Effective treatment of stroke rehabilitation: A Synthesis of Findings from 27 Studies

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Original Abstract of the Article

Major Research Findings

Research on the effectiveness of treatment in stroke rehabilitation has examined a variety of therapeutic approaches. 2 demonstrated that a higher proportion of elderly stroke patients admitted to a stroke unit were assessed as independent in self-care compared to patients with similar neurological impairment treated in medical units. This may be attributed to the earlier introduction of rehabilitation in the stroke unit than in the medical unit. 19 suggests that obstructive sleep apnea (OSA) is associated with stroke severity and poorer functional outcomes, and continuous positive airway pressure (CPAP) may improve functional recovery in stroke rehabilitation. A review on interventions for improving upper limb function after stroke synthesizes evidence on the effects of individual treatment techniques and modalities. 8 . However, a comprehensive overview of systematic reviews in this area is currently lacking.

A paper focusing on top-down and bottom-up stimulation techniques combined with action observation treatment in stroke rehabilitation proposes the bimodal balance-recovery model (interhemispheric competition model and vicariation model) as the mechanism of functional recovery after stroke. 10 . This paper analyzes how combinations of motor observation treatment approaches, transcranial electrical (TES) or magnetic (TMS) stimulation, and peripheral electrical (PES) or magnetic (PMS) stimulation techniques can be used as accessorial physical therapy methods for symptom reduction in stroke patients. Top-down and bottom-up stimulation techniques combined with action observation treatment could synergistically develop into valuable physical therapy strategies in neurorehabilitation after stroke. The study explores how TES or TMS intervention over the contralesional hemisphere or the lesioned hemisphere combined with PES or PMS of the paretic limbs during motor observation followed by action execution have super-additive effects to potentiate the effect of conventional treatment in stroke patients. This proposed paradigm could be an innovative and adjunctive approach to potentiate the effect of conventional rehabilitation treatment, especially for those patients with severe motor deficits.

An observational study on the assessment and treatment of dysphagia during inpatient stroke rehabilitation highlights that oropharyngeal dysphagia, a common swallowing impairment post-stroke, is managed by speech-language pathologists (SLP). 11 . This article demonstrates a local “know-do” gap assessment for usual dysphagia care for patients undergoing inpatient stroke rehabilitation in primary healthcare in Norway. This assessment includes an evaluation of the functional level of the patients and the characteristics and outcomes of treatment. This study suggests a gap in the assessment and treatment of dysphagia in stroke rehabilitation.

treatmentまとめ

Treatment in stroke rehabilitation includes physical therapy, occupational therapy, continuous positive airway pressure (CPAP), action observation treatment combined with transcranial electrical (TES) or magnetic (TMS) stimulation and peripheral electrical (PES) or magnetic (PMS) stimulation techniques, neurodevelopmental treatment, brain-computer interfaces (BCI), etc.

Benefits and Risks

Benefits Summary

Benefits of treatment in stroke rehabilitation include:

  • Improved self-care independence
  • Functional recovery
  • Improved motor skills
  • Cognitive improvement
  • Improved quality of life

Risks Summary

Risks of treatment in stroke rehabilitation include:

  • Side effects
  • Financial burden
  • Time commitment

Comparison Between Studies

Commonalities

Research on the effectiveness of treatment in stroke rehabilitation suggests that early rehabilitation plays a crucial role in functional recovery across many studies. Furthermore, there is a common understanding that individualized treatment tailored to the specific needs of each patient is essential.

Differences

Differences between studies include the therapeutic approach, the target patient population, and the assessment methods used. For instance, some studies examine the effectiveness of physical therapy while others focus on occupational therapy. Additionally, the target patient population may vary between studies, including patients in the acute, subacute, or chronic phases of stroke.

Consistency and Contradictions in Results

While some studies on the effectiveness of treatment in stroke rehabilitation have yielded consistent results, others have shown contradictory findings. This may be attributed to differences in research methods, target patient populations, and assessment methods. Future research should prioritize using more standardized research methodologies.

