We would like to thank Christine Fyfe, Heather Goodare, Tammy Hoffman, Kedar K Mate, Peter Sandercock, Brenda Thomas and Phil Wiffen for providing peer review comments on the overview. Metaanalysis examining the effectiveness of electrical stimulation in improving functional use of the upper limb in stroke patients, Physical & Occupational Therapy in Geriatrics, Interventions to promote upper limb recovery in stroke survivors with severe paresis: a systematic review. We have provided a detailed, transparent assessment of the quality of included reviews in Figure 4 and Table 8 and have described issues related to each of the 11 AMSTAR questions in Methodological quality of included reviews. This review pools the data from 2 interventions: RTT and CIMT. government site. Geest JN, Hamel C, Allison R, Moderatequality evidence showed no benefit or harm for upper limb function as a result of repetitive task training, immediately at the end of intervention or at longerterm followup (data from French 2007; eight trials, 412 participants). Lankhorst GJ. Murphy BT, The aim of that review was to synthesise evidence and carry out metaanalyses related to "stroke rehabilitation interventions in the domain of physical therapy." Cusack T, Leathley MJ, The same group of authors published two reviews (French 2007 with dual publication French 2010; and French 2008), both of which explored the effects of repetitive task training on functional ability in people with stroke. Sirtori 2009 (last search June 2008; 19 trials, 619 participants), although not as uptodate as Corbetta 2010, provided subgroup comparisons related to time post stroke and dose of intervention. For most (19/21) of the nonCochrane reviews, this information was not provided or was unclear. WebFind out more about each database by reading its Database Description. for effectiveness studies if the author(s) chose to include only randomized, doubleblind, placebocontrolled studies or allocation concealment as inclusion criteria); for other types of studies, alternative items will be relevant. Lai SM, This head design can also handle the standard C-21 and C-22 casing hangers. Desrosiers J, Massucci M. Is healthrelated quality of life of stoke patients influenced by neurological impairments at one year after stroke? Functional electrical stimulation: upper extremity, In: Stroke Engine Intervention. Electoral College Further work is clearly required to explore our methods of applying GRADE levels of evidence. Manage and improve your online marketing. et al. A systematic review. Wood D, For selection of effective rehabilitation treatment, the relative effectiveness of interventions must be known. Veerbeek JM, Alternatively, exercises may be done in classes directed by a therapist or exercise professional, may utilise various exercise machines or may involve circuit training. Our search of DARE may have failed to reveal some potentially relevant nonCochrane reviews; this was particularly the case for reviews for which a record but no structured abstract was available. Functional electrical stimulation (FES) involves stimulation aimed at replacing or assisting a voluntary muscle contraction during a functional task (Roy 2010). Buurke JH, Interventions for sensory impairment in the upper limb after stroke. Timmermans AAA, Sisto S, Electoral College Email: vinay.mehndiratta2@boeing.com Mehta S, Wijck F, Pain, which is a common complication, often secondary to shoulder subluxation, but also commonly associated with the musculoskeletal changes caused by immobility. Wicjk F, Such interventions may be delivered by the therapist with or without devices (e.g. Lawes MM, Prevo A. Incumbent Brian Kemp (R) defeated Stacey Abrams (D) and three other candidates in the general election for governor of Georgia on November 8, 2022.. Kemp and Abrams faced each other in the 2018 Georgia gubernatorial election, with Kemp defeating Abrams 50-49%.At the time of the election, Georgia had had a Republican governor since Were the characteristics of the included studies provided? The International Classification of Functioning, Disability and Health, known more commonly as the ICF, can be used to describe whether treatments are aimed at reducing impairments, increasing activity or increasing participation (ICF 2001). However, some evidence from subgroup analyses indicates that a greater effect size may occur with increased dose of an individual intervention. ENGINEERS . Sherrington C, A stroke causes damage within the brain that can directly affect movement and sensation of the arm. Wishart L. Does taskoriented practice improve upper extremity motor recovery after stroke? Furthermore, pooled comparisons included trials with any type of control group intervention, including no intervention, usual care or other active interventions such as physiotherapy, passive stretching or botulinum toxin. Ijzerman MJ, Moderatequality evidence showed a beneficial effect of mirror therapy compared with any other treatment on a combined upper limb function and impairment outcome (10 trials, 421 participants) and on ADL outcomes (four trials, 217 participants) (Thieme 2012). Assessment of risk of bias in rehabilitation reviews, International Journal of Robotics Research. Sutton C, CB200 adhesives replace riveting, welding, and other fastening methods and are the recommended Zivold G. Relation between stimulation characteristics and clinical outcome in studies using electrical stimulation to improve motor control of upper extremity in stroke. Search methods: We comprehensively searched the Cochrane Database of Systematic Reviews; the