451
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Kegelmeyer DA, Kloos AD, Siles AB. Selecting measures for balance and mobility to improve assessment and treatment of individuals after stroke. Top Stroke Rehabil 2014; 21:303-15. [PMID: 25150662 DOI: 10.1310/tsr2104-303] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Assessment of individuals with stroke using reliable and valid outcome measures is a key component of the treatment planning process. Health care professionals may have difficulty selecting balance and mobility measures given the large number of measures to choose from. This article utilizes a case-based approach to describe the benefits of using a common set of outcome measures and a process for selecting optimal measures across body structure/function, activity, and participation domains of the International Classification of Functioning, Disability and Health (ICF) model and stages of stroke recovery. Specific measures for use in acute care, rehabilitation, outpatient, and home health care settings are discussed based on StrokEDGE task force recommendations by the Neurology Section of the American Physical Therapy Association.
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Affiliation(s)
- Deb A Kegelmeyer
- Division of Physical Therapy, The Ohio State University, College of Medicine, Columbus, Ohio
| | - Anne D Kloos
- Division of Physical Therapy, The Ohio State University, College of Medicine, Columbus, Ohio
| | - Amelia B Siles
- Division of Physical Therapy, The Ohio State University, College of Medicine, Columbus, Ohio
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452
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Rosa MCN, Marques A, Demain S, Metcalf CD. Knee posture during gait and global functioning post-stroke: a theoretical ICF framework using current measures in stroke rehabilitation. Disabil Rehabil 2014; 37:904-13. [DOI: 10.3109/09638288.2014.948132] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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453
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Takahashi J, Takami A, Wakayama S. Clinical Reasoning of Physical Therapists regarding In-hospital Walking Independence of Patients with Hemiplegia. J Phys Ther Sci 2014; 26:771-5. [PMID: 24926149 PMCID: PMC4047249 DOI: 10.1589/jpts.26.771] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 12/20/2013] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Physical therapists must often determine whether hemiparetic patients can walk
independently. However, there are no criteria, so decisions are often left to individual
physical therapists. The purpose of this study was to explore how physical therapists
determine whether a patient with hemiplegia can walk independently in a ward. [Methods]
The subjects were 15 physical therapists with experience of stroke patients’
rehabilitation. We interviewed them using semi-structured interviews related to the
criteria of the states of walking in the ward of hemiparetic patients. The interviews were
transcribed in full, and the texts were analyzed by coding and grouping. [Results] From
the results of the interviews, PTs determined patients’ independence of walking in
hospital by observation of behavior during walking or treatment. The majority of PTs
focused on the patients’ state during walking, higher brain function, and their ability to
balance. In addition, they often asked ward staff about patients’ daily life, and
self-determination. [Conclusions] We identified the items examined by physical therapists
when determining the in-hospital walking independence of stroke patients. Further
investigation is required to examine which of these items are truly necessary.
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Affiliation(s)
- Junpei Takahashi
- Department of Rehabilitation, Faculty of Medical Science and Welfare, Tohoku Bunka Gakuen University, Japan ; Hirosaki University Graduate School of Health Sciences, Japan
| | - Akiyoshi Takami
- Hirosaki University Graduate School of Health Sciences, Japan
| | - Saichi Wakayama
- Hirosaki University Graduate School of Health Sciences, Japan
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454
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Chung BPH. Effect of different combinations of physiotherapy treatment approaches on functional outcomes in stroke patients: A retrospective analysis. Hong Kong Physiother J 2014. [DOI: 10.1016/j.hkpj.2013.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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455
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Gjelsvik BEB, Hofstad H, Smedal T, Eide GE, Næss H, Skouen JS, Frisk B, Daltveit S, Strand LI. Balance and walking after three different models of stroke rehabilitation: early supported discharge in a day unit or at home, and traditional treatment (control). BMJ Open 2014; 4:e004358. [PMID: 24833680 PMCID: PMC4025466 DOI: 10.1136/bmjopen-2013-004358] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To compare the effects on balance and walking of three models of stroke rehabilitation: early supported discharge with rehabilitation in a day unit or at home, and traditional uncoordinated treatment (control). DESIGN Group comparison study within a randomised controlled trial. SETTING Hospital stroke unit and primary healthcare. INCLUSION CRITERIA a score of 2-26 on National Institutes of Health Stroke Scale, assessed with Postural Assessment Scale for Stroke (PASS), and discharge directly home from the hospital stroke unit. INTERVENTIONS Two intervention groups were given early supported discharge with treatment in either a day unit or the patient's own home. The controls were offered traditional, uncoordinated treatment. OUTCOME MEASURES Primary: PASS. Secondary: Trunk Impairment Scale-modified Norwegian version; timed Up-and-Go; 5 m timed walk; self-reports on problems with walking, balance, ADL, physical activity, pain and tiredness. The patients were tested before randomisation and 3 months after inclusion. RESULTS From a total of 306 randomised patients, 167 were tested with PASS at baseline and discharged directly home. 105 were retested at 3 months: mean age 69 years, 63 men, 27 patients in day unit rehabilitation, 43 in home rehabilitation and 35 in a control group. There were no group differences, either at baseline for demographic and test data or for length of stroke unit stay. At 3 months, there was no group difference in change on PASS (p>0.05). Some secondary measures tended to show better outcome for the intervention groups, that is, trunk control, median (95% CI): day unit, 2 (0.28 to 2.31); home rehabilitation, 4 (1.80 to 3.78); control, 1 (0.56 to 2.53), p=0.044; and for self-report on walking, p=0.021 and ADL, p=0.016. CONCLUSIONS There was no difference in change between the groups for postural balance, but the secondary outcomes indicated that improvement of trunk control and walking was better in the intervention groups than in the control group. TRIAL REGISTRATION This study is part of the Early Supported Discharge after Stroke in Bergen, ClinicalTrials.gov (NCT00771771).
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Affiliation(s)
- Bente Elisabeth Bassøe Gjelsvik
- Department of Physiotherapy, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, Physiotherapy Research Group, University of Bergen, Norway
| | - Håkon Hofstad
- Department of Global Public Health and Primary Care, Physiotherapy Research Group, University of Bergen, Norway
- Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway
| | - Tori Smedal
- Department of Physiotherapy, Haukeland University Hospital, Bergen, Norway
| | - Geir Egil Eide
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - Halvor Næss
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
- Centre for Age-related Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Jan Sture Skouen
- Department of Global Public Health and Primary Care, Physiotherapy Research Group, University of Bergen, Norway
- Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway
| | - Bente Frisk
- Department of Physiotherapy, Haukeland University Hospital, Bergen, Norway
| | - Silje Daltveit
- Department of Physiotherapy, Haukeland University Hospital, Bergen, Norway
| | - Liv Inger Strand
- Department of Physiotherapy, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, Physiotherapy Research Group, University of Bergen, Norway
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456
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McDonnell MN, Mackintosh SF, Hillier SL, Bryan J. Regular group exercise is associated with improved mood but not quality of life following stroke. PeerJ 2014; 2:e331. [PMID: 24749010 PMCID: PMC3976114 DOI: 10.7717/peerj.331] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 03/13/2014] [Indexed: 11/30/2022] Open
Abstract
Purpose. People with stroke living in the community have an increased prevalence of depression and lower quality of life than healthy older adults. This cross-sectional observational study investigated whether participation in regular exercise was associated with improved mood and quality of life. Methods. We recruited three groups of community dwelling participants: 13 healthy older adults, 17 adults post-stroke who regularly participated in group exercise at a community fitness facility and 10 adults post-stroke who did not regularly exercise. We measured mood using the Depression, Anxiety, Stress Scale (DASS) and quality of life using the Assessment of Quality of Life (AQoL) scale. Results. Levels of stress and depression were significantly greater in the people with stroke who did not undertake regular exercise (p = 0.004 and p = 0.004 respectively), although this group had more recent strokes (p < 0.001). Both stroke groups had lower quality of life scores (p = 0.04) than the healthy adults. Conclusions. This small, community-based study confirms that people following stroke report poorer quality of life than stroke-free individuals. However, those who exercise regularly have significantly lower stress and depression compared to stroke survivors who do not. Future research should focus on the precise type and amount of exercise capable of improving mood following stroke.
