functional recovery after stroke suggests rehabilitation should consist of high intensity repetitive task-specific practice 3-6 . However despite this, the amount of therapy time dedicated to upper limb rehabilitation remains low 7 and upper limb exercises, when prescribed, are often of low intensity 8 .Therapists working in stroke rehabilitation are being challenged to find new ways of increasing the intensity of practice that stroke survivors engage in each day 7 with suggested strategies including self-administered exercise 9 , group exercise 10 and family assisted exercise 11 . Despite the strength of evidence supporting intensity, objectively quantifying intensity...

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“…the classification, previously used in a systematic review in the field of neurological rehabilitation, included five scientific evidence categories according to the pEdro score and the results available in the studies 16 (appendix 1).…”

Section: Introductionmentioning

confidence: 99%

Efeitos da estimulação elétrica funcional nos músculos do punho e dedos em indivíduos hemiparéticos: uma revisão sistemática da literatura

Arantes¹,

Vaz

Mc³

et al. 2007

Rev. bras. fisioter.

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The impact of physical therapy on functional outcomes after stroke: what's the evidence?

Abstract: This review showed small to large effect sizes for task-oriented exercise training, in particular when applied intensively and early after stroke onset. In almost all high-quality RCTs, effects were mainly restricted to tasks directly trained in the exercise programme.

Cited by 782 publications

References 166 publications

Subluxation of the shoulder joint in stroke patients and the influence of selected factors on the incidence of instability

Subluxation of the shoulder joint in stroke patients and the influence of selected factors on the incidence of instability

Investigating Measures of Intensity During a Structured Upper Limb Exercise Program in Stroke Rehabilitation: An Exploratory Study

Efeitos da estimulação elétrica funcional nos músculos do punho e dedos em indivíduos hemiparéticos: uma revisão sistemática da literatura

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