Article: Sharon - Things That You Can Do and Can Ask For!

Sharon - SSTattler

When I ask stroke survivors and their families why they don’t go to their local stroke recovery association or why they don’t look for information about stroke on the web, the most common answer is — “There is just no information that is useful  and useable for me.”  I understand that sentiment.

Although research on stem cells or a new treatment for arm and hand may be promising for someone who has a stroke ten or twenty years from now, it will make very little difference  for stroke survivors right now.

So what is available right now?  What does the research say is promising and available right now?

1. BionNess H200

The main commercially available neuroprosthesis developed to restore stroke survivors arm and hand movement is the Bioness H200.  It has various training modes for hand opening and closing.  It has been used with mild, moderate and severe paresis to undertake repetitive task-specific practice.

High quality randomized controlled trials and lower quality case studies report reductions in impairment (less spasticity and pain) and increases in use of hand in mild to moderate paresis in survivors using the Bioness H200.

Similarly, single case studies reported reduced impairment (less spasticity and pain) in survivors with severe arm and hand paresis (no active extension of the wrist or fingers).

In severe paresis of arm and hand, adding repetitive task specific training – in other words constraint therapy -- for 20 hours over 8 weeks resulted in increases in cortical activation (brain function in brain scans) which the researchers believe comes from increased use of the arm.

Based on these findings, these researchers suggest that the H200 could be used as an adjunct ‘gateway’ or ‘bridge’ in therapy.  Arm and hand therapy should include the use of the Bioness H200 along with constraint induced movement therapy (Hayward et al., 2010).

Read the review on FES:

• Advances in neuromuscular electrical stimulation for the upper limb post-stroke. 

2. The Acute Care Stroke Unit and Multidisciplinary In-patient Rehabilitation Unit

This is certainly not new research — Stroke survivors admitted to stroke units in acute care and then to in-patient rehabilitation units have much better recovery than those admitted to general wards(Chang et al., 2012; Chollet & Albucher, 2012) .  Canadian Stroke Network Best Practice Guidelines recommend this as best practice. So if you or someone in your family has a stroke, ensure that you (they) are admitted immediately to a dedicated stroke unit and to an in-patient stroke rehabilitation unit.  As well, rehabilitation should be as intensive as possible.

Read the studies:

• Strategiesto augment recovery after stroke.
• Cost-effectiveness analysis of stroke managementunder a universal health insurance system.

3. Read-Right Therapy

This free downloadable therapy can help improve reading speed in people with Hemianopia Alexia. People with alexia have difficulty understanding written or printed language.   This program produced significant improvements in text reading speeds at with all amounts of use.  However there was a clear dose effect with more usage producing greater effects : 10 % at 5 h, 20 % at 10 h, 39 % at 15 h and 46 % at 20 h.  Sub-analyses demonstrated that greater dose effect was real. The gains were not likely due to multiple exposures to the testing materials (familiarity) or to the simple passage of time.

This is a good example of a clinically proven therapy being delivered over the internet. It demonstrates once again that therapists’ time is more limited than patients’ capacity to improve.  Consequently carefully designed, web-based resources like Read-Right are a realistic way of delivering a sufficient therapy dose to patients so they can obtain clinically meaningful improvements (Ong et al., 2012).

Read the study:

• Read-right: A "web app" that improves reading speeds in patients with hemianopia.

References

• Chang, K., Lee, H., Huang, Y., Hung, J., Chiu, H. E., Chen, J., & Lee, T. (2012). Cost-effectiveness analysis of stroke management under a universal health insurance system. Journal of the Neurological Sciences, 323(1-2), 205-215. doi: 10.1016/j.jns.2012.09.018 
• Chollet, F., & Albucher, J. (2012). Strategies to augment recovery after stroke. Current Treatment Options in Neurology, 14(6), 531-540. doi: 10.1007/s11940-012-0196-3 
• Hayward, K.S., Barker, R. N., Brauer, S.G., (2010). Advances in neuromuscular electrical stimulation for the upper limb post-stroke. Physical Therapy Reviews, 15 (4) 309
• Ong, Y., Brown, M. M., Robinson, P., Plant, G. T., Husain, M., & Leff, A. P. (2012). Read-right: A "web app" that improves reading speeds in patients with hemianopia. Journal of Neurology, 259(12), 2611-2615. doi: 10.1007/s00415-012-6549-8