Stroke Rehabilitation Intervention Strategies

A comprehensive set of vocabulary flashcards covering key research studies, clinical researchers, and evidenced-based guidelines for stroke rehabilitation intervention strategies.

Kwah (2012) Study Findings

A prospective cohort study of $200$ stroke patients finding that $52\%$ developed at least one contracture within $6$ months, most frequently in the shoulder, hips, and plantar flexors ($PFs$).

Moderate to Severe Stroke Contracture Risk

An increase in contracture incidence by $66\%$ as identified by Kwah (2012).

Nudo (1996) Research

Study involving monkeys that demonstrated neuroplasticity requires thousands ($1000s$) of repetitions; hand cortical representation can invade elbow and shoulder regions following intensive practice post-stroke.

Scrivener K et al (2012) Dosage Metric

Completing more than the median of $703$ repetitions in the first week was associated with faster recovery of unassisted walking in $200$ consecutive stroke unit patients.

Hill et al (2023) Brain Priming

A study of $33$ chronic stroke survivors showing that a single $20$-minute bout of moderate-intensity treadmill exercise significantly increases motor evoked potentials ($MEPs$) in the contralesional hemisphere for $10$ minutes.

AVERT Trial (Bernhardt et al, 2015)

A multi-country trial showing that shorter, more frequent mobilization sessions ($6-7$ times per day versus $3$ times) improved the odds of walking at $3$ months post-stroke.

Canning (2004) Strength vs. Dexterity

A longitudinal study finding that strength and dexterity explained $75\%$ of variance in function, with loss of strength being the greater contributor to activity limitations.

Ada et al (2003) Inner Range Weakness

Research showing that contracture reduces muscle sarcomere length and motor unit recruitment but does not contribute to inner range weakness; strength training should target muscles in shortened positions.

Pointederra Isometric Research

Found a rapid reduction in force during a $30s$ sustained contraction in $MS$ patients, caused by diminished voluntary activation, suggesting the need for fatigue training.

Canning (1999) / Dorsch (2011) Speed Research

Stroke patients were found to be half as strong and took $2$ to $3$ times longer to produce torque, indicating a need for high-velocity movements to target fast-twitch muscle fibers.

Most Severely Affected Muscle Groups (Dorsch, 2011)

Identified as the hip extensors, ankle dorsiflexors, and hip adductors in the paretic limb.

Intact Limb Weakness (Dorsch, 2011)

The study found significant weakness even in the unaffected limb, specifically in the hip extensors, ankle dorsiflexors, and knee flexors.

Ada (2006) Systematic Review

A meta-analysis of $21$ RCTs supporting the use of progressive resistance training ($PRT$), biofeedback, $E-Stim$, task-specific training, and mental practice for weak stroke patients.

Kautz and Brown (1998) Muscle Timing

Found stroke patients had disordered muscle activation timing (e.g., rectus femoris and semimembranosus turned on too late) which reduced mechanical output.

Dean (1997/1999) Sitting Balance Training

High-repetition reaching ($300$ reps/day) in sitting increases reaching distance and loading on the affected leg, but did not directly improve walking speed.

Ada (2017) Shoulder Subluxation Management

Recommends electrical stimulation to the deltoid and supraspinatus for $6$ hours per day to prevent subluxation, alongside firm supports and avoid manual pulling of the arm.

Carey et al (2011) SENSe Program

A specific somatosensory discrimination training program ($3\times 60mins$ per week for $3$ weeks) that halved sensory deficits in $70\%$ of chronic stroke survivors.

Stanton et al (2017) Biofeedback

A systematic review confirming biofeedback is more effective than usual physiotherapy for improving standing after stroke.

Janssen et al (2014) Enriched Environment

A pilot trial showing patients in an environment with games, books, and radio were $1.2$ times more likely to engage in activity.

Tardieu Scale (Ada & Patrick, 2006)

A clinical tool superior to the Ashworth Scale for differentiating between contracture and spasticity by utilizing both fast and slow velocity stretches.

Arborelius et al (1992) Seat Height

Rising from a high stool or using armrests reduces the mean maximum hip moment by about $50\%$, making sit-to-stand easier.

Nascimento et al (2015/2021) Rhythmic Cueing

Using rhythmic auditory stimulation (metronomes) improved walking speed by $0.23\,m/s$ and stride length by $20\,cm$.

Preston (2021) Prognostic Factors

Found independence in $ADLs$ and an intact corticospinal tract are the strongest predictors for independent walking at $3$ months.

Hesse (1997/1999) Body Weight Support (BWS)

Identified a 'sweet spot' of $15-30\%$ $BWS$ on a treadmill for symmetric gait; support exceeding $30\%$ causes a significant drop in muscle activation.

Ada L. et al (2003) Treadmill vs. Placebo

Proved that treadmill and overground walking programs yield significant improvements in speed and distance compared to stretching or low-intensity tasks.

Constraint-Induced Movement Therapy (CIMT) Guidelines

Recommends at least $2$ hours of active therapy per day for $2$ weeks plus restraint of the unaffected limb for at least $6$ hours a day.

Jeannerod (1984) Reach and Manipulation

Established that transport (arm) and manipulation (hand) are synchronized by the brain, with maximum hand aperture coinciding with the deceleration phase of the reach.

Thumb Invariance

The physiological observation that the thumb remains stable and fixed during the reach-to-grasp phase of hand movement.

Australian Clinical Guidelines: Mobilization Timing

All stroke patients should commence out-of-bed activity within $48$ hours, though intensive mobilization within the first $24$ hours is not recommended.

Acute Period Therapy Dosage (0-7 days)

Guidelines recommend a minimum of $3$ hours a day of scheduled therapy, with at least $2$ hours focused on active task practice.