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Chapter 23 - Evidence-based Motor Rehabilitation after Stroke

from Part VI - Stroke Rehabilitation and Recovery

Published online by Cambridge University Press:  15 December 2020

By
Gert Kwakkel  and
Janne M. Veerbeek
Edited by
Jeffrey L. Saver  and
Graeme J. Hankey
Jeffrey L. Saver
Affiliation:
David Geffen School of Medicine, University of Ca
Graeme J. Hankey
Affiliation:
University of Western Australia, Perth
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Summary

Worldwide, stroke is a most common disabling disorder that requires rehabilitation services if curative and preventive treatments fail. There is growing evidence that intensive rehabilitation offered by a multidisciplinary team is effective to improve outcome in terms of independent daily living and health–related quality of life. This conclusion is based on systematic reviews and recent pragmatic phase III and IV trials. Although intensity of practice is an important part of effective stroke care, very early mobilization should be restricted and applied in small doses within 24 hours post-stroke. Systematic review shows that evidence-based therapies for the upper limb are constraint–induced movement therapy and upper limb robotics, whereas interventions that could be beneficial to gait include fitness training and high-intensive, task-specific training. A number of novel therapies, such as combining exercise therapy with transcranial direct current stimulation, repetitive transcranial magnetic stimulation or pharmacological interventions, and virtual reality are under way. However, the evidence for most of these therapies is still unclear and in its infancy.

Keywords

Constraint-induced movement therapyroboticsfitness trainingtranscranial direct stimulationtranscranial magnetic stimulationphysical therapyupper limbgaitstrokerecoverytreatment
Type
Chapter
Information
Stroke Prevention and Treatment
An Evidence-based Approach
 , pp. 485 - 500
Publisher: Cambridge University Press
Print publication year: 2020

