Repetitive peripheral magnetic stimulation alone or in combination with repetitive transcranial magnetic stimulation in poststroke rehabilitation: a systematic review and meta-analysis

 Instead of doing lazy crapola review research like this, WHY THE FUCK AREN'T YOU PROVIDING RESEARCH THAT GETS SURVIVORS RECOVERED? Are your mentors and senior researchers that fucking incompetent? 

Send me hate mail on this: oc1dean@gmail.com. I'll print your complete statement with your name and my response in my blog. Or are you afraid to engage with my stroke-addled mind? I would like to know why you aren't creating research that gets survivors recovered!

You'll want 100% recovery when you become the 1 in 4 per WHO that has a stroke!). I'd suggest you start working on that now!

Repetitive peripheral magnetic stimulation alone or in combination with repetitive transcranial magnetic stimulation in poststroke rehabilitation: a systematic review and meta-analysis

• Yong Wang,
• Kenneth N. K. Fong,
• Youxin Sui,
• Zhongfei Bai &
• Jack Jiaqi Zhang 

Journal of NeuroEngineering and Rehabilitation volume 21, Article number: 181 (2024) Cite this article

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Abstract

Objective

This study aimed to comprehensively review the effects of repetitive peripheral magnetic stimulation (rPMS) alone or in combination with repetitive transcranial magnetic stimulation (rTMS) on improving upper limb motor functions and activities of daily living (ADL) in patients with stroke, and to explore possible efficacy-related modulators.

Methods

A literature search from 1st January 2004 to 1st June 2024 was performed to identified studies that investigated the effects of rPMS on upper limb motor functions and ADL in poststroke patients.

Results

Seventeen studies were included. Compared with the control, both rPMS alone or rPMS in combination with rTMS significantly improved upper limb motor function (rPMS: Hedge’s g = 0.703, p = 0.015; rPMS + rTMS: Hedge’s g = 0.892, p < 0.001) and ADL (rPMS: Hedge’s g = 0.923, p = 0.013; rPMS + rTMS: Hedge’s g = 0.923, p < 0.001). However, rPMS combined with rTMS was not superior to rTMS alone on improving poststroke upper limb motor function and ADL (Hedge’s g = 0.273, p = 0.123). Meta-regression revealed that the total pulses (p = 0.003) and the number of pulses per session of rPMS (p < 0.001) correlated with the effect sizes of ADL.

Conclusions

Using rPMS alone or in combination with rTMS appears to effectively improve upper extremity functional recovery and activity independence in patients after stroke. However, a simple combination of these two interventions may not produce additive benefits than the use of rTMS alone. Optimization of rPMS protocols, such as applying appropriate dosage, may lead to a more favourable recovery outcome in poststroke rehabilitation.

Introduction

Repetitive peripheral magnetic stimulation (rPMS) is a non-invasive therapeutic approach for facilitating motor recovery following neurological diseases, which was first proposed for the purpose of neurological rehabilitation in 1996 [1]. The rPMS technique employs focused magnetic pulses over various peripheral targets (e.g., muscles, nerves, or spinal roots) [2], and this technique induces repetitive contraction-relaxation cycles by depolarizing neurons [3] and then provides proprioceptive inputs to afferent fibers [4,5,6,7], therefore modulating sensorimotor plasticity. In the literature, rPMS is considered a unique, promising neuromodulation technique due to its advantage of providing more deeply penetrating, focused, painless stimulation than conventional electrical stimulation provides [5, 8, 9].

In 2023, rPMS was delivered using a transcranial magnetic stimulator, which was originally used for repetitive transcranial magnetic stimulation (rTMS), and has been approved by the US Food and Drug Administration for relieving chronic pain [10]. In poststroke rehabilitation, rPMS is different from rTMS in the neural mechanism - rTMS has been extensively used to facilitate motor recovery by modulating cortical plasticity in a top-down approach [11] whereas rPMS is adopting a bottom-up approach through recruitment of proprioceptive afferents thus up-regulate the excitability of the sensorimotor areas via the ascending pathway [2, 6]. Therefore, combining central and peripheral magnetic stimulation may produce a synergistic effect on the facilitation of motor recovery after stroke [12].