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Affiliation(s)
- Michelle N McDonnell
- International Centre for Allied Health Evidence, University of South Australia , Adelaide, South Australia , Australia
| | - Shylie F Mackintosh
- International Centre for Allied Health Evidence, University of South Australia , Adelaide, South Australia , Australia
| | - Susan L Hillier
- International Centre for Allied Health Evidence, University of South Australia , Adelaide, South Australia , Australia
| | - Janet Bryan
- School of Psychology, Social Work and Social Policy, University of South Australia , Australia
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457
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Seong JW, Kim MH, Shin HK, Lee HD, Park JB, Yang DS. Usefulness of the combined motor evoked and somatosensory evoked potentials for the predictive index of functional recovery after primary pontine hemorrhage. Ann Rehabil Med 2014; 38:13-8. [PMID: 24639921 PMCID: PMC3953356 DOI: 10.5535/arm.2014.38.1.13] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 09/13/2013] [Indexed: 12/02/2022] Open
Abstract
Objective To investigate the predictive index of functional recovery after primary pontine hemorrhage (PPH) using the combined motor evoked potential (MEP) and somatosensory evoked potential (SEP) in comparison to the hematoma volume and transverse diameter measured with computerized tomography. Methods Patients (n=14) with PPH were divided into good- and poor-outcome groups according to the modified Rankin Score (mRS). We evaluated clinical manifestations, radiological characteristics, and the combined MEP and SEP responses. The summed MEP and SEP (EP sum) was compared to the hematoma volume and transverse diameter predictive index of global disability, gait ability, and trunk stability in sitting posture. Results All measures of functional status and radiological parameters of the good-outcome group were significantly better than those of the poor-outcome group. The EP sum showed the highest value for the mRS and functional ambulatory category, and transverse diameter showed the highest value for "sitting-unsupported" of Berg Balance Scale. Conclusion The combined MEP and SEP is a reliable and useful tool for functional recovery after PPH.
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Affiliation(s)
- Jin Wan Seong
- Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Min Ho Kim
- Biomedical Research Center, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Hyo Keong Shin
- Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Han Do Lee
- Department of Physical Medicine and Rehabilitation, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, Korea
| | - Jun Bum Park
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Dong Seok Yang
- Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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458
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Bai X, Kwok TCY, Ip IN, Woo J, Chui MYP, Ho FKY. Physical restraint use and older patients' length of hospital stay. Health Psychol Behav Med 2014; 2:160-170. [PMID: 25750775 PMCID: PMC4346038 DOI: 10.1080/21642850.2014.881258] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 01/06/2014] [Indexed: 10/25/2022] Open
Abstract
In both acute care and residential care settings, physical restraints are frequently used in the management of patients, older people in particular. Recently, the negative outcomes of physical restraint use have often been reported, but very limited research effort has been made to examine whether such nursing practice have any adverse effects on patients' length of stay (LOS) in hospitals. The aim of this study was to examine the association between physical restraint use on older patients during hospitalization and their LOS. Medical records of 910 older patients aged 60 years and above admitted to one of the Hong Kong public hospitals in 2007 were randomly selected and recorded during July to September 2011. The recorded items included patients' general health status, physical and cognitive function, the use of physical restraints, and patients' LOS. Hierarchical regression analysis was conducted to analyze the data. The results indicated that older patients' general health status, physical, and cognitive function were important factors affecting their LOS. Independent of these factors, the physical restraint use was still significantly predictive of longer LOS, and these two blocks of variables together served as an effective model in predicting older patients' LOS in the hospital. Since physical restraint use has been found to be predictive of longer hospital stay, physical restraints should be used with more caution and the use of it should be reduced on older patients in the hospital caring setting. All relevant health care staff should be aware of the negative effects of physical restraint use and should reduce the use of it in hospital caring and nursing home settings.
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Affiliation(s)
- Xue Bai
- Department of Applied Social Sciences, The Hong Kong Polytechnic University , Hung Hom , Kowloon , Hong Kong, People's Republic of China ; Jockey Club Centre for Positive Ageing , Shatin , New Territories , Hong Kong SAR, People's Republic of China
| | - Timothy C Y Kwok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong , Shatin , New Territories , Hong Kong SAR, People's Republic of China
| | - Isaac N Ip
- Jockey Club Centre for Positive Ageing , Shatin , New Territories , Hong Kong SAR, People's Republic of China
| | - Jean Woo
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong , Shatin , New Territories , Hong Kong SAR, People's Republic of China
| | - Maria Y P Chui
- Shatin Hospital & Bradbury Hospice , Shatin , New Territories , Hong Kong SAR, People's Republic of China
| | - Florence K Y Ho
- Jockey Club Centre for Positive Ageing , Shatin , New Territories , Hong Kong SAR, People's Republic of China
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459
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Schramm A, Ndayisaba JP, auf dem Brinke M, Hecht M, Herrmann C, Huber M, Lobsien E, Mehnert S, Reuter I, Stenner A, van der Ven C, Winterholler M, Kupsch A, Wissel J. Spasticity treatment with onabotulinumtoxin A: data from a prospective German real-life patient registry. J Neural Transm (Vienna) 2014; 121:521-30. [DOI: 10.1007/s00702-013-1145-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 12/16/2013] [Indexed: 10/25/2022]
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460
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Abstract
BACKGROUND The step activity monitor (SAM) quantifies steps taken in the home and community by patient populations. Although the SAM has been used to study individuals after stroke, adherence to the use of SAMs has not been addressed. Participants' adherence to wearing the monitor is critical for obtaining accurate assessments. OBJECTIVE The purpose of this study was to determine the rate of and predictors for inferred adherence to the use of the SAM after stroke. DESIGN A cross-sectional design was used. METHODS Community-dwelling individuals (n=408) 2 months after stroke with moderate-to-severe gait impairment (gait speed of ≤0.8 m/s) were studied. Step activity was assessed for 2 days with the SAM. Inferred adherence was established in 3 periods: 6:00 am to 12:00 pm, 12:01 pm to 6:00 pm, and 6:01 pm to 12:00 am. Adherence was defined as activity recorded in all 3 periods. The percentage of participant adherence for the first day, second day, both days, and either day was calculated. Demographic and clinical characteristics of adherers and nonadherers were compared. Independent adherence predictors were identified by means of stepwise logistic regression. RESULTS Inferred adherence rates for the first day, second day, both days, and either day were 68%, 61%, 53%, and 76%, respectively. Upper and lower extremity impairment, balance control, and endurance were significantly different between adherers and nonadherers. On the other hand, older age, greater balance self-efficacy, and better walking endurance were significant predictors of adherence. LIMITATIONS Participants were individuals with subacute stroke. Therefore, the findings of this study may not be generalized to individuals during the acute and chronic phases of stroke recovery. CONCLUSIONS Strategies to improve adherence are needed when collecting data for more than 1 day and in samples with younger individuals and those with low levels of balance self-efficacy and walking endurance.
