Neuro References

Question 1

What are the 3 key treatments for Stroke Rehab (with references)?

Answer 1

1. RTT (NICE Stroke Rehab Guidelines, 2013; Thomas et al, 2016)
2. Early Mobilisation & Intervention (Morreale, 2016; Hordacre, 2021)
3. Core Strengthening (Gamble et al, 2021)

Question 2

What were the key findings/recommendations of the NICE Stroke Rehab Guidelines of 2013 (with critical appraisal)?

Answer 2

• Offer patients repetitive task training after stroke on a range of tasks for upper limb weakness (such as reaching, grasping, pointing, moving, and manipulating objects in functional tasks) and lower limb weakness (such as sit-to-stand transfers, walking and using stairs).
• Recommend the inclusion of progressive strength training, this may include: bodyweight activities (such as sit-to-stand repetitions), progressive resistance exercise, or the use of ergometers. Maier et al (2019) recommends these exercises should be functional and meaningful to the patient.
  Critical Appraisal
  Clinical Guidlines

Question 3

What were the key findings/recommendations of Thomas et al (2016) regarding RTT (with critical appraisal)?

Answer 3

Patients who receive RTT may be more likely to improve upper and lower limb function after treatment and sustain these improvements ≤6 months after treatment than patients receiving usual care.

Critical Appraisal
* Journal: Stroke (IF = 7.2)
* Design: SR

Question 4

What were the key findings/recommendations of Gamble et al (2021) regarding core strengthening in stroke patients (with critical appraisal)?

Answer 4

Determined that the addition of core stability exercises improves trunk control and dynamic balance, thus they should be incorporated into rehabilitation planning.

Critical Appraisal
* Journal: Archives of Physical Medicine & Rehabilitation (IF = 4)
* Design: SR

Question 5

What were the key findings/recommendations of Morreale et al (2016) regarding early mobilisation for stroke patients (with critical appraisal)?

Answer 5

Early mobilisation is reported to produce greater improvements in ambulation and general function at 12 months post-stroke

Critical Appraisal
* Journal: European Journal of Physical and Rehabilitation Medicine (IF = 5.3)
* Design: RTC

Question 6

What were the key findings/recommendations of Maier et al (2019) regarding early mobilisation for stroke patients (with critical appraisal)?

Answer 6

• Spaced repetition is more effective than massed repetition for promoting neuronal activity and cell survival, and results in greater long-term potential.
• There is a direct dose-response relationship in euro-rehab with high-dose protocols able to induce structural plastic changes and the reorganisation of neural networks.
• Function-oriented practice is more effective in producing functional gains than movement-orientated protocols.
  Variable practice may facilitate greater functional gains through increased neuronal activity, and the recruitment of visual processing areas and neuromodulatory systems.
• The difficulty of trained tasks should be individually appropriate and graded to patients but challenging enough to adequately activate neural networks.
• Multi-sensory Input can enhance the ability to detect, discriminate and reorganise sensory information.
• Auditory cueing improves walking velocity, cadence, and stride length (Yoo and Kim, 2016) and beneficial effects on improving upper limb impairment and function (Ghai, 2018) after stroke.
• The combined provision of explicit and implicit feedback has been shown to recover impaired movement patterns, to reduce learned non- use, and to lead to longer- lasting recovery effects.
• Modulation of effector selection (the proactive use of an affected limb) may combat learned non-use and improve functional gains through increased cerebella activation.

Critical Appraisal
* Journal: Frontiers in Medicine (IF = 3.8)
* Design: SR

Question 7

What were the key findings/recommendations of Hordacre et al (2021) regarding early mobilisation for stroke patients (with critical appraisal)?

Answer 7

There exists a post-stroke window of enhanced neuroplasticity in human stroke survivors at 2-4 weeks post stroke. During which the brain is more receptive and adaptive to rehab programmes.
Early PT intervention is critical to take advantage of this window of enhanced capacity for neuroplasticity.
Delaying, or provisioning too little rehab is likely to lead to poorer outcomes

Critical Appraisal
* Journal: Neurorehabilitation and Neural Repair (IF = 4.9)
* Design: SR

Question 8

What are the psychometric properties of the Modified Ashworth Scale (with reference(s) & critical analysis)?

Answer 8

• Validity: Adequate content validity (SCC = 0.5) when compared to biceps T-reflex, excellent construct validity when compared to other clinical measures (r = ≥0.83).
• Reliability: Adequate intra-rata (57.5-85%), poor inter-rata (42.5-50%).
• Responsiveness: Very responsive of both upper (SRM = 0.99) and lower (SRM = 0.82) extremity muscles.
• Feasibility: Excellent. Already a prevalently used tool in neurological assessment, easy to integrate into practice and requires no special training or equipment unlike alternatives.

Saleh et al (2022) - Meta-Analysis (Acute stroke)

Question 9

What are the psychometric properties of the 4AT (with reference(s) & critical analysis)?

Answer 9

Validity: Pooled SN: 88%, SP: 88%
Tieges et al, (2021) - Meta-Analysis