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      Repetitive Peripheral Sensory Stimulation and Upper Limb Performance in Stroke: A Systematic Review and Meta-analysis

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          Abstract

          <div class="section"> <a class="named-anchor" id="S1"> <!-- named anchor --> </a> <h5 class="section-title" id="d1108660e198">Background:</h5> <p id="P1">Enhancement of sensory input in the form of repetitive peripheral sensory stimulation (RPSS) can enhance excitability of the motor cortex and upper limb performance. Objective: To perform a systematic review and meta-analysis of effects of RPSS compared to control stimulation on improvement of motor outcomes in the upper limb of subjects with stroke. </p> </div><div class="section"> <a class="named-anchor" id="S2"> <!-- named anchor --> </a> <h5 class="section-title" id="d1108660e203">Methods:</h5> <p id="P2">We searched studies published between 1948 until December, 2017 and selected five studies that provided individual data and applied a specific paradigm of stimulation (trains of 1 millisecond pulses at 10 Hz, delivered at 1 Hz). Continuous data were analyzed with means and standard deviations of differences in performance before and after active or control interventions. Adverse events were also assessed. </p> </div><div class="section"> <a class="named-anchor" id="S3"> <!-- named anchor --> </a> <h5 class="section-title" id="d1108660e208">Results:</h5> <p id="P3">There was a statistically significant beneficial effect of RPSS on motor performance (standard mean difference between active and control RPSS, 0.67; 95% confidence interval, 0.09–1.24; I <sup>2</sup>=65%). Only one study included subjects in the subacute phase after stroke. Subgroup analysis of studies that only included subjects in the chronic phase showed a significant effect (1.04;0.66–1.42) with no heterogeneity. Significant results were obtained for outcomes of body structure and function as well as for outcomes of activity limitation according to the International Classification of Function, Disability and Health, when only studies that included subjects in the chronic phase were analyzed. No serious adverse events were reported. </p> </div><div class="section"> <a class="named-anchor" id="S4"> <!-- named anchor --> </a> <h5 class="section-title" id="d1108660e216">Conclusions:</h5> <p id="P4">RPSS is a safe intervention with potential to become an adjuvant tool for upper extremity paresis rehabilitation in subjects with stroke in the chronic phase. </p> </div>

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          Global Burden of Stroke.

          Bo Norrving, George Mensah, Valery L. Feigin (2017)
          On the basis of the GBD (Global Burden of Disease) 2013 Study, this article provides an overview of the global, regional, and country-specific burden of stroke by sex and age groups, including trends in stroke burden from 1990 to 2013, and outlines recommended measures to reduce stroke burden. It shows that although stroke incidence, prevalence, mortality, and disability-adjusted life-years rates tend to decline from 1990 to 2013, the overall stroke burden in terms of absolute number of people affected by, or who remained disabled from, stroke has increased across the globe in both men and women of all ages. This provides a strong argument that "business as usual" for primary stroke prevention is not sufficiently effective. Although prevention of stroke is a complex medical and political issue, there is strong evidence that substantial prevention of stroke is feasible in practice. The need to scale-up the primary prevention actions is urgent.
          Article 0 comments Cited 670 times – based on 0 reviews     Review now
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            Impact of time on improvement of outcome after stroke.

