Interventions for improving coordination of reach to grasp following stroke: a systematic review

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Executive SummaryBackgroundStroke is associated with disruption to efficient and accurate reach to grasp function. Information about treatments for upper limb coordination deficits and their effectiveness may contribute to improved recovery of upper limb function after stroke.Review ObjectivesTo identify all existing interventions targeted at coordination of arm and hand segments for reach to grasp following stroke.To determine the effectiveness of current treatments for improving coordination of reach to grasp after stroke.Inclusion CriteriaWe included studies with a specific design objective related to coordination of the hand and arm during reach to grasp and involving participants with a clinical diagnosis of stroke. The review was inclusive with regard to study design. To determine effectiveness of interventions we analysed studies with coordination measures that exist within impairment measurement scales or specific kinematic measures of coordination.Search StrategyThe search included The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); MEDLINE; EMBASE; CINAHL; AMED; ProQuest Dissertations and Theses (International) and ISI Proceedings (Conference) databases. A grey literature search included Mednar, Dissertation International, Conference Proceedings, National Institute of Health (NIH) Clinical Trials and the National Institute of Clinical Studies. We also explored PEDro, CSP Research and REHABDATA therapy databases. Finally, the reference lists of identified articles were examined for additional studies. The search spanned from 1950 to April 2010 and was limited to English language papers only.Critical appraisalThe methodological quality of the studies was assessed by two independent authors using the JBI Critical Appraisal Checklist for Comparable Cohort/ Case Control and the JBI Critical Appraisal Checklist for Experimental Studies together with additional questions from Downs and BlackData extractionTwo review authors independently extracted data from the studies using standardised JBI-MAStARI data extraction forms.Data synthesisPooling of results was not appropriate so the findings were summarized in tables and in narrative form.ResultsOne RCT, two case control studies and 4 experimental studies without controls were included in this review. The review has identified three categories of potential interventions for improving hand and arm coordination after stroke; functional therapy, biofeedback or electrical stimulation and robot or computerised training. In view of the limited availability of good quality evidence and lack of empirical data this review does not draw a definitive conclusion for the second question regarding the effectiveness of interventions aimed at improving hand and arm coordination after stroke. Improvements in hand and arm coordination during reach to grasp were reported in 4 studies, whereas one study found no benefit. Two studies did not report specific effects of interventions for hand and arm coordination after stroke.ConclusionsImplications for practiceThere is currently insufficient evidence to provide strong recommendations about the effect of interventions for improving hand and arm coordination during reach to grasp after stroke.Implications for researchConsensus regarding outcome measures for evaluating the effects of interventions on hand and arm coordination should be established. RCTs with good methodological quality, using standardized outcome measures would enable meta-analysis comparison in the future. Studies which monitor functional performance together with detailed kinematic measures of hand and arm coordination over time would help evaluate levels of recovery and compensation after stroke.

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