Effects of (music-based) rhythmic auditory cueing training on gait and posture post-stroke: A systematic review & dose-response meta-analysis

Shashank Ghai, Ishan Ghai, Shashank Ghai, Ishan Ghai

Abstract

Gait dysfunctions are common post-stroke. Rhythmic auditory cueing has been widely used in gait rehabilitation for movement disorders. However, a consensus regarding its influence on gait and postural recovery post-stroke is still warranted. A systematic review and meta-analysis was performed to analyze the effects of auditory cueing on gait and postural stability post-stroke. Nine academic databases were searched according to PRISMA guidelines. The eligibility criteria for the studies were a) studies were randomized controlled trials or controlled clinical trials published in English, German, Hindi, Punjabi or Korean languages b) studies evaluated the effects of auditory cueing on spatiotemporal gait and/or postural stability parameters post-stroke c) studies scored ≥4 points on the PEDro scale. Out of 1,471 records, 38 studies involving 968 patients were included in this present review. The review and meta-analyses revealed beneficial effects of training with auditory cueing on gait and postural stability. A training dosage of 20-45 minutes session, for 3-5 times a week enhanced gait performance, dynamic postural stability i.e. velocity (Hedge's g: 0.73), stride length (0.58), cadence (0.75) and timed-up and go test (-0.76). This review strongly recommends the incorporation of rhythmic auditory cueing based training in gait and postural rehabilitation, post-stroke.

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
PRISMA flow chart for the inclusion of studies.
Figure 2
Figure 2
Risk of bias across studies.
Figure 3
Figure 3
Trim and Fill funnel plot for Hedge’s g and standardized effect for each value in the meta-analysis. Each of the effect is represented in the plot as a circle. Imputed studies are represented by darkened circles. Funnel boundaries represent area where 95% of the effects are expected to lie if there were no publication biases. The vertical line represents the mean standardized effect of zero.
Figure 4
Figure 4
Forest plot illustrating individual studies evaluating the effects of rhythmic auditory cueing on gait velocity amongst post-stroke patients. Weighted effect sizes; Hedge’s g (boxes) and 95% C.I (whiskers) are presented, demonstrating repositioning errors for individual studies. The (Diamond) represents pooled effect sizes and 95% CI. A negative effect size indicated reduction in gait velocity; a positive effect size indicated enhancement in gait velocity. (CB: Cerebellum, P&M: Pons & medulla, TH: Thalamus, PU: Putamen, CR: Corona radiata, T: Treadmill).
Figure 5
Figure 5
Forest plot illustrating individual studies evaluating the effects of rhythmic auditory cueing, on stride length amongst post-stroke patients. Weighted effect sizes; Hedge’s g (boxes) and 95% C.I (whiskers) are presented, demonstrating repositioning errors for individual studies. The (Diamond) represents pooled effect sizes and 95% CI. A negative effect size indicated reduction in stride length; a positive effect size indicated enhancement in stride length. (CB: Cerebellum, P&M: Pons & medulla, TH: Thalamus, PU: Putamen, CR: Corona radiata, T: Treadmill).
Figure 6
Figure 6
Forest plot illustrating individual studies evaluating the effects of rhythmic auditory cueing, on cadence amongst post stroke patients. Weighted effect sizes; Hedge’s g (boxes) and 95% C.I (whiskers) are presented, demonstrating repositioning errors for individual studies. The (Diamond) represents pooled effect sizes and 95% CI. A negative effect size indicated reduction in cadence; a positive effect size indicated enhancement in cadence. (T: Treadmill).

References

    1. Benjamin EJ, et al. Heart disease and stroke statistics-2017 update: a report from the American Heart Association. Circulation. 2017;135:e146–e603. doi: 10.1161/CIR.0000000000000485.
    1. Amanda GT, et al. Global stroke statistics. International Journal of Stroke. 2016;12:13–32. doi: 10.1177/1747493016676285.
    1. Cerniauskaite M, et al. Quality-of-Life and Disability in Patients with Stroke. American Journal of Physical Medicine & Rehabilitation. 2012;91:S39–S47. doi: 10.1097/PHM.0b013e31823d4df7.
    1. Bhalla A, Wang Y, Rudd A, Wolfe CDA. Does Admission to Hospital Affect Trends in Survival and Dependency After Stroke Using the South London Stroke Register? Stroke. 2016;47:2269–2277. doi: 10.1161/strokeaha.116.014136.
