Evidence-based arm rehabilitation--a systematic review of the literature
Abstract
Based on a systematic MEDLINE search and informal sources, 40 references were identified that evaluate training therapy or neuromuscular electric stimulation for arm paresis after stroke and describe either a systematic review, meta-analysis, randomised controlled trial, or controlled cohort study. The evidence was grouped into three areas of interest: comparison of physiotherapy schools, effects of intensity of training, and efficacy of specific arm rehabilitation techniques. The only physiotherapy school with evidence of superior efficacy was the task-oriented 'motor relearning programme'. Higher intensities of motor rehabilitation can accelerate motor recovery. Various training techniques with demonstrated efficacy are available for specific patient subgroups: arm ability training for mildly affected patients with reduced efficiency of motor control, constrained-induced movement therapy for patients with partial functional deficits and learned nonuse of the affected arm, and repetitive sensorimotor training techniques, EMG-biofeedback, functional electrical stimulation, and robot-assisted training for patients with severe arm paresis.
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Evidence Hub reads this as a systematic review, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
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