Interventions for improving upper limb function after stroke: a Cochrane overview of reviews

Researchers at NESSIE are planning a new project that aims to search for interventions that help to promote upper limb (arm and hand) recovery after stroke. There are many different treatments used to improve arm function in a person who has a stroke.

In 2014, a Cochrane Overview brought together all the best evidence about the effectiveness of interventions for improving upper limb function after stroke.  

You can read this here: Interventions for improving upper limb function after stroke

This Overview has continued to be accessed by many people. 

The evidence in this overview is now out-of-date. Our team is therefore updating the evidence in this overview and are currently developing the protocol for this study. 

In the meantime, we would be grateful for information from anyone involved in treatments for improving upper limb function after stroke. 

Can you help us?

We are keen to involve a wide range of people in our research

We are involving people who have had a stroke, caregivers, and health professionals to help us identify treatments that they have experience of or know to currently be in use. We would like to know about the treatments you are using or are aware of being used for improving upper limb function after stroke.  Here is a list of upper limb interventions that were covered by the 2014 Cochrane review; we would like to ask you:

  • What interventions are you currently using to improve upper limb function? and 
  • Are you aware of, or do you have experience of, the use of any interventions not included in the list? 

 

Pollock et al. 2014
Intervention name Brief description of interventions to improve upper limb function after stroke
Action observation Action observation involves the person observing the performance of a motor task (live or video), followed by a series of repeated demonstrations, the person attempts to perform the same action
Bilateral arm training Simultaneous bilateral arm training uses activities for which both arms perform identical movements at the same time. Different forms of simultaneous bilateral arm training are available
Biofeedback Biofeedback provides enhanced awareness of movement or function, with the goal of improving voluntary control of that movement or function
Bobath therapy "A problem solving approach to the assessment and treatment of individuals with disturbances of function, movement, and postural control due to a lesion of the central nervous system"
Brain stimulation: Transcranial magnetic stimulation (TMS) Thought to have an effect similar to that of TMS (above), it is applied through two surface electrodes placed on the skull
Complementary therapies Includes traditional Chinese therapies, such as acupuncture
Constraint-Induced Movement Therapy (CIMT) In CIMT, or 'forced use therapy,' the non-affected hand is placed in an arm sling or a mitt that prevents its use during fine movement; used to increase task difficulty for the affected hand in small amounts
Electrical stimulation Usually delivered with the aim of strengthening a muscle contraction or improving voluntary motor control, or both. Functional electrical stimulation (FES) involves stimulation aimed at replacing or assisting a voluntary muscle contraction during a functional task
Gaming Gaming devices (e.g. Nintendo Wii or Sony Playstation) may be used to encourage repetitive arm movements, and may motivate people to spend more time using their upper limb
“Hands-on” therapy (manual therapy techniques) Includes passive movement and joint mobilisation. The arm and hand joints are moved by a therapist providing partial or full assistance if active control is inadequate. Can be aimed at maintaining joint and soft tissue mobility
Mental practice Mental practice, sometimes called mental imagery or motor imagery, involves no actual movement. It involves mental rehearsal, which is often combined with (or followed by) physical practice; the type used most often in stroke rehabilitation involves cognitive rehearsal of specific activities by imagining task performance
Mirror therapy Based on visual stimulation; a mirror is placed in the patient's sagittal plane, thus reflecting the non-affected side as if it were the affected side, so that movements of the non-affected limb give the illusion that the affected limb is moving
Music therapy Can stimulate movement, cognition and speech, to enhance relaxation or to reduce pain. May include listening and moving to music, performing, improvising or composing music, singing or performing vocal activities
Orthotics Orthotics are external devices (similar to splints) applied to elbow, wrist and/or finger joints to optimise position, provide stability and prevent, limit or assist movement. These may be used alone or with electrical stimulation
Pharmacological interventions Generally used to reduce spasticity, including baclofen, diazepam and dantrolene. Botulinum toxin can be injected to provide a focal treatment when spasticity in a specific muscle or muscle group is the cause of problems
Repetitive task training Repetitive task training is an umbrella term for a range of interventions that involve the repeated practice of functional tasks (whole task practice when possible), combining elements of intensity of practice and functional relevance (see also 'Task-specific training,' below)
Robotics / electromechanical devices These devices can move passive limbs while providing assistance or resistance to movement of a single joint or control of intersegmental co-ordination. Devices may be used to deliver or enhance repetitive task training or task-specific training; thought to support motor learning and increase motor control and strength
Sensory interventions Strategies to enhance movement and somatosensory awareness including techniques e.g. sensory re-education, tactile kinaesthetic guiding, repetitive sensory practice or desensitisation. Sensory and positional awareness may be stimulated by passive or active-assisted movement, and stimulatory techniques such as stroking and tapping
Strength training Directed at contracting a specific muscle, or group of muscles, by using voluntary control. Movement may be assisted or resisted by a therapist or by gym equipment
Stretching & positioning Used to prevent or manage joint contractures, optimise joint position and to maintain or regain soft tissue length. There are several techniques, including manual therapy or self-stretching, and often supportive devices, splints and orthoses are involved
Surgical interventions Includes tendon surgery to relieve shoulder pain and reduce spasticity in the upper limb after stroke; not part of routine clinical practice in the UK
Task-specific training (functional task training) Involves practice of tasks relevant to daily life, including part- and whole-task practice. The 'motor learning,' 'motor relearning' or 'movement science' approach involves functional or task-specific training, often supplemented by other modalities, such as assistive technologies
Virtual reality Involves interactive simulations created with computer hardware and software to provide a simulated practice environment, as well as feedback on movement execution or goal attainment, or both. Enables engagement in activities that appears and feels similar to real-world objects and events, using devices such as a keyboard and a mouse, or through multi-modal devices such as a wired glove
Rehabilitation setting In addition to the interventions listed above, upper limb rehabilitation may be delivered in a range of different ways. For example; in-patient or out-patient rehabilitation, home-based rehabilitation, telerehabilitation or self-management
Combined interventions Single interventions, listed above, are often delivered in combination. For example; biofeedback plus electrostimulation

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