    1. Haun J, Rittman M, Sberna M. The continuum of connectedness and social isolation during post stroke recovery. Journal of Aging Studies. 2008;22:54–64. doi: 10.1016/j.jaging.2007.03.001.
    1. Franceschini M, La Porta F, Agosti M, Massucci M. Is health-related-quality of life of stroke patients influenced by neurological impairments at one year after stroke? European journal of physical and rehabilitation medicine. 2010;46:389–399.
    1. Gorelick, P. B. & Farooq, M. U. Stroke: an emphasis on guidelines. Lancet. Neurol. 14, 2–3, 10.1016/S1474-4422(14)70290-X.
    1. Foerch C, et al. Difference in recognition of right and left hemispheric stroke. The Lancet. 2005;366:392–393. doi: 10.1016/S0140-6736(05)67024-9.
    1. Hendricks HT, van Limbeek J, Geurts AC, Zwarts MJ. Motor recovery after stroke: a systematic review of the literature. Arch Phys Med Rehabil. 2002;83:1629–1637. doi: 10.1053/apmr.2002.35473.
    1. Belda-Lois J-M, et al. Rehabilitation of gait after stroke: a review towards a top-down approach. J. Neuroeng. Rehabil. 2011;8:66–66. doi: 10.1186/1743-0003-8-66.
    1. Cho K, Lee K, Lee B, Lee H, Lee W. Relationship between Postural Sway and Dynamic Balance in Stroke Patients. Journal of Physical Therapy Science. 2014;26:1989–1992. doi: 10.1589/jpts.26.1989.
    1. Hong E. Comparison of quality of life according to community walking in stroke patients. Journal of Physical Therapy Science. 2015;27:2391–2393. doi: 10.1589/jpts.27.2391.
    1. Hubbard IJ, Parsons MW, Neilson C, Carey LM. Task‐specific training: evidence for and translation to clinical practice. Occupational therapy international. 2009;16:175–189. doi: 10.1002/oti.275.
    1. Van Peppen RP, et al. The impact of physical therapy on functional outcomes after stroke: what’s the evidence. Clin. Rehabil. 2004;18:833–862. doi: 10.1191/0269215504cr843oa.
    1. Ghai, S. Effects of real-time (sonification) and rhythmic auditory stimuli on recovering arm function post stroke: A systematic review & meta-analysis Front. Neurol Accepted, In press, 10.3389/fneur.2018.00488 (2018).
    1. Ghai, S. Effects of Real-Time (Sonification) and Rhythmic Auditory Stimuli on Recovering Arm Function PostStroke: A Systematic Review and Meta-Analysis. Front. Neurol. 9, 10.3389/fneur.2018.00488 (2018).
    1. Effenberg AO, Fehse U, Schmitz G, Krueger B, Mechling H. Movement Sonification: Effects on Motor Learning beyond Rhythmic Adjustments. Frontiers in Neuroscience. 2016;10(149):67. doi: 10.3389/fnins.2016.00219.
    1. Ghai, S., Schmitz, G., Hwang, T.-H. & Effenberg, A. O. Training proprioception with sound: Effects of real-time auditory feedback on intermodal learning. Ann. N. Y. Acad. Sci., Accepted, In press, 10.1111/nyas.13967 (2018).
    1. Ghai S, Ghai I, Schmitz G, Effenberg AO. Effect of rhythmic auditory cueing on parkinsonian gait: A systematic review and meta-analysis. Sci. Rep. 2018;8:506. doi: 10.1038/s41598-017-16232-5.
    1. Rodriguez‐Fornells A, et al. The involvement of audio–motor coupling in the music‐supported therapy applied to stroke patients. Ann. N. Y. Acad. Sci. 2012;1252:282–293. doi: 10.1111/j.1749-6632.2011.06425.x.
    1. Altenmüller E, Marco‐Pallares J, Münte T, Schneider S. Neural Reorganization Underlies Improvement in Stroke‐induced Motor Dysfunction by Music‐supported Therapy. Ann. N. Y. Acad. Sci. 2009;1169:395–405. doi: 10.1111/j.1749-6632.2009.04580.x.