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461
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Mohan U, Babu SK, Kumar KV, Suresh BV, Misri ZK, Chakrapani M. Effectiveness of mirror therapy on lower extremity motor recovery, balance and mobility in patients with acute stroke: A randomized sham-controlled pilot trial. Ann Indian Acad Neurol 2013; 16:634-9. [PMID: 24339596 PMCID: PMC3841617 DOI: 10.4103/0972-2327.120496] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 01/28/2013] [Accepted: 03/04/2013] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To evaluate the effectiveness of mirror therapy on lower extremity motor recovery, balance and mobility in patients with acute stroke. DESIGN A randomized, sham-controlled, assessor blinded, pilot trial. SETTING Inpatient stroke rehabilitation unit. SUBJECTS First time onset of stroke with mean post-stroke duration of 6.41 days, able to respond to verbal instructions, and Brunnstrom recovery stage 2 and above were enrolled. INTERVENTION Mirror therapy group performed 30 minutes of functional synergy movements of non-paretic lower extremity, whereas control group underwent sham therapy with similar duration. In addition, both groups were administered with conventional stroke rehabilitation regime. Altogether 90 minutes therapy session per day, six days a week, for two weeks duration was administered to both groups. OUTCOME MEASURES Lower extremity motor subscale of Fugl Meyer Assessment (FMA), Brunnel Balance Assessment (BBA) and Functional Ambulation Categories (FAC). RESULTS Amongst the 22 patients included, equal number of patients participated in mirror group (N = 11) and control group (N = 11). Baseline variables were similar in both groups, except for Brunnstrom recovery stage. There was no statistical difference between groups, except for FAC. (FMA: P = 0.894; BBA: P = 0.358; FAC: P = 0.02). Significance was set at P < 0.05. CONCLUSION Administration of mirror therapy early after stroke is not superior to conventional treatment in improving lower limb motor recovery and balance, except for improvement in mobility.
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Affiliation(s)
- Uthra Mohan
- Department of Physiotherapy, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
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462
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Hariohm K, Prakash V. Deep flexion activity training in a patient with stroke using task-oriented exercise: a case report. Physiother Theory Pract 2013; 30:196-201. [PMID: 24188030 DOI: 10.3109/09593985.2013.850564] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND PURPOSE Many individuals with stroke express desires to resume activities involving deep knee flexion, such as daily living, work-related, and sports activities. However, training methods for improving deep flexion activities have not commonly been reported in the stroke rehabilitation literature. The purpose of this case report is to describe the development of a task-oriented training program and demonstrate its use in improving deep flexion activities in an individual with sub-acute hemiplegia. CASE DESCRIPTION The patient was a 55-year-old shoe salesman diagnosed with ischemic stroke 6 weeks before physical therapy evaluation. His primary concerns were functional activities that required deep flexion, such as the inability to squat and to maintain a squatting position in the Eastern toilet and difficulty in performing work-related activities (e.g. fitting shoes for customers while sitting on a low stool). INTERVENTION We developed a task-oriented training program that specifically targeted deep flexion activities. The first phase of training consisted primarily of practicing sit-to-stand on a low stool and the second phase consisted of practicing squatting. OUTCOMES After 6 weeks of intervention, the patient achieved more than the expected outcome on the Goal Attainment Scale (score = +2) for both primary goals and reported positive changes in social participation, such as visiting his friends and relatives and praying at the temple. DISCUSSION The task-oriented deep flexion activity intervention was associated with positive changes in functional activity and social participation in a patient recovering from stroke.
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Affiliation(s)
- K Hariohm
- MSAJ College of Physiotherapy , Chennai, Tamil Nadu , India and
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463
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Tripp F, Krakow K. Effects of an aquatic therapy approach (Halliwick-Therapy) on functional mobility in subacute stroke patients: a randomized controlled trial. Clin Rehabil 2013; 28:432-9. [DOI: 10.1177/0269215513504942] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To evaluate the effects of an aquatic physiotherapy method (Halliwick-Therapy) upon mobility in the post-acute phase of stroke rehabilitation. Design: Randomized controlled trial. Setting: Hospital for neurological rehabilitation. Participants: Adult patients after first-ever stroke in post-acute inpatient rehabilitation at least two weeks after the onset of stroke ( n = 30). Interventions: In the Halliwick-Therapy group ( n = 14) the treatment over a period of two weeks included 45 minutes of aquatic therapy three times per week and a conventional physiotherapeutic treatment twice a week. Subjects in the control group ( n = 16) received conventional physiotherapeutic treatment over a period of two weeks five times per week. Outcome measures: The primary outcome variable was postural stability (Berg Balance Scale). Secondary outcome variables were functional reach, functional gait ability and basic functional mobility. Results: Compared to the control group, significantly more subjects in the Halliwick-Therapy group (83.3% versus 46.7%) attained significant improvement of the Berg Balance Scale ( P < 0.05). Improvement of the functional gait ability was significantly higher in the Halliwick-Therapy group (mean (SD) 1.25(0.86)) than in the control group (mean (SD) 0.73 (0.70)) ( P < 0.1). The mean differences of improvements in functional reach and basic functional mobility were not statistically significant between groups. Conclusions: This study indicates that Halliwick-Therapy is safe and well tolerated in stroke patients in post-acute rehabilitation and has positive effects upon some aspects of mobility.
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Affiliation(s)
- Florian Tripp
- Department of Physiotherapy, Asklepios Neurological Hospital Falkenstein, Königstein/Taunus, Germany
| | - Karsten Krakow
- Department of Neurology and Neurological Rehabilitation, Asklepios Neurological Hospital Falkenstein, Königstein/Taunus, Germany
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464
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Choi YK, Nam CW, Lee JH, Park YH. The Effects of Taping Prior to PNF Treatment on Lower Extremity Proprioception of Hemiplegic Patients. J Phys Ther Sci 2013; 25:1119-22. [PMID: 24259927 PMCID: PMC3818771 DOI: 10.1589/jpts.25.1119] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 04/26/2013] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to compare the effects of taping on the articular angle of the knee joint and on the functioning of patients with hemiplegia resulting from stroke. [Subjects] The subjects of this study were 30 patients who were diagnosed with hemiplegia due to stroke. The subjects were randomly assigned to either an experimental group which received proprioceptive neuromuscular facilitation combination patterns and kinesio taping were applied, or a control group which received neurodevelopmental treatment. [Methods] Joint angle was measured at the hip and the ankle for both the paretic and non-paretic sides using a goniometer. Dynamic balance ability was assessed using the Berg Balance Scale. Gait velocity was measured as the 10-m walking time using a stopwatch. [Results] Comparative analysis of the experimental group's pre-test and post-test results showed statistically significant differences in the BBS and 10-m walking test. There were significant differences between the groups in ankle dorsiflexion, BBS, and 10-m walking times. [Conclusion] We judge the application of taping on the knee joint prior to rehabilitation treatment for patients in accordance with nervous system damage positively influences their functional improvement.
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Affiliation(s)
- Yong-Kyu Choi
- Department of Physical Therapy, Graduate school of Physical Therapy, Korea National University of Transportation
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465
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Isaksson M, Johansson L, Olofsson I, Eurenius E. Shoulder pain and concomitant hand oedema among stroke patients with pronounced arm paresis. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2013; 15:208-214. [PMID: 24765589 PMCID: PMC3990940 DOI: 10.3109/21679169.2013.843202] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 09/08/2013] [Indexed: 11/13/2022]
Abstract
BACKGROUND The aim of this prospective study was to identify clinical factors associated with the development of shoulder pain in stroke patients with pronounced arm paresis. METHODS At stroke onset, 485 patients were initially assessed in 2007-2009. Sixty-three patients with pronounced arm paresis completed the study, and 21 of these developed shoulder pain. Clinical findings were recorded fortnightly by the attending physiotherapist during hospital stay. RESULTS Hand oedema on the paretic side was more common in patients developing shoulder pain compared with those who did not develop shoulder pain. The onset of shoulder pain was associated with concomitant hand oedema. High NIHSS score was associated with developing shoulder pain. Patients with a history of shoulder pain developed pain earlier than those without previous shoulder pain. Patients with haemorrhagic stroke were significantly more prone to developing shoulder pain. CONCLUSIONS One-third of the stroke patients with pronounced arm paresis developed shoulder pain. Concomitant hand oedema seems to be an additional symptom of shoulder injury. Patients with low general status are more vulnerable to develop post-stroke shoulder pain.
