Rehabilitation of hemineglect of the left arm using movement detection bracelets activating a visual and acoustic alarm.
Jose M Trejo-Gabriel-Galan, V Rogel-Melgosa, S Gonzalez and 3 others
PMID 27590188WHAT IT FOUND
Left-arm movement improved in three tasks only while alarms were active during seven days of occupational therapist-guided bimanual task practice with wrist alarm bracelets in nine stroke patients with arm neglect.
No lasting benefit was seen after the alarms were switched off.
Key findings
01Right-left hand movement asymmetry decreased during days 1 to 7 when alarms were active.
02The improvement was restricted to button fastening, knife and fork, and carrying a tray, and did not occur for face washing or hand sway while walking.
03When alarms were switched off on days 8 and 30, asymmetry rose again, and the inactive-alarm measurements did not differ from baseline.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
Only nine patients were studied, and they were a convenience sample, so the results are preliminary. There was no control group, so practice, attention, therapist instruction or the bracelet itself could have contributed to the change. The intervention combined bracelet alarms, seven days of therapist-guided bimanual task practice and task-specific feedback, so the contribution of any single component cannot be separated. One patient with right-arm neglect was analysed together with the left-arm neglect patients. Patients had to have normal or near normal hand strength and no cognitive or language impairment, so the findings may not apply to more impaired stroke patients. Improvement occurred only while alarms were active and was not maintained on day 8 or day 30. Face washing and arm sway while walking did not improve, so the alarm did not help all tasks.
Declared interests
The paper names GRS, Junta de Castilla y León as the funder; no further conflict-of-interest details are provided in the supplied text.
The easy way to misread this
Do not conclude that the alarm bracelet alone treats hemineglect. The patients also received seven days of one-hour occupational therapist-guided bimanual task practice, and the benefit disappeared when alarms were switched off. The study had no control group, so this cannot be read as proof of efficacy.