Systematic literature review of treatment interventions for upper extremity hemiparesis following stroke

Abstract

The primary purpose of this review article is to critically analyse the literature from 1999 to 2005 regarding effective interventions for upper extremity hemiparesis following stroke. The researchers narrowed the scope of the review based on inclusion and exclusion criteria, which yielded 11 pertinent studies congruent with the selection criteria. Studies were categorized using Sackett's levels of evidence, level I being the highest degree of certainty and level V the lowest. Grades of recommendations were then developed, grade A being highly recommended, grade B discretionary and grade C not endorsed. Two studies were endorsed as level I - grade A, six were level II - grade B, and three were level III - grade C. Clinical recommendations inferred from the present evaluation are as follows:* Electrical stimulation can be used to improve upper limb outcomes in patients with moderate to severe upper limb dysfunction and is feasible for home-based interventions.* Therapy that utilizes goal-directed reaching behaviours promotes more typical reaching patterns than non-goal-directed interventions.* Reach-to-grasp movements show greater improvement when compensatory trunk movements are reduced.* As an addition to regular exercise therapy time, Arm BASIS training may enhance selective movements of the upper extremity (i.e. reaching).* When performed in conjunction with active neuromuscular stimulation, random and blocked practice may improve pre-motor, motor and total reaction times of the upper extremity.