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This article is for Q4 2012

http://stroke.ahajournals.org/content/35/11/2529.full.pdf+html

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My Key Points from this article were as follows:

- An overal benefit of 4-5% was found with a minimum of 16 hours of therapy, which equates to only a gain on one on the barthel index, questionable how significant this is.

- Benefits of the extra time were mainly found when it was focused on the LE or on ADLs and not to additional time spent on rehabbing the upper limb.  However, the authors point out that the Barthel index was frequently used and even the ADL gains on this measure are more sensitive to LE gains than UE gains so it may just be a poor choice of outcome measure.

- It was noted that UE outcome for MCA strokes at 6 months is highly related to outcome at 1 month. Further it is noted that studies suggest UE gains require mroe intense and repetive practice as compared to the LE and that these may only be possible in people that already have some function (perhaps the lower function patients will be able to increase their reps with the tDCS discussed in other meetings we've had)

-The research also suggests that patients expected to achieve some dexterity and function in the UE should focus on regaining motor control, whereas those with a poor functional prognosis should focus on maintaining comfort and flexibility in the UE and learning compensation strategies.

- highly variable differences in extra time were given (ranged from 132 to 6818 minutes) and no ceiling effect was noted suggesting that more seems to be beneficial above the 16 hour floor.  Gains on the FIM had a weak, but significant correlation to increased time and intensity of rehab.

- For those interested in the debate on NDT/PNF, on p 2534 the task specific had much higher effect sizes than the NDT/PNF studies.  It may be worth taking a closer look at these studies.  NDT/PNF had almost no effect, tasks specific exercises had larger effects, but in both directions.

- For clinics with limited resources it was suggested to have group therapy in circuits with different types of treatment being supervised at each station.

- Of note was that "methodological quality, however, was negatively associated with effect size" (right side of p 2531).  If I'm interpreting this correctly it means that the main studies showing a change as the result of exercise were porrer quality, meaning that the results may have been erroneous, and that good studies should little change.

-Some key issues I found with this study were the negation of many treatments because they required equipment such as balance platforms, treadmills biofeedback, constraint induced therapy, etc., many of which are now common place. Like the other paper, it covered a 20 year span during which a lot of change in treatment guidelines has occured and could make the approahces in the older studies outdates.  I'm not great with statistics, but I also questioned some of the methods they used and will try to get clarification if able.

- Like the other augmented exercise paper I was annoyed with how they used 'intensity'. At times they appear to use the actual definition of intensity, at other times they appear to be referring more to duration or volume.