The effects of rPMS for motor function of the hemiplegic upper extremity or ADL after stroke have been reviewed in previous systematic reviews, which generally have reported positive effects of rPMS [2, 8, 13,14,15,16,17,18]. However, these reviews are not free from methodological limitations. Firstly, a few reviews did not perform meta-analysis to quantitively evaluate the treatment effects [2, 14, 18]. Secondly, in the previous meta-analytic reviews, no detailed subgroup analysis or meta-regression was performed to identify the influence of different stimulation protocols, patient demographics, or patients’ clinical profiles on the treatment effect sizes [8, 13, 15, 16]. Thirdly, some reviews covered a wide range of neurological disease conditions, so the specific effect of rPMS in stroke rehabilitation was still not conclusive [2, 17]. Lastly, these reviews did not systematically investigate the effect of rPMS alone or in combination with rTMS to elaborate the possible synergistic effect of the combined interventions [2, 8, 13,14,15,16,17,18].

Therefore, a comprehensive understanding of clinical effectiveness as well as neural mechanisms underlying the therapeutic benefits of using rPMS alone or in combination with rTMS in poststroke rehabilitation is needed. Here, our review aimed to: (1) investigate the effects of these two interventional methods (using rPMS alone or in combination with rTMS) on upper limb motor function and ADL in poststroke patients, using meta-analysis; (2) identify any significant relationship between various rPMS parameters, patient demographics, clinical characteristics, and effect sizes using subgroup analyses and meta-regression; and (3) clarify the mechanisms underlying the therapeutic effects of rPMS by qualitatively assessing rPMS studies using neuroimaging and/or neurophysiological outcomes.

A Predictive Model for Functionality Improvement after Stroke Rehabilitation

 Predicting failure to recover is ABSOLUTELY USELESS! Survivors would like you to deliver 100% recovery protocols! When the fuck will you do what survivors want?

A Predictive Model for Functionality Improvement after Stroke Rehabilitation

Author links open overlay panel

, , , ,

https://doi.org/10.1016/j.jnrt.2024.100157

Get rights and content

Under a Creative Commons license

open access

Abstract

Objective

This study develops a simple predictive model for identifying stroke patients who have a better chance of showing improved activities of daily living (ADL) outcomes following a stroke.

Methods

The cohort of 489 stroke patients was divided into testing and training groups. Multivariate logistic regression analysis was conducted for each model. Four models were compared using the C statistic (AUC), Akaike’s information criterion (AIC), and other metrics. The best model was assessed using a nomogram.

Results

Univariate analysis revealed that several variables measured significantly higher at discharge than at admission, including manual muscle testing, standing, and so on. Multivariate logistic regression analysis revealed that activities-specific balance confidence, Brunnstrom recovery stage for lower extremities, standing, the mini-balance evaluation systems test, and the Hamilton anxiety scale were independent predictors of ADL. Model 1 was found to be more accurate for the prediction of ADL (AUC: training, 0.916 [0.889−0.943] and test, 0.887 [0.806−0.968]; AIC: training, 257.42 and test, 76.79) than model 2 (AUC: training, 0.850 [0.894−0.806] and test, 0.819 [0.715−0.923]; AIC: training, 314.44 and test, 83.78), model 3 (AUC: training, 0.862 [0.901−0.823] and test, 0.830 [0.731−0.929]; AIC: training, 307.76 and test, 86.55), and model 4 (AUC: training, 0.862 [0.901−0.823] and test, 0.833 [0.733−0.932]; AIC: training, 305.8 and test, 86.28).