Considerations for Real-World Application

When applying findings from research on the effectiveness of treatment in stroke rehabilitation to real-world settings, the following considerations are crucial:

  • Patients’ conditions and needs vary, so treatment plans should be customized for each individual.
  • Treatment requires time and financial resources, making patient motivation and family support indispensable.
  • Treatment outcomes can vary between patients, and not all patients will experience the desired results.

Limitations of Current Research

Research on the effectiveness of treatment in stroke rehabilitation still faces several challenges. For example, there is a shortage of long-term outcome studies, highlighting the need for larger-scale research. Additionally, research on individual differences in treatment outcomes is insufficient, necessitating more in-depth analysis.

Future Research Directions

Future research on the effectiveness of treatment in stroke rehabilitation should prioritize the following:

  • Long-term outcome studies
  • Studies on individual differences in treatment outcomes
  • Development of new therapeutic approaches

Conclusion

Research on the effectiveness of treatment in stroke rehabilitation has rapidly advanced in recent years, leading to the development of various therapeutic approaches. Based on these findings, selecting the optimal treatment plan tailored to each patient’s needs is crucial. Rehabilitation following stroke holds significant potential for improving patients’ quality of life. With active involvement from patients themselves, their families, and healthcare professionals, we can expect even better results.

Treatment List

Physical therapy, occupational therapy, continuous positive airway pressure (CPAP), action observation treatment combined with transcranial electrical (TES) or magnetic (TMS) stimulation and peripheral electrical (PES) or magnetic (PMS) stimulation techniques, neurodevelopmental treatment, brain-computer interfaces (BCI), mirror therapy, intervention-based exercise training, neurofeedback, functional electrical stimulation (FES), robotic therapy, hand exoskeleton training, etc.

Literature analysis of 27 papers
Positive Content
26
Neutral Content
1
Negative Content
0
Article Type
9
1
2
6
27
1.

Enhanced physical therapy improves recovery of arm function after stroke. A randomised controlled trial.

Author: SunderlandA, TinsonD J, BradleyE L, FletcherD, Langton HewerR, WadeD T

Improved recovery of arm function

A study of 132 stroke patients found that enhanced physical therapy with behavioral techniques slightly improved arm function recovery at 6 months, especially for patients with milder initial impairments.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

2.

Therapy impact on functional outcome in a controlled trial of stroke rehabilitation.

Author: SmithM E, GarrawayW M, SmithD L, AkhtarA J

Improved self-care

This study compared stroke unit care with medical unit care for elderly patients. Patients in the stroke unit were more likely to be independent in self-care, despite similar neurological impairments. While stroke unit patients received less therapy overall, they started occupational therapy earlier after admission. These findings suggest that starting rehabilitation early may be more important than the total amount of therapy time.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

3.

Outcome of subacute stroke rehabilitation: a randomized controlled trial.

Author: RønningO M, GuldvogB

Improved stroke treatment

This study aimed to determine if subacute rehabilitation in a hospital setting after stroke reduces death, dependence, and improves health-related quality of life. It is unclear if the benefits of stroke treatment are due to early or later interventions.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

4.

Long-term antidepressant treatment with moclobemide for aphasia in acute stroke patients: a randomised, double-blind, placebo-controlled study.

Author: LaskaA C, von ArbinM, KahanT, HellblomA, MurrayV

Aphasia recovery

The study investigated whether antidepressive drug therapy could enhance regression from aphasia after acute stroke.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

5.

A pilot randomized controlled trial of community-based occupational therapy in late stroke rehabilitation.

Author: EganMary, KesslerDorothy, LaporteLouis, MetcalfeValerie, CarterMelanie

Improved stroke recovery
Stroke

This study examined the impact of a brief, client-centered occupational therapy program on participation in everyday activities in people who had experienced a stroke at least six months prior. While both the intervention group and the control group reported similar improvements in their ability to perform activities, those who received occupational therapy were significantly more satisfied with their performance. There were no significant differences in measures of well-being or overall participation between the groups. The study suggests that further investigation of this type of late-stage stroke rehabilitation program is warranted.

Evaluation StudyResearch that systematically evaluates the effectiveness of a particular program or policy. It measures its outcomes and provides important information for future decision-making.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

6.

The role of caregiver involvement in upper-limb treatment in individuals with subacute stroke.

