Postural control exercise without using the upper limbs improves activities of daily living in patients with stroke.
Akio Kamijo, Chisato Furihata, Yuki Kimura and 3 others
PMID 37113747WHAT IT FOUND
Stroke patients who practiced postural control without using their arms showed greater gains in daily living tasks and walking recovery than those who relied on arm support.
This suggests training balance in more unstable conditions may improve functional independence.
Key findings
01Patients who practiced postural control without upper limb support had significantly greater improvement in FIM motor scores from admission to discharge compared to those who used their upper limbs.
02The group avoiding upper limb support achieved a higher rate of gait acquisition at discharge (80%) compared to the group using upper limb support (62.5%).
03Significant differences in improvement were found in postural-dependent tasks such as bathing, dressing, transfers, locomotion, and stairs, but not in tasks like eating or grooming.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
This is a retrospective observational study, not a randomized controlled trial. Patients were not randomly assigned to groups, so differences in outcomes could be due to other factors such as initial severity, motivation, or specific therapist approaches. The study did not measure walking speed, specific posture, brain damage location, or muscle activity, so the mechanism behind the improvement is not fully understood. Group B had lower baseline function, which might have allowed for greater room for improvement (floor effect), though the authors note this was possibly due to more severe paralysis. The definition of 'without using upper limbs as much as possible' in Group B is subjective and may have varied between therapists or patients.
The easy way to misread this
Do not assume that removing upper limb support is safe or effective for all patients. This study observed patients in a rehabilitation unit where safety was monitored, and it did not report on falls or adverse events. The improvement in Group B may also be partly due to their lower starting scores rather than the intervention alone, given the lack of randomization.