Conclusion

A multivariate model can be used to predict functionality improvement, as measured by ADL, following hospitalization with a stroke.

A Review of Rehabilitation Devices to Promote Upper Limb Function Following Stroke

 But you didn't write up a protocol on which one is the best. COMPLETE FAILURE!

A Review of Rehabilitation Devices to Promote Upper Limb Function Following Stroke

Jacob Brackenridge 1 , Lynley V. Bradnam 2,3 , Sheila Lennon 2 , John J. Costi 1 and David A. Hobbs 1, * 1 Medical Device Research Institute, School of Computer Science, Engineer- ing and Mathematics, Flinders University, Adelaide, South Australia, Austra- lia; 2 Discipline of Physiotherapy, School of Health Sciences, Flinders Uni- versity, Adelaide, South Australia, Australia; 3 Discipline of Physiotherapy, Graduate School of Health, University of Technology, Sydney, NSW, Australia  

 

Abstract:  

 

Background:  

 

Stroke is a major contributor to the reduced ability to carry out activities of daily living (ADL) post cerebral infarct. There has been a major focus on understanding and improving rehabilitation interventions in order to target cortical neural plasticity to support recovery of upper limb function. Conventional therapies delivered by therapists have been combined with the application of mechanical and robotic devices to provide controlled and assisted movement of the paretic upper limb. The ability to provide greater levels of intensity and reproducible repetitive task practice through the application of intervention devices are key mechanisms to support rehabilitation efficacy.  

 

Results: 

 

 This review of literature published in the last decade identified 141 robotic or mechanical devices. These devices have been characterised and assessed by their individual characteristics to provide a review of current trends in rehabilitation device interventions. Correlation of factors identified to promote positive targeted neural plasticity has raised questions over the benefits of expensive robotic devices over simple mechanical ones.  

 

Conclusion: 

 

 A mechanical device with appropriate functionality to support the promotion of neural plasticity after stroke may provide an effective solution for both patient recovery and to stimulate further research into the use of medical de- vices in stroke rehabilitation. These findings indicate that a focus on simple, cost effective and efficacious intervention solutions may improve rehabilitation outcomes.

Technology-related interventions to improve performance in activities of daily living for adults with stroke (2012–2019)

So in those 8 years nothing was accomplished in ADL stroke research to get survivors recovered! Good to know HOW FUCKING INCOMPETENT EVERYTHING IN STROKE IS!

The takeaway is; don't have a stroke!

 Technology-related interventions to improve performance in activities of daily living for adults with stroke (2012–2019)

American Journal of Occupational Therapy (AJOT). Volume 77(Supplement 1), Pgs. 7710393020.

NARIC Accession Number: J93246. What's this?
Author(s): Goldberg, Carly, Winterbottom, Lauren, Geller, Daniel, Nilsen, Dawn M., Mahoney, Danielle, Gillen, Glen.
Publication Year: 2023.
Abstract: Article summarizes the findings from a systematic review of technology-related interventions to improve performance in activities of daily living (ADL) for adults with stroke, such as virtual reality/gaming, biofeedback, robotics, electrical stimulation, and telerehabilitation. Four systematic reviews and 16 randomized control trials met the criteria for inclusion and provided evidence for the effectiveness of technology interventions to improve ADL performance. Overall, evidence to support the use of technology-related interventions to improve ADL outcome after stroke is limited by the diverse nature of the interventions within this theme. In addition, within each of the themes, evidence was limited in that many studies demonstrated no statistical significance in favor of interventions.
Descriptor Terms: ASSISTIVE TECHNOLOGY, BIOFEEDBACK, COMPUTER APPLICATIONS, DAILY LIVING, ELECTRICAL STIMULATION, INTERVENTION, OCCUPATIONAL THERAPY, REHABILITATION TECHNOLOGY, RESEARCH REVIEWS, ROBOTICS, STROKE, TELEREHABILITATION.


Can this document be ordered through NARIC's document delivery service*?: Request Information.

