Efficacy and task structure of bimanual training post stroke: a systematic review.

BACKGROUND: Bimanual training has been shown to be as effective as, but not superior to, unimanual paretic upper extremity (UE) training interventions in improving paretic UE function and use post stroke. However, it is still unclear whether different training interventions or task structures within bimanual interventions may differentially affect the outcomes. OBJECTIVE: The objectives of this review were to (1) systematically determine the efficacy of bimanual training in relation to the International Classification of Functioning, Disability and Health model components and (2) explore the structure of current bimanual training interventions. METHOD: A systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eleven studies were accepted for review. RESULTS: Three main types of bimanual training emerged: functional task training (FTT), bilateral training with rhythmic auditory cues (BATRAC), and robot-assisted training (RAT). Bimanual training is generally efficacious overall in improving paretic UE movement in individuals with subacute and/or chronic stroke as compared with other interventions. FTT, BATRAC, and RAT showed no significant differences compared with conventional therapy. Bimanual training may have greater proximal control benefits but fewer benefits in terms of subjects' perceived amount and quality of use as compared with constraint-induced movement therapy. CONCLUSION: There were not enough data to draw any conclusions about the effects of bimanual task symmetry or commonality of goal.

Exercise guidelines for inpatients following ventricular assist device placement: a systematic review of the literature.

BACKGROUND: For patients with end-stage heart failure awaiting transplantation, lack of donor organs has created an increased need for alternatives such as left ventricular assist device (LVAD) implantation. The purpose of this study is to determine safe and effective exercise parameters for physical therapy in the acute care setting. METHODS: A systematic literature review was conducted according to PRISMA guidelines using Sackett's Levels of Evidence to rate the evidence. Multiple databases were searched with inclusion criteria of: available in English, inpatient care up to 6 months postoperatively, description of intervention type and exercise parameters. EXCLUSION CRITERIA: no defined exercise parameters, outpatient treatment, infection post VAD, or palliative or hospice care post VAD. RESULTS: Six studies out of 1,291 articles met inclusion criteria. Common exercise parameters used were the Borg Rating of Perceived Exertion scale 11-13 (6-20 scale) or > 4 (0-10 scale), Dyspnea scale > 2 (0-4 scale) and > 5 (0-10 scale), mean arterial pressure (MAP) 70-95 mmHg, and LVAD flow > 3L/min. Levels of evidence ranged from case controlled to expert opinion. CONCLUSION: Current evidence on inpatient exercise parameters for patient's status post LVAD implantation is not sufficient to suggest definitive guidelines; however, these exercise parameters provide a reference for patient care.