Dose of arm activity training during acute and subacute rehabilitation post stroke: a systematic review of the literature

Aim: To determine the dose of activity-related arm training undertaken by stroke survivors during acute and subacute rehabilitation. Methods: A systematic review of PubMed, CINAHL and EMBASE up to December 2014 was completed. Studies were eligible if they defined the dose (time or repetitions) of activity-related arm training using observational methods for a cohort of adult stroke survivors receiving acute or subacute rehabilitation. All studies were quality appraised using an evidence-based learning critical appraisal checklist. Data was analysed by method of documented dose per session (minutes, repetitions), environment (acute or subacute rehabilitation) and therapy discipline (physiotherapy, occupational therapy). Results: Ten studies were included: two observed stroke survivors during acute rehabilitation and eight during subacute rehabilitation. During acute rehabilitation, one study reported 4.1 minutes per session during physiotherapy and 11.2 minutes during occupational therapy, while another study reported 5.7 minutes per session during physiotherapy only. During inpatient rehabilitation, activity-related arm training was on average undertaken for 4 minutes per session (range 0.9 to 7.9, n = 4 studies) during physiotherapy and 17 minutes per session (range 9.3 to 28.9, n = 3 studies) during occupational therapy. Repetitions per session were reported by two studies only during subacute rehabilitation. One study reported 23 repetitions per session during physiotherapy and occupational therapy, while another reported 32 repetitions per session across both disciplines. Conclusion: The dose of activity-related arm training during acute and subacute rehabilitation after stroke is limited.

[1]  Amy L Shortal.  Recovery of Walking Function in Stroke Patients: The Copenhagen Stroke Study , 1996 .

[2]  Catherine E Lang,et al.  Comparison of amounts and types of practice during rehabilitation for traumatic brain injury and stroke. , 2010, Journal of rehabilitation research and development.

[3]  I. Tarkka,et al.  Effects of intensive gait-oriented physiotherapy during early acute phase of stroke. , 2007, Journal of rehabilitation research and development.

[4]  G. Kwakkel,et al.  Probability of regaining dexterity in the flaccid upper limb: impact of severity of paresis and time since onset in acute stroke. , 2003, Stroke.

[5]  Theresa A. Jones,et al.  Training Intensity Affects Motor Rehabilitation Efficacy Following Unilateral Ischemic Insult of the Sensorimotor Cortex in C57BL/6 Mice , 2015, Neurorehabilitation and neural repair.

[6]  S. Brauer,et al.  Dose and Content of Training Provided to Stroke Survivors with Severe Upper Limb Disability Undertaking Inpatient Rehabilitation: An Observational Study , 2013, Brain Impairment.

[7]  D. Reisman,et al.  Observation of amounts of movement practice provided during stroke rehabilitation. , 2009, Archives of physical medicine and rehabilitation.

[8]  Susan D Horn,et al.  Stroke rehabilitation patients, practice, and outcomes: is earlier and more aggressive therapy better? , 2005, Archives of physical medicine and rehabilitation.

[9]  C. Lang,et al.  Feasibility of high-repetition, task-specific training for individuals with upper-extremity paresis. , 2014, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[10]  J. Kleim,et al.  Functional reorganization of the rat motor cortex following motor skill learning. , 1998, Journal of neurophysiology.

[11]  G. Kwakkel.  Impact of intensity of practice after stroke: issues for consideration. , 2012, Disability and rehabilitation.

[12]  C. Gowland,et al.  Recovery of motor function following stroke: Profile and predictors , 1982 .

[13]  C. English,et al.  How Physically Active Are People with Stroke in Physiotherapy Sessions Aimed at Improving Motor Function? A Systematic Review , 2012, Stroke research and treatment.

[14]  T. Hafsteinsdóttir,et al.  Time Use of Stroke Patients with Stroke Admitted for Rehabilitation in Skilled Nursing Facilities , 2013, Rehabilitation nursing : the official journal of the Association of Rehabilitation Nurses.

[15]  L. Gustafsson,et al.  Occupational Therapy Practice in Hospital-based Stroke Rehabilitation? , 2012, Scandinavian journal of occupational therapy.

[16]  N. Young,et al.  Cortical stimulation improves skilled forelimb use following a focal ischemic infarct in the rat , 2003, Neurological research.

[17]  Caroline L Watkins,et al.  Prescribing upper limb exercises after stroke: a survey of current UK therapy practice. , 2014, Journal of rehabilitation medicine.

[18]  J. Kleim,et al.  Principles of experience-dependent neural plasticity: implications for rehabilitation after brain damage. , 2008, Journal of speech, language, and hearing research : JSLHR.

[19]  C. English,et al.  How much physical activity do people recovering from stroke do during physiotherapy sessions , 2009 .

[20]  L. Ada,et al.  Routine physiotherapy does not induce a cardiorespiratory training effect post-stroke, regardless of walking ability. , 2006, Physiotherapy research international : the journal for researchers and clinicians in physical therapy.

