Resource collection

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Resource collection2021-08-08T18:36:55+00:00

StrokeEd resources

(Australian) Clinical Guidelines for Stroke Management

Description

The Clinical Guidelines for Stroke Management produced by the Stroke Foundation ( Australia ) are a comprehensive guide to the evidence-base for stroke care. These guidelines are organised so that individual activities / impairments can be searched (eg sitting, walking, upper limb function, communication), and recommendations for each activity / impairment can be found. These are living guidelines, meaning that they are constantly being updated as new evidence emerges.

Target Audience
Physiotherapists, Occupational Therapists, Doctors, Nurses, General Rehabilitation Clinicians
Attribution
Stroke Foundation
Resource type
URL
Visit website
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Journal article (1993) Making inferences about muscle forces from clinical observations

Description

This article discusses the analysis of movement dysfunction and how muscles work, with a focus on the examination of muscle forces producing movement. Freely available from the Journal of Physiotherapy. 

Target Audience
Attribution
Journal of Physiotherapy (1993)
Resource type
URL
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Analysis

Journal article (1993) Observation and analysis of hemiplegic gait: Swing phase

Description

This 1993 article describes how to systematically analyse the causes of common kinematic deviations seen during the swing phase of walking in people with stroke.

Target Audience
Physiotherapists
Attribution
Journal of Physiotherapy (1993)
Resource type: URL
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Journal article (1993) Observation and analysis of hemiplegic gait: Stance phase

Description

This article describes how to systematiclly analyse common kinematic deviations seen during the stance phase of walking in people with stroke

Target Audience
Physiotherapists
Attribution
Journal of Physiotherapy (1993)
Resource type: URL
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Stroke Foundation learning module (2018). Recovery of walking

Description

This learning module contains practical advice for physiotherapists assessing and planning treatment for walking recovery after stroke. Dr Kate Scrivener and Dr Simone Dorsch developed content for this interactive learning module based on the Stroke Foundation’s Clinical Guidelines for Stroke Management 2017

Target Audience
Physiotherapists
Attribution
Kate Scrivener & Simone Dorsch, The StrokeEd Collaboration & Stroke Foundation (Australia) (2018)
Resource type: URL
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Training

Stroke Foundation guideline recommendations for improving walking after stroke

Description

This StrokeEd Blog shares our interpretation of the Stroke guideline recommendation for Walking, Stroke survivors with difficulty walking should be given the opportunity to undertake tailored repetitive practice of walking (or components of walking) as much as possible. Three points will be discussed:

  • “Tailored” repetitive practice of walking
  • “Components” of walking
  • “As much as possible”
Target Audience
Physiotherapists
Attribution
StrokeEd
Resource type
URL
Visit website
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Journal review (2018): Systematic review about the cueing of cadence

Description

A blog discussing a systematic review evaluating the effect of cueing to improve walking cadence, and practical strategies for implementing cueing in practice. 

Target Audience
Physiotherapists
Attribution
Dorsch S, The StrokeEd Collaboration (2018)
Resource type
URL
Visit website
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The TRAIN module (2019): Walking 1

Description

This module provides an introduction to task-specific walking retraining for people with stroke. Each module is based on evidence-based research and is accompanied by pre and post knowledge checks.

Target Audience
Physiotherapists
Attribution
Kate Scrivener, Macquarie University & The StrokeEd Collaboration (2019)
Resource type
URL
Visit website
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The TRAIN module (2019): Walking 2

Description

An introuduction to task-specific walking retraining for people with stroke. Each module is based on evidence-based research and accompanied by pre and post-knowledge checks.

Target Audience
Physiotherapists
Attribution
Kate Scrivener, Macquarie University & The StrokeEd Collaboration (2019)
Resource type
URL
Visit website
Access resource

Stroke Foundation learning module (2018). Recovery of walking

Description

This learning module contains practical advice for physiotherapists assessing and planning treatment for walking recovery after stroke. Dr Kate Scrivener and Dr Simone Dorsch developed content for this interactive learning module based on the Stroke Foundation’s Clinical Guidelines for Stroke Management 2017

Target Audience
Physiotherapists
Attribution
Kate Scrivener & Simone Dorsch, The StrokeEd Collaboration & Stroke Foundation (Australia) (2018)
Resource type
URL
Visit website
Access resource

Training

REPS

Description

The REPS app consists of post-stroke exercise programs that are guided by videos. The programs include:

1) TASK in which you practice everyday tasks; sitting, standing, stepping and standing up.

2) PUSH in which you can start to practice arm movements if your arm is very weak and difficult to move.

The programs were designed to improve and/or maintain strength and mobility, as well as encouraging people after stroke to be more physically active.

The programs within the app were developed by a team of physiotherapists at Macquarie University  in Australia, led by Dr Kate Scrivener. The aim of the app is to assist people after stroke to exercise at home, on an ongoing basis. The app is free. 

Target Audience
Physiotherapists, Occupational Therapists
Attribution
Kate Scrivener and colleagues, Macquarie University (2018)
Resource type
URL
Visit website
Access resource

The TRAIN module (2019): Standing

Description

This module provides an introduction to task-specific retraining of standing for people with stroke. Each module is based on evidence-based research and is accompanied by pre and post knowledge checks.

Target Audience
Physiotherapists
Attribution
Kate Scrivener (2019), Macquarie University & The StrokeEd Collaboration
Resource type
URL
Visit website
Access resource

Training

REPS

Description

The REPS app consists of post-stroke exercise programs that are guided by videos. The programs include:

1) TASK in which you practice everyday tasks; sitting, standing, stepping and standing up.

2) PUSH in which you can start to practice arm movements if your arm is very weak and difficult to move.

The programs were designed to improve and/or maintain strength and mobility, as well as encouraging people after stroke to be more physically active.

The programs within the app were developed by a team of physiotherapists at Macquarie University  in Australia, led by Dr Kate Scrivener. The aim of the app is to assist people after stroke to exercise at home, on an ongoing basis. The app is free. 