            Boudewijn J. Kollen, Jos Twisk, Gert Kwakkel (2006)
            Longitudinal conducted studies show that neurologic and functional recovery show faster recovery in the first weeks poststroke. The aim of the present study was to study the effects of progress of time on observed improvements in motor strength, synergisms, and activities during the first 16 weeks poststroke. Based on data from a previous study, 101 patients with first-ever ischemic middle cerebral artery strokes were prospectively investigated during the first 16 weeks after stroke. Progress of time was categorized into 8 biweekly time intervals and was used as the independent covariate in a first-order longitudinal regression model. The biweekly time change (progress of time) was related to improvement in upper and lower limb motor recovery assessed with Fugl-Meyer score and Motricity Index, reduction in visuospatial inattention based on the letter cancellation task, and improvement in walking ability, dexterity, and activities of daily living measured with the Functional Ambulation Categories, Action Research Arm test, and Barthel Index. Time explained a significant change of 8.4 (42%) measurement units on the Barthel Index for the first 10 weeks poststroke, 1.1 (22%) measurement units on Functional Ambulation Categories, and 19% on the Action Research Arm test for the first 6 and 8 weeks poststroke. Approximately 25% (for Fugl-Meyer-arm) to 26% (for Motricity Index-arm) of the significant change in measurements units was explained by time alone for the upper limb compared with 33% for Fugl-Meyer-leg and 39% for Motricity Index-leg of the lower limb. Time accounted for a reduction of 16% in the letter cancellation task. Observed associations did not change after controlling for covariates such as age, gender, hemisphere of stroke, type of stroke, or intervention. Progress of time is an independent covariate that reflects spontaneous recovery of body functions and activities explaining &16% to 42% of the observed improvements in the first 6 to 10 weeks after stroke onset.
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              Very Early Constraint-Induced Movement during Stroke Rehabilitation (VECTORS): A single-center RCT.

              Stefanie Lang, T Videen, Jodi Edwards … (2009)
              Constraint-induced movement therapy (CIMT) is among the most developed training approaches for motor restoration of the upper extremity (UE). Very Early Constraint-Induced Movement during Stroke Rehabilitation (VECTORS) was a single-blind phase II trial of CIMT during acute inpatient rehabilitation comparing traditional UE therapy with dose-matched and high-intensity CIMT protocols. Participants were adaptively randomized on rehabilitation admission, and received 2 weeks of study-related treatments. The primary endpoint was the total Action Research Arm Test (ARAT) score on the more affected side at 90 days after stroke onset. A mixed model analysis was performed. A total of 52 participants (mean age 63.9 +/- 14 years) were randomized 9.65 +/- 4.5 days after onset. Mean NIHSS was 5.3 +/- 1.8; mean total ARAT score was 22.5 +/- 15.6; 77% had ischemic stroke. Groups were equivalent at baseline on all randomization variables. As expected, all groups improved with time on the total ARAT score. There was a significant time x group interaction (F = 3.1, p < 0.01), such that the high intensity CIT group had significantly less improvement at day 90. No significant differences were found between the dose-matched CIMT and control groups at day 90. MRI of a subsample showed no evidence of activity-dependent lesion enlargement. Constraint-induced movement therapy (CIMT) was equally as effective but not superior to an equal dose of traditional therapy during inpatient stroke rehabilitation. Higher intensity CIMT resulted in less motor improvement at 90 days, indicating an inverse dose-response relationship. Motor intervention trials should control for dose, and higher doses of motor training cannot be assumed to be more beneficial, particularly early after stroke.
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                Author and article information

                Journal
                Title: Neurorehabilitation and Neural Repair
                Abbreviated Title: Neurorehabil Neural Repair
                Publisher: SAGE Publications
                ISSN (Print): 1545-9683
                ISSN (Electronic): 1552-6844
                Publication date Created: September 10 2018
                Publication date Created: October 2018
                Publication date (Electronic): September 10 2018
                Publication date (Print): October 2018
                Volume: 32
                Issue: 10
                Pages: 863-871
                Affiliations
                [1 ]Hospital das Clínicas São Paulo University, São Paulo, Brazil
                [2 ]Hospital Israelita Albert Einstein, São Paulo, Brazil
                [3 ]University of Alabama at Birmingham, Birmingham, AL, USA
                [4 ]São Paulo University Medical School, São Paulo, Brazil
                [5 ]Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
                [6 ]National Institutes of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
                Article
                DOI: 10.1177/1545968318798943
                PMC ID: 6404964
                PubMed ID: 30198383
                SO-VID: 5c81bc5b-2f51-4b8c-9d0a-22298d93ae3e
                Copyright © © 2018
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                http://journals.sagepub.com/page/policies/text-and-data-mining-license

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