[21]  J. Kleim,et al.  Distributed Versus Focal Cortical Stimulation to Enhance Motor Function and Motor Map Plasticity in a Rodent Model of Ischemia , 2011, Neurorehabilitation and neural repair.

[22]  E. Lesaffre,et al.  Use of Time by Stroke Patients , 2005 .

[23]  C. English,et al.  Circuit Class Therapy and 7-Day-Week Therapy Increase Physiotherapy Time, But Not Patient Activity: Early Results From the CIRCIT Trial , 2014, Stroke.

[24]  J. Kleim,et al.  A Novel Phosphodiesterase Type 4 Inhibitor, HT-0712, Enhances Rehabilitation-Dependent Motor Recovery and Cortical Reorganization After Focal Cortical Ischemia , 2007, Neurorehabilitation and neural repair.

[25]  N. Fong,et al.  Total direct cost, length of hospital stay, institutional discharges and their determinants from rehabilitation settings in stroke patients , 2006, Acta neurologica Scandinavica.

[26]  A. G. Feldman,et al.  Interjoint coordination dynamics during reaching in stroke , 2003, Experimental Brain Research.

[27]  W. Miller,et al.  A Self-Administered Graded Repetitive Arm Supplementary Program (GRASP) Improves Arm Function During Inpatient Stroke Rehabilitation: A Multi-Site Randomized Controlled Trial , 2009, Stroke.

[28]  J. Bernhardt,et al.  An Early Mobilization Protocol Successfully Delivers More and Earlier Therapy to Acute Stroke Patients , 2012, Neurorehabilitation and neural repair.

[29]  R. Teasell,et al.  Inpatient rehabilitation following stroke: amount of therapy received and associations with functional recovery , 2012, Disability and rehabilitation.

[30]  Peter Langhorne,et al.  Effects of Augmented Exercise Therapy Time After Stroke: A Meta-Analysis , 2004, Stroke.

[31]  S. Brauer,et al.  Interventions to promote upper limb recovery in stroke survivors with severe paresis: a systematic review , 2010, Disability and rehabilitation.

[32]  S. Brauer,et al.  Advances in neuromuscular electrical stimulation for the upper limb post-stroke , 2010 .

[33]  C. Sherrington,et al.  Many participants in inpatient rehabilitation can quantify their exercise dosage accurately: an observational study. , 2011, Journal of physiotherapy.

[34]  Mary Elizabeth Parker,et al.  Recovery of Upper Extremity Function in Stroke Patients: The Copenhagen Stroke Study , 1995 .

[35]  Lara A. Boyd,et al.  Is More Better? Using Metadata to Explore Dose–Response Relationships in Stroke Rehabilitation , 2014, Stroke.

[36]  J. Kleim,et al.  Motor cortex stimulation enhances motor recovery and reduces peri-infarct dysfunction following ischemic insult , 2003, Neurological research.

[37]  J. Bosch,et al.  Does Task-Oriented Practice Improve Upper Extremity Motor Recovery after Stroke? A Systematic Review , 2014 .

[38]  Sandra G Brauer,et al.  Factors Affecting the Ability of the Stroke Survivor to Drive Their Own Recovery outside of Therapy during Inpatient Stroke Rehabilitation , 2014, Stroke research and treatment.

[39]  Glen Jenson,et al.  Use of Time , 2001 .

[40]  G. Kwakkel,et al.  Presence of Finger Extension and Shoulder Abduction Within 72 Hours After Stroke Predicts Functional Recovery: Early Prediction of Functional Outcome After Stroke: The EPOS Cohort Study , 2010, Stroke.

[41]  Julie Bernhardt,et al.  Little therapy, little physical activity: rehabilitation within the first 14 days of organized stroke unit care. , 2007, Journal of rehabilitation medicine.

[42]  F. Q. Ribeiro.  The meta-analysis , 2017, Brazilian journal of otorhinolaryngology.

[43]  L. Ada,et al.  Stroke rehabilitation: Does the therapy area provide a physical challenge? , 1998, The Australian journal of physiotherapy.

[44]  R. Nudo,et al.  Reorganization of movement representations in primary motor cortex following focal ischemic infarcts in adult squirrel monkeys. , 1996, Journal of neurophysiology.

[45]  J. Eng,et al.  Investigating measures of intensity during a structured upper limb exercise program in stroke rehabilitation: an exploratory study. , 2014, Archives of physical medicine and rehabilitation.

[46]  J. Kleim,et al.  Synaptogenesis and FOS Expression in the Motor Cortex of the Adult Rat after Motor Skill Learning , 1996, The Journal of Neuroscience.

[47]  Nicola Smania,et al.  Active Finger Extension: A Simple Movement Predicting Recovery of Arm Function in Patients With Acute Stroke , 2007, Stroke.