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3 Stroke articles and 1 Parkinson’s disease article.

High intensity arm resistance training is not better than low intensity in stroke!!

A self-rehabilitation program to improve upper limb function after stroke.

Motor Imagery for gait after stroke.

Which interventions are effective for Parkinson’s disease?

Estimated reading time: 5 minutes, 56 seconds.

Articles

High intensity arm resistance training is not better than low intensity in stroke!!

• This RCT recruited 43 participants, 23 were allocated to high intensity training (HIT) group and 20 in the low intensity training (LIT) group to investigate their effect on grip strength, arm function, activates, participation and adverse events in sub-acute stroke patients.
• Outcome measures: Grip strength, Motricity Index, Fugl-Meyer Assessment for the upper limb, Box and Block Test, Goal Attainment Scale, Modified Ashworth Scale, and adverse events before and after 3 weeks of training.

Interventions:

• HIT group: 60 min/session, 3 sessions/week for 3 weeks, 80% of a 1 Repetition Maximum (RM), started with 3 sets of 10 repetitions, progressed gradually to higher repetitions. standard treatment was added (described below).
  • The training included unilateral, active, and functional exercises performed in a sitting position:
    • Lifting objects from the lap to a high desk
    • Pulling a resistance band from the forehead to the lap
    • Pulling a mineral-water crate on a desk from the unaffected to the affected side
    • Lifting objects over a block of wood with the elbow resting on the table (as in arm wrestling)
    • Pulling a laundry bag lying on an exercise mat with a rowing motion
• LIT group: Similar to HIT group but with 40% of a 1 Repetition Maximum (RM).
• Standard Treatment: 30 minutes/session, 3 sessions/week with PT or OT including: mobilization exercises, stretching, positioning, functional training, strengthening exercises, and activity training. also participants received group therapy.

Results:

• Both groups improved grip strength, HIT slightly better but not statistically significant.
• No difference between groups for arm function, activities and participation, although, 60% of HIT group and 55% of LIT group reached their participation goals and even better in some cases.
• Adverse events: 30% of the HIT group and 10% of the LIT group reported having shoulder or arm pain before starting training, pain occurred only once and subsided after a break.
• Spasticity did not increase in either group.

As the authors discussed and from my 5 years experience with stroke patients, sometimes more repetitions takes priority over load intensity to improve functional recovery, therefore, using low intensity exercise and increasing repetition might lead to better improvements, but of course that’s case by case dependent.

A self-rehabilitation program to improve upper limb function after stroke.

This a single blinded RCT that investigated the effect of a self-rehabilitation program on upper limb function in patients with chronic stroke.

Sample size (evaluated): 20 participants in intervention group, 29 in control group (no intervention).

The program included:

2 hours/day, 6 days/week for 8 weeks, 21 exercises divided into 3 parts:

• Self-mobilization exercises (15 min).
• Unimanual exercises oriented toward a functional task (60 min).
• Bimanual exercises (45 min).
• Participants were given a kit with equipment needed for the exercise.

Results:

• The self-rehabilitation program increased manual ability by 20%.
• The self-rehabilitation program increased strength by 20%.
• Improved quality of life in physical and psychological health.
• The self-rehabilitation program did not influence motor impairment and manual dexterity.

This type of articles can be really helpful in many countries where access to physiotherapy is very restricted.

Motor Imagery for gait after stroke.

Motor imagery is a mentally rehearsed task that is only imagined without movement/causing muscle contraction.

This systematic assessed effect of motor imagery (MI) on gait after stroke.

21 RCT including 762 participants.

Intervention:

30-60 min/1 session/day, 2-6 session/week for 2-8 weeks.

Application of MI:

• Participant watch a video of a specific movement, then imagine performing the movement.
• voice recording to guide participants in imagining the movements.

Results:

• MI had a greater effect than other therapies on walking speed (Very low certainty evidence).
• MI is NOT effective regarding motor function and functional mobility (very low-certainty evidence).

OK!

Which interventions are effective for Parkinson’s disease?

This long meta-analysis, analyzed physiotherapy interventions effect on Parkinson’s disease. let jump right to results.

See this table for results and abbreviations (Table).

