Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Thursday, January 14, 2016

Upper Extremity Interventions post stroke

Not much hope here. But with the 163 pages and 37 pages of references I'm sure your doctor has this all covered already. But maybe you want to give a quiz.

Everything here should be publicly available with corresponding stroke protocols to accomplish them. But that won't occur because we have NO stroke leadership.  You'll just have to hope that your doctor/therapist knows how to competently reproduce the interventions that were done in the research cited. With no link from this summary to the research this is actually pretty useless.

HAH! You're fucking screwed.

Upper Extremity Interventions post stroke

I'm only including the summary here.

10.11
Summary
1. There is consensus (Level 3) opinion that in severely impaired upper extremities (less than stage
4) the focus of treatment should be on palliation and compensation. For those upper extremities
with signs of some recovery (stage 4 or better) there is consensus (Level 3) opinion that
attempts to restore function through therapy should be made.
2. There is strong (Level 1a) evidence that neurodevelopmental techniques such as Bobath are not
superior to other therapeutic approaches. There is moderate (level 1b) evidence that indicates
compared to Bobath, motor relearning programs may result in improved short-term motor
functioning and shorter lengths of hospital stay.
3. There is moderate (Level 1b) evidence that both functional and neuropsychological approaches
both help to improve dressing performance.
4. There is conflicting (Level 4) evidence that enhanced therapies improve short-term upper
extremity function. There is evidence that results may not be long lasting. There is moderate
(Level 1b) evidence that a program of daily stretch regimens does not prevent the development
of contractures.
5. There is strong (Level 1a) evidence that repetitive task-specific training techniques improve
measures of upper extremity function.
6. There is conflicting (Level 4) evidence that sensorimotor treatments improve upper extremity
function.
7. There is conflicting (Level 4) evidence that bilateral arm training is superior to unilateral
training.
8. There is conflicting (Level 4) evidence that specialized programs improve reaching.
9. There is conflicting (level 4) evidence that mental practice may improve upper-extremity motor
and ADL performance following stroke.
10. There is strong (Level 1a) evidence that hand splinting does not improve impairment or reduce
disability.
11. There is conflicting (Level 4) evidence of benefit of CIMT in the acute stage of stroke.
12. There is strong (Level 1a) evidence of benefit of mCIMT in the acute/subacute stage of stroke.
Benefits appear to be confined to stroke patients with some active wrist and hand movements,
particularly those with sensory loss and neglect.
There is moderate (Level 1b) evidence that any intensity of CIMT will provide benefit.
13. There is conflicting (Level 4) evidence that mirror therapy improves motor function following
stroke and moderate (Level 1b) evidence that it does not reduce spasticity.
14. There is moderate (Level 1b) evidence that action observation improves performance on the Box
& Block test.
15.  There is strong (Level 1a) evidence that extrinsic feedback helps to improve motor learning
following stroke.
16. There is strong (Level 1a) evidence that sensorimotor training with robotic devices improves
upper extremity functional outcomes, and motor outcomes of the shoulder and elbow.
There is strong (Level 1a) evidence that robotic devices do not improve motor outcomes of the wrist and hand.
17. There is strong (Level 1a) evidence that virtual reality treatment can improve locomotor
function in the chronic stages of stroke.
18. There is strong (Level 1a) evidence that hand splinting does not reduce the development of
contracture or reduce spasticity.
19. There is moderate (Level 1a) evidence that a nurse-led stretching program can help to increase
range of motion in the upper extremity and reduce pain in the chronic stage of stroke.
20. There is strong (Level Ia) that treatment with BTX alone or in combination with therapy
significantly decreases spasticity in the upper extremity in stroke survivors.
21. There is conflicting (Level 4) evidence that treatment with BTX alone or in combination with
therapy significantly improves upper limb function or quality of life.
22. There is moderate (Level 1b) evidence that electrical stimulation combined with botulinum toxin
injection is associated with reductions in muscle tone.
23. There is moderate (Level 1b) evidence that electrical stimulation can reduce spasticity and
improve motor function in the upper extremity.
24. There is limited (Level 2) evidence that treatment with ethyl alcohol improves elbow and finger
PROM and can decrease spasticity in the upper extremity in stroke survivors.
25. There is strong (Level 1a) evidence that physical therapy does not reduce spasticity in the upper
extremity.
26. There is limited (Level 2) evidence that shock wave therapy can reduce tone in the upper
extremity.
27. There is moderate (Level 1b) evidence that tolperisone can reduce spasticity following stroke.
28. There is strong (Level 1a) evidence that EMG/Biofeedback therapy is not superior to other forms
of treatment.
29. There is conflicting (Level 4) evidence that treatment with TENS in the upper extremity improves
a variety of outcomes, including motor recovery, spasticity and ADLs.
30. There is strong (Level 1a) evidence that FES treatment improves upper extremity function in
chronic stroke.
31. There is moderate (Level 1b) evidence that EMG-triggered FES is not superior to cyclic FES.
32. There is conflicting (Level 4) evidence that stimulants can improve upper extremity impairment
following stroke.
33. There is conflicting (Level 4) evidence that levodopa can improve upper extremity motor
function following stroke.
34. There is strong (Level 1a) evidence that a single dose of either a SSRI or NARI can enhance short-term manual dexterity in the affected hand following stroke.
35. There is moderate (Level 1b) evidence that a 90-day course of SSRIs initiated acutely following
stroke improves motor recovery of the upper extremity.
36. There is moderate (Level 1b) evidence that intermittent pneumatic compression does not reduce
hand edema following stroke. There is limited (Level 2) evidence that both neuromuscular nerve
stimulation and continuous passive motion help to reduce hand edema compared to limb
elevation

2 comments:

  1. So it looks like NOTHING helps to treat the arm and hand movement. Surprise. I went to Peru for stem cell therapy, hoping to get an improvement in the fatigue and memory areas, more than my hand, which I have just accepted, over 20 years is never going to get back to what it used to be. I got no improvement in memory or fatigue, but my arm works SLIGHTLY better in tight spaces than it did before the treatment, and that is about all, although, I went square dancing last week, and one of the other dances commented that my hand seemed to be working better (I have not noticed, nor has anyone else). so who knows

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  2. Mare how is your hand affected? Is that the only impairment you have?
    Your the first person I know who received Stem cell. It's disappointing it didn't have much affect.

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