Stroke: Stroke Issues in Recovery and Rehabilitation

doi:10.1016/S0031-9406(05)66623-0

Physiotherapy

Volume 81, Issue 11, November 1995, Pages 689-694

https://doi.org/10.1016/S0031-9406(05)66623-0 Get rights and content

Summary

The rehabilitation of survivors of stroke places heavy demands on NHS resources. Studies investigating the efficacy of stroke rehabilitation have produced equivocal results. We argue that the research methods used may be inappropriate, the research question may be too general or there may be a failure to take account of factors other than the physical problems following stroke.

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Cited by (21)

A comprehensive review of motor movement challenges and rehabilitative robotics
2023, Smart Health
Individuals who have motor movement challenges may have their quality of life significantly impacted. Activities for Daily Living (ADL) become a challenge and this can also greatly affect their mental state, leading to anxiety and depression. Rehabilitative Robotics allows these individuals to regain some level of movement that can assist them in their ADL. There can be several reasons for an individual to experience impaired motor ability. Rehabilitative systems will need to factor in this underlying reason for the motor movement challenge in order for it be an effective solution. In this comprehensive review, we first look at the causes of motor movement challenges. We then explore existing techniques and physiological signals used to perform the required assistance. We then review the various signal processing and machine learning techniques being used in such systems.
Virtual reality games for rehabilitation of upper extremities in stroke patients
2021, Journal of Bodywork and Movement Therapies
Citation Excerpt :
About 30–40% of people who survive stroke, suffer from severe disabilities (Dehghani Firoozabadi et al., 2013; Hosseini et al., 2010). Stroke-induced disorders include disturbances in consciousness, physical disorders (power, great range of movements, and coordination), cognitive impairment (memory, language, and perception), visual disturbances, emotional problems, and urinary disorders (Riddoch et al., 1995) which affects the quality of life and the level of individuals' autonomy (Turolla et al., 2013). Hemiparalysis is the most common post-stroke disorder.
Stroke is one of the main causes of physical disability in which doing frequent and early exercise is imperative for rehabilitation. Virtual reality gaming has a high potential in rehabilitation leading to increased performance of patients. This study aimed to develop, validate and examine virtual reality games in chronic stroke patients.
This was a single before-after study. To determine the movements and content of games, 9 physiotherapists and 11 game designers were asked to participate in a questionnaire-based survey. Then, to evaluate the impact of games on rehabilitation, patients (N = 10; mean age = 52 ± 4.38) with chronic stroke were asked to play the games three times a week for four weeks. Outcomes included measurement of the ability to perform shoulder, elbow and wrist movements was performed using goniometric instrument, Modified Motor Assessment Scale (MMAS) was used to assess the functional ability of patients and muscle spasticity, and brunnstrom's stages of recovery test was also used to assess spastic and involuntary muscle movement.
Games have positive effects on the horizontal abduction of shoulder (16.26 ± 23.94, P = 0.02), horizontal adduction of shoulder (59.24 ± 74.76, P = 0.00), supination of wrist (10.68 ± 53.52, P = 0.02), elbow flexion (0.1 ± 1.5, P = 0.00), and wrist flexion (0.06 ± 1.34, P = 0.03). However, they had no effects on the flexion of shoulder, flexion of elbow, extension of elbow, and extension of wrist (p-value> 0.05).
The results showed that games improve the range of motion of the participants in terms of horizontal abduction and abduction of the shoulder, elbow flexion, and supination and flexion of the wrist. Due to the small sample size in this study, we recommend more studies with larger samples and a control group.
The Combined Effects of Adaptive Control and Virtual Reality on Robot-Assisted Fine Hand Motion Rehabilitation in Chronic Stroke Patients: A Case Study
2018, Journal of Stroke and Cerebrovascular Diseases
Citation Excerpt :
Stroke can result in paralysis, speech impairment, loss of memory and reasoning ability, coma, or even death.1
Robot-assisted therapy is regarded as an effective and reliable method for the delivery of highly repetitive training that is needed to trigger neuroplasticity following a stroke. However, the lack of fully adaptive assist-as-needed control of the robotic devices and an inadequate immersive virtual environment that can promote active participation during training are obstacles hindering the achievement of better training results with fewer training sessions required. This study thus focuses on these research gaps by combining these 2 key components into a rehabilitation system, with special attention on the rehabilitation of fine hand motion skills. The effectiveness of the proposed system is tested by conducting clinical trials on a chronic stroke patient and verified through clinical evaluation methods by measuring the key kinematic features such as active range of motion (ROM), finger strength, and velocity. By comparing the pretraining and post-training results, the study demonstrates that the proposed method can further enhance the effectiveness of fine hand motion rehabilitation training by improving finger ROM, strength, and coordination.
Neuroprotective effects of Gualou Guizhi decoction in vivo and in vitro
2014, Journal of Ethnopharmacology
Citation Excerpt :
Stroke, a cerebrovascular disease, has a clear three-high (high incidence, high morbidity, and high mortality) phenomenon and it becomes the third worldwide leading cause of mortality and main cause of handicap following cardiovascular diseases and cancer (Donnan et al., 2008; Hong and Saver, 2009). It has been reported that 70–80% of stroke survivors suffer serious physical and cognitive disabilities, particularly post-apoplectic limb spasm, which has become an increasingly serious social problem (Riddoch et al., 1995; Goldstein and Rothwell, 2008). At present, there are many agents of ischemic stroke in clinic, including calcium channel blockers, glutamate antagonists, GABA agonists, antioxidants/radical scavengers, phospholipid precursor, nitric oxide signal-transduction down-regulator, leukocyte inhibitors, hemodilution, and a miscellany of other agents (Ginsberg, 2008; Moskowitz et al., 2010).
Gualou Guizhi decoction (GLGZD) prescribed in traditional Chinese medicine has been reported to have protective effects on ischemic stroke. The present study is to investigate the therapeutic effect of GLGZD on ischemic stroke and explore its mode of action.
GLGZD was studied on transient middle cerebral artery occlusion (MCAO) followed by reperfusion in vivo, as well as on hippocampal primary neuron cultures in vitro.
In vivo, it was shown that GLGZD treatment for 7 days could ameliorate transient middle cerebral artery occlusion (MCAO)-induced neurological deficit, histopathology changes and decrease infarct area. Further study demonstrated that GLGZD inhibited over-activation of astrocytes and apoptosis of neurons and GLGZD promoted up-regulation of neuronal specific marker neuron-specific nuclear (NeuN) and microtubule-associated protein 2 (MAP-2) in brain. Moreover, the in vitro study revealed that GLGZD treatment protected against NMDA-induced cell apoptosis and neuronal loss, and promoted up-regulation of neuronal specific marker NeuN.
Taken together, the present study demonstrates that GLGZD produces a protection in the MCAO model rats via inhibiting over-activation of astrocytes, apoptosis of neurons and up-regulation of neuronal specific marker NeuN and MAP-2. Our study reveals that GLGZD might be a potential neuroprotective agent for stroke and can provide basic data for clinical use.
Physiotherapists working with stroke patients: A national survey
2000, Physiotherapy
This study sought to develop an insight into the existing profile of physiotherapists working with stroke patients in the United Kingdom. Its focus was on demography, approach to treatment, conflict with other professionals and assumptions or beliefs surrounding intervention.
A total of 1,667 questionnaires were distributed to 262 hospitals and health centres in the UK. Of these, 1,078 were returned (representing a 64.67% return rate). A total of 973 were analysed (representing an effective return rate for the purposes of analysis of 58.36%). The research focused on senior I and senior II physiotherapists, although junior physiotherapists with at least one year's experience were included.
The analysis revealed that stroke patients were treated across many locations, the most frequent locations being the community, medical wards, elderly wards and stroke units. Information regarding age, sex, designation and geographical location of respondents is included as are details of approach followed. Examination of the results showed a great deal of variation in the beliefs held by physiotherapists about treatment of stroke patients, despite the strong similarities in stated approach. The analysis also revealed the extent to which physiotherapists are in conflict with other professionals (namely doctors and nurses) about delaying walking with patients and their early discharge.
Physiotherapy for stroke rehabilitation: A need for evidence-based handling techniques: Literature review
2000, Physiotherapy
This paper seeks to identify, through reviewing the literature, a focus for future research on manual handling practices in neurological physiotherapy. The lack of evidence to support neurological rehabilitation in general places some treatment modalities in question. One of these is the use of the ‘pivot' assisted transfer.
The introduction of the EC Manual Handling Operations Regulations (1992) prompted the scrutiny of lifting and handling methods within the health sector. Some manoeuvres, such as the pivot transfer, were then condemned by various professional bodies who considered it to be physically dangerous to the handler.
However, anecdotal evidence still suggests that the pivot transfer is widely used by neurological physiotherapists practising the Bobath technique. Neither the effectiveness nor outcome of this method of neurological handling has been adequately researched in light of these regulations.
Similarly, there is little research on the incidence of musculoskeletal disorders among neurological physiotherapists as a result of their handling methods. This literature review indicates an immediate need for further investigation of these subjects.

