Fifteen million people in the world each year have a stroke, with 85% of survivors losing upper limb function, unable to do everyday tasks, such as using a knife and fork, unscrewing tops off jars, or doing up buttons. Six months later, 60% of severely impaired and 30% of moderately impaired survivors are still unable to perform many activities of daily life, work, and leisure unassisted. This lack of use can persist for years and adversely affect the survivor’s quality of life and participation. Stroke survivors themselves cite insufficient upper limb recovery as one of the major barriers to achieving a good quality of life after stroke.
The majority of survivors are discharged to their usual residence. Current community rehabilitation for the upper limb after stroke is therapist-led, with most of the therapy being in-person treatment from the therapist, with supplementary practice by the survivor. The costs of providing in-person treatment means the period of rehabilitation is relatively short. For example, in Australia, people receive approximately 6 weeks of inpatient therapy, then an additional outpatient or day hospital rehabilitation or home-based community rehabilitation for a further approximate 6 weeks, at which time therapy ceases.
It is not surprising that many people do not recover good arm and hand function, as recovery occurs through neuroplasticity, which requires thousands of repetitions of movements to create the neural pathways underlying learned movements. Neuroplasticity takes time, extending long after the initial 12-weeks into several years after stroke. Health systems are unlikely to ever provide this longer period of therapy. Therefore, there is a pressing need to focus on how rehabilitation can best be managed at home beyond 12-weeks. An overall aim is for practice to persist for the months and years following stroke, until the person feels they have reached their maximum potential.
This Research Topic aims to explore solutions and ideas about how to organize and enable upper limb home-based training. We welcome articles describing effectiveness of therapeutic interventions and the evaluation of new techniques and methods, as well as high quality discussion, theoretical, and point of view articles. Contributions that explore, innovate, and evaluate the best ways to self-manage continued upper limb practice at home, for example using co-design with stroke survivors, are welcomed. Articles exploring the following example aspects of therapy at home to reduce upper limb functional impairment could be included:
1) how therapy is managed in the home or how it could be delivered;
2) scheduling of training and practice, and the amount required;
3) who delivers or supervises the therapy (e.g., combinations of therapists, therapy assistants, exercise physiologists, personal trainers);
4) blending of home therapy with therapy at other locations, such as outpatient hospital departments or community locations including gymnasiums.
We encourage authors to contact us with related suggestions not listed here.
Articles exploring the wider issues that influence practice and recovery of upper limb, are also of interest, such as:
5) The patient experience and self-efficacy.
6) Brain recovery and neuroplasticity that relate to upper limb recovery at home.
7) Robotic, virtual reality, and gaming devices that can be used at home to enhance upper limb recovery.
Topic Editor, Paulette van Vliet, is the owner of Central Coast Neuro Rehab. The other Topic Editors declare no competing interests with regard to the Research Topic subject.
Fifteen million people in the world each year have a stroke, with 85% of survivors losing upper limb function, unable to do everyday tasks, such as using a knife and fork, unscrewing tops off jars, or doing up buttons. Six months later, 60% of severely impaired and 30% of moderately impaired survivors are still unable to perform many activities of daily life, work, and leisure unassisted. This lack of use can persist for years and adversely affect the survivor’s quality of life and participation. Stroke survivors themselves cite insufficient upper limb recovery as one of the major barriers to achieving a good quality of life after stroke.
The majority of survivors are discharged to their usual residence. Current community rehabilitation for the upper limb after stroke is therapist-led, with most of the therapy being in-person treatment from the therapist, with supplementary practice by the survivor. The costs of providing in-person treatment means the period of rehabilitation is relatively short. For example, in Australia, people receive approximately 6 weeks of inpatient therapy, then an additional outpatient or day hospital rehabilitation or home-based community rehabilitation for a further approximate 6 weeks, at which time therapy ceases.
It is not surprising that many people do not recover good arm and hand function, as recovery occurs through neuroplasticity, which requires thousands of repetitions of movements to create the neural pathways underlying learned movements. Neuroplasticity takes time, extending long after the initial 12-weeks into several years after stroke. Health systems are unlikely to ever provide this longer period of therapy. Therefore, there is a pressing need to focus on how rehabilitation can best be managed at home beyond 12-weeks. An overall aim is for practice to persist for the months and years following stroke, until the person feels they have reached their maximum potential.
This Research Topic aims to explore solutions and ideas about how to organize and enable upper limb home-based training. We welcome articles describing effectiveness of therapeutic interventions and the evaluation of new techniques and methods, as well as high quality discussion, theoretical, and point of view articles. Contributions that explore, innovate, and evaluate the best ways to self-manage continued upper limb practice at home, for example using co-design with stroke survivors, are welcomed. Articles exploring the following example aspects of therapy at home to reduce upper limb functional impairment could be included:
1) how therapy is managed in the home or how it could be delivered;
2) scheduling of training and practice, and the amount required;
3) who delivers or supervises the therapy (e.g., combinations of therapists, therapy assistants, exercise physiologists, personal trainers);
4) blending of home therapy with therapy at other locations, such as outpatient hospital departments or community locations including gymnasiums.
We encourage authors to contact us with related suggestions not listed here.
Articles exploring the wider issues that influence practice and recovery of upper limb, are also of interest, such as:
5) The patient experience and self-efficacy.
6) Brain recovery and neuroplasticity that relate to upper limb recovery at home.
7) Robotic, virtual reality, and gaming devices that can be used at home to enhance upper limb recovery.
Topic Editor, Paulette van Vliet, is the owner of Central Coast Neuro Rehab. The other Topic Editors declare no competing interests with regard to the Research Topic subject.