1. Conventional physiotherapy: (Active exercise interventions traditionally used by physiotherapists to manage people with PD), 45 trials (n = 2608)
   • Moderate effect on the (MDS)-UPDRS, 10 MWT and cadence.
   • Can reduce fear of falling and freezing of gait. (Functional reach test, FES-I and FOG-Q)
2. Treadmill Training: 32 trials (n = 823) compared to no or sham intervention.
   • Moderate effect on the 10MWT and a moderately large effect on gait speed.
3. Strategy Training (Including Cueing): (14 trials (n = 364)), compared with no exercise or sham treatment.
   • Significantly improved balance and gait outcomes compared with the control group.
     • Moderate to large effect on gait speed and the TUG.
   • NO significant effect on freezing of gait as measured with the (N)FOG-Q.
4. Dance: 11 trials (n = 339), Compared with no exercise or sham treatment.
   • Improved motor symptoms, balance, and gait.
     • Moderately large effect on the (MDS)-UPDRS, BBS, Mini-BESTest and TUG.
   • Did NOT improve freezing of gait as measured with the (N)FOG-Q.
5. Martial Arts (Tai Chi and Qigong): 11 trials (n = 580), compared with no exercise or sham treatment.
   • beneficial effect on motor symptoms, balance, and gait parameters.
     • Moderately large effect on TUG and Functional Reach Test.
     • Moderate effect on the (MDS)-UPDRS, gait speed, and stride length.
6. Nordic Walking: 3 trials (n = 73), compared with no exercise or sham treatment.
   • Moderately large effect on motor symptoms.
   • Large effect on the BBS and the 6MWT.
7. Resistance Training: 17 trials (n = 663), compared with no exercise or sham treatment.
   • Moderately large effect on the 6MWT.
   • That’s it, no other significant effect found.
8. Aerobic Exercises: 5 trials (n = 231), compared aerobic exercises to standard care or no exercise.
   • Significantly improves motor symptoms, balance, and gait outcome.
   • Did not mention how significant. ??‍♀️
9. Balance and Gait Training: 28 trials (n = 1069), compared with no exercise, sham, or active treatment.
   • Improve motor symptoms, balance, and gait outcomes.
     • Moderate effect on MDS-UPDRS, gait speed, stride length, step length and ABC scale.
     • Moderately large effect on BBS.
     • Large significant effect on Mini-BEST test.
     • Moderately significant effect was also found for step length and ABC scale.
10. Hydrotherapy: 8 trials (n = 230), compared to standard physiotherapy or no exercise.
    • Moderately large effect on TUG and fear of falling (FES-I).
11. Dual Tasking: 3 trials (n = 167), compared with no exercise or sham treatment.
    • Did NOT significantly improve any of the outcomes described in this meta-analysis. ☹️
12. Exergaming: 9 trials (n = 303), compared with no exercise or sham treatment.
    • Moderately large effect on the TUG, BBS, and PDQ-39.
    • Large effect on EQ5D.

Notes:

• The authors did not find enough data for whole body vibration, massage, boxing, yoga, and fall prevention programs.
• Conventional physiotherapy, dance, martial arts, Nordic walking, and balance and gait training improved PD motor symptoms ((MDS)-UPDRS-III).
• Balance outcomes did NOT improve after treadmill training but did improve with other interventions such as strategy training and dance (as measured using the TUG or BBS).
• All treatment modalities, with the exception of dual tasking training and exergaming, improved gait, with the evidence being most convincing for treadmill training and strategy training (improving gait speed and step length).
• Quality of life only improved with conventional physiotherapy, and exergaming.

??Good Note

• Sub-acute stroke patients don’t need high intensity training to improve arm recovery. (not entirely applicable) ?
• A self rehabilitation program can benefit chronic stroke patients, this study and studies similar to it make me happy, I worked with a non-profit rehabilitation organization for 6 months, we worked in refugee camps where the numbers are high and no appropriate settings, so we relied heavily on home programs to help these patients as much as possible. ?
• A list on the effectiveness of 12 different interventions is always a good addition to our knowledge.

??Bad Note

• Motor imagery still needs more investigating, honestly, I root for it.

References

• High-intensity arm resistance training does not lead to better outcomes than low-intensity resistance training in patients after subacute stroke: A randomized controlled trial. (Open Access)
• Effectiveness of a self-rehabilitation program to improve upper-extremity function after stroke in developing countries: A randomized controlled trial. (Restricted Access)
• Motor imagery for gait rehabilitation after stroke. (Restricted Access)
• Physiotherapy in Parkinson’s Disease: A Meta-Analysis of Present Treatment Modalities. (Open Access)