    1. Käll LB, et al. The effects of a rhythm and music-based therapy program and therapeutic riding in late recovery phase following stroke: a study protocol for a three-armed randomized controlled trial. BMC neurology. 2012;12:141. doi: 10.1186/1471-2377-12-141.
    1. Bangert M, et al. Shared networks for auditory and motor processing in professional pianists: evidence from fMRI conjunction. Neuroimage. 2006;30:917–926. doi: 10.1016/j.neuroimage.2005.10.044.
    1. Bangert M, Altenmüller EO. Mapping perception to action in piano practice: a longitudinal DC-EEG study. BMC. Neurosci. 2003;4:26. doi: 10.1186/1471-2202-4-26.
    1. Ross B, Jamali S, Tremblay KL. Plasticity in neuromagnetic cortical responses suggests enhanced auditory object representation. BMC. Neurosci. 2013;14:151. doi: 10.1186/1471-2202-14-151.
    1. Ross B, Barat M, Fujioka T. Sound-Making Actions Lead to Immediate Plastic Changes of Neuromagnetic Evoked Responses and Induced beta-Band Oscillations during Perception. J. Neurosci. 2017;37:5948–5959. doi: 10.1523/jneurosci.3613-16.2017.
    1. Nascimento LR, de Oliveira CQ, Ada L, Michaelsen SM, Teixeira-Salmela LF. Walking training with cueing of cadence improves walking speed and stride length after stroke more than walking training alone: a systematic review. ‎J. Physiother. 2015;61:10–15. doi: 10.1016/j.jphys.2014.11.015.
    1. Yoo GE, Kim SJ. Rhythmic Auditory Cueing in Motor Rehabilitation for Stroke Patients: Systematic Review and Meta-Analysis. J Music Ther. 2016;53:149–177. doi: 10.1093/jmt/thw003.
    1. Zhang Y, et al. Improvement in stroke-induced motor dysfunction by music-supported therapy: a systematic review and meta-analysis. Sci. Rep. 2016;6:38521. doi: 10.1038/srep38521.
    1. Magee, W. L., Clark, I., Tamplin, J. & Bradt, J. Music interventions for acquired brain injury. The Cochrane Library (2017).
    1. Bradt, J., Magee, W. L., Dileo, C., Wheeler, B. L. & McGilloway, E. Music therapy for acquired brain injury. Cochrane Database of Systematic Reviews7 (2010).
    1. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS medicine. 2009;6:e1000097. doi: 10.1371/journal.pmed.1000097.
    1. Gasq D, et al. Between and within-day reliability of spatiotemporal gait parameters following stroke: Why measurement at maximal gait speed is required. Annals of Physical and Rehabilitation Medicine. 2017;60:e4. doi: 10.1016/j.rehab.2017.07.023.
    1. Chan PP, Tou JIS, Mimi MT, Ng SS. Reliability and validity of the timed up and go test with a motor task in people with chronic stroke. Archives of physical medicine and rehabilitation. 2017;98:2213–2220. doi: 10.1016/j.apmr.2017.03.008.
    1. Elkins MR, Herbert RD, Moseley AM, Sherrington C, Maher C. Rating the Quality of Trials in Systematic Reviews of Physical Therapy Interventions. Cardiopulmonary Physical Therapy Journal. 2010;21:20–26. doi: 10.1097/01823246-201021030-00005.
    1. de Morton NA. The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study. Australian Journal of Physiotherapy. 2009;55:129–133. doi: 10.1016/S0004-9514(09)70043-1.
    1. Maher CG, Sherrington C, Herbert RD, Moseley AM, Elkins M. Reliability of the PEDro scale for rating quality of randomized controlled trials. Physical therapy. 2003;83:713–721.
    1. Teasell, R. et al. Evidence-Based Review of Stroke Rehabilitation: executive summary, 12th edition. Topics in stroke rehabilitation 16, 463–488, 10.1310/tsr1606-463 (2009).
    1. Borenstein M, Hedges LV, Higgins J, Rothstein HR. A basic introduction to fixed‐effect and random‐effects models for meta‐analysis. Research synthesis methods. 2010;1:97–111. doi: 10.1002/jrsm.12.
    1. Higgins, J. P. & Green, S. Cochrane handbook for systematic reviews of interventions. Vol. 4 (John Wiley & Sons, 2011).
    1. Cumming, G. Understanding the new statistics: Effect sizes, confidence intervals, and meta-analysis. (Routledge, 2013).
