Introduction
Post-stroke activity limitation secondary to upper-extremity motor impairment is common, and increasing. We do not currently have effective, globally applicable interventions to improve activity limitation. The burden of post-stroke disability is rising in low and middle-income countries, resulting in an immediate need for effective interventions that can be implemented throughout the world.
Purpose
This program of research was structured to address three important questions, 1) In all parts of the world, do people with stroke experience similar degrees of activity limitation secondary to upper extremity motor impairment? 2) Are there simple interventions that can be initiated by health care workers, but autonomously sustained by people with stroke, that can improve activity limitation secondary to upper extremity motor impairment? and 3) Are these interventions effective?
Methods
To address the first question, data from an international stroke study were used to quantify the amount of post-stroke upper extremity weakness and characterize the people. For the second question, a systematic review was conducted to identify current evidence on the effectiveness of simple, task-based practice. To address the third question a protocol was developed for an outcome study.
Results
Post-stroke upper extremity weakness is common throughout the world, ranging from 67.3% of those with stroke in high-income countries to 97.3% in low-income countries. There is inconclusive, but promising evidence on the effectiveness of simple, task-based practice to improve upper-extremity motor impairment. It is likely that multiple interventions are needed to address the problem and a two-by-two factorial design trial, evaluating simple, task-based practice or a motor enhancing pharmacological agent, implemented in all regions of the world, would be a novel and efficient means of addressing the question.
Conclusions
The answers to these questions have provided novel information that is a required next step to providing effective, globally applicable interventions for people with stroke. / Thesis / Doctor of Philosophy (PhD) / After having a stroke, more than half the people have difficulty moving their arm. This difficulty often results in difficulties doing every day tasks. Most of the information on what happens after stroke comes from developed countries and we do not know if these problems exist to the same extent in developed countries. We also do not know the most effective interventions to help improve arm function after stroke. Possible interventions could include rehabilitation strategies, drugs or a combination of both. This thesis describes the amount of arm weakness after stroke throughout the world, looks at the evidence for a simple intervention that could be used throughout the world, and describes the design of study that could look at the effectiveness of both rehabilitation and drug interventions throughout the world. This work provides information on the globally applicable interventions to improve arm function after stroke, which has not been considered in the literature to date.
| Identifer | oai:union.ndltd.org:mcmaster.ca/oai:macsphere.mcmaster.ca:11375/15953 |
| Date | 11 1900 |
| Creators | Bosch, Jackie |
| Contributors | Wishart, Laurie, Rehabilitation Science |
| Source Sets | McMaster University |
| Detected Language | English |
| Type | Thesis |
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