Author: HarrisJocelyn E, EngJanice J, MillerWilliam C, DawsonAndrew S

Stroke rehabilitation

This study highlights the importance of exercise intensity in improving arm function after stroke. While the severity of initial arm weakness is a key factor, it cannot be changed through rehabilitation. The study emphasizes the need for alternative approaches to increase exercise intensity and improve arm function, particularly when one-on-one therapy is not always available.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

7.

Balance and walking after three different models of stroke rehabilitation: early supported discharge in a day unit or at home, and traditional treatment (control).

Author: GjelsvikBente Elisabeth Bassøe, HofstadHåkon, SmedalTori, EideGeir Egil, NæssHalvor, SkouenJan Sture, FriskBente, DaltveitSilje, StrandLiv Inger

Improve trunk control
Improve walking
Stroke

There was no difference in change between the groups for postural balance. The secondary outcomes indicated that improvement of trunk control and walking was better in the intervention groups than in the control group.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

8.

Interventions for improving upper limb function after stroke.

Author: PollockAlex, FarmerSybil E, BradyMarian C, LanghornePeter, MeadGillian E, MehrholzJan, van WijckFrederike

Stroke rehabilitation

Improving arm function is a key goal of stroke rehabilitation. While many reviews have examined the effectiveness of different treatment approaches, there's a lack of a comprehensive overview of these reviews to help determine which treatments are most effective.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

9.

Treatments for Poststroke Motor Deficits and Mood Disorders: A Systematic Review for the 2019 U.S. Department of Veterans Affairs and U.S. Department of Defense Guidelines for Stroke Rehabilitation.

Author: D'AnciKristen E, UhlStacey, OristaglioJeffrey, SullivanNancy, TsouAmy Y

ADL improvement
Depression reduction
Stroke

Cardiorespiratory training, repetitive task training, and transcranial direct current stimulation may improve activities of daily living in adults with stroke. Cognitive behavioral therapy and SSRIs may reduce depression.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

10.

Top-down and bottom-up stimulation techniques combined with action observation treatment in stroke rehabilitation: a perspective.

Author: QiFengxue, NitscheMichael A, RenXiping, WangDuanwei, WangLijuan

Stroke recovery

This paper analyzes how combinations of motor observation treatment approaches, transcranial electrical or magnetic stimulation and peripheral electrical or magnetic stimulation techniques can be used as accessorial physical therapy methods for stroke patients.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

16.

Treatment of hiccups in stroke rehabilitation with gabapentin: A case series and focused clinical review.

Author: GotTiffany, VivasLilian, FanCary, MacNeillHeather

Hiccup treatment
Sedation

This study explores the use of gabapentin as a treatment option for persistent and intractable hiccups, particularly in patients recovering from stroke. Gabapentin has shown promising results in several cases and offers a potential alternative to chlorpromazine, which can have sedating effects.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

17.

Wearable technology in stroke rehabilitation: towards improved diagnosis and treatment of upper-limb motor impairment.

Author: Maceira-ElviraPablo, PopaTraian, SchmidAnne-Christine, HummelFriedhelm C

Individualized rehabilitation
Limited resources

Wearable sensors are increasingly being used in stroke rehabilitation research. This review provides an overview of wearable sensors used in stroke rehabilitation research, with a particular focus on the upper extremity.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

18.

Balance and walking after three different models of stroke rehabilitation: early supported discharge in a day unit or at home, and traditional treatment (control).

Author: GjelsvikBente Elisabeth Bassøe, HofstadHåkon, SmedalTori, EideGeir Egil, NæssHalvor, SkouenJan Sture, FriskBente, DaltveitSilje, StrandLiv Inger

Improve trunk control
Improve walking
Stroke

There was no difference in change between the groups for postural balance. The secondary outcomes indicated that improvement of trunk control and walking was better in the intervention groups than in the control group.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

19.

The effect of obstructive sleep apnea and treatment with continuous positive airway pressure on stroke rehabilitation: rationale, design and methods of the TOROS study.

Author: AaronsonJustine A, van BennekomCoen A M, HofmanWinni F, van BezeijTijs, van den AardwegJoost G, GroetErny, KylstraWytske A, SchmandBen A

Cognitive function
Functional outcome

This study will investigate the effectiveness of continuous positive airway pressure on cognitive and functional outcomes in stroke patients with obstructive sleep apnea.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

20.