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References

ATTEND Collaborative Group. (2017). Family-led rehabilitation after stroke in India (ATTEND): a randomised controlled trial. Lancet, 390(10094), 588–99. doi:10.1016/S0140-6736(17)31447-2. Epub 2017 Jun 27. Erratum in: Lancet, 2017, 390(10094), 554. PubMed PMID: 28666682.Google Scholar
Barclay-Goddard, R, Stevenson, T, Poluha, W, Thalman, L. (2011). Mental practice for treating upper extremity deficits in individuals with hemiparesis after stroke. Cochrane Database Syst Rev, 5. CD005950. available from: PM:21563146Google Scholar
Berkhemer, O, Fransen, P, Beumer, D, van den Berg, L, Lingsma, H, Yoo, A, et al. (2015). A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med, 372(1), 11–20. available from: PM:25517348CrossRefGoogle ScholarPubMed
Bernhardt, J, Dewey, H, Thrift, A, Donnan, G. (2004). Inactive and alone: physical activity within the first 14 days of acute stroke unit care. Stroke, 35(4), 1005–09CrossRefGoogle ScholarPubMed
Bernhardt, J, English, C, Johnson, L, Cumming, T. (2015a). Early mobilization after stroke: early adoption but limited evidence. Stroke, 46(4), 1141–6 available from: PM:25690544Google Scholar
Bernhardt, J, Langhorne, P, Lindley, R, Thrift, A, Ellery, F, Collier, J, et al. (2015b). Efficacy and safety of very early mobilisation within 24 h of stroke onset (AVERT): a randomised controlled trial. Lancet, 386, (9988), 46–55. available from: PM:25892679Google Scholar
Bernhardt, J, Hayward, KS, Kwakkel, G, Ward, NS, Wolf, SL, Borschmann, K, et al. (2017). Agreed definitions and a shared vision for new standards in stroke recovery research: The Stroke Recovery and Rehabilitation Roundtable Taskforce. Neurorehabil Neural Repair, 31(9), 793–9. doi:10.1177/1545968317732668. PubMed PMID: 28934920.Google Scholar
Buma, F, Kwakkel, G, Ramsey, N. (2013). Understanding upper limb recovery after stroke. Restor Neurol Neurosci, 31(6) 707–22. available from: PM:23963341Google Scholar
Cortes, JC, Goldsmith, J, Harran, MD, Xu, J, Kim, N, Schambra, HM, et al. (2017). A short and distinct time window for recovery of arm motor control early after stroke revealed with a global measure of trajectory kinematics. Neurorehabil Neural Repair, 31(6), 552–60. available from: PM 28506149Google Scholar
Coupar, F, Pollock, A, Rowe, P. Weir, C, Langhorne, P. (2013). Predictors of upper limb recovery after stroke: a systematic review and meta-analysis. Clin Rehabil, 26(4), 291–313.Google Scholar
Coupar, F, Pollock, A, van Wijck, F, Morris, J, Langhorne, P. (2010). Simultaneous bilateral training for improving arm function after stroke. Cochrane Database Syst Rev, 4. CD006432. available from: PM:20393947Google Scholar
Cramer, S. 2008a. Repairing the human brain after stroke. II. Restorative therapies. Annul Neurol, 63(5) 549–60.Google Scholar
Cramer, S. 2008b. Repairing the human brain after stroke: I. Mechanisms of spontaneous recovery. Ann Neurol, 63(3) 272–87.Google Scholar
Duncan, P., Sullivan, K., Behrman, A., Azen, S., Wu, S., Nadeau, S., et al. (2011). Body-weight-supported treadmill rehabilitation after stroke. N Engl J Med, 364(21), 2026–36. available from: PM:21612471Google Scholar
English, C, Hillier, S. (2017). Circuit class therapy for improving mobility after stroke. Cochrane Database Syst Rev, 7. CD007513. available from: PM: 28573757Google Scholar
Feigin, VL, Krishnamurthi, RV, Parmar, P, Norrving, B, Mensah, GA, Bennett, DA, et al.; GBD 2013 Writing Group; GBD 2013 Stroke Panel Experts Group. (2015). Update on the global burden of ischemic and hemorrhagic stroke in 1990–2013: the GBD 2013 Study. Neuroepidemiology, 45(3), 161–76. available from: PM 26505981Google Scholar
French, B, Thomas, LH, Coupe, J, McMahon, NE, Connell, L, Harrison, J, et al. (2016). Repetitive task training for improving functional ability after stroke. Cochrane Database Syst Rev, 11. CD006073. available from: PM 27841442Google Scholar
Hoonhorst, MHJ, Nijland, RHM, van den Berg, PJS, Emmelot, CH, Kollen, BJ, Kwakkel, G. (2018). Does transcranial magnetic stimulation have an added value to clinical assessment in predicting upper-limb function very early after severe stroke? Neurorehabil Neural Repair, 32(8), 682–90.Google Scholar
