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Open Access Study protocol

Cost-effectiveness of a structured progressive task-oriented circuit class training programme to enhance walking competency after stroke: The protocol of the FIT-Stroke trial

Ingrid GL van de Port*, Lotte Wevers, Hanneke Roelse, Lenneke van Kats, Eline Lindeman and Gert Kwakkel

BMC Neurology 2009, 9:43  doi:10.1186/1471-2377-9-43

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Neuro developmental approach

Paule Morbois   (2010-07-12 15:16)  none

A few comments relevant to your article and per se your study of adult stroke patients.
The neurodevelopmental approach (Bobath) has for decades emphasized on purposeful activities for patients with spasticity or low muscle tones or fluctuating muscle tone. Where purposeful activities reinforce the willingness of patients to practice activities, enhancing the natural motor pathways in the brain and perhaps help developping the emergence of collateral pathways where the main motor pathways may have been damaged during the stroke.
This, however is not only confined to stroke patients but to everybody in life. If purposeless activities are presented to anyone, the reluctancy to practice any activity becomes obvious and no progress may be observed, including in the non stroke community.
Group therapy does involve some social interaction amongst participating patients and enhance those patients in further their "diminished skills" (either communication or motor).
The Peto system is also another good example of what can be done and achieved in group therapy, whether for stroke patients or any other type of neurological disorder.
The sensory integration system based on Jean Ayres theory has proven an excellent approach too to any neurological disorder and again this theory is based on purposeful activities and sometimes great fun for the patients.
Many rehabilitation centres around the world have associated these treatment approaches with fairly good results, sometimes with excellent results.

There is however a question I would like to raise as to the assessement you propose in your study, you include nowhere the assessment of spasticity or the reduction of tone of those stroke patients either in the upper of lower extremities. Is it something your study has intentionally omitted as being irrelevant to the main approach of the study you present or something which does not seem to be relevant when involving stroke patients in group activity?

And finally my last question, do you think it is normal that cost should be involved when treating patients and cost effectiveness should ever be considered in health care?
I find cost effectiveness is only a confounding factor when treating patients and not either a cause or an end in itself because much time may be devoted to patients, in this case stroke patients and yet their treatment approach may be biased, superficial or inadequate either in individual treatment or group treatment. The cost effectiveness comes from having a ethically informed therapists and doctors, supporting entourage and willing patients, and this is why cost effectiveness is a confounding factor and its complexity in resolving cost effectiveness is beyond the scope of research based on outcome of treatments per se, yet one which would include the background of therapists, entourage support and doctors inputs and also maybe the preferences of the patients to either type of treatments which ultimately enhance the participation of any patient.

Interesting study, indeed.

truthfully,



Competing interests

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