Clinical Evidence

Clinical evidences of the multiple benefits of the therapies provided by the Lambda are widely represented in the litterature. Here you will find various examples along with publication references of principles used in the Lambda concept.

Feedback

Feedback to patients as to how they perform motor tasks during gait rehabilitation has been shown to improve performance and learning. Taking into consideration all types of sensory feedback, in aggregate was associated with significant short and long-term outcomes [4].

Bilateral Training

Symmetric movements of the paretic and nonparetic limb related with bilateral training reduce the disinhibition of the corticomotor networks and improve the motor control [16].

Robotic Training

People who receive electromechanical-assisted gait training in combination with physiotherapy after stroke are more likely to achieve independent walking than people who receive gait training without these devices [12].

End-effector

They are significantly higher rates of independent walking in end-effector compared with exoskeleton-based training [13].

Intensity

Post-stroke rehabilitation increases motor brain reorganization, while lack of rehabilitation reduces reorganization. Functional reorganization of cortex is greater for tasks that are meaningful; repetitive activity is not enough [4]. More intensive motor training increases brain reorganization. The greater the intensity of therapies, the better the outcomes [4].

Repetitive and progressive

As with all aspects of stroke rehabilitation, the training regimen should emphasize repetition, gradually progressive task difficulty, adaptive training and functional practice [3],[5]. Patients should engage in training that is meaningful, engaging, progressively adaptive, intensive, task-specific and goal-oriented in an effort to improve transfer skills and mobility. Patients should receive rehabilitation therapies of appropriate intensity and duration, individually designed to meet their needs for optimal recovery and tolerance levels [6]. Interventions involving repetitive practice improve strength after stroke, and these improvements are accompanied by improvements in activity [10].

Cost Effective

Solutions, which allow efficient use of the physical therapist’s time, are requested. Therapies that make possible for patients to exercise for longer within the same available time slot, which may save costs, are more and more necessary [7]. There is an association between effect size and additional treatment time [8].

Assessment

Periodic assessments with the same standardized tools to document progress in rehabilitation are needed [3].

Virtual Reality

Virtual Reality helps the patient to obtain an illusion of movement and thereby more vividly get engaged mentally in the training [9]. When VR therapy replaced standard rehab, walking speed, balance and mobility were significantly improved [14].

Mirror Therapy

There is evidence that mirror therapy in combination with other therapies or alone improves motor function following stroke [4], [15].

Spasticity

When spasticity is present, the cost of care is 4 times higher than when spasticity is absent. The prevalence of post stroke spasticity in any limb is in the range of 25% to 43% over the first year after stroke [3].

Bibliographic references

[1]
Intercollegiate Stroke Working Party, “National clinical guideline for stroke,” 2016.
[2]
Haute Autorité de Santé (HAS), “Accident vasculaire cérébral : méthodes de rééducation de la fonction motrice chezl’adulte - Argumentaire scientifique,” 2012.
[3]
C. J. Winstein et al., “Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for HealthcareProfessionals from the American Heart Association/American Stroke Association,” Stroke, vol. 47, no. 6. 2016.
[4]
R. Teasell, “Stroke Rehabilitation Clinician Handbook 2016,” Clin. Handb., vol. 0, pp. 1–230, 2016.
[5]
P. Lindsay, K. L. Furie, S. M. Davis, G. A. Donnan, and B. Norrving, “World stroke organization global stroke servicesguidelines and action plan,” Int. J. Stroke, vol. 9, no. A100, pp. 4–13, 2014.
[6]
D. Hebert et al., “Canadian stroke best practice recommendations: Stroke rehabilitation practice guidelines, update2015,” Int. J. Stroke, vol. 11, no. 4, pp. 459–484, 2016.
[7]
Royal Dutch Society for Physical Therapy, “KNGF Clinical Practice Guideline for Physical Therapy in patients withstroke,” 2014.
[8]
G. Kwakkel, B. Kollen, and J. Twisk, “Impact of time on improvement of outcome after stroke,” Stroke, vol. 37, no. 9,pp. 2348–2353, 2006.
[9]
J. B. Nielsen, M. Willerslev-Olsen, L. Christiansen, J. Lundbye-Jensen, and J. Lorentzen, “Science-basedneurorehabilitation: recommendations for neurorehabilitation from basic science.,” J. Mot. Behav., vol. 47, no. 1, pp.7–17, 2015.
[10]
D. G. de Sousa, L. A. Harvey, S. Dorsch, and J. V. Glinsky, “Interventions involving repetitive practice improve strengthafter stroke: a systematic review,” J. Physiother., vol. 64, no. 4, pp. 210–221, 2018.
[11]
D. Saunders et al., “Physical fitness training for stroke patients,” Cochrane Database Syst. Rev., no. 3, 2016.
[12]
J. Mehrholz, S. Thomas, C. Werner, J. Kugler, M. Pohl, and B. Elsner, “Electromechanical-Assisted Training forWalking After Stroke: A Major Update of the Evidence.,” Stroke, Jun. 2017.
[13]
J. Mehrholz and M. Pohl, “Electromechanical-assisted gait training after stroke: A systematic review comparing end-effector and exoskeleton devices,” J. Rehabil. Med., vol. 44, no. 3, pp. 193–199, 2012.J. Mehrholz and M. Pohl, “Electromechanical-assisted gait training after stroke: A systematic review comparing end-effector and exoskeleton devices,” J. Rehabil. Med., vol. 44, no. 3, pp. 193–199, 2012.
[14]
D. Corbetta, F. Imeri, and R. Gatti, “Rehabilitation that incorporates virtual reality is more effective than standardrehabilitation for improving walking speed, balance and mobility after stroke: A systematic review,” J. Physiother., vol.61, no. 3, pp. 117–124, 2015.
[15]
H. Thieme et al., “Mirror therapy for improving motor function after stroke,” Cochrane Database Syst. Rev., no. 7, 2018.
[16]
D. A. Cunningham, K. A. Potter-Baker, J. S. Knutson, V. Sankarasubramanian, A. G. Machado, and E. B. Plow,“Tailoring Brain Stimulation to the Nature of Rehabilitative Therapies in Stroke. A Conceptual Framework Based ontheir Unique Mechanisms of Recovery,” Phys. Med. Rehabil. Clin. N. Am., vol. 26, no. 4, pp. 759–774, 2015.