Year: 2020
Type: dissertation
Abstract: Stroke is one of the leading causes of death and disability. Muscle weakness in the paretic arm and leg is one of the most common impairments after stroke. Muscle weakness has been identified as one of the main contributors to activity limitations (such as walking or reaching and manipulation) and participation restrictions. This thesis includes a systematic review with meta-analysis and two assessor-blinded, multi-centre randomised controlled trials. The systematic review investigated if interventions involving repetitive practice improve strength after stroke, and if any improvements in strength are accompanied by improvements in activity. The overall SMD of repetitive practice on strength was 0.25 SD (95% CI 0.16 to 0.34) in favour of repetitive practice. The first trial investigated the effects of Functional Electrical Stimulation cycling on mobility and strength after acquired brain injury caused by stroke or trauma. The mean between-group differences (95% CI) for mobility and strength of the knee extensors of the paretic lower limb were –0.3/21 points (–3.2 to 2.7) and 7.5 Nm (–5.1 to 20.2), respectively, where positive values favoured the experimental group. The second trial investigated the effects of intensive sit-to-stand training on sit-to-stand ability and gross lower limb extension strength in people who are unable to stand up independently after stroke. The mean between-group differences (95% CI) for clinicians’ impressions of sit-to-stand change and gross lower limb extension strength were 1.57/15 points (0.02 to 3.11) and 6.2 degrees (0.5 to 11.9), respectively. The results from this research program suggest that: 1. Interventions involving repetitive practice should be prioritised in stroke rehabilitation programs because these interventions can improve both strength and activity after stroke. 2. Functional Electrical Stimulation cycling in addition to usual care may provide more opportunities for people who are very weak and immobile after acquired brain injury caused by stroke or trauma to improve lower limb strength, but there are no accompanied improvements in mobility. 3. Intensive sit-to-stand training in addition to usual care improves sit-to-stand ability and gross lower limb extension strength in people who are unable to stand up independently after stroke.
Author: Davide de Sousa
Language: English
Subfield: Rehabilitation
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funder: National Stroke Foundation
OpenAlex ID: W3015713465