Citation: Goldberg, Carly, Winterbottom, Lauren, Geller, Daniel, Nilsen, Dawn M., Mahoney, Danielle, Gillen, Glen. (2023.) Technology-related interventions to improve performance in activities of daily living for adults with stroke (2012–2019). American Journal of Occupational Therapy (AJOT)., 77(Supplement 1), Pgs. 7710393020. Retrieved 1/30/2024, from REHABDATA database.

John Wesley Powell pocketknife

 Powell as captain of battery F of the 2nd Illinois artillery took part in the battle of Shiloh, losing his right arm at Pittsburg Landing. He is most famous for being first down the Colorado River thru the Grand Canyon.

No idea if he had a pocketknife like this but it was the one thing I retained from my ex until losing it on a nightstand in Yosemite, it must have slid under the lamp base.  Took me a while to find it at Woodcraft and bought a replacement.

One blade opens incredibly easy one-handed, you just have to remember not to carry it on planes or any music or sporting venue that does metal detection. I should have gotten purchase information on that from my therapists to do all the ADLs I was used to.

The left blade is the one you grab with your thumb and finger, then set the base of the knife against your hip and it pops open.

The blade completely open, the other standard blade I barely use, too hard to get open. Friends dislike this because the blade is so sharp which I consider necessary since any sawing motion with a knife is nigh impossible one-handed.

Can I Discharge My Stroke Patient Home After Inpatient Neurorehabilitation? LIMOS Cut-Off Scores for Stroke Patients “Living Alone” and “Living With Family”

 Of course you can. With your effective stroke rehab protocols in the hospital and the ones you are sending home with them they will soon be back to 100% recovery. OH, YOU DON'T HAVE THAT? Well, what the fuck are you doing to get there?

Can I Discharge My Stroke Patient Home After Inpatient Neurorehabilitation? LIMOS Cut-Off Scores for Stroke Patients “Living Alone” and “Living With Family”

Beatrice Ottiger¹, Dirk Lehnick², Tobias Pflugshaupt¹, Tim Vanbellingen^1,3 and Thomas Nyffeler^1,3*

• ¹Neurocenter, Luzerner Kantonsspital, Lucerne, Switzerland
• ²Clinical Trial Unit Central Switzerland, University of Lucerne, Lucerne, Switzerland
• ³ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation Group, University Bern, Bern, Switzerland

Background: Discharge planning of stroke patients during inpatient neurorehabilitation is often difficult since it depends both on the patient's ability to perform activities of daily living (ADL) and the social context. The aim of this study was to define ADL cut-off scores using the Lucerne ICF-based multidisciplinary observation scale (LIMOS) that allow the clinicians to decide whether stroke patients who “live alone” and “live with a family” can be discharged home or must enter a nursing home. Additionally, we investigated whether age and gender factors influence these cut-off scores.

Methods: A single-center retrospective cohort study was conducted to establish cut-off discharge scores for the LIMOS. Receiver-operating-characteristics curves were calculated for both patient groups “living alone” and “living with family” to illustrate the prognostic potential of the LIMOS total score with respect to their discharge goals (home alone or nursing home; home with family or nursing home). A logistic regression model was used to determine the (age- and gender-adjusted) odds ratios of being released home if the LIMOS total score was above the cut-off. A single-center prospective cohort study was then conducted to verify the adequacy of the cut-off values for the LIMOS total score.

Results: A total of 687 stroke inpatients were included in both studies. For the group “living alone” a LIMOS total score above 158 indicated good diagnostic accuracy in predicting discharge home (sensitivity 93.6%; specificity 95.4%). A LIMOS total cut-off score above 130 points was found for the group “living with family” (sensitivity 92.0%; specificity 88.6%). The LIMOS total score odds ratios, adjusted for age and gender, were 292.5 [95% CI: (52.0–1645.5)] for the group “living alone” and were 89.4 [95% CI: (32.3–247.7)] for the group “living with family.”