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Affiliation(s)
| | - Lars Johansson
- Department of Public Health and Clinical Medicine, Umeå University , Sweden
| | | | - Eva Eurenius
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University , Sweden
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466
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Woodbury ML, Velozo CA, Richards LG, Duncan PW. Rasch Analysis Staging Methodology to Classify Upper Extremity Movement Impairment After Stroke. Arch Phys Med Rehabil 2013; 94:1527-33. [DOI: 10.1016/j.apmr.2013.03.007] [Citation(s) in RCA: 103] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2012] [Revised: 03/08/2013] [Accepted: 03/12/2013] [Indexed: 11/16/2022]
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467
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Chin RPH, Ho CH, Cheung LPC. Scheduled analgesic regimen improves rehabilitation after hip fracture surgery. Clin Orthop Relat Res 2013; 471:2349-60. [PMID: 23543417 PMCID: PMC3676603 DOI: 10.1007/s11999-013-2927-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Accepted: 03/08/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Postoperative pain often is the limiting factor in the rehabilitation of patients after hip fracture surgery. QUESTIONS/PURPOSES We compared an approach using scheduled analgesic dosing with as-needed analgesic dosing in patients after hip fracture surgery, to compare these approaches in terms of (1) resting and dynamic pain intensity, (2) postoperative patient mobility, and (3) functional end points. METHODS We conducted a prospective cohort study of 400 patients who underwent surgical treatment of hip fractures at our hospital. The groups were formed sequentially, such that the first 200 patients formed the intervention group (treated with scheduled analgesic intake for the first 3 weeks after surgery), and the next 200 patients were the control group (treated using a protocol of analgesic administration on request). Resting and dynamic pain intensity, mobility, and functional performance were compared between the two analgesic protocols. RESULTS As expected, analgesic consumption was lower in the control group (tramadol doses, 27 versus 63; paracetamol doses, 29 versus 63). Despite the large difference in the amounts of analgesics consumed, resting and dynamic pain intensity showed improvement in each group and there was no difference between groups in terms of postoperative pain. However, there was a positive correlation between functional outcomes and analgesic consumption in the control group. The intervention group achieved higher functional performance on discharge (elderly mobility scale, 11 versus 8; functional independence measure, 88 versus 79). On discharge, fewer patients in the intervention group were wheelchair ambulators (3 versus 32), meaning more patients in the intervention group were able to walk. CONCLUSIONS The study showed that a scheduled analgesic intake can improve the functional outcomes of patients with geriatric hip fractures after surgery. LEVEL OF EVIDENCE Level II, therapeutic study. See the guidelines for authors for a complete description of levels of evidence.
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Affiliation(s)
- Raymond Ping-Hong Chin
- Department of Orthopaedics and Traumatology, Queen Elizabeth Hospital, Hospital Authority, 3/Floor, M Block, 30 Gascoigne Road, Jordon, Kowloon, Hong Kong, China ,Orthopaedic Rehabilitation Centre, Kowloon Hospital, Hospital Authority, Hong Kong, China
| | - Chin-Hung Ho
- Department of Orthopaedics and Traumatology, Queen Elizabeth Hospital, Hospital Authority, 3/Floor, M Block, 30 Gascoigne Road, Jordon, Kowloon, Hong Kong, China ,Orthopaedic Rehabilitation Centre, Kowloon Hospital, Hospital Authority, Hong Kong, China
| | - Lydia Po-Chee Cheung
- Department of Orthopaedics and Traumatology, Queen Elizabeth Hospital, Hospital Authority, 3/Floor, M Block, 30 Gascoigne Road, Jordon, Kowloon, Hong Kong, China ,Orthopaedic Rehabilitation Centre, Kowloon Hospital, Hospital Authority, Hong Kong, China
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468
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Rosanna Chau MW, Chan SP, Wong YW, Lau MYP. Reliability and validity of the Modified Functional Ambulation Classification in patients with hip fracture. Hong Kong Physiother J 2013. [DOI: 10.1016/j.hkpj.2013.01.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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469
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van Ooijen MW, Roerdink M, Trekop M, Visschedijk J, Janssen TW, Beek PJ. Functional gait rehabilitation in elderly people following a fall-related hip fracture using a treadmill with visual context: design of a randomized controlled trial. BMC Geriatr 2013; 13:34. [PMID: 23590327 PMCID: PMC3637244 DOI: 10.1186/1471-2318-13-34] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Accepted: 04/09/2013] [Indexed: 11/11/2022] Open
Abstract
Background Walking requires gait adjustments in order to walk safely in continually changing environments. Gait adaptability is reduced in older adults, and (near) falls, fall-related hip fractures and fear of falling are common in this population. Most falls occur due to inaccurate foot placement relative to environmental hazards, such as obstacles. The C-Mill is an innovative, instrumented treadmill on which visual context (e.g., obstacles) is projected. The C-Mill is well suited to train foot positioning relative to environmental properties while concurrently utilizing the high-intensity practice benefits associated with conventional treadmill training. The present protocol was designed to examine the efficacy of C-Mill gait adaptability treadmill training for improving walking ability and reducing fall incidence and fear of falling relative to conventional treadmill training and usual care. We hypothesize that C-Mill gait adaptability treadmill training and conventional treadmill training result in better walking ability than usual care due to the enhanced training intensity, with superior effects for C-Mill gait adaptability treadmill training on gait adaptability aspects of walking given the concurrent focus on practicing step adjustments. Methods/design The protocol describes a parallel group, single-blind, superiority randomized controlled trial with pre-tests, post-tests, retention-tests and follow-up. Hundred-twenty-six older adults with a recent fall-related hip fracture will be recruited from inpatient rehabilitation care and allocated to six weeks of C-Mill gait adaptability treadmill training (high-intensity, adaptive stepping), conventional treadmill training (high-intensity, repetitive stepping) or usual care physical therapy using block randomization, with allocation concealment by opaque sequentially numbered envelopes. Only data collectors are blind to group allocation. Study parameters related to walking ability will be assessed as primary outcome pre-training, post-training, after 4 weeks retention and 12 months follow-up. Secondary study parameters are measures related to fall incidence, fear of falling and general health. Discussion The study will shed light on the relative importance of adaptive versus repetitive stepping and practice intensity for effective intervention programs directed at improving walking ability and reducing fall risk and fear of falling in older adults with a recent fall-related hip fracture, which may help reduce future fall-related health-care costs. Trial registration The Netherlands Trial Register (http://NTR3222).
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Affiliation(s)
- Mariëlle W van Ooijen
- MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University Amsterdam, Van der Boechorststraat 9, Amsterdam, 1081 BT, The Netherlands.
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470
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Hsu HW, Lee CL, Hsu MJ, Wu HC, Lin R, Hsieh CL, Lin JH. Effects of Noxious Versus Innocuous Thermal Stimulation on Lower Extremity Motor Recovery 3 Months After Stroke. Arch Phys Med Rehabil 2013. [DOI: 10.1016/j.apmr.2012.11.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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471
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Lee WJ, Park GY, Han ZA, Kim HW, Cho SU, Oh SJ, Oh HM, Im S. Korean Version of the ABILOCO Questionnaire in the Assessment of Locomotion in Hemiplegic Stroke Patients. Ann Rehabil Med 2013; 37:72-81. [PMID: 23525494 PMCID: PMC3604237 DOI: 10.5535/arm.2013.37.1.72] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Accepted: 08/29/2012] [Indexed: 11/11/2022] Open
Abstract
Objective To investigate the intra- and inter-rater reliability of the Korean version of the ABILOCO questionnaire (K-ABILOCO). Methods The original ABILOCO questionnaire was translated into Korean and back-translated into English. Stroke patients (n=30) with hemiplegia were evaluated using the K-ABILOCO at one week interval. At each visit, the physiatrist also evaluated patient performance of the activities described in the K-ABILOCO, and the total logit scores were recorded. The total scores were used to evaluate intraclass correlation (ICC). Test-retest scores and each test scores were compared to obtain the intra- and inter-rater reliability. Results The K-ABILOCO showed good intra-rater correlation at one week interval in both patient and physiatrist evaluations (ICC=0.81, 0.91), respectively. It also showed a high inter-rater correlation between the patient and physiatrist at both the first and second visits (ICC=0.76, 0.84), respectively. Conclusion The K-ABILOCO is a useful tool that may reliably evaluate the locomotion ability in hemiplegic stroke patients.