A comparison of analytic hierarchy process and conjoint analysis methods in assessing treatment alternatives for stroke rehabilitation.

Author: IjzermanMaarten J, van TilJanine A, BridgesJohn F P

More realistic treatment scenarios
Overestimation of preference for surgical scenarios

Both Analytic Hierarchy Process (AHP) and Conjoint Analysis (CA) methods were effective in eliciting patient preferences for stroke rehabilitation treatments. The most preferred treatments were soft tissue surgery (STS) and orthopedic shoes (OS). However, AHP method tended to overestimate the preference for surgical scenarios.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

21.

Mirror neurons: action observation treatment as a tool in stroke rehabilitation.

Author: FranceschiniM, AgostiM, CantagalloA, SaleP, MancusoM, BuccinoG

Action observation effective

The study found that action observation treatment may improve upper limb motor impairment in chronic stroke patients.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.

Language : English

22.

Occupational therapists' identification, assessment, and treatment of unilateral spatial neglect during stroke rehabilitation in Canada.

Author: Menon-NairAnita, Korner-BitenskyNicol, OgourtsovaTatiana

While most occupational therapists recognize unilateral spatial neglect (USN) as a potential problem after stroke, they rarely use standardized assessment tools or evidence-based interventions to manage this disabling impairment. This highlights the need for improved awareness and implementation of best practices in stroke rehabilitation.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

23.

Prophylaxis for and treatment of deep venous thrombosis after stroke: the Post-Stroke Rehabilitation Outcomes Project (PSROP).

Author: ZorowitzRichard D, SmoutRandall J, GassawayJulie A, HornSusan D

DVT Prevention
Effective DVT Treatment
DVT After Stroke

Deep venous thrombosis (DVT) is a common and preventable complication after a stroke. This study examined the incidence and temporal sequence of DVT in the Post-Stroke Rehabilitation Outcomes Project (PSROP) database and found that 5.6% of patients had DVTs during their inpatient rehabilitation facility stay.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Research Support, U.S. Gov't, Non-P.H.S.Research funding provided by US government agencies other than the Public Health Service.

Language : English

24.

Neurodevelopmental treatment stroke rehabilitation: a critique and extension for neuroscience nursing practice.

Author: SeneviratneCydnee, ReimerMarlene

Stroke recovery

Neurodevelopmental treatment (NDT) is used to encourage stroke patients to use the affected side of their body and to reduce muscle spasticity. Neuroscience nurses play an important role in facilitating stroke patients to practice activities of daily living.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

25.

Full-time integrated treatment program, a new system for stroke rehabilitation in Japan: comparison with conventional rehabilitation.

Author: SonodaShigeru, SaitohEiichi, NagaiShota, KawakitaMinako, KanadaYoshikiyo

Improved stroke rehabilitation

The Full-time Integrated Treatment (FIT) program for stroke rehabilitation was more efficient and effective than the conventional rehabilitation program.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Validation StudyResearch to assess the validity and reliability of new measurement methods or diagnostic tests.

Language : English

26.

Diagnosis and treatment of obstructive sleep apnea in a stroke rehabilitation unit: a feasibility study.

Author: DislerPeter, HansfordAlison, SkeltonJulie, WrightPamela, KerrJudy, O'ReillyJan, HepworthJudy, MiddletonSally, SullivanColin

Stroke recovery

Obstructive sleep apnea (OSA) is prevalent among stroke survivors and is associated with increased mortality and poor functional outcome. This study shows that it is feasible to diagnose and treat OSA on a rehabilitation ward. Of the 38 stroke survivors studied, 18 were diagnosed with OSA, and five were successfully treated with nasal continuous positive airway pressure. This approach may improve mortality, functional outcome, and secondary prevention.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

27.

Pitfalls in effectiveness research: a comparative analysis of treatment goals and outcome measures in stroke rehabilitation.

Author: LettingaA T, ReyndersK, MulderT H, MolA

Treatment effectiveness research for stroke rehabilitation should consider the theoretical basis of the therapy being evaluated, as the use of neutral measurement tools does not guarantee objective judgement.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

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