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Hemiparesis Hemiparesis Presentation Transcript

  • Hemiparesis Research in Physical Therapy Treatment of the Upper Limb Chris Keating SPT Thomas Jefferson University
  • Outline
    • Research
      • Good or Bad
    • Bimanual Task
      • Research
      • Benefits
      • PT Implications
    • Mirror Therapy
      • Research
      • Benefits
      • PT Implications
  • Reading Research
    • Don’t read the entire article from cover to cover
    • Invest time wisely to make sure its worth your time
    • Abstract---Introduction---Methods---Results---Discussion---Data Analysis
    • Read one section then decide whether to continue reading
  • Evaluating Research See Attachment
    • Is the problem clearly stated?
    • Is the problem probable based on the author’s review of the literature?
    • Were inclusion and exclusion criteria specified?
    • How many independent variables were examined, and how many levels do they have?
    • Have the authors documented the reliability and validity of the instruments?
    • Are operational definitions supplied for all independent and dependent variables?
    • Are the results statistically significant?
    • Regardless of the statistical outcome, are the results clinically important?
    • Is the evidence strong enough to suggest a change in clinical practice?
  • Bimanual Task
    • Only 20% of patients with a flaccid upper limb after 2 weeks recover functional use
    • Research has taken place to explore the use of bimanual task therapy in order to increase the functional use of the paretic arm
    • Where do you start your search for the best research in order to provide the best care?
  • Cochrane Review
    • Searched the Cochrane Database of Systematic Reviews
      • Key words crossed
        • Stroke
        • Bimanual
    • Found 1 article protocol
      • Provided SRL blue print for aspiring researcher to develop and execute (not useful)
      • Provided background on the current evidence available (useful)
  • Cochrane Review
    • A small number of randomized controlled trials of bilateral training have been published, which appear to have inconsistent results
    • investigations of the impact of bilateral training on neural mechanisms provide equivocal results
    • In order to determine the effects of bilateral training compared to no treatment, placebo or other interventions for improving arm function after stroke, a systematic review of the relevant literature is required
  • Rose: Findings
    • The purpose of this experiment is to investigate anticipatory planning and movement control processes involved in bimanual aiming for individuals with mild stroke-induced hemiparesis.
    • Nonparetic limb movement time was prolonged by 21% in the bimanual compared with the unimanual condition
    • Compared to the unimanual task the bimanual task exhibited a higher peak velocity in the paretic limb – This was not noted in the control
  • Rose: Benefits
    • Individuals with mild paresis post stroke retain a level of bimanual coordination. This ability may be harnessed for rehabilitation interventions to benefit recovery of function
    • PT Implications
      • Goal oriented bimanual tasks increase the feedback to the CNS increasing neuroplasticity and chance of remediation
  • Cauraugh: Findings
    • The leading question focused on within-limb transfer of coupled protocols on distal joints to a bimanual aiming task that involved proximal joints
    • This study determined that within-limb transfer from distal joints to a combination of proximal joints was feasible
  • Cauraugh: Benefits
    • Peak velocity, variability in peak velocity, and deceleration time (adjustment phase) findings revealed a target aiming task advantage for the coupled bilateral group
    • PT Implications:
      • Bimanual goal oriented task training improves kinetics of proximal joints thereby improving hand placement and function
  • Dohle: Purpose
    • The Purpose was to evaluate the potential beneficial effect of viewing the mirror image of the unaffected upper limb on recovery in patients with severe hemiparesis early after stroke
  • Dohle: Findings
    • No difference in motor function, ROM, Pain or Motor FIM between the 2 groups (CT and MT)
    • MT had significant gains over the CT in Function, Neglect and Sensory outcome measures (ARAT and Light Touch)
  • Dohle: Benefits
    • Watching a healthy moving arm and hand in the neglected hemifield provides a stronger stimulus for recovery from neglect than watching the attempted movements of a paretic side
    • MT most effective when person has no distal movement at onset of treatment compared to CIMT where functional gains are made but only when distal function is available
    PT Implications: This offers another option when treating a very difficult impairment
  • Reference
    • Coupled Bimanual Movements and Active Neuromuscular Stimulation: Intralimb Transfer Evidence During Aiming . Cauraugh, Kim and Duley, Neuroscience Letters 382 (2005) 39-44.
    • The Co-Ordination of Bimanual Rapid Aiming Movements After Stroke . Rose and Winstein, Clinical Rehabilitation 19 (2005) 452-462.
    • Mirror Therapy Promotes Recovery From Severe Hemiparesis: A Randomized Control Trial . Dohle, Pullen and Nakaten, Neurorehabilitation and Neural Repair 23 (2009) 209-217
    • Simultaneous Bilateral Training For Improving Arm Function After Stroke (Protocol). Couper, Van Wijck and Pollock 2009.
    • Portney LG, Watkins MP. Foundations of Clinical Research: Applications to Practice . Norwalk, CT: Appleton and Lange; 1993