Conclusion: Stroke survivors living alone needed a higher ADL level to return home than those living with a family. A LIMOS total score above 158 points allows a clinician to discharge a patient that lives alone, whereas a lower LIMOS score above 130 points can be sufficient in a patient that lives with a family. Neither age nor gender played a significant role.

Introduction

The planning of discharge during inpatient neurorehabilitation in stroke patients is a dynamic process and critically depends on the patients' functional progress and ability to perform activities of daily living (ADLs). In addition to performance in ADL, various factors such as demographic background, age, gender, access to municipal organizations and the social context also plays an important role in deciding whether a patient can return home or must enter a nursing home (1, 2). Previous studies emphasized that one of the strongest factors of being discharged home or not is the living situation [i.e., if a patient lives alone or with a family (3–5)]. Stroke survivors often require the assistance of family caregivers to cope with their physical, cognitive and emotional deficits at home (6, 7). After inpatient neurorehabilitation, patients who have a caregiver at home are therefore more likely to be discharged home (3, 4) than patients living alone (1, 3, 4, 8). For instance, although stroke survivors living alone can partially be supported by community or professional organizations, they lack the twenty-four-seven support of a person living in the same household. This suggests that to be discharged home, a stroke patient living alone must show better performance in the activities of daily living (ADLs; e.g., moving around at home, preparing a meal etc.) than a stroke patient living with a family. This is particularly relevant for Switzerland, since a third of the Swiss population lives alone (9). This trend is also steadily increasing worldwide (10, 11).

Therefore, it is important to continuously assess ADL performance of inpatients during neurorehabilitation and to estimate performance levels sufficient for returning home. To accurately measure the ability of ADL performance according to the International Classification of Functioning, Disability and Health (ICF) framework set by the World Health Organization (WHO), we recently developed the Lucerne ICF-based Multidisciplinary Observation Scale (LIMOS) and validated it in stroke patients (12). Using this scale, patients with stroke are observed with respect to their activity ability by health professionals involved in their neurorehabilitation (nurses, physiotherapists, speech therapists, occupational therapists, as well as neurologists). This will be done in the first 72 h after admission, then weekly during the stay and in the last 72 h before discharge from inpatient neurorehabilitation. The observations are structured and consist of 45 basic and instrumental ADL items based on the (ICF) framework, which are categorized in four factors (interpersonal activities, motor and self-care; communication; knowledge and general tasks; and domestic life). The LIMOS measures the level of assistance needed from the health professionals, with higher scores representing more independence (12). As each discipline rates their own subpart within the whole LIMOS, it is easy and short to conduct and requires only 5 to 10 min per discipline. The advantage of LIMOS is that it is more comprehensive and more sensitive than the Functional Independence Measure (FIM) and Barthel Index (BI) (13). In addition, the LIMOS scale shows neither floor nor ceiling effects at admission and discharge, in contrast, to the FIM and BI (12, 13). Using the LIMOS thus allows the patients' activity levels to be assessed comprehensively.

Based on previous studies suggesting that ADL performance and living situations are crucial factors to be able to return home after stroke neurorehabilitation (1, 5), the aim of the present study was to define LIMOS cut-off scores in ADL performance for stroke patients living alone and those living with a family. Such scores would provide clinicians a tool that facilitates the decision concerning the discharge destination during inpatient rehabilitation. A second aim was to verify whether the factors age and gender influence these cut-off scores because previous studies have found that older people and women had a worse prognosis for returning home after stroke (1, 14, 15).

 

RECENT ADVANCEMENT TO IMPROVE BALANCE IN STROKE REHABILITATION.

Even professors subscribe to the tyranny of low expectations. The rot is incredibly deep in the stroke world, I think it needs to be completely destroyed.

RECENT ADVANCEMENT TO IMPROVE BALANCE IN STROKE REHABILITATION.