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Affiliation(s)
- Won Joon Lee
- Department of Rehabilitation Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Bucheon, Korea
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472
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Scrivener K, Sherrington C, Schurr K. A systematic review of the responsiveness of lower limb physical performance measures in inpatient care after stroke. BMC Neurol 2013; 13:4. [PMID: 23305322 PMCID: PMC3551684 DOI: 10.1186/1471-2377-13-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2012] [Accepted: 01/03/2013] [Indexed: 11/25/2022] Open
Abstract
Background Responsiveness refers to a measurement tool’s ability to detect change in performance over time. The aim of the review was to summarise studies of responsiveness of lower limb physical performance measures during inpatient care after stroke. Methods A systematic literature review was conducted. Prospective studies that included participants with a diagnosis of stroke, were commenced in the acute or subacute phase of inpatient care and included a measure of a lower limb physical performance were included in this review. Results Twenty-one studies met these inclusion criteria. A variety of measures were investigated including the Berg Balance Scale, various timed walking tests and the Rivermead Mobility Index. Ten of the included studies had small sample sizes (50 participants or less), 2 studies used a convenience sample rather than consecutive recruitment and 5 studies excluded potential participants with poor physical abilities at baseline. Responsiveness varied between and within studies but was generally large, Effect Size (ES) or Standardised Response Mean (SRM) > 0.8. Measures displaying large responsiveness included the twelve-minute walk test (SRM 1.90) and the Modified Rivermead Mobility Index (SRM 1.31) when re-measured at four weeks after stroke, and the Berg Balance Scale (ES 1.11) and Postural Assessment Scale for Stroke Patients (ES 1.12) when re-measured at approximately six months after stroke. Conclusion Studies conducted to date have generally found physical performance measures after stroke to have large responsiveness i.e., to be able to detect changes. Further investigation of the responsiveness of measurement tools after stroke in larger prospective cohort studies is required.
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Affiliation(s)
- Katharine Scrivener
- Bankstown-Lidcombe Hospital, 70 Eldridge Rd, Bankstown, NSW 2200, Australia.
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473
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Saywell N, Vandal AC, Brown P, Hanger HC, Hale L, Mudge S, Milosavljevic S, Feigin V, Taylor D. Telerehabilitation to improve outcomes for people with stroke: study protocol for a randomised controlled trial. Trials 2012; 13:233. [PMID: 23216861 PMCID: PMC3543302 DOI: 10.1186/1745-6215-13-233] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 11/14/2012] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND In New Zealand, around 45,000 people live with stroke and many studies have reported that benefits gained during initial rehabilitation are not sustained. Evidence indicates that participation in physical interventions can prevent the functional decline that frequently occurs after discharge from acute care facilities. However, on-going stroke services provision following discharge from acute care is often related to non-medical factors such as availability of resources and geographical location. Currently most people receive no treatment beyond three months post stroke. The study aims to determine if the Augmented Community Telerehabilitation Intervention (ACTIV) results in better physical function for people with stroke than usual care, as measured by the Stroke Impact Scale, physical subcomponent. METHODS/DESIGN This study will use a multi-site, two-arm, assessor blinded, parallel randomised controlled trial design. People will be eligible if they have had their first ever stroke, are over 20 and have some physical impairment in either arm or leg, or both. Following discharge from formal physiotherapy services (inpatient, outpatient or community), participants will be randomised into ACTIV or usual care. ACTIV uses readily available technology, telephone and mobile phones, combined with face-to-face visits from a physiotherapist over a six-month period, to help people with stroke resume activities they enjoyed before the stroke. The impact of stroke on physical function and quality of life will be assessed, measures of cost will be collected and a discrete choice survey will be used to measure preferences for rehabilitation options. These outcomes will be collected at baseline, six months and 12 months. In-depth interviews will be used to explore the experiences of people participating in the intervention arm of the study. DISCUSSION The lack of on-going rehabilitation for people with stroke diminishes the chance of their best possible outcome and may contribute to a functional decline following discharge from formal rehabilitation. Best practice guidelines recommend a prolonged period of rehabilitation, however this is expensive and therefore not undertaken in most publicly funded centres. An effective, cost-effective, and preference-sensitive therapy using basic technology to assist programme delivery may improve patient autonomy as they leave formal rehabilitation and return home. TRIAL REGISTRATION ACTRN12612000464864.
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Affiliation(s)
- Nicola Saywell
- Health and Rehabilitation Research Institute, AUT University, Private Bag 92006, Auckland, 1142, New Zealand.
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474
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Lee SH, Byun SD, Kim CH, Go JY, Nam HU, Huh JS, Jung TD. Feasibility and effects of newly developed balance control trainer for mobility and balance in chronic stroke patients: a randomized controlled trial. Ann Rehabil Med 2012; 36:521-9. [PMID: 22977778 PMCID: PMC3438419 DOI: 10.5535/arm.2012.36.4.521] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 06/29/2012] [Indexed: 11/23/2022] Open
Abstract
Objective To investigate the feasibility and effects of balance training with a newly developed Balance Control Trainer (BCT) that applied the concept of vertical movement for the improvements of mobility and balance in chronic stroke patients. Method Forty chronic stroke patients were randomly assigned to an experimental or a control group. The experimental group (n=20) underwent training with a BCT for 20 minutes a day, 5 days a week for 4 weeks, in addition to concurrent conventional physical therapy. The control group (n=20) underwent only conventional therapy for 4 weeks. All participants were assessed by: the Functional Ambulation Categories (FAC), 10-meter Walking Test (10mWT), Timed Up and Go test (TUG), Berg Balance Scale (BBS), Korean Modified Barthel Index (MBI), and Manual Muscle Test (MMT) before training, and at 2 and 4 weeks of training. Results There were statistically significant improvements in all parameters except knee extensor power at 2 weeks of treatment, and in all parameters except MBI which showed further statistically significant progress in the experimental group over the next two weeks (p<0.05). Statistically significant improvements on all measurements were observed in the experimental group after 4 weeks total. Comparing the two groups at 2 and 4 weeks of training respectively, 10mWT, TUG, and BBS showed statistically more significant improvements in the experimental group (p<0.05). Conclusion Balance training with a newly developed BCT is feasible and may be an effective tool to improve balance and gait in ambulatory chronic stroke patients. Furthermore, it may provide additional benefits when used in conjunction with conventional therapies.