    1. Cohen, J. Statistical power analysis for the behavioral sciences. 2nd edn, (L, Erlbaum Associates, 1988).
    1. Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ: British Medical Journal. 2003;327:557–560. doi: 10.1136/bmj.327.7414.557.
    1. Cooper, H., Hedges, L. V. & Valentine, J. C. The handbook of research synthesis and meta-analysis. (Russell Sage Foundation, 2009).
    1. Sue D, Richard T. Trim and Fill: A Simple Funnel-Plot–Based Method of Testing and Adjusting for Publication Bias in Meta-Analysis. Biometrics. 2000;56:455–463. doi: 10.1111/j.0006-341X.2000.00455.x.
    1. Borenstein, M. Software for publication bias. Publication bias in meta-analysis: Prevention, assessment and adjustments, 193–220 (2005).
    1. Hashiguchi Y, et al. Effect of rhythmic auditory stimulation on gait parameters and gait emg in patients with hemiplegia after stroke. Gait. Posture. 2014;39:S139. doi: 10.1016/j.gaitpost.2014.04.199.
    1. Kim J-S, Oh D-W. Home-based auditory stimulation training for gait rehabilitation of chronic stroke patients. Journal of Physical Therapy Science. 2012;24:775–777. doi: 10.1589/jpts.24.775.
    1. Schauer M, Mauritz KH. Musical motor feedback (MMF) in walking hemiparetic stroke patients: randomized trials of gait improvement. Clin Rehabil. 2003;17:713–722. doi: 10.1191/0269215503cr668oa.
    1. Fouad MA, Mousa G. Effect of rhythmic auditory stimulation on gait in patients with stroke. Parkinsonism & Related Disorders. 2016;22:e125. doi: 10.1016/j.parkreldis.2015.10.295.
    1. Sangita K, Remya N. The Effect of Rhythmic Auditory Stimulation in Gait Training among Stroke Patients. Indian Journal of Physiotherapy and Occupational Therapy-An International Journal. 2016;10:61–66. doi: 10.5958/0973-5674.2016.00120.9.
    1. Oh Y-S, Kim H-S, Woo Y-K. Effects of rhythmic auditory stimulation using music on gait with stroke patients. Physical Therapy Korea. 2015;22:81–90. doi: 10.12674/ptk.2015.22.3.081.
    1. Kobinata N, Ueno M, Imanishi Y, Yoshikawa H. Immediate effects of rhythmic auditory stimulation on gait in stroke patients in relation to the lesion site. Journal of Physical Therapy Science. 2016;28:2441–2444. doi: 10.1589/jpts.28.2441.
    1. Ghai, S., Ghai, I. & Effenberg, A. O. Effect of rhythmic auditory cueing on aging gait: a systematic review and meta-analysis. Aging. Dis., 131–200 (2017).
    1. Hayden R, Clair AA, Johnson G, Otto D. The effect of rhythmic auditory stimulation (RAS) on physical therapy outcomes for patients in gait training following stroke: a feasibility study. International Journal of Neuroscience. 2009;119:2183–2195. doi: 10.3109/00207450903152609.
    1. Handley A, Medcalf P, Hellier K, Dutta D. Movement disorders after stroke. Age and ageing. 2009;38:260–266. doi: 10.1093/ageing/afp020.
    1. Hallett, M. The intrinsic and extrinsic aspects of freezing of gait. Movement Disorders23 (2008).
    1. Nombela C, Hughes LE, Owen AM, Grahn JA. Into the groove: can rhythm influence Parkinson’s disease? Neuroscience & Biobehavioral Reviews. 2013;37:2564–2570. doi: 10.1016/j.neubiorev.2013.08.003.
    1. Nieuwboer A, et al. Cueing training in the home improves gait-related mobility in Parkinson’s disease: the RESCUE trial. Journal of Neurology, Neurosurgery & Psychiatry. 2007;78:134–140. doi: 10.1136/jnnp.200X.097923.
    1. Ghai, S. & Ghai, I. Role of sonification and rhythmic auditory cueing for enhancing gait associated deficits induced by neurotoxic cancer therapies: A perspective on auditory neuroprosthetics. Frontiers in Neurology Accepted, In Press, 10.3389/fneur.2019.00021 (2019).
