Article

Objective: To evaluate the effect of altering a single component of a rehabilitation programme (e.g. adding bilateral practice alone) on functional
recovery after stroke, defined using a measure of activity. Data sources: A search was conducted of Medline/Pubmed, CINAHL and Web of Science. Review
methods: Two reviewers independently assessed eligibility. Randomized controlled
trials were included if all participants received the same base intervention, and
the experimental group experienced alteration of a single component of the
training programme. This could be manipulation of an intrinsic component of
training (e.g. intensity) or the addition of a discretionary component (e.g.
augmented feedback). One reviewer extracted the data and another independently
checked a subsample (20%). Quality was appraised according to the PEDro scale.
Results: Thirty-six studies (n = 1724 participants) were included. These
evaluated nine training components: mechanical degrees of freedom, intensity of
practice, load, practice schedule, augmented feedback, bilateral movements,
constraint of the unimpaired limb, mental practice and mirrored-visual feedback.
Manipulation of the mechanical degrees of freedom of the trunk during reaching
and the addition of mental practice during upper limb training were the only
single components found to independently enhance recovery of function after
stroke. Conclusion: This review provides limited evidence to support the
supposition that altering a single component of a rehabilitation programme
realises greater functional recovery for stroke survivors. Further investigations
are required to determine the most effective single components of rehabilitation
programmes, and the combinations that may enhance functional recovery.

Langue : ANGLAIS