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Affiliation(s)
- So Hyun Lee
- Department of Rehabilitation Medicine, Kyung-pook National University College of Medicine, Daegu 700-721, Korea
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475
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van Bloemendaal M, van de Water ATM, van de Port IGL. Walking tests for stroke survivors: a systematic review of their measurement properties. Disabil Rehabil 2012; 34:2207-21. [PMID: 22583082 DOI: 10.3109/09638288.2012.680649] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To provide an overview of walking tests including their measurement properties that have been used in stroke survivors. METHOD Electronic databases were searched using specific search strategies. Retrieved studies were selected by using specified inclusion criteria. A modified consensus-based standards for the selection of health status measurement instruments (COSMIN) checklist was applied for methodological quality assessment of the included studies. A quality assessment for statistical outcomes was used to assess measurement properties of the walking tests. Tests that were included were categorized according to the framework of the international classification of functioning, disability and health (ICF). RESULTS Thirty-two studies, evaluating 23 walking tests, were included. The tests assessed walking using the outcome measures of walking speed, walking distance, functional ambulation and walking on different surfaces. The methodological design and statistical methods of most studies evaluating reliability and criterion validity were sufficient, and found the outcome measures to be reliable and valid. However, data on measurement error, minimal important difference and minimal important change were lacking and responsiveness was correctly evaluated in one study only. CONCLUSIONS Many walking tests have been clinimetrically evaluated in stroke survivors. Most walking tests were found to be reliable and valid.
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476
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Verma R, Arya KN, Garg RK, Singh T. Task-oriented circuit class training program with motor imagery for gait rehabilitation in poststroke patients: a randomized controlled trial. Top Stroke Rehabil 2012; 18 Suppl 1:620-32. [PMID: 22120031 DOI: 10.1310/tsr18s01-620] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND OBJECTIVE The ability to walk is impaired in more than 80% of poststroke patients. The objective of the present study was to evaluate the effectiveness of the task-oriented circuit class training (TOCCT) with motor imagery (MI) on the gait during the subacute phase after a stroke. METHOD This was a randomized, controlled, assessor-blinded trial in a neurology department of a university hospital. A convenience sample of 30 people, 4 to 12 weeks (mean, 6.3 weeks) after the stroke was randomized into 2 groups (the TOCCT with MI and standard training group) of 15 people each. Twenty-nine participants completed the 6-week follow-up. Participants were assigned to receive either the TOCCT with MI or dose-matched standard training program based on the Bobath's neurodevelopmental technique, 7 days a week for 2 weeks, as outpatients or inpatients. Outcome measures were the Functional Ambulation Classification (FAC), the Rivermead Visual Gait Assessment (RVGA), step length asymmetry, walking speed, and 6-minute walk test (6MWT). RESULTS The TOCCT with MI group showed a positive improvement in the mean/median scores on most of the outcome measures at post and follow-up assessments in comparison to the control group. However, statistically significant differences were observed in changes between the groups at post and follow-up assessment for FAC, RVGA, walking speed, and 6MWT (ANOVA, P = .001 to .049; Mann-Whitney U test, P = .001). CONCLUSION Among the patients who had a stroke within the previous 4 to 12 weeks, the TOCCT with MI produced statistically significant and clinically relevant improvements in the gait and the gait-related activities.
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Affiliation(s)
- Rajesh Verma
- Department of Neurology, CSM Medical University, Lucknow, India
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477
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Conesa L, Costa Ú, Morales E, Edwards DJ, Cortes M, León D, Bernabeu M, Medina J. An observational report of intensive robotic and manual gait training in sub-acute stroke. J Neuroeng Rehabil 2012; 9:13. [PMID: 22329866 PMCID: PMC3305481 DOI: 10.1186/1743-0003-9-13] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Accepted: 02/13/2012] [Indexed: 11/21/2022] Open
Abstract
Background The use of automated electromechanical devices for gait training in neurological patients is increasing, yet the functional outcomes of well-defined training programs using these devices and the characteristics of patients that would most benefit are seldom reported in the literature. In an observational study of functional outcomes, we aimed to provide a benchmark for expected change in gait function in early stroke patients, from an intensive inpatient rehabilitation program including both robotic and manual gait training. Methods We followed 103 sub-acute stroke patients who met the clinical inclusion criteria for Body Weight Supported Robotic Gait Training (BWSRGT). Patients completed an intensive 8-week gait-training program comprising robotic gait training (weeks 0-4) followed by manual gait training (weeks 4-8). A change in clinical function was determined by the following assessments taken at 0, 4 and 8 weeks (baseline, mid-point and end-point respectively): Functional Ambulatory Categories (FAC), 10 m Walking Test (10 MWT), and Tinetti Gait and Balance Scales. Results Over half of the patients made a clinically meaningful improvement on the Tinetti Gait Scale (> 3 points) and Tinetti Balance Scale (> 5 points), while over 80% of the patients increased at least 1 point on the FAC scale (0-5) and improved walking speed by more than 0.2 m/s. Patients responded positively in gait function regardless of variables gender, age, aetiology (hemorrhagic/ischemic), and affected hemisphere. The most robust and significant change was observed for patients in the FAC categories two and three. The therapy was well tolerated and no patients withdrew for factors related to the type or intensity of training. Conclusions Eight-weeks of intensive rehabilitation including robotic and manual gait training was well tolerated by early stroke patients, and was associated with significant gains in function. Patients with mid-level gait dysfunction showed the most robust improvement following robotic training.
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Affiliation(s)
- Lucas Conesa
- Functional Rehabilitation Department, Neurorehabilitation Hospital Institut Guttmann, Badalona, Barcelona, Spain.
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478
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Yalcin E, Akyuz M, Onder B, Kurtaran A, Buyukvural S, Ozbudak Demir S. Position Sense of the Hemiparetic and Non-Hemiparetic Ankle after Stroke: Is the Non-Hemiparetic Ankle also Affected. Eur Neurol 2012; 68:294-9. [DOI: 10.1159/000342025] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Accepted: 07/22/2012] [Indexed: 11/19/2022]
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479
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Effects of the Combination of Rhythmic Auditory Stimulation and Task-oriented Training on Functional Recovery of Subacute Stroke Patients. J Phys Ther Sci 2012. [DOI: 10.1589/jpts.24.1307] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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480
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Miyai I, Ito M, Hattori N, Mihara M, Hatakenaka M, Yagura H, Sobue G, Nishizawa M. Cerebellar Ataxia Rehabilitation Trial in Degenerative Cerebellar Diseases. Neurorehabil Neural Repair 2011; 26:515-22. [DOI: 10.1177/1545968311425918] [Citation(s) in RCA: 162] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective. To investigate short- and long-term effects of intensive rehabilitation on ataxia, gait, and activities of daily living (ADLs) in patients with degenerative cerebellar disease. Methods. A total of 42 patients with pure cerebellar degeneration were randomly assigned to the immediate group or the delayed-entry control group. The immediate group received 2 hours of inpatient physical and occupational therapy, focusing on coordination, balance, and ADLs, on weekdays and 1 hour on weekends for 4 weeks. The control group received the same intervention after a 4-week delay. Short-term outcome was compared between the immediate and control groups. Long-term evaluation was done in both groups at 4, 12, and 24 weeks after the intervention. Outcome measures included the assessment and rating of ataxia, Functional Independence Measure, gait speed, cadence, functional ambulation category, and number of falls. Results. The immediate group showed significantly greater functional gains in ataxia, gait speed, and ADLs than the control group. Improvement of truncal ataxia was more prominent than limb ataxia. The gains in ataxia and gait were sustained at 12 weeks and 24 weeks, respectively. At least 1 measure was better than at baseline at 24 weeks in 22 patients. Conclusions. Short-term benefit of intensive rehabilitation was evident in patients with degenerative cerebellar diseases. Although functional status tended to decline to the baseline level within 24 weeks, gains were maintained in more than half of the participants.
