Literature review about

neurodevelopmental
approaches

Presented to: Sir Shakir

Submitted by: Shabana &
Labeenah
  Motor relearning program
 Bobath approach
 Brunnstrom approach
Different types of  Proprioceptive
Neuro-Rehabilitative neuromuscular
approach(PNF)
approaches in NND.
 Roods approach
 Virtual Reality
Neurorehabilitation (VRN)
 robotics
  Cochrane Library
Literature  PUBMED
review  PUBMED CENTRAL
 PEDRO
through these  BMC
databases  Physiopedia
Cochrane library
 Interventions for improving upper limb function after stroke
 Abstract:
 Research question
 Which interventions help to promote arm and hand recovery after a person has had a
stroke?
 Objectives
 To carry out a Cochrane overview by synthesizing systematic reviews of interventions
provided to improve upper limb function after stroke.
Background
 Problems with arm function (upper limb impairments) are very common after a
stroke. These upper limb impairments commonly include difficulty moving and
coordinating the arms, hands and fingers, often resulting in difficulty carrying out
daily activities such as eating, dressing and washing. More than half of people with
upper limb impairment after stroke will still have problems many months to years
after their stroke. Improving arm function is a core element of rehabilitation. Many
possible interventions have been developed; these may involve different exercises or
training, specialist equipment or techniques, or they could take the form of a drug
(pill or injection) given to help arm movement.
 Upper limb rehabilitation after stroke often involves several different interventions
and generally requires the co‐operation of the patient, careers and rehabilitation
team.
 To help people easily access information about effective interventions, and to help
them compare the effects of different interventions, we have carried out a
Cochrane overview. We aimed to bring together all systematic reviews of
interventions provided to improve upper limb (arm) function after stroke.
 Review characteristics
 We searched for Cochrane and non‐Cochrane reviews of the effectiveness
of interventions to improve arm function after stroke. We included 40
systematic reviews (19 Cochrane reviews and 21 non‐Cochrane reviews).
The evidence is current to June 2013.
 The reviews covered 18 different types of interventions, as well as the
dose of the intervention and the setting in which the intervention was
delivered. These reviews varied in relation to the populations included
(initial upper limb impairment and stroke severity) and in relation to the
comparison groups included (which were given control interventions, no
treatment and conventional therapy).
 We extracted details of 127 comparisons that had been explored within
the reviews. These showed the extent to which different interventions had
had an effect on upper limb function, upper limb impairment and ability to
perform activities of daily living.
 Key results
 Currently no high‐quality evidence is available for any interventions currently used
as part of routine practice. Evidence is insufficient to show which are the most
effective interventions for improving upper limb function.
 Moderate‐quality evidence suggests that the following interventions may be
effective: constraint‐induced movement therapy (CIMT), mental practice, mirror
therapy, interventions for sensory impairment, virtual reality and a relatively high
dose of repetitive task practice. Moderate‐quality evidence also indicates that
unilateral arm training (exercise for the affected arm) may be more effective than
bilateral arm training (doing the same exercise with both arms at the same time).
 Some evidence shows that a greater dose of an intervention is better than a lesser
dose. Additional research to identify the optimal dose of arm rehabilitation is
essential.
 Bringing together all available systematic review evidence has helped us make
specific recommendations for future research. These recommendations include (but
are not limited to) large randomized controlled trials of CIMT, mental practice, mirror
therapy and virtual reality. We recommend high‐quality up‐to‐date reviews and
further primary research for several specific interventions.
 Implications for practice
 A diverse range of interventions are aimed at improving upper limb function after
stroke. In general, evidence is of low quality and does not support clear clinical
decisions. However, some moderate‐quality evidence suggests that CIMT, mental
practice, mirror therapy, interventions for sensory impairment, virtual reality and
a relatively high dose of repetitive task practice may be effective interventions.
These interventions should be considered for this patient group. However, clinical
application of evidence will depend on specific details of an individual patient or
setting, or both, and clinical decisions will require expert clinical reasoning and
judgement if available evidence is to be interpreted and applied effectively.
Taxonomy of rehabilitation
interventions used within this overview.
 The Bobath Concept (NDT) as
rehabilitation in stroke patients: A
systematic review
PMID: 35136756
PMCID: PMC8797128
DOI: 10.4103/jfmpc.jfmpc_528_21
Abstract
Background and objectives: The Bobath approach, also
known as neurodevelopmental treatment (NDT), is a widely
used concept in the rehabilitation of stroke patients with
hemiparesis in many countries. This technique is being used
since years all over the world; however, strong evidence of
its usefulness is still not present. This review is aimed to find
out its effectiveness based on the randomized controlled
trials in the rehabilitation of stroke patients with motor
disability and to compare it with other therapeutic
techniques.
 Materials and methods: A systematic literature search on PubMed Central,
Science-Direct, Cochrane, Scopus, Clinical Trial Database, and Indian
Clinical Trial Registry in English till 31st July 2021 was undertaken. The
review is published in Prospective Register of Systematic Reviews
(PROSPERO) with registration number "CRD42019125400." Physiotherapy
Evidence-based Database (PEDro) score has been used for the quality
assessment of the studies. Randomized clinical trials that studied the
comparative effect of the NDT/Bobath concept on motor activity outcomes
and cognition/behavior in stroke patients in comparison with other
rehabilitative techniques were included.
 Results: No strong documentation describing the effectiveness of this neuro-
developmental treatment or its supporting neuro-developmental treatment in
comparison with other advanced neuro-physiotherapeutic techniques has been
found so as to consider it as the recommended treatment for post-stroke
hemiplegia/hemiparesis. Methodological aspects of selected studies for further
research are suggested.