Kohrmann, M, Juttler, E, Fiebach, J, Huttner, H, Siebert, S, Schwark, C, et al. (2006). MRI versus CT-based thrombolysis treatment within and beyond the 3 h time window after stroke onset: a cohort study. Lancet Neurol, 5(8), 661–7. available from: PM:16857571Google Scholar
Krakauer, JW, Carmichael, ST. (2018). Broken Movement: The Neurobiology of Motor Recovery after Stroke. Cambridge, MA: MIT Press.Google Scholar
Kwakkel, G, Wagenaar, R, Twisk, J, Lankhorst, G, Koetsier, J. (1999). Intensity of leg and arm training after primary middle-cerebral-artery stroke: a randomised trial. Lancet, 354(9174), 191–6.CrossRefGoogle ScholarPubMed
Kwakkel, G. (2006a). Impact of intensity of practice after stroke: issues for consideration. Disabil Rehabil, 28(13–14), 823–30. available from: PM:16777769Google Scholar
Kwakkel, G. (2015a). Very early mobilisation within 24 hours results in a less favorable outcome at 3 months [commentary 2]. Physiotherapy, 61(4), 220.Google Scholar
Kwakkel, G, Kollen, B. (2007). Predicting improvement in the upper paretic limb after stroke: a longitudinal prospective study. Restor Neurol Neurosci, 25(5–6), 453–60. available from: PM:18334763Google Scholar
Kwakkel, G, Kollen, B. (2013). Predicting activities after stroke: what is clinically relevant? Int J Stroke, 8(1) 25–32. available from: PM:23280266Google Scholar
Kwakkel, G, Kollen, B, Twisk, J. (2006b). Impact of time on improvement of outcome after stroke. Stroke, 37(9), 2348–53. available from: PM:16931787Google Scholar
Kwakkel, G, Meskers, C. (2014). Effects of robotic therapy of the arm after stroke. Lancet Neurol, 13(2), 132–3. available from: PM:24382581Google Scholar
Kwakkel, G, van Peppen, R, Wagenaar, R, Wood Dauphinee, S, Richards, C, Ashburn, A, et al. (2004). Effects of augmented exercise therapy time after stroke: a meta-analysis. Stroke, 35(11), 2529–39. available from: PM:15472114CrossRefGoogle ScholarPubMed
Kwakkel, G, van Wegen, EEH. (2017). Family-delivered rehabilitation services at home: is the glass empty? Lancet, 390(10094), 538–9. doi:10.1016/S0140-6736(17)31489-7. Epub 2017 Jun 27. PubMed PMID: 28666681.Google Scholar
Kwakkel, G, Veerbeek, J, van Wegen, E, Wolf, S. (2015b). Constraint-induced movement therapy after stroke. Lancet Neurol, 14(2), 224–34. available from: PM:25772900CrossRefGoogle ScholarPubMed
Lang CE, Strube MJ, Bland MD, Waddell KJ, Cherry-Allen KM, Nudo RJ, Dromerick AW, Birkenmeier RL. (2016). Dose response of task-specific upper limb training in people at least 6 months poststroke: a phase II, single-blind, randomized, controlled trial. Ann Neurol, 80(3), 342–54. Available from PM: 27447365CrossRefGoogle Scholar
Langhorne, P, Baylan, S. (2017). Early Supported Discharge Trialists. Early supported discharge services for people with acute stroke. Cochrane Database Syst Rev, 7. CD000443. available from: PM: 28703869Google Scholar
Langhorne, P, Bernhardt, J, Kwakkel, G. (2011). Stroke rehabilitation. Lancet, 377(9778), 1693–1702. available from: PM:21571152Google Scholar
Langhorne, P, Collier, JM, Bate, PJ, Thuy, MN, Bernhardt, J. (2018). Very early versus delayed mobilisation after stroke. Cochrane Database Syst Rev, 10. CD006187. doi:10.1002/14651858.CD006187.pub3.Google Scholar
Langhorne, P. Legg, L. (2003). Evidence behind stroke rehabilitation. J Neurol Neurosurg Psychiatry, 74(Suppl 4), iv18–iv21.Google Scholar
Laver, KE, Lange, B, George, S, Deutsch, JE, Saposnik, G, Crotty, M. (2017). Virtual reality for stroke rehabilitation. Cochrane Database Syst Rev, 11. CD008349. available from: PM 29156493Google ScholarPubMed
Lazar, R, Minzer, B, Antoniello, D, Festa, J, Krakauer, J, Marshall, R. (2010). Improvement in aphasia scores after stroke is well predicted by initial severity. Stroke, 41(7), 1485–8. available from: PM:20538700Google Scholar
Lejeune, T., Stoquart, G. (2015). The challenge of assessment in rehabilitation. J Rehabil Med, 47, 672. available from: PM:26074394CrossRefGoogle ScholarPubMed