Target Audience
Physiotherapists, Occupational Therapists
Attribution
Kate Scrivener and colleagues, Macquarie University (2018)
Resource type
URL
Visit website
Access resource

The TRAIN module - training sitting

Description

This module is an introuduction to task-specific training of sitting for people with stroke. Each module is based on evidence-based research and is accompanied by pre and post knowledge checks.

Target Audience
Attribution
Kate Scrivener
Resource type
URL
Visit website
Access resource

Training

REPS

Description

The REPS app consists of post-stroke exercise programs that are guided by videos. The programs include:

1) TASK in which you practice everyday tasks; sitting, standing, stepping and standing up.

2) PUSH in which you can start to practice arm movements if your arm is very weak and difficult to move.

The programs were designed to improve and/or maintain strength and mobility, as well as encouraging people after stroke to be more physically active.

The programs within the app were developed by a team of physiotherapists at Macquarie University  in Australia, led by Dr Kate Scrivener. The aim of the app is to assist people after stroke to exercise at home, on an ongoing basis. The app is free. 

Target Audience
Physiotherapists, Occupational Therapists
Attribution
Kate Scrivener and colleagues, Macquarie University (2018)
Resource type
URL
Visit website
Access resource

The TRAIN module (2019): Sit to stand

Description

This module provides an introduction to task-specific training of sit-to-stand for people with stroke. Each module is based on evidence-based research and is accompanied by pre and post knowledge checks.

Target Audience
Physiotherapists
Attribution
Kate Scrivener (2019), Macquarie University & The StrokeEd Collaboration
Resource type
URL
Visit website
Access resource

(Australian) Clinical Guidelines for Stroke Management

Description

The Clinical Guidelines for Stroke Management produced by the Stroke Foundation ( Australia ) are a comprehensive guide to the evidence-base for stroke care. These guidelines are organised so that individual activities / impairments can be searched (eg sitting, walking, upper limb function, communication), and recommendations for each activity / impairment can be found. These are living guidelines, meaning that they are constantly being updated as new evidence emerges.

Target Audience
Physiotherapists, Occupational Therapists, Doctors, Nurses, General Rehabilitation Clinicians
Attribution
Stroke Foundation
Resource type
URL
Visit website
Access resource

Stroke Foundation Learning module - Assessing and retraining UL function

Description

The learning module contains practical advice for therapists about assessing and retraining upper limb function after stroke. Annie McCluskey developed content for this interactive learning module based on the (Australian) Stroke Foundation guidelines. Annie demonstrates how to assess upper limb function in hospital or at home using everyday objects, and a standardised outcome measure, the Box and Block Test, what equipment to take and use, and how to set up the environment for success. Multiple videos demonstrate how to progress training for a person who wants to be able to use cutlery but has limited hand function. The module demonstrates use of evidence-based interventions including task-specific training, mirror therapy and mental practice.

Produced by: Stroke Foundation (Australia), InformMe
Featuring: Dr Annie McCluskey, The StrokeEd Collaboration and stroke survivor Hong
Estimated time for completion: 30-60 minutes
Certificate of completion provided: Yes

Target Audience
Physiotherapists, Occupational Therapists
Attribution
Stroke Foundation
Resource type
URL
Visit website
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Book chapter (2017): Optimising upper limb performance (English version)

Description

McCluskey A, Lannin NA, Schurr K, & Dorsch S. (Pre-publication copy, 2017). Chapter 40: Optimizing motor performance and sensation after brain impairment. In M Curtin, M Egan & J Adams (Eds.). Occupational therapy for people experiencing illness, injury or impairment: Promoting occupation and participation (7th ed.). Elsevier

This chapter summarises the process of analysing reach to grasp, postural adjustments when reaching in sitting, common compensations and best-practice teaching of motor skills, and evidence-based interventions including strength training, electrical stimulation, mirror therapy, coordination training, mental practice and CIMT.  Research on the effectiveness of therapy interventions is also summarised.  Available in English, Spanish and Chinese.

Target Audience
Physiotherapists, Occupational Therapists
Attribution
McCluskey, Lannin, Schurr & Dorsch (2017) published by Elsevier
Resource type
PDF
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Book chapter (2017) Optimising upper limb performance - Chinese translation

Description

McCluskey A, Lannin NA, Schurr K, & Dorsch S. (Pre-publication copy, 2017). Chapter 40: Optimizing motor performance and sensation after brain impairment. In M Curtin, M Egan & J Adams (Eds.). Occupational therapy for people experiencing illness, injury or impairment: Promoting occupation and participation (7th ed.). Elsevier

This chapter summarises the process of analysing reach to grasp, postural adjustments when reaching in sitting, common compensations and best-practice teaching of motor skills, and evidence-based interventions including strength training, electrical stimulation, mirror therapy, coordination training, mental practice and CIMT.  Research on the effectiveness of therapy interventions is also summarised

摘要 - 本章节将描述一个关于改善脑损伤后运动表现和感觉功能的知识框架。本章提及的脑损伤主要为脑卒中和脑外伤,但也可以应用于其他的神经系统疾病。同时本章会以进食活动作为主要范例。研究生阶段所需要的知识和技能会特别指出来,包括运动行为的知识、伸手抓握和坐位拿取物品动作的组成成分、以及如何识别代偿策略、提出并验证一个运动假设。我们也会讨论促进技能学习的因素,包括任务的特异性,锻炼的强度和及时的反馈,以及治疗师教授技能时的技巧。最后,会基于循证依据给出一份改善运动表现和感觉的干预方式,包括高强度任务为导向性的训练、镜像疗法、想象疗法、电刺激和强制性运动训练。

 

Acknowledgements: Thankyou to the following therapists who completed the translation into Chinese and back translation in 2018:

1) From Shanghai Ruijin Rehabilitation Hospital 上海市瑞金康复医院 

YUANFENG SUN   孙远丰    ZHENG WANG   王正   ZIHAO XIAO 肖梓豪   ZHENNI WANG  王臻旎

 

2) Dr Tim XU TIANMA,  Health & Social Sciences Cluster, Singapore Institute of Technology, 10 Dover Drive, SINGAPORE 138683

Email: tim.xu@singaporetech.edu.sg

 

3) Ms YU GU, Physiotherapy Department,  Royal Prince Alfred Hospital & Discipline of Physiotherapy,

Faculty of Health Sciences,  The University of Sydney,  AUSTRALIA - Email: yugu5468@uni.sydney.edu.au

Target Audience
Physiotherapists, Occupational Therapists
Attribution
McCluskey A, Lannin NA, Schurr K, & Dorsch S
Resource type
PDF
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Book chapter (2017) Optimising upper limb performance - Spanish translation

Description

Acknowledgement: Thankyou to Mireya Osario Verdejo &  Sebastián Contreras Marcone from Chile, who generously translated the book chapter into Spanish.  

