Interventions to promote upper limb recovery in stroke survivors with severe paresis: a systematic review

Abstract

Purpose. To investigate the effect of interventions that promote upper limb (UL) recovery in stroke survivors with severe paresis. Methods. A systematic search of the scientific literature from January 1970 to March 2009 was conducted using CINAHL, Cochrane, PEDro, Pubmed and Web of Science. keywords used included stroke, severe, hemiplegia, UL, task-oriented, robot, non-robot and electrical stimulation. Methodological quality of the studies was assessed using the PEDro rating scale. Studies were grouped into one of three intervention categories: robotic therapy, electrical stimulation or ‘other’ therapy. Results. Seventeen randomised controlled trials met the inclusion criteria. A ‘best evidence synthesis’ indicated strong evidence that robotic therapy provides a large beneficial effect and limited evidence that electrical stimulation and ‘other’ interventions provide a large beneficial effect on function. There is no evidence that these interventions influence use of the arm in everyday tasks. Conclusion. There are a number of newly developed interventions that enable stroke survivors with severe paresis to actively participate in task-oriented practice to promote UL recovery. While these interventions offer some promise for stroke survivors with severe paresis, ultimately, the effectiveness of these interventions will be dependent on whether they lead to restoration of function to the point at which the stroke survivor can practice everyday tasks.