Database of Reviews of Effects; and PROSPERO (an international prospective register of systematic reviews) (June 2013). McIlroy W, We judged that eight of 40 reviews assessed publication bias. Keeling J, 3. WebCreate a new spreadsheet using Google Sheets. Arm function after stroke: an evaluation of grip strength as a measure of recovery and prognostic indicator. Passive or active movements of the wrist and interphalangeal and metacarpophalangeal joints of the fingers and thumb can be used to stretch the wrist and finger muscles to their maximum painfree range. Lyons BE, Walker M. Therapybased rehabilitation services for patients living at home more than one year after stroke, The effectiveness of constraintinduced therapy as a stroke intervention: a metaanalysis. Sveen U, Consequently, evidence of 'no benefit or harm' may be a product of insufficient dose rather than of an ineffective intervention. The conclusions from both our overview and the review of Veerbeek 2014 are in agreement that evidence suggests a beneficial effect (on outcomes of upper limb function, impairment and/or ADLs) for CIMT, mental practice, robotics, interventions for sensory impairment and virtual reality. Therefore upper limb rehabilitation after stroke is likely to involve a complex intervention that requires the cooperation of patient, carers and the rehabilitation team. Physical rehabilitation approaches for the recovery of function and mobility following stroke, Correction of severe spastic flexion contractures in the nonfunctional hand. Within muscles, this neurotoxin inhibits the release of acetylcholine, thereby blocking nerve impulses and limiting hyperactivity in treated muscles. #1 or #2 or #3 or #4 or #5 or #6 Marian C Brady: received a small consultancy fee paid to employer from Genentech in respect of time spent on a research project investigating the properties of EQ5D. Was there duplicate study selection and data extraction? The ZIP file include Microsoft Excel spreadsheet or Access database and GIS files in shapefile format. Five of these were Cochrane reviews (Elsner 2013; French 2010; Hao 2013; Katalinic 2010; Mehrholz 2012), and three were nonCochrane reviews (Braun 2013; French 2008; Wang 2011). Often review authors make important decisions related to whether to pool (or to not pool) data arising from relatively diverse trials. et al. Decisions to update must be made with consideration of the priority of the review topic, the likelihood of new highquality trials and the current quantity and quality of evidence within the review. Methodological limitations are seen in these reviews, and available trial evidence is limited. Pharmacological therapies for upper limb spasticity. Roger VL, It cures quickly at room temperature and exhibits excellent environmental and chemical resistance. Shoulder subluxation (partial, temporary dislocation of the shoulder joint), caused by lack of motor control and muscle weakness in the rotator cuff muscles. Willmann RD, CIMT: Constraintinduced movement therapy. 6.1 Were details provided on the participants of included studies (including age, gender, severity of stroke, time since stroke)? The search dates of included reviews, as illustrated in Figure 6, range from December 2003 to July 2013. #2. stroke or poststroke or poststroke or cerebrovasc* or brain next vasc* or cerebral next vasc* or cva* or apoplex* or SAH Cauraugh JH. If there is no pooling of data, then 'not applicable' should be entered into the AMSTAR. However, clinical application of evidence will depend on specific details of an individual patient or setting, or both, and clinical decisions will require expert clinical reasoning and judgement if available evidence is to be interpreted and applied effectively. I'm sure they'd appreciate the business. Campbell P, Data from two small trials (46 participants) provided moderatequality evidence related to upper limb impairment, as measured by the FuglMeyer Scale, demonstrating that telerehabilitation (comprising a computerbased training programme) resulted in no benefit or harm when compared with usual care (MD 3.65, 95% CI 0.26 to 7.57). Virtual reality in stroke rehabilitation: still more virtual than real. This evidence shows that further research investigating bilateral arm training as a generic intervention for the population of people with impaired arm function after stroke may not represent an efficient use of resources. Bouter LM, The impairment outcome was based on an analysis of trials that delivered a fourweek intervention; pooled evidence related to the effects of a sixweek or eightweek intervention was of very low quality (four trials, 90 participants) and of low quality (six trials, 282 participants), respectively. Puhan MA, The part-A of sealant has a boiling point of 360 degrees C. Relative density of part-A sealant is 1.88 while part-B possesses 1.57. Steen N, Contact details: Anca CATRINA Procurement & Logistics ALRO S.A. 64 Splaiul Unirii, zipcode 040036 Bucharest, Romania Phone: +40 21 408 35.00 Mob: +40 752 105 376 Fax: +40 21 408 35 84 acatrina@alro.ro www.alro.ro. et al. Connell LA, Heart diseases and stroke statistics2013 update: a report from the American Heart Association. Moderatequality evidence showed a beneficial effect of robotics compared with any comparison intervention (other rehabilitation, placebo or no treatment) on measures of impairment (FuglMeyer) (16 trials, 586 participants) and ADLs (13 trials, 552 participants), and moderatequality evidence indicated no benefit or harm for measures of strength (10 trials, 321 participants) (data from Mehrholz 2012). In mirror therapy, a mirror is placed in the patient's sagittal plane, thus reflecting the nonaffected side as if it were the affected side, so that movements of the nonaffected limb give the illusion that the affected limb is moving (Michielsen 2010). Miller JP, Key: CIMT: constraintinduced movement therapy; NDT: neurodevelopmental treatment; PNF: proprioceptive neuromuscular facilitation; Tx: treatment. 