national-clinical-guidelines-for-stroke-fourth-edition

etween 2 days and 7 months across a broad range of pathologies in adults and children.
The majority of studies looked at stretch interventions of 0–6 weeks duration and in
most instances to 4 weeks. Until the evidence base is more conclusive therapists must be
analytical and critical in their practice in identifying who and when to splint and when
not to splint. Splinting may be used to help manage tone, reduce pain and improve range
of movement and function (passive and active). Splints should only be assessed, fitted
and reviewed by appropriately skilled staff.
6.11.1 Recommendations
A Any patient who has increased tone sufficient to reduce passive or active movement
around a joint should have their range of passive joint movement assessed and
monitored.
B Splinting of the arm and hand should not be used routinely after stroke.
6.11.2 Sources
A Consensus
B Lannin et al 2007a
6.12 Biofeedback
One key aspect of any therapist’s work is to provide the patient with feedback on their
performance of an activity or exercise. One method of enhancing feedback is to use
technology which can often also provide more consistent, detailed and sometimes
individually adapted feedback. Performance measures monitored in this way include
muscle activity (electromyography (EMG)) and balance (force platform), and the
feedback may be auditory or visual. For biofeedback for dysphagia see section 6.21.
Evidence to recommendations
The stroke literature on biofeedback contains small to moderate sized RCTs and
systematic reviews. From the current evidence it is not possible to determine which
combinations or characteristics of feedback are most beneficial, but augmented visual
feedback in general has added value (Molier et al 2010). When feedback is directed
towards Knowledge of Performance (KP), quality of movement improves more than
when Knowledge of Results (KR) feedback is given (Cirstea and Levin 2007).
Many biofeedback machines are promoted for use after stroke but there remains
insufficient evidence of benefit to justify their use outside the context of a clinical trial
(van Dijk et al 2005; Woodford and Price 2007).
6.12.1 Recommendation
6 Recovery phase from impairments and limited activities: rehabilitation
A Stroke patients should not be offered biofeedback outside the context of a clinical
trial.
© Royal College of Physicians 2012 89