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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.