 2019, International Journal of Advanced Research (IJAR)
Jyoti Sharma 1 and 

Umar Abdullah 2
.
1. Assiatant Professor, Galgotias University, Greater Noida.

2. Student, Noida International University, Greater Noida
Abstract


 Manuscript History
Received: 08 January 2019 Final Accepted: 10 February 2019 Published: March 2019
Key words:-
Stroke; Rehabilitation; Balance Techniques.
After stroke, a main goal of rehabilitation is promote independent in activity of daily living.(Wrong, wrong, wrong; 100% RECOVERY IS THE GOAL.) An important determinant of activities of daily living performance is standing and balance, which is a strong predictor of functional recovery and walking capacity in post stroke rehabilitation. Purpose of this study was to investigate the effects of different balance Techniques/Approaches on post stroke rehabilitation. Furthermore, the study was aimed to identify which training regimen was most effective. Electronic databases were searched to evaluate the effects of exercise therapy on balance capacity in stroke rehabilitation. 63 articles were studied and 42 were selected after inclusion and exclusion criteria strategies. After going through all the articles, it was concluded that both the three approaches (Mental Practice/Mental Imagery MP/MI, Visual Reality VR, and Mirror Therapy MT) were effective, but MP/MI is more effective according to my studies, it was observed that mental imagery is a safe and low-cost technique that can  be performed even without supervision once the patient has completed appropriate training.
Copy Right, IJAR, 2019,. All rights reserved.

An extended stroke rehabilitation service for people who have had a stroke: the EXTRAS RCT

How do you reconcile these two conflicting results?   

did not improve stroke survivors' performance in extended activities of daily living but did improve their overall satisfaction with services. Your stroke team was excellent at getting you to accept the tyranny of low expectations but didn't deliver actual results? Not my idea of excellence.  

An extended stroke rehabilitation service for people who have had a stroke: the EXTRAS RCT

Shaw L¹,

Bhattarai N²,

Cant R³,

Drummond A⁴,

Ford GA¹,

Forster A⁵,

Francis R¹,

Hills K¹,

Howel D²,

Laverty AM⁶,

McKevitt C⁷,

McMeekin P⁸,

Price C¹,

Stamp E²,

Stevens E⁷,

Vale L²,

Rodgers H¹

Author information

Health Technology Assessment (Winchester, England), 30 Apr 2020, 24(24):1-202
PMID: 32468989 

Abstract 

---

BACKGROUND:

There is limited evidence about the effectiveness of rehabilitation in meeting the longer-term needs of stroke patients and their carers. 

OBJECTIVE:

To determine the clinical effectiveness and cost-effectiveness of an extended stroke rehabilitation service (EXTRAS). DESIGN:A pragmatic, observer-blind, parallel-group, multicentre randomised controlled trial with embedded health economic and process evaluations. Participants were randomised (1 : 1) to receive EXTRAS or usual care. SETTING:Nineteen NHS study centres.  

PARTICIPANTS:

Patients with a new stroke who received early supported discharge and their informal carers.  

INTERVENTIONS:

Five EXTRAS reviews provided by an early supported discharge team member between 1 and 18 months post early supported discharge, usually over the telephone. Reviewers assessed rehabilitation needs, with goal-setting and action-planning. Control treatment was usual care post early supported discharge. 

MAIN OUTCOME MEASURES:

The primary outcome was performance in extended activities of daily living (Nottingham Extended Activities of Daily Living Scale) at 24 months post randomisation. Secondary outcomes at 12 and 24 months included patient mood (Hospital Anxiety and Depression Scale), health status (Oxford Handicap Scale), experience of services and adverse events. For carers, secondary outcomes included carers' strain (Caregiver Strain Index) and experience of services. Cost-effectiveness was estimated using resource utilisation costs (adaptation of the Client Service Receipt Inventory) and quality-adjusted life-years. 

