Effect of a therapeutic intervention for the hemiplegic upper limb in the acute phase after stroke: a single-blind, randomized, controlled multicenter trial.

BACKGROUND AND PURPOSE: Arm function recovery is notoriously poor in stroke patients. The effect of treatment modalities, particularly those directed at improving upper limb function, has been studied primarily in chronic stroke patients. The purpose of this study was to investigate the effect of a specific therapeutic intervention on arm function in the acute phase after stroke. METHODS: In a single-blind, randomized, controlled multicenter trial, 100 consecutive patients were allocated to either an experimental group that received an additional treatment of sensorimotor stimulation or to a control group. The intervention was applied for 6 weeks. Patients were evaluated for level of impairment (Brunnström-Fugl-Meyer test) and disability (Action Research Arm test, Barthel Index) before, midway, and after the intervention period and at follow-up 6 and 12 months after stroke. RESULTS: Patients in the experimental group performed better on the Brunnström-Fugl-Meyer test than those in the control group throughout the study period, but differences were significant only at follow-up. Results on the Action Research Arm test and Barthel Index revealed no effect at the level of disability. The effect of the therapy was attributed to the repetitive stimulation of muscle activity. The treatment was most effective in patients with a severe motor deficit and hemianopia or hemi-inattention. No adverse effects due to the intervention were found. CONCLUSIONS: Adding a specific intervention during the acute phase after stroke improved motor recovery, which was apparent 1 year later. These results emphasize the potential beneficial effect of therapeutic interventions for the arm.

Problem list of stroke patients as identified in the problem orientated medical record.

In a retrospective study problem orientated physiotherapy records were examined on 156 consecutive stroke patients admitted to medical wards and referred to the physiotherapy department. The purpose of the study was to identify from the problem lists those problems physiotherapists are dealing with in stroke care. There were 1338 problems recorded, and these were divided into 16 clinically meaningful subgroups. Three of the sixteen subgroups accounted for 60.2 percent of all the problems recorded, namely lack of voluntary movement and mobility in general (25.7%), imbalance in muscle tone (19.5%), and problems in maintaining balance (15.0%). On discharge only 34.1 per cent of all problems were reported to be resolved. There was wide variation in the success rate claimed with different problems.