Lohse, K, Lang, C, Boyd, L. (2014). Is more better? Using metadata to explore dose-response relationships in stroke rehabilitation. Stroke, 45(7), 2053–8. available from: PM:24867924Google Scholar
Mehrholz, J, Pohl, M, Platz, T, Kugler, J, Elsner, B. (2018). Electromechanical and robot-assisted arm training for improving activities of daily living, arm function, and arm muscle strength after stroke. Cochrane Database Syst Rev, 9, CD006876. available from: PM:30175845Google Scholar
Mehrholz, J, Thomas, S, Elsner, B. (2017). Treadmill training and body weight support for walking after stroke. Cochrane Database Syst Rev, 8. CD002840. available from: PM:28815562Google Scholar
Moseley, A, Stark, A, Cameron, I, Pollock, A. (2005). Treadmill training and body weight support for walking after stroke. Cochrane Database Syst Rev, 4. CD002840. available from: PM:16235304Google Scholar
Murphy, T, Corbett, D. (2009). Plasticity during stroke recovery: from synapse to behaviour. Nat Rev Neorosci, 10(12), 861–72.Google Scholar
Nijboer, T, van de Port, I, Schepers, V, Post, M, Visser-Meily, A. (2013). Predicting functional outcome after stroke: the influence of neglect on basic activities in daily living. Front Hum Neurosci, 7, 182.Google Scholar
Nijland, R, van Wegen, E, Harmeling-van der Wel, B, Kwakkel, G. (2010). 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. Stroke, 41(4), 745–50. available from: PM:20167916Google Scholar
Pomeroy, V, King, L, Pollock, A, Baily-Hallam, A, Langhorne, P. (2006). Electrostimulation for promoting recovery of movement or functional ability after stroke. Cochrane Database Syst Rev, 2. CD003241. available from: PM:16625574Google Scholar
Prabhakaran, S, Zarahn, E, Riley, C, Speizer, A, Chong, J, Lazar, R, et al. (2008). Inter-individual variability in the capacity for motor recovery after ischemic stroke. Neurorehabil Neural Repair, 22(1), 64–71. available from: PM:17687024Google Scholar
Prabhakaran S, Ruff I, Bernstein RA. (2015). Acute stroke intervention: a systematic review. JAMA, 313(14), 1451–62. Available from: PM: 25871671Google Scholar
Saver JL, Goyal M, van der Lugt A, et al. (2016). Time to treatment with endovascular thrombectomy and outcomes from ischemic stroke: a meta-analysis. JAMA, 316(12),1279–88. Available from: PM: 27673305Google Scholar
Saunders, DH, Sanderson, M, Hayes, S, Kilrane, M, Greig, CA, Brazzelli, M, Mead, GE. (2016). Physical fitness training for stroke patients. Cochrane Database Syst Rev, 3. CD003316. available from: PM 27010219Google Scholar
Schulz, K, Altman, D, Moher, D. (2010). CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. J Clin Epidemiol, 63(8), 834–40. available from: PM:20346629Google Scholar
Scrutinio, D, Lanzillo, B, Guida, P, Mastropasqua, F, Monitillo, V, Pusineri, M, et al. (2017). Development and validation of a predictive model for functional outcome after stroke rehabilitation: the Maugeri model. Stroke, 48(12), 3308–15. available from: PM:29051222Google Scholar
Smith, MC, Barber, PA, Stinear, CM. (2017). The TWIST algorithm predicts time to walking independently after stroke. Neurorehabil Neural Repair, 31(10–11), 955–64. available from: PM 29090654Google Scholar
Stinear, C. (2010). Prediction of recovery of motor function after stroke. Lancet Neurol, 9(12), 1228–32. available from: PM:21035399CrossRefGoogle ScholarPubMed
Stinear, CM, Byblow, WD, Ackerley, SJ, Smith, MC, Borges, VM, Barber, PA. (2017). PREP2: A biomarker-based algorithm for predicting upper limb function after stroke. Ann Clin Transl Neurol, 4(11), 811–20. available from: PM 29159193Google Scholar
Stinear, CM. (2017). Prediction of motor recovery after stroke: advances in biomarkers. Lancet Neurol, 16(10), 826–36. available from: PM:28920888Google Scholar
Thieme, H, Morkisch, N, Mehrholz, J, Pohl, M, Behrens, J, Borgetto, B, Dohle, C. (2018). Mirror therapy for improving motor function after stroke. Cochrane Database Syst Rev, 7, CD008449. available from: PM:22419334Google ScholarPubMed
van de Port, I, Wevers, L, Lindeman, E, Kwakkel, G. (2012). Effects of circuit training as alternative to usual physiotherapy after stroke: randomised controlled trial. BMJ, 344, e2672. available from: PM:22577186Google Scholar