 Interpretation and conclusions: This study is inconclusive in determining the

effectiveness of the Bobath approach for the movement rehabilitation of stroke
patients. These results are similar to the results of previous reviews done on
the same topic.
 Exploring the transformative influence
of neuroplasticity on stroke
rehabilitation: a narrative review of
current evidence
PMCID: PMC10473303
PMID: 37663728
Published online 2023 Aug 7. doi: 10.1097/MS9.0000000000001137

Abstract:
This review aims to assess the role of neuroplasticity in facilitating
stroke recovery and identify the challenges and limitations
associated with its implementation. A comprehensive literature
search was conducted to identify relevant studies, which were
meticulously evaluated to determine the potential solutions for
effectively harnessing neuroplasticity. The results indicate that
neuroplasticity holds significant promise in stroke rehabilitation;
however, individual variability in response to interventions, timing
and duration of interventions and sociocultural and clinical factors
pose challenges.
 Tailoring interventions to individual patient characteristics is crucial for
optimizing the impact of neuroplasticity. Despite challenges and limitations,
the transformative potential of neuroplasticity in stroke rehabilitation is
undeniable. The abstract concludes by emphasizing the importance of a
comprehensive understanding of individual variability, optimizing intervention
timing and duration and considering sociocultural and clinical factors. Future
research and clinical practice should prioritize personalized interventions and
interdisciplinary collaborations to fully exploit the vast potential of
neuroplasticity in stroke recovery.
  A comprehensive literature search was conducted
across electronic databases, including PubMed,
Methodology Embase and the Cochrane Library, to identify
relevant studies exploring the role of neuroplasticity
in stroke rehabilitation. The search strategy utilized
appropriate keywords and Medical Subject Headings
(MeSH) to retrieve articles published in English from
2000 to April 2023.
 The inclusion criteria encompassed original research articles, reviews and
meta-analyses that investigated the impact of neuroplasticity on stroke
recovery and rehabilitation, focusing on both animal models and human
participants. Exclusion criteria included studies with insufficient data, case
reports, editorials, conference abstracts and non-English language publications
  CIMT has emerged as a novel method for improving
neuroplasticity in stroke patients26. CIMT is known to
promote motor recovery after stroke, but the exact
mechanisms underlying its effectiveness are not yet fully
understood. However, recent research has provided
CIMT valuable insights into the potential neuroplastic changes
induced by CIMT. A study investigated the neuroplastic
effects of CIMT and found that it promotes structural
neuroplasticity primarily oriented towards the
contralesional hemisphere while eliciting bihemispheric
functional neuroplasticity27. These findings suggest that
CIMT can induce adaptive changes in the brain,
contributing to motor recovery.
 Combining CIMT with tDCS has emerged as a promising approach to stroke
rehabilitation. A recent clinical study conducted in 2023 explored the combined use
of tDCS and CIMT in post stroke patients, specifically targeting motor and functional
upper limb recovery31. The study demonstrated that patients who received this
combined intervention showed functional improvement, attributed to the
underlying neuroplasticity mechanisms triggered by the interventions. Using CIMT
and tDCS as adjunctive therapies provides valuable insights into the role of
neuroplasticity in stroke recovery.
 VR and AR present innovative tools in the field of stroke rehabilitation. VR
creates immersive environments that facilitate motor learning and
functional recovery, while AR enhances performance in everyday tasks
and supports neuroplasticity-based rehabilitation.
 Using robotics and exoskeletons as assistive devices in stroke
rehabilitation is gaining increasing attention. These technologies enable
precise and repetitive movements, promoting motor recovery and
facilitating neuroplasticity.
  The study of neuroplasticity’s impact on stroke
rehabilitation holds great potential but faces
challenges. Individual variability in responses,
timing/duration of interventions and
Conclusion sociocultural/clinical factors complicate treatment.
However, emerging technologies like brain
stimulation, V/A reality and robotics offer promising
avenues. Personalized interventions, understanding
underlying mechanisms and interdisciplinary
collaborations are key for optimizing neuroplasticity’s
role in stroke recovery. Future research and practice
must focus on these areas to improve outcomes and
enhance the lives of stroke survivors.
Progress in the clinical application of constraint-induced therapy
following stroke since 2014