    1. Repp BH, Su YH. Sensorimotor synchronization: a review of recent research (2006–2012) Psychon. Bull. Rev. 2013;20:403–452. doi: 10.3758/s13423-012-0371-2.
    1. Schwartze M, Keller PE, Patel AD, Kotz SA. The impact of basal ganglia lesions on sensorimotor synchronization, spontaneous motor tempo, and the detection of tempo changes. Behav Brain Res. 2011;216:685–691. doi: 10.1016/j.bbr.2010.09.015.
    1. Scholz DS, Rhode S, Großbach M, Rollnik J, Altenmüller E. Moving with music for stroke rehabilitation: a sonification feasibility study. Ann. N. Y. Acad. Sci. 2015;1337:69–76. doi: 10.1111/nyas.12691.
    1. Fujioka T, Ween JE, Jamali S, Stuss DT, Ross B. Changes in neuromagnetic beta‐band oscillation after music‐supported stroke rehabilitation. Ann. N. Y. Acad. Sci. 2012;1252:294–304. doi: 10.1111/j.1749-6632.2011.06436.x.
    1. Fujioka T, Trainor LJ, Large EW, Ross B. Internalized timing of isochronous sounds is represented in neuromagnetic beta oscillations. J. Neurosci. 2012;32:1791–1802. doi: 10.1523/JNEUROSCI.4107-11.2012.
    1. Thaut MH, McIntosh GC. Neurologic Music Therapy in Stroke Rehabilitation. Current Physical Medicine and Rehabilitation Reports. 2014;2:106–113. doi: 10.1007/s40141-014-0049-y.
    1. Thaut, M. H. Rhythm, music, and the brain: Scientific foundations and clinical applications. Vol. 7 (Routledge, 2005).
    1. Thaut MH, Abiru M. Rhythmic auditory stimulation in rehabilitation of movement disorders: a review of current research. Music Perception: An Interdisciplinary Journal. 2010;27:263–269. doi: 10.1525/mp.2010.27.4.263.
    1. Ghai, S., Schmitz, G., Hwang, T.-H. & Effenberg, A. O. Auditory Proprioceptive Integration: Effects of Real-Time Kinematic Auditory Feedback on Knee Proprioception. Front. Neurosci. 12, 10.3389/fnins.2018.00142 (2018).
    1. Ghai S, Ghai I, Effenberg AO. Effect of rhythmic auditory cueing on gait in cerebral palsy: a systematic review and meta-analysis. Neuropsychiatr. Dis. Treat. 2018;14:43–59. doi: 10.2147/ndt.s148053.
    1. Ghai S, Ghai I, Effenberg AO. “Low road” to rehabilitation: a perspective on subliminal sensory neuroprosthetics. ‎Neuropsychiatr. Dis. Treat. 2018;14:301. doi: 10.2147/NDT.S153392.
    1. Thaut MH, McIntosh GC, Hoemberg V. Neurobiological foundations of neurologic music therapy: rhythmic entrainment and the motor system. Front. Psychol. 2014;5:1185. doi: 10.3389/fpsyg.2014.01185.
    1. Rossignol S, Jones GM. Audio-spinal influence in man studied by the H-reflex and its possible role on rhythmic movements synchronized to sound. Electroencephalogr Clin Neurophysiol. 1976;41:83–92. doi: 10.1016/0013-4694(76)90217-0.
    1. Thaut MH, McIntosh GC, Prassas SG, Rice RR. Effect of rhythmic auditory cuing on temporal stride parameters and EMG. Patterns in hemiparetic gait of stroke patients. Journal of Neurologic Rehabilitation. 1993;7:9–16.
    1. Schaefer RS. Auditory rhythmic cueing in movement rehabilitation: findings and possible mechanisms. Philosophical Transactions of the Royal Society B: Biological Sciences. 2014;369:20130402. doi: 10.1098/rstb.2013.0402.
    1. Kleim JA, Jones TA. Principles of experience-dependent neural plasticity: implications for rehabilitation after brain damage. Journal of speech, language, and hearing research: JSLHR. 2008;51:S225–239. doi: 10.1044/1092-4388(2008/018).
    1. Höner, O., Hunt, A., Pauletto, S., Röber, N., Hermann, T., & Effenberg, A. O. Aiding movement with sonification in “exercise, play and sport”. The sonification handbook, 525–553 (2011).