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Affiliation(s)
| | - Mizuki Ito
- Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Noriaki Hattori
- Morinomiya Hospital, Osaka, Japan
- PRESTO, Japan Science and Technology Agency, Saitama, Japan
| | | | | | | | - Gen Sobue
- Nagoya University Graduate School of Medicine, Nagoya, Japan
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481
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Hillier S, English C, Crotty M, Segal L, Bernhardt J, Esterman A. Circuit Class or Seven-Day Therapy for Increasing Intensity of Rehabilitation after Stroke: Protocol of the CIRCIT Trial. Int J Stroke 2011; 6:560-5. [DOI: 10.1111/j.1747-4949.2011.00686.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Rationale There is strong evidence for a dose–response relationship between physical therapy early after stroke and recovery of function. The optimal method of maximizing physical therapy within finite health care resources is unknown. Aims To determine the effectiveness and cost-effectiveness of two alternative models of physical therapy service delivery (seven-days per week therapy services or group circuit class therapy over five-days a week) to usual care for people receiving inpatient rehabilitation after stroke. Design Multicenter, three-armed randomized controlled trial with blinded assessment of outcomes. Study A total of 282 people admitted to inpatient rehabilitation facilities after stroke with an admission functional independence measure (FIM) score within the moderate range (total 40–80 points or motor 38–62 points) will be randomized to receive one of three interventions: • usual care therapy over five-days a week • standard care therapy over seven-days a week, or • group circuit class therapy over five-days a week. Participants will receive the allocated intervention for the length of their hospital stay. Analysis will be by intention-to-treat. Outcomes The primary outcome measure is walking ability (six-minute walk test) at four-week postintervention with three- and six-month follow-up. Economic analysis will include a costing analysis based on length of hospital stay and staffing/resource costs and a cost-utility analysis (incremental quality of life per incremental cost, relative to usual care). Secondary outcomes include walking speed and independence, ability to perform activities of daily living, arm function, quality of life and participant satisfaction.
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Affiliation(s)
- Susan Hillier
- International Centre for Allied Health Evidence, School of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Coralie English
- International Centre for Allied Health Evidence, School of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Maria Crotty
- Department of Rehabilitation and Aged Care, Flinders University, Adelaide, SA, Australia
| | - Leonie Segal
- Health Economics and Social Policy Group, Division of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Julie Bernhardt
- National Stroke Research Institute (Florey Neuroscience Institute), Adelaide, SA, Australia
| | - Adrian Esterman
- Sansom Institute of Health Research, University of South Australia, Adelaide, SA, Australia
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482
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Kempen JCE, de Groot V, Knol DL, Polman CH, Lankhorst GJ, Beckerman H. Community walking can be assessed using a 10-metre timed walk test. Mult Scler 2011; 17:980-90. [DOI: 10.1177/1352458511403641] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: A decline in mobility is a common feature of multiple sclerosis (MS). Community walking scales are used to categorize patients in their ability to move independently. The first purpose of this study was to determine which specific gait speed corresponded with the categories of the Modified Functional Walking Categories (MFWC). The second purpose was to determine the Minimally Important Change (MIC) in absolute gait speed using the MFWC and Expanded Disability Status Scale (EDSS) as external criteria. Method: MS patients were measured six times in 6 years. Gait velocity was measured with the 10-metre timed walk test (10-m TWT), the severity of MS was determined with the EDSS, and community walking was assessed with the MFWC. For each category of the MFWC, Receiver Operating Characteristic (ROC) curves were used to find the best possible cut-off point on the 10-m TWT. The MIC in absolute gait speed was determined using a change of one category on the MFWC or one point on the EDSS. Results: A strong relationship was found between gait speed and the MFWC; all areas under the ROC curves (AUCs) were between 0.74 and 0.86. The MIC in absolute gait speed could not be determined, because the AUCs were below the threshold of 0.70 and changes in gait speed were small. Conclusions: Gait speed is related to community walking, but an MIC in absolute gait speed could not be determined using a minimally important change on the MFWC or the EDSS as external criteria.
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Affiliation(s)
- JCE Kempen
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands
- EMGO Institute for Health and Care Research, VU University and VU University Medical Center, Amsterdam, The Netherlands
- MS Center Amsterdam, The Netherlands
| | - V de Groot
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands
- EMGO Institute for Health and Care Research, VU University and VU University Medical Center, Amsterdam, The Netherlands
- MS Center Amsterdam, The Netherlands
| | - DL Knol
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - CH Polman
- MS Center Amsterdam, The Netherlands
- Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
| | - GJ Lankhorst
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - H Beckerman
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands
- EMGO Institute for Health and Care Research, VU University and VU University Medical Center, Amsterdam, The Netherlands
- MS Center Amsterdam, The Netherlands
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483
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Hancock NJ, Shepstone L, Rowe P, Myint PK, Pomeroy V. Clinical efficacy and prognostic indicators for lower limb pedalling exercise early after stroke: study protocol for a pilot randomised controlled trial. Trials 2011; 12:68. [PMID: 21385361 PMCID: PMC3061926 DOI: 10.1186/1745-6215-12-68] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Accepted: 03/07/2011] [Indexed: 11/18/2022] Open
Abstract
Background It is known that repetitive, skilled, functional movement is beneficial in driving functional reorganisation of the brain early after stroke. This study will investigate a) whether pedalling an upright, static exercise cycle, to provide such beneficial activity, will enhance recovery and b) which stroke survivors might be able to participate in pedalling. Methods/Design Participants (n = 24) will be up to 30 days since stroke onset, with unilateral weakness and unable to walk without assistance. This study will use a modified exercise bicycle fitted with a UniCam crank. All participants will give informed consent, then undergo baseline measurements, and then attempt to pedal. Those able to pedal will be entered into a single-centre, observer-blinded randomised controlled trial (RCT). All participants will receive routine rehabilitation. The experimental group will, in addition, pedal daily for up to ten minutes, for up to ten working days. Prognostic indicators, measured at baseline, will be: site of stroke lesion, trunk control, ability to ambulate, and severity of lower limb paresis. The primary outcome for the RCT is ability to voluntarily contract paretic lower limb muscle, measured by the Motricity Index. Secondary outcomes include ability to ambulate and timing of onset and offset of activity in antagonist muscle groups during pedalling, measured by EMG. Discussion This protocol is for a trial of a novel therapy intervention. Findings will establish whether there is sufficient evidence of benefit to justify proceeding with further research into clinical efficacy of upright pedalling exercise early after stroke. Information on potential prognostic indicators will suggest which stroke survivors could benefit from the intervention. Trial Registration ISRCTN: ISRCTN45392701
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Affiliation(s)
- Nicola J Hancock
- Institiute of Health and Social Sciences, Faculty of Health, University of East Anglia, Norwich, UK.
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484
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Byun SD, Jung TD, Kim CH, Lee YS. Effects of the sliding rehabilitation machine on balance and gait in chronic stroke patients - a controlled clinical trial. Clin Rehabil 2010; 25:408-15. [PMID: 21131336 DOI: 10.1177/0269215510385850] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To investigate the effects of a sliding rehabilitation machine on balance and gait in chronic stroke patients. DESIGN A non-randomized crossover design. SETTING Inpatient rehabilitation in a general hospital. SUBJECTS Thirty patients with chronic stroke who had medium or high falling risk as determined by the Berg Balance Scale. INTERVENTIONS Participants were divided into two groups and underwent four weeks of training. Group A (n = 15) underwent training with the sliding rehabilitation machine for two weeks with concurrent conventional training, followed by conventional training only for another two weeks. Group B (n = 15) underwent the same training in reverse order. The effect of the experimental period was defined as the sum of changes during training with sliding rehabilitation machine in each group, and the effect of the control period was defined as those during the conventional training only in each group. MAIN MEASURES Functional Ambulation Category, Berg Balance Scale, Six-Minute Walk Test, Timed Up and Go Test, Korean Modified Barthel Index, Modified Ashworth Scale and Manual Muscle Test. RESULTS Statistically significant improvements were observed in all parameters except Modified Ashworth Scale in the experimental period, but only in Six-Minute Walk Test (P < 0.01) in the control period. There were also statistically significant differences in the degree of change in all parameters in the experimental period as compared to the control period. CONCLUSIONS The sliding rehabilitation machine may be a useful tool for the improvement of balance and gait abilities in chronic stroke patients.