View all citing articles on Scopus

¹: M Jane Riddoch PhD CPsychol MCSP is a senior lecturer in psychology, Glyn W Humphreys PhD CPsychol FBPS is a professor in psychology, and Andrew Bateman BSc MCSP is a research associate in psychology at the University of Birmingham.

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REVIEW PAPERStroke: Stroke Issues in Recovery and Rehabilitation

Summary

Neuropsychologia

Archives of Physical Medicine and Rehabilitation

Physiotherapy

The Lancet

Archives of Physical Medicine and Rehabilitation

Physiotherapy

‘A psychological framework for neurorehabilitation’

Physiotherapy Practice

‘The rate of recovery from stroke — And its measurement’

International Journal of Rehabilitation Medicine

‘Patterns of recovery from hemiplegia following stroke’

Neuropsychological Rehabilitation

‘Treatment of adult hemiplegia’

Physiotherapy

Adult Hemiplegia: Evaluation and treatment

‘Using a single-subject research design to evaluate the effectiveness of treatment’

American Journal of Occupational Therapy

Physiotherapy in Disorders of the Brain

‘The functional anatomy of motor recovery after stroke in humans: A study with positron emission tomography’

Annals of Neurology

‘Stroke rehabilitation. 5. Stroke outcome’

Archives of Physical Medicine and Rehabilitation

‘A therapeutic approach to physical disability’

Physiotherapy Canada

‘Unilateral spatial neglect and recovery from hemiplegia: A follow-up study’

Brain

‘Stroke rehabilitation: Three exercise therapy approaches’

Physical Therapy

‘Metabolic plasticity following infarction: A 2-deox-glucose study in adult rats’

‘Focused stroke rehabilitation programmes do not improve outcome’

Archives of Neurology

‘Rehabilitation for stroke: A review’

Stroke

‘Who goes home? Predictive factors in stroke recovery’

Journal of Neurology, Neurosurgery and Psychiatry

‘Rehabilitation of the stroke patient’

Current Opinion in Neurology

‘Has sensory stimulation a role in stroke rehabilitation?’

Scandinavian Journal of Rehabilitation Medicine

‘The influence of stroke unit rehabilitation on functional recovery from stroke’

Stroke

REVIEW PAPER
Stroke: Stroke Issues in Recovery and Rehabilitation