RESULTS:

A total of 573 patients (EXTRAS, n = 285; usual care, n = 288) with 194 carers (EXTRAS, n = 103; usual care, n = 91) were randomised. Mean 24-month Nottingham Extended Activities of Daily Living Scale scores were 40.0 (standard deviation 18.1) for EXTRAS (n = 219) and 37.2 (standard deviation 18.5) for usual care (n = 231), giving an adjusted mean difference of 1.8 (95% confidence interval -0.7 to 4.2). The mean intervention group Hospital Anxiety and Depression Scale scores were not significantly different at 12 and 24 months. The intervention did not improve patient health status or carer strain. EXTRAS patients and carers reported greater satisfaction with some aspects of care. The mean cost of resource utilisation was lower in the intervention group: -£311 (95% confidence interval -£3292 to £2787), with a 68% chance of EXTRAS being cost-saving. EXTRAS was associated with 0.07 (95% confidence interval 0.01 to 0.12) additional quality-adjusted life-years. At current conventional thresholds of willingness to pay for a quality-adjusted life-year, there is a 90% chance that EXTRAS is cost-effective. 

CONCLUSIONS:

EXTRAS did not improve stroke survivors' performance in extended activities of daily living but did improve their overall satisfaction with services. Given the impact on costs and quality-adjusted life-years, there is a high chance that EXTRAS could be considered cost-effective. FUTURE WORK:Further research is required to identify whether or not community-based interventions can improve performance of extended activities of daily living, and to understand the improvements in health-related quality of life and costs seen by provision of intermittent longer-term specialist review. TRIAL REGISTRATION:Current Controlled Trials ISRCTN45203373. FUNDING:This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 24. See the NIHR Journals Library website for further project information.

Effect of East-West Integrative Rehabilitation on Activities of Daily Living and Cognitive Functional Recovery in Stroke Patients: A Retrospective Study

Three things tell me this can't be trusted.

1. Integrative - Meaning that it is not scientifically proven.

“Integrative medicine”: A brand, not a specialty

2. Nothing suggests that the two groups had the same objective damage diagnosis starting points. 

3. Acupuncture.  Energy meridians have never been proven to exist, all just placebo.

4. PEMF actually works so it doesn't fall the the integrative camp, it is real therapy.

• PEMF (2)

Effect of East-West Integrative Rehabilitation on Activities of Daily Living and Cognitive Functional Recovery in Stroke Patients: A Retrospective Study

Moon, Sori;Keum, Dongho
문소리;금동호

• Received : 2020.03.14
• Accepted : 2020.04.01
• Published : 2020.04.30

---

Abstract

Objectives 

This study was conducted to verify the effectiveness of east-west integrative rehabilitation therapy on activity of daily living and cognitive functional recovery in stroke patients by comparing with integrative rehabilitation therapy group and conventional rehabilitation therapy group in a single institution. 

Methods 

The medical records of 106 stroke patients hospitalized in Department of Rehabilitation Medicine, Dongguk University Bundang Oriental Hospital from January 1, 2017 to February 28, 2019 were reviewed. After screening and dividing it into conventional rehabilitation (CR) group and integrative rehabilitation (IR) group, Korean version of Modified Barthel Index (K-MBI), functional independence measure (FIM), clinical dementia rating-sum of boxes (CDR-SB) were statistically analyzed. Results IR group showed significant improvement in K-MBI, FIM, and CDR-SB after treatment (p<0.001) and there was a statistically significant difference in K-MBI and CDR-SB score changes than CR group (p<0.05). And chronic patient of IR group showed significant improvement in K-MBI, FIM, and CDR-SB after treatment (p<0.01) and there was a statistically significant difference in CDR-SB score changes than CR group (p<0.05). In particular, the earlier the treatment initiation time, the more the improvement in function and when the treatment started within 2 years from the onset and patients took acupuncture and pulsed electromagnetic therapy, all scales significantly improved (p<0.001). 

Conclusions 

IR showed more improvement on activities of daily life and cognitive functional recovery than CR in this study.

Keywords

• Stroke rehabilitation;
• Activities of daily living;
• Cognition;
• Integrative medicine;
• Acupuncture;
• Pulsed electromagnetic therapy

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Effects of Robot-assisted therapy on upper limb recovery after stroke: A Systematic Review

Interesting that significant improvement in upper limb function but not ADLs.  Ask your hospital EXACTLY what updates to this have occurred in the last 14 years.  You do expect your hospital to be competently following appropriate stroke research? Or are you giving them a pass on their incompetency?

Effects of Robot-assisted therapy on upper limb recovery after stroke: A Systematic Review

Gert Kwakkel, PhD1,2, Boudewijn J. Kollen, PhD3, and Hermano I. Krebs, PhD4,5,6
1 Department Rehabilitation and Research Institute MOVE, VU University Medical Center Amsterdam, The Netherlands 2 Department Rehabilitation, Rudolf Magnus Institute of NeuroScience, University Medical Center Utrecht, The Netherlands 3 Research Bureau, Isala Klinieken Zwolle, The Netherlands 4 Mechanical Engineering Department, Massachusetts Institute of Technology, Cambridge, MA, USA 5 Department of Neurology and Neuroscience, Burke Institute of Medical Research, Weill Medical College, Cornell University, White Plains, NY, USA 6 Department of Neurology, University of Maryland, School of Medicine, Baltimore, MD, USA

Abstract Background and Purpose— 

To present a systematic review of studies that investigates the effects of robot-assisted therapy on motor and functional recovery in patients with stroke. Summary of Review—A database of articles published up to October 2006 was compiled using the following MEDLINE key words: cerebral vascular accident, cerebral vascular disorders, stroke, paresis, hemiplegia, upper extremity, arm and robot. References listed in relevant publications were also screened. Studies that satisfied the following selection criteria were included: (1) patients were diagnosed with cerebral vascular accident; (2) effects of robot-assisted therapy for the upper limb were investigated; (3) the outcome was measured in terms of motor and/or functional recovery of the upper paretic limb; (4) The study was a randomised clinical trial (RCT). For each outcome measure, the estimated effect size (ES) and the summary effect size (SES) expressed in standard deviation units (SDU) were calculated for motor recovery and functional ability (ADL) using fixed and random effect models. Ten studies, involving 218 patients, were included in the synthesis. Their methodological quality ranged from 4 to 8 on a (maximum) 10 point scale. Meta-analysis showed a non-significant heterogeneous SES in terms of upper limb motor recovery. Sensitivity analysis of studies involving only shoulder-elbow robotics subsequently demonstrated a significant homogeneous SES for motor recovery of the upper paretic limb. No significant SES was observed for functional ability (ADL). 

Conclusion—

As a result of marked heterogeneity in studies between distal and proximal arm robotics, no overall significant effect in favour of robot-assisted therapy was found in the present meta-analysis. However, subsequent sensitivity analysis showed a significant improvement in upper limb motor function after stroke for upper arm robotics. No significant improvement was found in ADL function. However, the administered ADL scales in the reviewed studies fail to adequately reflect recovery of the paretic upper limb and valid instruments that measure outcome of dexterity of the paretic arm and hand are mostly absent in selected studies. Future research on the effects of robot-assisted therapy should therefore distinguish between upper and lower robotics arm training and concentrate on kinematical analysis to differentiate between genuine upper limb motor recovery and functional recovery due to compensation strategies by proximal control of the trunk and upper limb.

Correspondence: G. Kwakkel (PhD), Senior Researcher, Dept. Rehabilitation Medicine, VU University Medical Center, de Boelelaan 1117, 1081 HV Amsterdam, PO Box 7057, 1007 MB Amsterdam, The Netherlands, E-mail: g.kwakkel@vumc.nl.