Evidence-based therapies for upper extremity dysfunction.
OBJECTIVE
The diversity of interventions aimed at improving upper extremity dysfunction is increasing. This article reviews the effectiveness of different therapeutic approaches that have been published in 2009 and 2010. Evidence is based on randomized controlled trials, systematic reviews, and meta-analyses.


RESULTS
Application of constraint-induced movement therapy in acute stroke patients was not more effective than a control intervention, and a more intense therapy may even be harmful. Botulinum toxin injections do not only reduce spasticity but, in children, also improve motor functions if combined with occupational therapy. Strength training improves arm function but not necessarily activities of daily living. Bilateral arm training is as effective as other interventions. Extrinsic feedback and sensory training may further improve motor functions. Mirror therapy was particularly effective for patients with initial hand plegia.


CONCLUSIONS
For some interventions (e.g. constraint-induced movement therapy, botulinum toxin), efficacy is evident, for others (e.g. mental practice, virtual reality), well designed studies with sufficient numbers of patients are needed. The ultimate goal still is to develop evidence-based therapies for all different degrees of motor impairment.
Liepert
Joachim
J
Kliniken Schmieder, Allensbach, Germany. j.liepert@kliniken-schmieder.de
D001132:Arm / Q000503:physiopathology*; D001905:Botulinum Toxins / Q000627:therapeutic use; D019317:Evidence-Based Medicine / Q000379:methods* / Q000639:trends; D026241:Exercise Movement Techniques / Q000379:methods / Q000639:trends; D005081:Exercise Therapy / Q000379:methods / Q000639:trends; D006801:Humans; D010291:Paresis / Q000503:physiopathology* / Q000534:rehabilitation*; D055070:Resistance Training / Q000379:methods / Q000639:trends; D020521:Stroke / Q000150:complications / Q000503:physiopathology; D000071939:Stroke Rehabilitation
D001905:Botulinum Toxins