    1. Ghai Shashank, Driller Matthew, Ghai Ishan. Effects of joint stabilizers on proprioception and stability: A systematic review and meta-analysis. Physical Therapy in Sport. 2017;25:65–75. doi: 10.1016/j.ptsp.2016.05.006.
    1. Ghai Shashank, Driller MatthewW, Masters RichSW. The influence of below-knee compression garments on knee-joint proprioception. Gait & Posture. 2018;60:258–261. doi: 10.1016/j.gaitpost.2016.08.008.
    1. Effenberg, A. O., Hwang, T.-H., Ghai, S., & Schmitz, G. Auditory Modulation of Multisensory Representations. In: M. Aramaki, M. Davis, R. Kronland-Martinet, S. Ystad, (Hrgs.). Music Technology with Swing. CMMR. 2017. Lecture Notes in Computer Science, vol. 11265. Springer, Cham. 10.1007/978-3-030-01692-0_20 (2018).
    1. Effenberg AO, Schmitz G. Acceleration and deceleration at constant speed: systematic modulation of motion perception by kinematic sonification. Annals of the New York Academy of Sciences. 2018;1425:52–69. doi: 10.1111/nyas.13693.
    1. Turton AJ, et al. Home-based reach-to-grasp training for people after stroke: study protocol for a feasibility randomized controlled trial. Trials. 2013;14:109–109. doi: 10.1186/1745-6215-14-109.
    1. Koch LV, Wottrich AW, Holmqvist LW. Rehabilitation in the home versus the hospital: the importance of context. Disability and rehabilitation. 1998;20:367–372. doi: 10.3109/09638289809166095.
    1. Conklyn D, et al. A home-based walking program using rhythmic auditory stimulation improves gait performance in patients with multiple sclerosis: a pilot study. Neurorehabil Neural Repair. 2010;24:835–842. doi: 10.1177/1545968310372139.
    1. Van Tulder M, Furlan A, Bombardier C, Bouter L, Group EB. o. t. C. C. B. R. Updated method guidelines for systematic reviews in the cochrane collaboration back review group. Spine. 2003;28:1290–1299.
    1. Crumley ET, Wiebe N, Cramer K, Klassen TP, Hartling L. Which resources should be used to identify RCT/CCTs for systematic reviews: a systematic review. BMC Medical Research Methodology. 2005;5:24–24. doi: 10.1186/1471-2288-5-24.
    1. Bryant M, Rintala D, Lai E, Protas E. An evaluation of self-administration of auditory cueing to improve gait in people with Parkinson’s disease. Clin. Rehabil. 2009;23:1078–1085. doi: 10.1177/0269215509337465.
    1. Ghai, S. & Ghai, I. Effects of Rhythmic Auditory Cueing in Gait Rehabilitation forMultiple Sclerosis: A Mini Systematic Review and Meta-Analysis. Front. Neurol. 9, 10.3389/fneur.2018.00386 (2018).
    1. Sharma S, et al. Telestroke in resource-poor developing country model. Neurology India. 2016;64:934–940. doi: 10.4103/0028-3886.190243.
    1. Muto T, Herzberger B, Hermsdoerfer J, Miyake Y, Poeppel E. Interactive cueing with walk-mate for hemiparetic stroke rehabilitation. J. Neuroeng. Rehabil. 2012;9:58. doi: 10.1186/1743-0003-9-58.
    1. Muto, T., Herzberger, B., Hermsdorfer, J., Miyake, Y. & Poppel, E. In Intelligent Robots and Systems, IROS 2007. IEEE/RSJ International Conference on. 2268–2274 (IEEE) (2007).
    1. Wu, A. Is robot-assisted gait training more effective on improving gait velocity and balance in poststroke patients compared to conventional overground gait training? a meta-analysis, (2017).
    1. Polese JC, Ada L, Dean CM, Nascimento LR, Teixeira-Salmela LF. Treadmill training is effective for ambulatory adults with stroke: a systematic review. J. Physiother. 2013;59:73–80. doi: 10.1016/S1836-9553(13)70159-0.
    1. Veerbeek JM, et al. What Is the Evidence for Physical Therapy Poststroke? A Systematic Review and Meta-Analysis. PLoS. One. 2014;9:e87987. doi: 10.1371/journal.pone.0087987.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren