Evidence-Based Medicine Comes to Neurorehabilitation. Welcome.
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Evidence-Based Medicine Comes to Neurorehabilitation
Presenters:Stephen E. Nadeau, MD.Medical Director BRRC, Chief of Neurology Malcom Randal NF/SG VAMCUniversity of Florida Neurology [email protected] E. Davis, Research P.T. BRRCUniversity of Florida Physical [email protected] G. Richards, OTR/L, PhDResearch Scientist BRRCUniversity of Florida Occupational [email protected]
EXCITE TRIALWolf SL et al. Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke. JAMA 2006;296:2095-2104
*Setting*Acuity*Length of Stay*Staffing*Support*Modifications*Home Program*Charge and Reimbursement*Legal and Ethical considerations
(Sterr, et al., 2002)
(Dettmers, et al., 2005)
Does it need to be given 6 hours every day?
Traditional therapy: Compensatory ADLs, ROM, strengthening, dexterity practice
mCIMT – 1/2 hrs/d 3x/wk shaping, 5 hr/d mitt
Page, et al., 2005
Traditional therapy: Compensatory ADLs, ROM, strengthening
Low CIMT – 2 hrs/d shaping, 5 hr/d mitt
High CIMT – 3 hr/d shaping, mitt 90% waking hrs
Dromerick, et al., 2009
(Kleim et al, 2004)
2 most common methods:
Transcranial Magnetic Stimulation
Functional Magnetic Resonance Imaging (fMRI)
Participants with intact M1 and MEPs at baseline
Participants with lesioned M1 and disturbed MEPs at baseline