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Affiliation(s)
- Seung-Deuk Byun
- Department of Physical Medicine and Rehabilitation, Daegu Fatima Hospital, Korea
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485
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Freund JE, Stetts DM. Use of trunk stabilization and locomotor training in an adult with cerebellar ataxia: A single system design. Physiother Theory Pract 2010; 26:447-58. [DOI: 10.3109/09593980903532234] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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486
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Dobkin BH, Plummer-D'Amato P, Elashoff R, Lee J. International randomized clinical trial, stroke inpatient rehabilitation with reinforcement of walking speed (SIRROWS), improves outcomes. Neurorehabil Neural Repair 2010; 24:235-42. [PMID: 20164411 DOI: 10.1177/1545968309357558] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Feedback about performance may optimize motor relearning after stroke. OBJECTIVES Develop an international collaboration to rapidly test the potential efficacy of daily verbal feedback about walking speed during inpatient rehabilitation after stroke, using a protocol that requires no research funds. METHODS This phase 2, single-blinded, multicenter trial randomized inpatients to either feedback about self-selected fast walking speed (daily reinforcement of speed, DRS) immediately after a single, daily 10-m walk or to no reinforcement of speed (NRS) after the walk, performed within the context of routine physical therapy. The primary outcome was velocity for a 15.2-m (50-foot) timed walk at discharge. Secondary outcomes were walking distance in 3 minutes, length of stay (LOS), and level of independence (Functional Ambulation Classification, FAC). RESULTS Within 18 months, 179 participants were randomized. The groups were balanced for age, gender, time from onset of stroke to entry, initial velocity, and level of walking-related disability. The walking speed at discharge for DRS (0.91 m/s) was greater (P = .01) than that for NRS (0.72 m/s). No difference was found for LOS. LOS for both DRS and NRS was significantly shorter, however, for those who had mean walking speeds >0.4 m/s at entry. The DRS group did not have a higher proportion of FAC independent walkers (P = .1) and did not walk longer distances ( P = .09). CONCLUSIONS An Internet-based collaboration of 18 centers found that feedback about performance once a day produced gains in walking speed large enough to permit unlimited, slow community ambulation at discharge from inpatient rehabilitation.
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Affiliation(s)
- Bruce H Dobkin
- Geffen School of Medicine, University of California Los Angeles, Los Angeles, California 90095, USA.
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487
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Willoughby KL, Dodd KJ, Shields N. A systematic review of the effectiveness of treadmill training for children with cerebral palsy. Disabil Rehabil 2009; 31:1971-9. [DOI: 10.3109/09638280902874204] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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488
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Thieme H, Ritschel C, Zange C. Reliability and validity of the functional gait assessment (German version) in subacute stroke patients. Arch Phys Med Rehabil 2009; 90:1565-70. [PMID: 19735785 DOI: 10.1016/j.apmr.2009.03.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2009] [Accepted: 03/08/2009] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To investigate validity and reliability of the Functional Gait Assessment (FGA) (German version) as a measure for balance abilities during walking in subacute stroke patients. DESIGN Cohort study. SETTING Inpatient rehabilitation center. PARTICIPANTS Ambulatory subjects (N=28) at a maximum of 6 months after stroke participated in this study. One direct observer and 2 video observers rated the FGA. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Performance of the FGA was video recorded and directly rated. For testing concurrent validity of the FGA, subjects also completed testing in the Berg Balance Scale, fast walking speed, the Functional Ambulatory Category, the Rivermead Mobility Index, and the Barthel Index. Intrarater reliability, interrater reliability, and concurrent validity of the FGA were analyzed. RESULTS Intrarater (intraclass correlation coefficient=.97) and interrater reliability (intraclass correlation coefficient=.94) were almost perfect for total scores. Reliability of single items varied between substantial and almost perfect values. Analysis revealed significant correlations between the FGA and other measures of gait and balance functions between Spearman rho values of .71 and .93. The FGA differs significantly between levels of gait ability (Functional Ambulatory Category) (P< or =.01). CONCLUSIONS Almost perfect intrarater and interrater reliability for total FGA scores and good concurrent validity were shown in this study. Therefore, the FGA (German version) can be used as a reliable and valid tool to assess functional gait performance of patients in subacute stages after stroke.
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Affiliation(s)
- Holm Thieme
- School for Physiotherapy, Occupational Therapy, and Speech and Language Therapy, Klinik Bavaria Kreischa, Sachsen, Germany.
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489
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Tyson S, Connell L. The psychometric properties and clinical utility of measures of walking and mobility in neurological conditions: a systematic review. Clin Rehabil 2009; 23:1018-33. [DOI: 10.1177/0269215509339004] [Citation(s) in RCA: 196] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objective: To identify psychometrically robust and clinically feasible measures of walking and mobility in people with neurological conditions Data sources: MEDLINE, CINAHL, EMBASE, PEDro and AMED. Review methods: Independent reviewers selected and extracted data from articles that assessed the reliability, validity, sensitivity to change or clinical utility of measures of walking and mobility in adult neurological conditions. Measures with ‘good’ psychometrics and 9/10 clinical utility scores were recommended. Results: Seventeen measures were selected. Of these, the 5-m and 10-m walk tests, six-minute walk test, High Level Mobility Assessment Tool (HiMAT) and the Rivermead Mobility Index (RMI) reached the required standards and are usable in clinical practice. None of the recommended measures assessed wheelchair mobility. The least frequently assessed property was sensitivity to change. Further measures could be recommended if the minimal detectable change were demonstrated. Conclusion: The 5-m, 10-m and six-minute walk test, High Level Mobility Assessment Tool and the Rivermead Mobility Index are psychometrically robust measures of walking and mobility and are feasible for use in clinical practice.
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Affiliation(s)
- Sarah Tyson
- Centre for Rehabilitation and Human Performance Research and Physiotherapy Directorate, University of Salford,
| | - Louise Connell
- Division of Physiotherapy Education, University of Nottingham, Nottingham, UK
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490
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Lin KC, Chen YA, Chen CL, Wu CY, Chang YF. The effects of bilateral arm training on motor control and functional performance in chronic stroke: a randomized controlled study. Neurorehabil Neural Repair 2009; 24:42-51. [PMID: 19729583 DOI: 10.1177/1545968309345268] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Most studies of bilateral arm training (BAT) did not employ a randomized controlled trial design and involved very limited functional training tasks. OBJECTIVE Compare the effects of BAT with control intervention (CI) on motor control and motor performance of the upper extremity and also functional gains in patients with chronic stroke. METHODS . This 2-group randomized controlled trial with pretreatment and posttreatment measures enrolled 33 stroke patients (mean age = 53.85 years) 6 to 67 months after onset of a first stroke. They received either a BAT program concentrating on both upper extremities moving simultaneously in functional tasks by symmetric patterns or CI (control treatment) for 2 hours on weekdays for 3 weeks. Outcome measures included kinematic analyses assessing motor control strategies for unilateral and bimanual reaching and clinical measures involving the Fugl-Meyer Assessment (FMA) of motor-impairment severity and the Functional Independence Measure (FIM) and the Motor Activity Log (MAL) evaluating functional ability. RESULTS After treatment, the BAT group showed better temporal and spatial efficiency during unilateral and bilateral tasks and less online error correction only during the bilateral task than the control group. The BAT group showed a significantly greater improvement in the FMA than the control group but not in the FIM and MAL. CONCLUSIONS Relative to CI, BAT improved the spatiotemporal control of the affected arm in both bilateral and unilateral tasks, decreased online corrections to perform bilateral tasks, and reduced motor impairment. These findings support the use of BAT to improve motor control and motor function of the affected upper limb in stroke patients.
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