van Delden, A, Beek, PJ, Roerdink, M, Kwakkel, G, Peper, C. (2015). Unilateral and bilateral upper-limb traning interventions after stroke have similar effects on bimanual coupling strength. Neurorehabil Neural Repair, 29(3) 255–67.Google Scholar
van Delden, A, Peper, C, Beek, P, Kwakkel, G. (2012). Unilateral versus bilateral upper limb exercise therapy after stroke: a systematic review. J Rehabil Med, 44 (2), 106–117. available from: PM:22266762Google Scholar
van Delden, A, Peper, C, Nienhuys, K, Zijp, N, Beek, J, Kwakkel, G. (2013). Unilateral versus bilateral upper limb training after stroke: the Upper Limb Training After Stroke clinical trial. Stroke, 44(9), 2613–16.Google Scholar
van Kordelaar, J, van Wegen, E, Nijland, R, Daffertshofer, A, Kwakkel, G. (2013). Understanding adaptive motor control of the paretic upper limb early poststroke: the EXPLICIT-stroke program. Neurorehabil Neural Repair, 27(9), 854–63. available from: PM:23884015Google Scholar
van der Vliet R, Selles RW, Andrinopoulou ER, Nijland R, Ribbers GM, Frens MA, Meskers C, Kwakkel G. (2020). Predicting upper limb motor impairment recovery after stroke: a mixture model. Ann Neurol, 2020 (in press). Available at PM: 31925838Google Scholar
Veerbeek, J, Koolstra, M, Ket, J, van Wegen, E, Kwakkel, G. (2011a). Effects of augmented exercise therapy on outcome of gait and gait-related activities in the first 6 months after stroke: a meta-analysis. Stroke, 42(11), 3311–15. available from: PM:21998062Google Scholar
Veerbeek, J, Kwakkel, G, van Wegen, E, Ket, J, Heymans, M. (2011b). Early prediction of outcome of activities of daily living after stroke: a systematic review. Stroke, 42(5), 1482–8. available from: PM:21474812Google Scholar
Veerbeek, J, van Wegen, E, Harmeling-van der Wel, B, Kwakkel, G. (2011c). Is accurate prediction of gait in nonambulatory stroke patients possible within 72 hours poststroke? The EPOS study. Neurorehabil Neural Repair, 25(3), 268–74. available from: PM:21186329CrossRefGoogle ScholarPubMed
Veerbeek, J, van Wegen, E, van Peppen, R, Van der Wees, P, Hendriks, E, Rietberg, M, et al. (2014). What is the evidence for physical therapy poststroke? A systematic review and meta-analysis. PLoS One, 9(2), e87987. available from: PM:24505342Google Scholar
Veerbeek, JM, Langbroek-Amersfoort, AC, van Wegen, EE, Meskers, CG, Kwakkel, G. (2017). Effects of robot-assisted therapy for the upper limb after stroke. Neurorehabil Neural Repair, 31(2), 107–21. doi:10.1177/1545968316666957. Review. PubMed PMID: 27597165.Google Scholar
Veerbeek, JM, Winters, C, van Wegen, EEH, Kwakkel, G. (2018). Is the proportional recovery rule applicable to the lower limb after a first-ever ischemic stroke? PLoS One, 13(1), e0189279. available from: PM:29329286Google Scholar
Vloothuis JDM, Mulder M, Nijland RHM, Goedhart QS, Konijnenbelt M, Mulder H, Hertogh CMPM, van Tulder M, van Wegen EEH, Kwakkel G. (2019). Caregiver-mediated exercises with e-health support for early supported discharge after stroke (CARE4STROKE): a randomized controlled trial. PLoS One, 14(4), e0214241. Available from PM: 30958833Google Scholar
Vloothuis, JDM, Mulder, M, Veerbeek, JM, Konijnenbelt, M, Visser-Meily, JMA, Ket, JCF, et al. (2016). Caregiver-mediated exercises for improving outcomes after stroke. Cochrane Database Syst Rev, 12. CD011058. doi:10.1002/14651858.CD011058.pub2.Google Scholar
Wang X, You S, Sato S, Yang J, Carcel C, Zheng D, Yoshimura S, Anderson CS, Sandset EC, Robinson T, Chalmers J, Sharma VK. (2018). Current status of intravenous tissue plasminogen activator dosage for acute ischaemic stroke: An updated systematic review. Stroke Vasc Neurol, 3(1), 28–33. Available from PM: 29600005Google Scholar
Winters, C, van Wegen, E, Daffertshofer, A, Kwakkel, G. (2015). Generalizability of the proportional recovery model for the upper extremity after an ischemic stroke. Neurorehabil Neural Repair, 29(7), 614–22. available from: PM:25505223Google Scholar
World Health Organization. (2001). International Classification of Functioning, Disability and Health (ICF). Geneva: WHO.Google Scholar

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