5.1 Was there a list of included studies? Wade DT, The six nonCochrane reviews judged to be unclear were allat a minimumunclear in relation to whether two independent review authors were involved in data extraction (Elia 2009; Harris 2010; Meilink 2008; NorouziGheidari 2012; Schabrun 2009; Wang 2011). Table 10, Table 11, Table 12, Table 13, Table 14 and Table 15 detail comparisons judged to provide moderate (or high) quality evidence; Table 16, Table 17, Table 18, Table 19, Table 20 and Table 21 detail comparisons judged to provide low or very lowquality evidence. 8. Common outcome measures include global measures of ADLs, such as Barthel ADL Index (Mahoney 1965), Rivermead ADL Assessment (Whiting 1980), Rivermead Motor Ability Scale (Collen 1991), Rankin Scale (Bonita 1988), Functional Independence Measure (FIM) (Keith 1987), Katz Index of Activities of Daily Living (Katz 1970) and Rehabilitation Activities Profile (Van Bennekom 1995). French B, As a result of overlap between included trials, this review is included within our qualitative synthesis only (Table 7). Rumping K, GRADE: Grades of Recommendation, Assessment, Development and Evaluation. In particular, arising from (but not limited to) the results of this overview, we support recommendations for the following. We would emphasise that we believe it is essential to consider the responses to all mAMSTAR questions to fully judge the quality of a review, and that the visual depiction of the number of 'yes' responses is meant only as a summary of the full information within Figure 4 (and summarised in Table 8). Effects of splinting on wrist contracture after stroke: a randomized controlled trial, The Bobath concept in stroke rehabilitation: a focus group study of the experienced physiotherapists' perspective. The AMSTAR (and mAMSTAR) questions often concentrate on documentation of the presence of information (e.g. For this overview, we use the term 'dose' to refer to the intensity (effort), frequency and duration (time) of an intervention, with reference to definitions recommended by the American Congress of Rehabilitation Medicine Stroke Movement Interventions Subcommittee (Page 2012) as follows. site.new . The aim of this review was to examine the effects of music therapy with standard care versus standard care alone or standard care combined with other therapies on gait, upper extremity function, communication, mood and emotions, social skills, pain, behavioural outcomes, activities of daily living and adverse events in participants with brain injury. Sjgren T, Latimer CP, 6.3 Were details provided on the outcomes reported by included studies? Shop Now. 4.1 Were studies searched for and included regardless of their publication type? The search date for Woodford 2007 was March 2006. Complementary therapies that can be used to promote upper limb function after stroke include traditional Chinese therapies, acupuncture and homeopathy. Timmermanns AAA, Pohl M, Wu Hong M, McAdam J, learning through consequences) is used to increase task difficulty for the affected hand in small amounts, so the stroke survivor can succeed in using the affected limb. WebMarketingTracer SEO Dashboard, created for webmasters and agencies. Bringing together all available systematic review evidence has helped us make specific recommendations for future research. Editorial: Bobath Concept: Bobath@50: midlife crisisWhat of the future? I2 = I2 statistic for heterogeneity, as reported within the review. Personal communication with author: February 2014 in final stages, Systematic review of selfmanagement interventions for stroke survivors, Physical therapies as an adjunct to botulinum toxininjection to the upper or lower limb for the treatment of spasticity following neurological impairment: a systematic review, Personal communication with author: August 2013, in press, To assess the efficacy and possible adverse effects of acupuncture for the treatment of poststroke upper limb pain, To determine whether pharmacological interventions for spasticity are more effective than no intervention, normal practice or control in improving function following stroke, To assess the effects of assistive technologies for the management of contractures in people with stroke, To determine whether physical treatment interventions are effective in preventing or minimising activity limitation and participation restrictions in patients developing spasticity post stroke, Personal communication with author: Publication date anticipated around May 2014, The role of transcranial direct current stimulation (tDCS) in motor rehabilitation in stroke survivors: a systematic review, A metaanalysis of all eligible randomised or quasirandomised trials of electrical stimulation for the treatment of shoulder subluxation, Surface electrical stimulation with motor response, To investigate the outcomes of numerous CIMT trials to gauge improvement in upper extremity motor function among individuals suffering from hemiparesis experienced after stroke, RCTs, controlled trials, pre/post cohorts. @ 50: midlife crisisWhat of the arm a greater effect size may occur with increased dose of individual! 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