Traducción del capítulo de inglés a español realizada por Mireya Osorio Verdejo, Kinesióloga y Sebastián Contreras Marcone, Kinesiólogo. Centro Comunitario de Rehabilitación Física. La Pintana, CHILE

McCluskey A, Lannin NA, Schurr K, & Dorsch S. (Pre-publication copy, 2017). Chapter 40: Optimizing motor performance and sensation after brain impairment. In M Curtin, M Egan & J Adams (Eds.). Occupational therapy for people experiencing illness, injury or impairment: Promoting occupation and participation (7th ed.). Elsevier

This chapter summarises the process of analysing reach to grasp, postural adjustments when reaching in sitting, common compensations and best-practice teaching of motor skills, and evidence-based interventions including strength training, electrical stimulation, mirror therapy, coordination training, mental practice and CIMT.  Research on the effectiveness of therapy interventions is also summarised

Target Audience
Physiotherapists, Occupational Therapists
Attribution
McCluskey A, Lannin NA, Schurr K, & Dorsch S
Resource type
PDF
Visit website
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Lecture (2019): 10 things I wish I'd known as a new graduate about UL retraining

Description

This 20-minute lecture was delivered by Dr Annie McCluskey as an invited presentation at the Occupational Therapy Australia 28th national conference in Sydney, 10th July 2019.  A PDF of the accompanying PPT slide handout is also provided.

10 things I wish I’d known as a new graduate about stroke and upper limb retraining

  • Introduction:  Occupational therapy graduates are often uncertain about their role in stroke rehabilitation, particularly how to improve upper limb function.  Historically this lack of confidence has been due to limited content in undergraduate curricula, particularly in diploma-level courses. The apprenticeship model of practice also affected therapists’ confidence, where graduates learned by watching more experienced therapists. Those therapists may (or may not) have had the necessary skills and knowledge. When I graduated, I was shown and practiced facilitation techniques and compensatory strategies, but had no science to inform my practice, and no outcome measures were used.  Continuing education about upper limb retraining was rare. I mostly learned from books and my Australian physiotherapy colleagues. Now, universities with an occupation-based curriculum teach intervention at the level of activity and participation, but may not teach body-function or impairment -level intervention. Graduates may be unsure if or how they should train upper limb impairments, yet rehabilitation teams and stroke survivors expect occupational therapists to assume this role.
  • Objectives: To highlight skills and knowledge needed by occupational therapists in 2019 and beyond, to retrain upper limb function and improve occupational performance after stroke.
  • Approach:  Knowledge and skills will be presented related to motor control (anatomy, biomechanics and movement science; video, task and activity analysis), strength and coordination training, motor learning (instructions, goals, feedback, active participation) and evidence-based practice (critical appraisal skills, decision-making, outcome measurement).
  • Practice implications: This presentation is aimed at students, novice and experienced clinicians and academics responsible for shaping university rehabilitation curricula. Audience members can identify knowledge and skill gaps requiring continuing education.
  • Conclusions: Occupational therapy clinicians need strong foundation skills in motor control and motor learning to work in stroke rehabilitation, to think like a movement scientist, an occupational scientist and an evidence-based practitioner.
Target Audience
Occupational Therapists
Attribution
Annie McCluskey, The StrokeEd Collaboration
Resource type
URL
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Spasticity 1

Description

This is the first in a series of blogs about spasticity, to help therapists make sense of what continues to be a very fraught issue – despite the strong evidence that spasticity is not the main problem preventing stroke survivors from moving.  These blogs present some of the problems arising from beliefs about spasticity and importantly, provide some evidence-based strategies therapists can use to help stroke survivors learn to move, even in the presence of spasticity.

Target Audience
Physiotherapists, Occupational Therapists, Doctors, Nurses, General Rehabilitation Clinicians
Attribution
Karl Schurr, The StrokeEd Collaboration
Resource type
URL
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Spasticity 2

Description

The second blog will considerthe 1980 definition of spasticity.  This clear unambiguous definition of spasticity attributed to Lance was generated at  convention held in 1980.  That definition is: “a motor disorder characterized by a velocity dependent increase in the tonic stretch reflex (muscle tone) with exaggerated tendon jerks, resulting from hyper excitability of the stretch reflex, as one component of the upper motor neurone syndrome.”

Target Audience
Physiotherapists, Occupational Therapists, Doctors, Nurses, General Rehabilitation Clinicians
Attribution
Karl Schurr, The StrokeEd Collaboration
Resource type
URL
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Spasticity 3

Description

A proposed definition of spasticity by Pandyan et al 2005. Over the years, there has been a reluctance to accept the Lance et al (1980) definition of spasticity (see blog 2). This reluctance seems to arise from the observation that there are many changes to the sensori-motor system that may occur after a stroke including:

  • loss of, or decrease in muscle activation (flaccid, weak muscles),
  • amplified reflex responses (hyperreflexia),
  • loss of co-ordination, excessive muscle activation when attempting to move
  • soft tissue adaptations such as stiffness and contracture.

These varied possible sequelae after stroke have led medical staff, therapists and medical companies involved with outcomes after stroke to find the Lance definition of spasticity limiting (Pandyan 2005).  The Lance definition, they claim, excludes these other neural and muscular changes that may be observed after stroke. To compensate for this perceived limitation, Pandyan et al have proposed an alternative definition of spasticity that allows for inclusion of many of these other possible sequelae after a stroke.  Here is their definition: ‘disordered sensori-motor control, resulting from an upper motor neuron lesion, presenting as intermittent or sustained involuntary activation of muscles’

Is this definition helpful ? In a word, no! Read this blog to learn why.....

Target Audience
Physiotherapists, Occupational Therapists, Doctors, Nurses, General Rehabilitation Clinicians
Attribution
Karl Schurr, The StrokeEd Collaboration
Resource type
URL
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Spasticity 4

Description

Distinguishing between spasticity, stiffness and contractures can be confusing for many therapists (and medical staff). There are many secondary complications or adaptations which may (or may not) occur after stroke including.  These can include neural (eg hypertonicity) and non-neural adaptations (eg stiffnesscontractureexcessive muscle activity associated with compensatory strategies and early skill acquisition).  Because of the lack of agreement about what spasticity actually is, often these secondary complications are assumed to be, or are described, as spasticity.

In this blog, we look at each of these sequelae in turn.

Target Audience
Physiotherapists, Occupational Therapists, Doctors, Nurses, General Rehabilitation Clinicians
Attribution
Karl Schurr, The StrokeEd Collaboration
Resource type
URL
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ViaTherapy - clinical decision making tool

Description

ViaTherapy is a clinical decision making tool that provides best practice and evidence-based recovery interventions for upper extremity stroke rehabilitation. It is available as a free downloadable App

ViaTherapy was developed in Canada by an international panel of rehabilitation researchers and clinicians, and is updated from time to time. References are provided, and dose of intervention is recommended. 

Target Audience
Physiotherapists, Occupational Therapists, General Rehabilitation Clinicians
Attribution
The Heart & Stroke Foundation Canadian Partnership for Stroke Recovery
Resource type
URL
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Analysis

Handwriting Assessment Battery (HAB) Training, Administration & Scoring Manual

Description

The HAB Test Booklet, for use with clients/patients, and the HAB Training Administration and Scoring Manual should be used together. The HAB Training Administration & Scoring Manual was developed in 2004  as part of an honours project at the University of Western Sydney by Kathrine Faddy, with honour supervisors Annie McCluskey & Natasha Lannin.

Target Audience
Physiotherapists, Occupational Therapists
Attribution
Faddy K (2008)
Resource type
PDF
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Handwriting Assessment Battery (HAB) for adults - test booklet

Description

The HAB Test Booklet, used with clients/patients, and the HAB Training and Administration Manual, should be used together. The HAB Training Administration & Scoring Manual was developed in 2004 as part of an honours project at the University of Western Sydney by Kathrine Faddy, with honour supervisors Annie McCluskey & Natasha Lannin.

Target Audience
Physiotherapists, Occupational Therapists
Attribution
McCluskey A & Lannin NA (2008)
Resource type
PDF
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Scroll down for CIMT, MENTAL PRACTICE and ELECTRICAL STIMULATION resources under the TRAINING category

Training very weak muscles

REPS

Description

The REPS app consists of post-stroke exercise programs that are guided by videos. The programs include:

1) TASK in which you practice everyday tasks; sitting, standing, stepping and standing up.

2) PUSH in which you can start to practice arm movements if your arm is very weak and difficult to move.

The programs were designed to improve and/or maintain strength and mobility, as well as encouraging people after stroke to be more physically active.

The programs within the app were developed by a team of physiotherapists at Macquarie University  in Australia, led by Dr Kate Scrivener. The aim of the app is to assist people after stroke to exercise at home, on an ongoing basis. The app is free. 

Target Audience
Physiotherapists, Occupational Therapists
Attribution
Kate Scrivener and colleagues, Macquarie University (2018)
Resource type
URL
Visit website
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The PUSH program (promoting use of shoulder and hand), 2011

Description

PUSH is an exercise program designed to elicit muscle activity in the arm after stroke.

The PUSH arm exercise program was originally designed and implemented at Bankstown-Lidcombe Hospital stroke unit, in Sydney, Australia. The program is based on evidence regarding arm training and dosage. There is not yet any research validating the effect or impact of the PUSH program.

The PUSH program is now available with accompanying videos as part of the REPS Recovery Exercises App (which is free) - also developed by Dr Kate Scrivener from Macquarie University.

Target Audience
Physiotherapists, Occupational Therapists, Nurses
Attribution
Kate Scrivener, The StrokeEd Collaboration
Resource type
PDF
Visit website
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Task training

Journal review: Intensive upper limb rehabilitation after stroke: Outcomes from the UK Queen Square programme

Description

Nick Ward’s team at Queen Square (London) published outcomes of 224 stroke survivors attending their NHS UL rehabilitation programme (a 3-week day program, 90 hours total, up to 6 hours of practice daily, with 1:1 therapist supervision). This is an observational study, not an RCT, of people referred by GPs/doctors to an NHS-funded program.  Median time post stroke= 18 months.

Good description provided of the task-specific retraining program (see ‘intervention’ on second page) with 2 sessions conducted per day, some 1:1, some group session. Coaching is a key part of the program. Fugl-Meyer UL change: median score 26 at baseline, 34 after 3 weeks, 35 at 6 weeks, 37 after 6 months. This represents a clinically important change, which was maintained and improved further after discharge.

ARAT change: median score 18 at baseline, 29 after 3 weeks 26 after 6 weeks, 27 after 6 months. Again this represents a clinically important change in UL function, which was maintained after discharge.

Repetitions are not reported in this paper but are likely to follow. The authors refer to an RCT by McCabe et al (2015) in Archives Phys Med & Rehab which investigated the effects of 300 hours of UL rehab (n=48), a study I haven’t read, so worthwhile reading these two studies together in your journal club.

Citation: Ward NS, Brander F, Kelly K (2019). Intensive upper limb neurorehabilitation in chronic stroke: outcomes from the Queen Square programme. Journal of Neurology, Neurosurgery & Psychiatry, 90, 498-506.

Related paper (also free): Kelly K, Brander F, Strawson A, et al (202). Pushing the limits of recovery in chronic stroke survivors: a descriptive qualitative study of users perceptions of the Queen Square Upper Limb Neurorehabilitation Programme. BMJ Open;10:e036481. doi: 10.1136/bmjopen-2019-036481

 

Target Audience
Physiotherapists, Occupational Therapists
Attribution
Ward NS, Brander F, Kelly K (2019)
Resource type
URL
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The GRASP program

Description

The GRASP program is an evidence-based program of graded repetitive arm practice, with three levels of difficulty. Visit the GRASP website to download pictures and descriptions of the exercises to give to stroke survivors.

Target Audience
Physiotherapists, Occupational Therapists, Nurses
Attribution
University of British Columbia
Resource type
URL
Visit website
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CIMT

CIMT workbook

Description

Developed by occupational therapists at three health services in Townsville, Queensland, Sydney, NSW and Launceston, Tasmania.. Contains a detailed description of what is expected of stroke survivors and their carer, as well as participating therapists during a 2-week CIMT program. A 22-page document, provided in Word format for local use and formatting, intended to assist and encourage therapists in public health services to deliver CIMT faithfully to the original research

Target Audience
Physiotherapists, Occupational Therapists
Attribution
Massie, L., Gibson, G., Vandenberg, A., & McCluskey, A. (2014). Modified constraint induced movement therapy (mCIMT) program: Participant workbook. Sydney, Australia.
Resource type
PDF
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TeleCIMT - a free 3-wk home-based CIMT program

Description

TeleCIMT is a three-week home-based CIMT program developed by an international group of therapists experienced in CIMT. This could be run fully via telehealth or a mix of both face-to-face and telehealth. There are therapist resources and patient/carer resources, incuding videos and worksheets.

TeleCIMT is free.

The resources were developed by the TIDE (TeleCIMT International DEvelopment) Group of occupational therapists and physiotherapists to help participants and therapists prepare for and conduct a remote three-week TeleCIMT program

Target Audience
Attribution
The TIDE group - TeleCIMT International DEvelopment Group
Resource type
URL
Visit website
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Frequently asked questions about constraint-induced movement therapy (CIMT) for the upper limb

Description

This 7-page document was produced in 2018 as a result of questions that arose during several 2-day workshops as part of the ACTIveARM project in Sydney, Australia to implement CIMT in practice. 

Target Audience
Physiotherapists, Occupational Therapists
Attribution
Lauren Christie (2018)
Resource type
URL
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CIMT: An Introduction to shaping (2019)

Description

An overview of shaping, which is a key component of any CIMT program.

Shaping involves gradually increasing the level of task difficulty. Shaping tasks should be selected to target an individual's specific motor impairments. One of six videos made by occupational therapy researcher Lauren Christie for the ACTIveARM project, a collaborative research project of South Western Sydney Local Health District, The University of Sydney and The Ingham Institute of Applied medical Research focused on CIMT implementation in practice.

This 9-min video features Lauren and three adults who have sustained a stroke or brain injury demonstrating various shaping exercises.

Target Audience
Physiotherapists, Occupational Therapists, Nurses
Attribution
Lauren Christie, the ACTIveARM project (2019)
Resource type
URL
Visit website
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World wide journal club

Description

This first PEDro World-Wide Journal Club is about constraint induced movement therapy for people with neurological conditions (particularly stroke). If you are interested in being involved, please follow these five steps.

1. invite your colleagues to be involved

2. read the article
Wolf SL, Winstein CJ, Miller JP, Taub E, Uswatte G, Morris D, Giuliani C, Light KE, Nichols-Larsen D, for the EXCITE Investigators. Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: the EXCITE randomized clinical trial. JAMA 2006;296(17):2095-104

3. watch (or listen to) the video summarising the EXCITE trial

4. watch (or listen to) the video of the panel discussing the EXCITE trial

5. meet with your colleagues to have your own discussion about the EXCITE trial

Target Audience
Physiotherapists, Occupational Therapists
Attribution
PEDro
Resource type
URL
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Mental practice

Mental practice - explanation and recording

Description

A good u-tube explanation and recording of mental practice for upper limb training. We use part of this recording in StrokeEd upper limb retraining workshops. This recording was recommended as a ‘good example’ for teaching stroke survivors ‘how to do’ mental practice by Dr Karen Liu at Western Sydney University; Karen conducts research on the effect of different modes of mental practice

http://strokeed.com/mental-practice-imagery/

https://youtu.be/LyURwFWvwmU

 

Target Audience
Physiotherapists, Occupational Therapists
Attribution
Resource type
URL
Visit website
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Electrical Stimulation

FAQs about using electrical stimulation (UL)

Description

This 5-page document was produced in 2012 as a result of questions asked at electrical stimulation training workshops in Australia. The workshops and this FAQ document aim to inform therapists about electrical stimulation for the upper limb, and help therapists implement electrical stimulation into practice. 

Target Audience
Physiotherapists, Occupational Therapists
Attribution
Lannin NA, Dorsch S, Barker R, Cannell J, & McCluskey A
Resource type
PDF
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Theoretical considerations in balance assessment

Description

This paper discusses balance by examining it in relation to function and the physical environment. Balance is affected by both the task being undertaken and the surroundings in which it is performed. Different tasks and environments alter the biomechanical and information processing needs for balance control. These issues are discussed and a modification of Gentile’s taxonomy of tasks is suggested for analysis of clinical balance tests, some of which are used as examples.

Target Audience
Physiotherapists, Occupational Therapists, General Rehabilitation Clinicians
Attribution
Frances E Huxham, Patricia A Goldie and Aftab E Patla 2001
Resource type
PDF
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Balance exercises

Balance exercises

Description

A list of balance retraining exercises, which aim to provide a moderate to high challenge to balance, using features identified by Sherrington et al, 2016 (see article in Balance Resources). These three features identified as a critical element of challenging balance exercises are:

1. Reduce the base of support

2. Make controlled moveemnts of the center of mass 

3. No (or limited) use of the upper limbs

Target Audience
Physiotherapists
Attribution
Simone Dorsch, The StrokeEd Collaboration
Resource type
PDF
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Clock yourself

Description

Clock Yourself combines cognitive and physical challenges into a brain game that makes you think on your feet. Download the App for Balance training.

Target Audience
Physiotherapists, Occupational Therapists, General Rehabilitation Clinicians
Attribution
Meggan Lowry and Dave Wallace
Resource type
URL
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Systematic review of exercise to prevent falls in older adults

Description

This is a comprehensive review of exercise interventions designed to reduce falls in older adults. The review shows that exercise alone can reduce falls by 39% if the exercises contain a moderate to high challenge to balance and there is 50 hours of exercise completed. 

 

Target Audience
Attribution
British Journal of Sports Medicine
Resource type
PDF
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World wide journal club - Exercise for falls prevention in community dwelling older people

Description

Go to the second world wide jounral club on the website

1. invite your colleagues to be involved

2. read the abridged version of the review
Sherrington C, Fairhall N, Wallbank G, Tiedemann A, Michaleff ZA, Howard K, Clemson L, Hopewell S, Lamb S. Exercise for preventing falls in older people living in the community: an abridged Cochrane systematic review. Br J Sports Med 2020;54(15):885-91

or the full version of the review
Sherrington C, Fairhall NJ, Wallbank GK, Tiedemann A, Michaleff ZA, Howard K, Clemson L, Hopewell S, Lamb SE. Exercise for preventing falls in older people living in the community (Cochrane review). Cochrane Database Syst Rev 2019;Issue 1

3. watch (or listen to) the video summarising the abridged version of the exercise for falls prevention review (5 minutes)

4. watch (or listen to) the video of the panel discussing the abridged version of the exercise for falls prevention review

5. meet with your colleagues to have your own discussion about the exercise for falls prevention review
This discussion should focus on the implications of the results, including exploring possible barriers and facilitators to implementation. Devising strategies to implement the evidence into practice in your clinical environment is critical. For example, making plans for audit and feedback to quantify current and future practice.

 

Target Audience
General Rehabilitation Clinicians
Attribution
PEDro
Resource type
URL
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Running Balance classes

Additional standing balance circuit classes during inpatient rehabilitation improved balance outcomes: an assessor-blinded randomised controlled trial

Description

This randomised controlled trial aimed to evaluate the impact on balance of six 1-h balance circuit classes done in addition to usual therapy in inpatient rehabilitation. 162 particpants were randomized into an intervention group who did six 1-h circuit classes over a 2-week period in addition to usual therapy or a control group who received usual therapy. Standing balance performance was better in the intervention group than in the control group at 2 weeks after adjusting for baseline values. This is an important study showing that a relatively small amount of additional balance training can make a significant difference to balance outcomes. 

Target Audience
Physiotherapists, Occupational Therapists, General Rehabilitation Clinicians
Attribution
Daniel Treacy, Karl Schurr, Bradley Lloyd, Catherine Sherrington 2015
Resource type
PDF
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Balance class exercises (2013)

Description

This document contains a list of exercises that can be used for a balance retraining class. The exercises are based on evidence-based recommendations published by Professor Cathie Sherrington. For each exercise there are suggestions for increasing and decreasing the level of difficulty.

Target Audience
Physiotherapists
Attribution
Bankstown Hospital, Physiotherapy Department, Sydney, Australia
Resource type
Word doc
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Scroll down for TRAIN, REPS and OTHER resources under the SET UP SAFE AND EFFECTIVE EXERCISES category

Apps and video based exercises

REPS

Description

The REPS app consists of post-stroke exercise programs that are guided by videos. The programs include:

1) TASK in which you practice everyday tasks; sitting, standing, stepping and standing up.

2) PUSH in which you can start to practice arm movements if your arm is very weak and difficult to move.

The programs were designed to improve and/or maintain strength and mobility, as well as encouraging people after stroke to be more physically active.

The programs within the app were developed by a team of physiotherapists at Macquarie University  in Australia, led by Dr Kate Scrivener. The aim of the app is to assist people after stroke to exercise at home, on an ongoing basis. The app is free. 

Target Audience
Physiotherapists, Occupational Therapists
Attribution
Kate Scrivener and colleagues, Macquarie University (2018)
Resource type
URL
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Video-based exercise programs

Description

In this interview Kate Scrivener outlines the evidence for and practical issues around the use of video-based exercise programs in stroke rehabilitation.

Target Audience
Physiotherapists, Occupational Therapists, General Rehabilitation Clinicians
Attribution
StrokeEd
Resource type
URL
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The TASK Program (2021)

Description

TASK is a post-stroke exercise program guided by videos. This program involves the practice of four everyday tasks:

  • sitting
  • standing
  • stepping
  • standing up

TASK was developed by a team of physiotherapists at Macquarie University, led by Dr Kate Scrivener. The program was designed to improve and/or maintain strength and mobility, as well as encouraging people after stroke to be more physically active. The aim of TASK is to assist people after stroke to exercise at home on an ongoing basis.

Target Audience
Physiotherapists
Attribution
Kate Scrivener (2021), Macquarie University & The StrokeEd Collaboration
Resource type
URL
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TASK

The TASK Program (2021)

Description

TASK is a post-stroke exercise program guided by videos. This program involves the practice of four everyday tasks:

  • sitting
  • standing
  • stepping
  • standing up

TASK was developed by a team of physiotherapists at Macquarie University, led by Dr Kate Scrivener. The program was designed to improve and/or maintain strength and mobility, as well as encouraging people after stroke to be more physically active. The aim of TASK is to assist people after stroke to exercise at home on an ongoing basis.

Target Audience
Physiotherapists
Attribution
Kate Scrivener (2021), Macquarie University & The StrokeEd Collaboration
Resource type
URL
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TRAIN

The TRAIN module (2019): Standing

Description

This module provides an introduction to task-specific retraining of standing for people with stroke. Each module is based on evidence-based research and is accompanied by pre and post knowledge checks.

Target Audience
Physiotherapists
Attribution
Kate Scrivener (2019), Macquarie University & The StrokeEd Collaboration
Resource type
URL
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The TRAIN module (2019): Sit to stand

Description

This module provides an introduction to task-specific training of sit-to-stand for people with stroke. Each module is based on evidence-based research and is accompanied by pre and post knowledge checks.

Target Audience
Physiotherapists
Attribution
Kate Scrivener (2019), Macquarie University & The StrokeEd Collaboration
Resource type
URL
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REPS

REPS

Description

The REPS app consists of post-stroke exercise programs that are guided by videos. The programs include:

1) TASK in which you practice everyday tasks; sitting, standing, stepping and standing up.

2) PUSH in which you can start to practice arm movements if your arm is very weak and difficult to move.

The programs were designed to improve and/or maintain strength and mobility, as well as encouraging people after stroke to be more physically active.

The programs within the app were developed by a team of physiotherapists at Macquarie University  in Australia, led by Dr Kate Scrivener. The aim of the app is to assist people after stroke to exercise at home, on an ongoing basis. The app is free. 

Target Audience
Physiotherapists, Occupational Therapists
Attribution
Kate Scrivener and colleagues, Macquarie University (2018)
Resource type
URL
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Other

CIMT workbook

Description

Developed by occupational therapists at three health services in Townsville, Queensland, Sydney, NSW and Launceston, Tasmania.. Contains a detailed description of what is expected of stroke survivors and their carer, as well as participating therapists during a 2-week CIMT program. A 22-page document, provided in Word format for local use and formatting, intended to assist and encourage therapists in public health services to deliver CIMT faithfully to the original research

Target Audience
Physiotherapists, Occupational Therapists
Attribution
Massie, L., Gibson, G., Vandenberg, A., & McCluskey, A. (2014). Modified constraint induced movement therapy (mCIMT) program: Participant workbook. Sydney, Australia.
Resource type
PDF
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Journal appendix (2019): Examples of semi-supervised practice

Description

These imagesfrom an appendix in the Journal of Physiotherapy illustrate the environmental set-up to increase safety and quality of semi-supervised practice.

Target Audience
Physiotherapists, Occupational Therapists, General Rehabilitation Clinicians
Attribution
Journal of Physiotherapy (2019)
Resource type
PDF
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Journal appendix (2019) Gym layout to increase semi-supervised practice

Description

This appendix show the layout of a gym area to enable set up of semi-supervised practice. You can see that all plinths are positioned next to walls, to create safe environmental set-up for semi-supervised practice. There are 12 height adjustable tables shown in the gym, that can be used to create safe, semi-supervised practice set-ups. Access the images of people doing semi-supervised practice in the gym to see how the envrironment can be set-up to create safety. 

Target Audience
Physiotherapists, General Rehabilitation Clinicians
Attribution
Journal of Physiotherapy (2019)
Resource type
PDF
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Tele-health - Is this the new normal?

Description

Dr Kate Scrivener presents this lecture for the Stroke Recovery Association of NSW. Kate has a wealth of experience in the dleivery of tele-rehab  - in both indivudual therapy sessions and group exercise sessions.

Target Audience
Physiotherapists, Occupational Therapists, General Rehabilitation Clinicians
Attribution
Kate Scrivener & Stroke Recovery Association NSW
Resource type
URL
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Tele-health resources 2020

Description

Resources on this page were collated in 2020 by the Australian Stroke Foundation, for use by stroke care and rehabilitation professionals who provide telehealth services due to COVID-19 isolation or social distancing.

Target Audience
Physiotherapists, Occupational Therapists, Doctors, Nurses, General Rehabilitation Clinicians
Attribution
Stroke Foundation (Australia) 2020
Resource type
URL
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Caitlin Reid: Motivation in Rehab

Description

Caitlin Reid is a rehab physio and a Traumatic Brain Injury survivor. In this video interview she describes stategies that therapists can use to help increase people's motivation to do large amounts of practice in rehabilitation. 

Target Audience
Attribution
Resource type
URL
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Using technology

Journal article: The AMOUNT trial - using technology in aged care and neurological rehab

Description

Hassett L et al (2020) Digitally enabled aged care and neurological rehabilitation to enhance outcomes with Activity and MObility UsiNg Technology

(AMOUNT) in Australia: A randomised controlled trial. PLOS One Medicine

Target Audience
Physiotherapists, Occupational Therapists, General Rehabilitation Clinicians
Attribution
Hassett et al (2020) PLOS One Medicine
Resource type
PDF
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Other

Semi-supervised practice in inpatient rehabilitation (2019)

Description

This 2019 observational study answers the following questions:

When a hospital gymnasium used for inpatient rehabilitation is set up to allow semi-supervised practice: what percentage of practice is performed as semi-supervised practice, what percentage of patients in the gym are actively engaged in practice at one time, and is the semi-supervised practice that occurs safe?

Target Audience
Physiotherapists, Occupational Therapists
Attribution
Journal of Physiotherapy (2019)
Resource type
PDF
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Environment enrichment in acute stroke units

Description

An important study just published in  Clinical Rehabilitation about the outcomes of an enriched acute stroke unit environment eg Providing i-pads with therapy apps/ideas, providing GRASP upper limb equipment, multiple group activities run by therapists by Australian researcher Ingrid Rosbergen. Recommended reading for your rehabilitation team.

Target Audience
General Rehabilitation Clinicians
Attribution
Resource type
URL
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Repetitions and Dose in Stroke Rehabilitation - an editorial

Description

This editorial by Dr Simone Dorsch in the Journal of Physiotherapy introduces a collection of studies related to stroke rehabilitation, specifically the dose response relationship between practice and activity outcomes, and strategies to increase the amount of practice undertaken by people with stroke.

Target Audience
Physiotherapists
Attribution
Journal of Physiotherapy
Resource type
PDF
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Be an effective coach

Coaching feedback sheet for peer review

Description

This worksheet is used by therapists at the StrokeEd coaching skills workshop when watching videos. This worksheet can be used at your workplace, where a colleague observes you training a client, then documents your instructions, demonstration, environmental set-up, feedback and other aspects of your interactions. 

Target Audience
Physiotherapists, Occupational Therapists
Attribution
The StrokeEd Collaboration (2020)
Resource type
PDF
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Effective coaching - lessons from Magill

Description

This document summarises features of effective coaching outlined in Richard Magill's 2017 text 'Motor Learning and Control'

Target Audience
General Rehabilitation Clinicians
Attribution
StrokeEd
Resource type
PDF
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Effective coaching principles: Lessons from Magill

Description

This document provides a summary of the key features of effective coaching, i.e. how many instructions should you give?, what focus should they have? what is effective feedback?

Target Audience
General Rehabilitation Clinicians
Attribution
Simone Dorsch, The StrokeEd Collaboration (2019)
Resource type
PDF
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Journal Clubs

Journal article (2019): Running a successful journal club

Description

Wenke R, O’Shea K, Hilder J, Thomas R & Michakn S. (2019). Factors that influence the sustainability of structured allied health journal clubs: aAqualitative study. BMC Medical Education, 19:6.

Wenke R, Thomas R, Hughes I, & Mickan S. (2018). The effectiveness and feasibility of TREAT (tailoring research evidence and theory) journal clubs in allied health: A randomised controlled trial. BMC Medical Education. 18:104.

If you run or participate in a journal club, you might be interested in reading some research about how to run a successful journal club. Rachel Wenke, Sharon Mickan and team at the Gold Coast, QLD Austrlia have conducted an RCT about this topic, then interviewed allied health professionals 6 months after the RCT concluded to explore sustainability.

Very useful summary of ‘how to’ run an evidence-based journal club (incl use of structured appraisal tools, circulating article for discussion, predictable attendance, …and food being provided!), what helps keep them going or enables journal clubs (EBP experience within your team, leadership culture that values EBP) or can become barriers (competing demands deprioritise journal clubs, staffing changes, lack of confidence and capability).

Target Audience
Physiotherapists, Occupational Therapists
Attribution
BMC Medical Education (2019)
Resource type
URL
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PEDro World wide journal clubs, 2020

Description

'The purpose of the PEDro World-Wide Journal Club is to encourage the global physiotherapy community to read trials, reviews and guidelines that have important implications for clinical practice. We hope that facilitating discussion of this research will help physiotherapists to implement the results into their clinical practice.'

These journal clubs include a discussion of the EXCITE trial and implementation of CIMT, and are therefore relevant to multiple stroke rehabilitation professionals.

Target Audience
Physiotherapists, Occupational Therapists, Doctors, Nurses, General Rehabilitation Clinicians
Attribution
PEDro (Physiotherapy Evidence Database) 2020
Resource type
URL
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Therapy approaches

Journal Article (2020): Bobath therapy is inferior to task-specific training and not superior to other interventions in improving lower limb activities after stroke: a systematic review

Description

Scrivener K, Dorsch S, McCluskey A, Schurr K, Graham CL, Cao Z, Shepherd R, Tyson S (2020). Bobath therapy is inferior to task-specific training and not superior to other interventions in improving lower limb activities after stroke: a systematic review. Journal of Physiotherapy, 66(4), 225-235.

Research question: In adults with stroke, does Bobath therapy improve lower limb activity performance, strength or co-ordination when compared with no intervention or another intervention?

Findings:  A total of 22 trials were included in the review. No trials compared Bobath therapy to no intervention. Meta-analyses estimated the effect of Bobath therapy on lower limb activities compared with other interventions including: task-specific training (nine trials), combined interventions (four trials), proprioceptive neuromuscular facilitation (one trial) and strength training (two trials).

Conclusions: Bobath therapy was inferior to task-specific training and not superior to other interventions, with the exception of proprioceptive neuromuscular facilitation. Prioritising Bobath therapy over other interventions is not supported by current evidence.

Full text article is freely available.

Target Audience
Physiotherapists, Occupational Therapists
Attribution
Journal of Physiotherapy (2020)
Resource type
URL
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Journal review: Díaz-Arribas et al (2019) Systematic review on the effectiveness of Bobath therapy – Part 1: Synopsis

Description

Part 1 - Synopsis of the review

Part 2 - Critical appraisal

Objectives of the review and PICO: To evaluate the effectiveness of the Bobath concept (Intervention) on mobility, motor control of the upper and lower limb including dexterity and gait, balance, and activities of daily living (Outcomes) of stroke survivors (Population), with the effect of other sensorimotor training approaches (Comparators).

Included 15 trials.

Journal authors’ conclusions: Bobath is not superior (no better, no worse) than other treatments / approaches for improving lower limb control or gait, balance, or ADL performance in stroke survivors. There is moderate evidence that upper limb outcomes and dexterity are better (when compared to outcomes from Bobath), when treatments involving forced use are used such as CIMT and robot-assisted devices.

Target Audience
Physiotherapists, Occupational Therapists
Attribution
Annie McCluskey, The StrokeEd Collaboration (2019)
Resource type
URL
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Journal review: Díaz-Arribas et al (2019) systematic review on the effectiveness of Bobath therapy – Part 2: Appraisal and interpretation

Description

Part 1: Synopsis of systematic review containing 15 trials

Part 2: Critical appraisal and interpretration of methods and results

This review adds to knowledge by presenting more recent trials involving Bobath therapy, but should not change clinical practice.  Grouping comparisons together from studies with/without statistically significant differences is a major limitation or weakness of this review. Studies with more robust methods (ie higher PEDro score) should be allocated greater weighting in future reviews.  Furthermore, non-English studies, particularly Chinese studies, should ideally be translated and their results summarised in future reviews.  Researchers conducting randomised trials now have to publish their methods, including intervention protocol and outcome measures, in advance and in detail, before trial results can be published in a respected journal. Therefore, triallists should – in theory – be describing their version of Bobath therapy in sufficient detail to allow replication, enabling reviewers to determine what was done and to extract, report and compare raw data and outcomes.

Target Audience
Physiotherapists, Occupational Therapists
Attribution
Annie McCluskey, The StrokeEd Collaboration (2019)
Resource type
URL
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