Article

OBJECTIVE: To describe a treatment protocol for the upper limb that standardizes
intensity of therapy input regardless of the severity of presentation. DESIGN:
The protocol is described
(Part 1) and feasibility and effect explored (Part 2).
SUBJECTS: Participants (n = 11) had a single ischaemic stroke in the middle
cerebral artery territory more than one year previously, and had residual
weakness of the hand with some extension present at the wrist and the ability to
grasp. INTERVENTIONS: Following two baseline assessments, participants attended
therapy for 1 hour a day for 10 consecutive working days. Treatment consisted of
a combination of strength and functional task training. Outcomes were measured
immediately after training, at one month and three months. OUTCOME MEASURES:
Intensity was measured with Borg Rating of Perceived Exertion. Secondary outcome
measures included Action Research Arm Test (ARAT), nine-hole peg test, and Goal
Attainment Scale. RESULTS: Borg scores indicated that the level of intensity was
appropriate and similar across all participants despite individual differences in
the severity of their initial presentation (median (interquartile range) = 14
(13-15)). The mean ARAT score significantly increased by 6.8 points (chi(2)(3) =
15.618, P<0.001), and was maintained at three-month follow-up (z = - 2.384, P =
0.016). The nine-hole peg test also showed a main effect of time and 88% of goals
set were achieved. CONCLUSIONS: The physiotherapy protocol standardized intensity
of treatment by grading exercise and task-related practice according to the
person's residual ability, rather than simply standardizing treatment times. It
was feasible and well tolerated in this group.

Langue : ANGLAIS