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Physiotherapeutic treatments compared on muscle tone in patients with chronic CVA : A Systematic Review

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Physiotherapeutic treatments compared on muscle tone in patients with chronic CVA : A Systematic Review

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The both of us have spent our second internship in Jakarta, Indonesia in a stroke center, where we have worked with neurological patients exclusively, (90% stroke). The internship was also based on an exchange of knowledge and the Nusantara Stroke and Medical Center has asked us to research what the most effective treatment method for abnormal muscle tone is, on patients with spasticity. Spasticity is one of the cardinal features of an upper motor neuron syndrome. Therefore we chose to conduct a systematic review to answer this question. We have laid attention on three different treatment methods, active movements, passive movements and functional electrical stimulation. Our target patient population was stroke victims in a chronic state, which means according to many guidelines six month after the accident. All the effects of various physiotherapeutic interventions have been compared to each other, looking at the differences on the short term. The researchers performed a search on the available computerised scientific databases, (including: Pubmed, Embase, Cochrane, Cinahl, PiCarta, GoogleSchoolar) to identify and gather relevant articles. Afterwards all articles were processed via inclusion and exclusion criteria to determine their individual relevance. The team had a list of nine articles which met the inclusion criteria and finally were read, analysed and graded according to the criteria list, which was build individually by the researchers. The selected articles were published between 2002 and 2007 (Mean 2004, 8 / Median 2007). Three of them focused on active exercises, three on passive exercises and three focussed mainly on FES. Four of them were classified as Randomised Controlled Trials and five of them were studies of another kind. Four articles were categorised as good quality articles according to our criteria list and five articles were graded as of moderate quality. Three of those studies showed significant changes from one or more points on the MAS. Other three showed changes of less than one point on the MAS and three of the studies showed no or only neglect able changes on the outcome measurement scale. Our study and the articles reviewed both, one the one side encountered, confounding factors like the reliability of the outcome measurement scale (MAS) and on the other side the quality of the investigated articles. In this systematic review it is visible that all three investigated treatment modalities have a beneficial effect on muscle tone in chronic CVA patients in the short term. However there were no significant differences found, when comparing the outcomes between those interventions. As we encountered many internal limitations in the reviewed articles like very individual settings and outcome measures we recommend that there should be future studies conducted, which use more reliable outcome measures and are of a better general quality.

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OrganisatieHogeschool van Amsterdam
InstituutGezondheid
Jaar2008
TypeBachelorscriptie
TaalEngels

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