Use of the novel optokinetic chart stimulation based OKCSIB protocol for upper limb recovery in...

Use of the novel optokinetic chart stimulation based

OKCSIB protocol for upper limb recovery in dense acute

strokes: Insights for future research from a case control

series

Background Globally: stroke is one of the most devastating of all

neurological diseases often leads to death, physical impairment and

disability (Mukherjee & Patil, 2011) Upper limb rehabilitation: remains a huge problem

in people with dense stroke (Hayward & Brauer, 2014)

Arm recovery: correlated to daily life autonomy in strokes (Smania et al., 2009; Likhi et al., 2013)

The extensor system and the UL Loss of extensor strength in the affected UL is

correlated to poor UL activity and function (Turk, Burridge & Simpson, 2012).

A third of stroke patients go on to develop spasticity of the affected UL (Kanovsky, & Fernandez, 2011)

IMPORTANT to find rehabilitation interventions that improve UL recovery and THUS reduce spasticity of the UL in dense strokes

Aim To explore if use of the optokinetic chart based

OKCSIB protocol had led to better and long lasting UL recovery when compared to conventional neurophysiotherapy using a retrospective case control series

Methodology• Design: retrospective case control series in the

community• Ethics: favourable opinion from Kent Research

Ethics Committee• Optokinetic chart was moved for 3 minutes each of

lateral, vertical and forwards. Chart placed 20 cm in front of participant

Sampling ProcedureSampling

Results 8 participants consented to be followed up 3 years

after their stroke.

Equal number of participants who had been treated by OKCSIB protocol and conventional neuro-physiotherapy (n=4 respectively)

Voluntary Movement Results

Spasticity Results

Data Analysis Results Variable OKCSIB Protocol Value (SD) Conventional Value (SD) p 

UL STREAM 18.8 (1.5) 9.8 (6.9) 0.04

MAS 0 (100%) 0 (25%) 0.04 4 (75%)

Discussion

OKCSIB protocol: statistically significant improvement in UL recovery

Striking finding: absence of affected hand spasticity in the OKCSIB group

Insights for research Key is in the rehabilitation of the anti-gravity

extensor system which supports muscle tone. Normal muscle tone is a prerequisite for normal

movement Research to start with completely hemiplegic

parietal centred stroke as any method that can cause recovery of such strokes can reduce intensity as well as length of recovery in hemiparesis

Research on hemiparesis can then focus on speed of recovery.