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Recovering hand function after stroke: mechanisms and treatment

Wallace, A.C.; (2012) Recovering hand function after stroke: mechanisms and treatment. Doctoral thesis , UCL (University College London).

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Abstract

Stroke is a major cause of long-term disability with less than 40% of survivors with arm paresis recovering useful function. This thesis was primarily concerned with recovery of distal hand function after stroke. A standardised protocol was developed based on a systematic search of past literature (chapter 1). The protocol was specifically devised to incorporate both strength and functional training and to allow quantification and standardisation of the intensity of the intervention (chapter 2). Investigation of people with stroke who underwent training with the protocol highlighted that training intensity could be standardised across people with varying severities of stroke. A standardised therapy intervention is critical in research trials aiming to evaluate the efficacy of adjuncts to therapy. Baseline analysis of a functional grasp release task in stroke survivors demonstrated that they were significantly impaired on all measures. Extensor muscle strength showed trends towards being important for functional ability. Inappropriate muscle cocontraction and spasticity did not appear to have any influence on function (chapter 3). The protocol led to a significant improvement in functional ability in this group measured by active wrist extension and the action research arm test (ARAT). Changes in strength showed trends towards correlation with improvements in function. Although changes in co-contraction and spasticity were borderline significant they had no effect on function (chapter 4). Finally, the protocol was implemented in a randomised controlled clinical trial designed to test a form of brain stimulation as an adjunct to therapy. The participants improved 15-20% on clinical measures but, in contrast to results from single intervention studies, the type of brain stimulation applied made no difference to the outcome (chapter 5). The best strategy for treatment in this heterogeneous population may be to predict which subjects will respond and target specific treatment. This needs focussed research to determine reliable predictors.

Type: Thesis (Doctoral)
Title: Recovering hand function after stroke: mechanisms and treatment
Language: English
Additional information: Permission for digitisation not received
UCL classification: UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology
URI: https://discovery.ucl.ac.uk/id/eprint/1344098
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