 PMCID: PMC10235632
 PMID: 37273704
 Published online 2023 May 19. doi: 10.3389/fneur.2023.1170420
 Abstract

Stroke is a group of cerebrovascular diseases with high prevalence and

mortality rate. Stroke can induce many impairments, including motor and
cognitive dysfunction, aphasia/dysarthria, dysphagia, and mood disorders,
which may reduce the quality of life among the patients. Constraint-induced
therapy has been proven to be an effective treatment method for stroke
rehabilitation. It has been widely used in the recovery of limb motor
dysfunction, aphasia, and other impairment like unilateral neglect after stroke
 . In recent years, constraint-induced therapy can also combine with telehealth
and home rehabilitation. In addition, constraint-induced therapy produces
significant neuroplastic changes in the central nervous system. Functional
magnetic resonance imaging, diffusion tensor imaging, and other
imaging/electrophysiology methods have been used to clarify the mechanism
and neuroplasticity. However, constraint-induced therapy has some limitations.
It can only be used under certain conditions, and the treatment time and
effectiveness are controversial. Further research is needed to clarify the
mechanism and effectiveness of CI therapy.
 A literature search was conducted based on a selective search in the
PubMed/MEDLINE databases to search the literature from 2014 up to 2022. We
used search terms related to “stroke,” “constraint-induced movement therapy,”
“intensive language-action therapy”, “constraint-induced aphasia therapy,” and
“constraint-induced therapy,” to review the clinical application of CI therapy in
upper and lower limb motor dysfunction, aphasia, and other impairments after
stroke. The literature search was limited to articles published in English, and the
full text was available
 A study combined CIMT with virtual reality training, the upper limb motor
function improved (30). Another study used mCIMT or intensive
conventional rehabilitation based on botulinum-A toxin injection, the
results showed that the motor function and ADL of botulinum-A toxin
injection combined with the mCIMT group were significantly improved
between groups
 Several studies have compared early and late delivery of CIMT. A study
showed that the early applied CIMT group had greater improvement in
motor function than the late applied group (54). But another study found
that early delivery of CIMT was as good as late intervention; however, the
early CIMT intervention group showed a faster recovery curve than the
late intervention group (55). Considering that according to the patient’s
condition, CIMT can be intervened early; if CI therapy has not been used in
the early stage, it can also be added when necessary, and there is no need
to worry about the late intervention of CIMT may be ineffective
  CI therapy is widely used in stroke rehabilitation, and
different CI therapies can meet diverse needs for
recovery of patients. It can be combined with other
treatment methods to provide additional benefits.
Conclusion Many studies have now demonstrated the
effectiveness of CIMT not only by rehabilitation
evaluation scales but also by electrophysiological and
imaging methods. With the development of
technology, CI therapy is linked to tele rehabilitation,
responding to the needs of patients with chronic
dysfunction and/or inconvenient access to the clinic.
However, CI therapy has some limitations.
MNG_D1_2. Rehabilitation guideline of Stroke.pdf
A randomized control trial comparing the effects of motor relearning
programme and mirror therapy for improving upper limb motor functions in
stroke patients
PMID: 31511706
Shafqatullah Jan 1, Aatik Arsh 2, Haider Darain 3, Shehla Gul 4

Abstract
Objective: To compare the effectiveness of motor relearning programme
with mirror therapy in upper limb motor functions of stroke patients.
Methods: The randomised control trial was conducted in Rafsan Neuro
Rehabilitation Centre, Peshawar, Pakistan, from June to December 2017, and
comprised stroke patients who had Mini Mental State Examination score
over 24. Participants were randomly allocated into treatment and control
groups. The treatment group underwent a Motor Relearning Programme,
while the control group received Mirror therapy. Upper limb sub-scales of
the motor assessment scale were used as data collection tool. SPSS 20 was
used for data analysis.
 Results: Of the 66 subjects, 46(69.7%) were males and 20(30.3%) were
females. The overall mean age was 55.44±9.21 years. Left hemiplegia
was found in 31(47%) subjects, while 35(53%) had right hemiplegia.
Each of the two groups had 33(50%) subjects. There were significant
differences between pre-treatment and post-treatment mean scores of
upper arm functions, hand function and advance hand activities of the
two groups (p<0.05 each). All the three variables significantly improved
in the treatment group compared to the control group (p<0.001).
 Conclusions: Motor Relearning Programme and Mirror therapy were
found to be effective in improving upper limb motor functions of stroke
patients, but the former was found to be more effective than the latter.
Thankyou