UK Stroke Forum 2012 Conference, North Yorkshire 4–6 December 2012

Abstract

Introduction: Assistive technologies (ATs) are defined as mechanical or electrical devices used in functional task-orientated training processes to induce a systemic or rehabilitative effect on the person. Cochrane reviews and NICE guidelines rarely recommend the routine use of any AT for arm rehabilitation following stroke. This study assessed available evidence using a systematic method to determine reasons for weakness in evidence for ATs. Method(s): Published evidence was identified with search terms for stroke, arm and ATs including biofeedback, electrical stimulation, constraint induced movement therapy, orthotics, robotics, brain stimulation and virtual reality. Risk of bias was assessed in relevant experimental and review articles to identify papers reporting assessor blinded RCTs for subjects with similar prognosis. Extracted data of functional outcome measures was used to calculate effect sizes. Result(s): Scientific rationale for treatment regimes was rarely explicitly expressed in a majority of the research. Temporal parameters (session duration, frequency and length treatment), joints and muscles treated, time post stroke and outcome measures varied between studies. Effect sizes for short term outcomes varied; for biofeedback 0.42-0.78 and electrical stimulation 0.23-2.43; constraint induced movement therapy (CIMT) 1.94-13.37; robotics 0.23-0.44; virtual reality 0.42. Conclusion(s): Given the lack of a scientific foundation for much research and variability in application and design, one concludes that current research simply models some interactions or is exploratory in nature (phase I/II). Further exploratory work to resolve strategic design issues is required before a definitive RCT can be designed to address the multi-factorial problems encountered in arm rehabilitation following stroke.