Rehabilitation for individuals who have experienced stroke may be a common part of the day-to-day work of many PTs and PTAs, but there's always more to learn. PTJ: Physical Therapy & Rehabilitation Journal remains a solid go-to for the profession to gain insights on opportunities — and possibilities.
And as with all other PTJ content, members have full-text access to this research for free as a member benefit.
Here are four recent examples of the stroke-related research available through PTJ.
To Improve Mobility Poststroke, Consider Improving Aerobic Capacity
Noting the tendency for individuals poststroke to be less active, more fatigued, and generally slower at performing activities than those who haven't experienced stroke, authors of this study of 79 participants aimed to determine whether the aerobic load of those in the poststroke group played a role in the differences. What they found: Individuals poststroke experienced higher aerobic loads during daily life activities than their nonstroke peers, even when they adopted a slower movement pace. Authors believe that employing aerobic training in stroke rehab programs could help to improve aerobic capacity and thereby increase mobility and functioning.(Relative Load of Daily Activities After Stroke)
Identifying Poststroke Disability Subgroups to Better Focus Care
While it's commonly known that for individuals poststroke, the greatest improvement in disability happens early on, the wide variation in the types of disability experienced can present challenges for the rehab care team in efficiently adopting the most effective approach. Authors of this study of 1,549 patients who experienced stroke sought to identify disability subgroups to "provide a common language for clinicians to organize the heterogeneity of disability after stroke." In the end, they identified five subgroups: globally impaired, impaired dynamic balance, impaired self-care, impaired mobility, and independent. Physical therapist and occupational therapist treatment varied widely among the groups, as did discharge disposition. "The number of current rehabilitation interventions is interminable," authors write. "These subgroups may help to guide clinicians in selecting the most beneficial interventions for patients based on subgroup membership."
(Identification of Disability Subgroups for Patients After Ischemic Stroke)
Exploring the Ways PTs Employ Motivational Strategies in Stroke Rehab
This qualitative study analyzes one-on-one semistructured interviews with 15 PTs who have 10 or more years of experience working in rehab for patients poststroke. During the interviews, the PTs were asked about the patient factors that affected which motivational strategies they used, as well as strategies they employed regardless of patient characteristics. Ultimately, researchers identified nine factors that the therapists said would affect their motivational strategies, including patient mental health, physical difficulties, environment, and type of rehab treatment they experienced. In addition, they found nine motivational strategies that the PTs tended to use no matter what. Among them: building rapport, maintaining a sense of humor, patient-centered communication, and establishing a collaborative partnership with the patient.
(Physical Therapists Use Different Motivational Strategies for Stroke Rehabilitation Tailored to an Individual's Condition: A Qualitative Study)
Rehab Approaches and Dosage for Severe Upper Limb Impairments Poststroke: What Works (and What's Realistically Possible)?
This systematic review analyzed randomized controlled trials that studied rehab interventions to improve severe upper limb impairments and disability conducted fewer than seven days poststroke (acute stage) or one week to three months afterward (subacute stage). In the end, 27 studies were included involving 1,271 participants. While robotic interventions and functional electronic stimulation were identified as the most popular approaches, at least in terms of studies, researchers couldn't establish a clear pattern of superiority for those interventions compared with standard care. When it came to dosage of an intervention, patients in the early subacute stage tended to gain the most improvement from upper limb programs that lasted four to five weeks. Lengthening session times to more than 60 minutes didn't seem to impact improvement. The clinical practicalities of pursuing either robotic interventions or more intensive therapy sessions could prove to be challenging, the researchers point out, given the expense and dedicated staff time related to robotic devices and the potential difficulties of introducing higher dosages into current practice models. Bottom line, according to authors: "Whether certain techniques should be chosen over others in early upper limb rehabilitation is currently unclear."
(Efficacy and Dose of Rehabilitation Approaches for Severe Upper Limb Impairments and Disability During Early Acute and Subacute Stroke: A Systematic Review)