Research focus

Upper limb rehabilitation following a stroke

Rehabilitation for upper limb impairment, which occurs in a majority of strokes, is reviewed in three research papers

Rehabilitation for upper limb impairment, which occurs in a majority of strokes, is reviewed in three research papers

Computer artwork depicts an MRI brain scan revealing the effects of a stroke, showing a blood clot. Upper limb impairment, which occurs in a majority of strokes and requires rehabilitation, is reviewed in three research papers.
Picture: Science Photo Library

Learning points

  • The majority of stroke survivors have upper limb impairment involving loss of movement, function, coordination and/or sensation
  • Intensive therapeutic intervention can bring about positive clinical improvement in upper limb function and activity
  • Upper limb somatosensory retraining may be helpful in improving upper limb sensation, functional arm use, daily performance and life participation

A stroke occurs in the UK approximately every five minutes, equating to more than 100,000 per year, of which 400 are in children. Although incidence has reduced in recent years due to increased awareness and improvements in NHS stroke care, 1 million stroke survivors in England, Wales and Northern Ireland need ongoing care on discharge from hospital. The majority have upper limb impairment involving loss of movement, function, coordination and/or sensation.

Improving upper limb function helps to maximise participation, increase independence and reduce physical disability. If the shoulder and arm are not protected by careful handling and positioning, significant neurological and musculoskeletal pain can result.

Treating an impaired arm with care requires avoiding the arm hanging down, reducing hand swelling and encouraging active movement training to prevent persistent pain and further restricted movement. Upper limb impairment is reviewed through three research papers.

Intensive upper limb neurorehabilitation in chronic stroke: outcomes from the Queen Square programme

Higher doses of intensive therapeutic intervention can bring about positive clinical improvement in upper limb function and activity, a quantitative, pre-post intervention study conducted at an upper limb neurorehabilitation service demonstrates.

Those with some movement observed in the shoulder, wrists or hand six months post stroke were given a three-week, twice daily, individualised, intensive programme of upper limb therapy. One-to-one coaching was delivered by physiotherapists and occupational therapists, increasing as appropriate each week to 90 hours of therapy.

Data from 224 of 268 stroke patients were analysed. Four validated outcome measures were used to report change in upper limb function at four time points over a six-month period, demonstrating positive results. Further research is needed to test these findings and gain consensus.

Ward N, Brander F, Kelly K (2019). Journal of Neurology, Neurosurgery & Psychiatry. 90, 5, 498-506. doi: 10.1136/jnnp-2018-319954

Experiences of Upper Limb Somatosensory Retraining in Persons With Stroke: An Interpretative Phenomenological Analysis

Upper limb somatosensory retraining after a stroke can be challenging and rewarding, but it helps patients improve upper limb sensation, functional arm use, daily performance and life participation, according to a qualitative, iterative study exploring their response to the treatment.

Eight out of 14 participants in an upper limb sensory training trial were interviewed. On average they had received the retraining therapy for 2.5 years. Five ‘subordinate’ themes falling under the three broad themes of motivation, process and outcome describe reclaiming normal sensation, harnessing positive therapeutic relationships and specialist training, facing cognitive and emotional challenges, awareness of gains and differences in sensation, and improved functioning.

The participants, who were predominantly younger survivors than previously investigated, perceived and described clear differences in upper limb sensory loss following their stroke. The therapeutic relationship encouraged greater awareness and supported engagement and motivation while meeting the challenges of retraining and recognising the positive influence of retraining on participation in everyday life.

Turville M, Walker J, Blennerhassett J et al (2019) Frontiers of Neuroscience. 13, 756,1-11. doi: 10.3389/fnins.2019.00756

A systematic review protocol of timing, efficacy and cost effectiveness of upper limb therapy for motor recovery post-stroke

A research protocol aims to aid understanding of knowledge gaps in current upper limb management and generate evidence-based thinking to improve therapeutic pathways and upper limb outcomes following stroke in the future.

The protocol will cover current evidence and clinical practice around upper limb impairment. A broad, single-search, systematic review strategy on the timing, efficacy and cost-effectiveness of upper limb therapy has been registered on the international prospective register of systematic reviews (PROSPERO).

The eligibility criteria, proposed methodology and data analyses are clearly explained using the preferred reporting items for systematic reviews and meta-analysis protocol (PRISMA_P) statement. The quality of the evidence surrounding a wide range of different interventions will be assessed using the internationally approved GRADE method and economic evaluation will be guided by the CHEERS statement.

Hayward K, Kramer S, Thijs V et al (2019). Systematic Reviews. 8, 1, 187. doi: 10.1186/s13643-019-1093-6


Compiled by Kathy Davis, research nurse, The Children's Trust

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