1. Use of the novel optokinetic chart stimulation based OKCSIB protocol for upper limb recovery in dense acute strokes: Insights for future research from a case control series

2. Background  Globally: stroke is one of the most devastating of all neurological diseases  often leads to death, physical impairment and disability (Mukherjee & Patil, 2011)  Upper limb rehabilitation: remains a huge problem in people with dense stroke ( Hayward & Brauer, 2014)  Arm recovery: correlated to daily life autonomy in strokes (Smania et al., 2009; Likhi et al., 2013)

3. The extensor system and the UL  Loss of extensor strength in the affected UL is correlated to poor UL activity and function (Turk, Burridge & Simpson, 2012).  A third of stroke patients go on to develop spasticity of the affected UL (Kanovsky, & Fernandez, 2011)  IMPORTANT to find rehabilitation interventions that improve UL recovery and THUS reduce spasticity of the UL in dense strokes

4. Aim  To explore if use of the optokinetic chart based OKCSIB protocol had led to better and long lasting UL recovery when compared to conventional neurophysiotherapy using a retrospective case control series

5. Methodology Design: retrospective case control series in the community Ethics: favourable opinion from Kent Research Ethics Committee Optokinetic chart was moved for 3 minutes each of lateral, vertical and forwards. Chart placed 20 cm in front of participant

6. Sampling Procedure Sampling

7. Results  8 participants consented to be followed up 3 years after their stroke.  Equal number of participants who had been treated by OKCSIB protocol and conventional neuro- physiotherapy (n=4 respectively)

10. Variable OKCSIB Protocol Value (SD) Conventional Value (SD) p UL STREAM 18.8 (1.5) 9.8 (6.9) 0.04 MAS 0 (100%) 0 (25%) 0.04 4 (75%)

11.  OKCSIB protocol: statistically significant improvement in UL recovery  Striking finding: absence of affected hand spasticity in the OKCSIB group

12.  Key is in the rehabilitation of the anti-gravity extensor system which supports muscle tone.  Normal muscle tone is a prerequisite for normal movement  Research to start with completely hemiplegic parietal centred stroke as any method that can cause recovery of such strokes can reduce intensity as well as length of recovery in hemiparesis  Research on hemiparesis can then focus on speed of recovery.