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Pereira F, Cameirão MS, Bermúdez I Badia S. The impact of exergames on the functional balance of a teenager with cerebral palsy - a case report. Disabil Rehabil Assist Technol 2023; 18:1074-1083. [PMID: 34591721 DOI: 10.1080/17483107.2021.1980623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 09/09/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To understand the impact of an intensive rehabilitation program based on exergames in balance and lower limb function in a teenager with cerebral palsy. METHODS The rehabilitation program comprised different customised exergames and was delivered in 5 weekly sessions of 30 min for 4 weeks. Pre-, post-, and 1-month Follow-up assessments included the following metrics: Berg Balance Scale (BBS), Dynamic Gait Index (DGI), Gross Motor Function Measure (GMFM), Posturography, and Gait analysis. RESULTS We observed increased scores after the intervention of 9/72 points in GMF - Module E (Walk, Run and Jump) and of 9/56 points in BBS, sustained at Follow-up. Changes in function, specifically in the quality and independence of the performance of specific movements such as turning 360°, increased distance reaching forward, walk behind, step over obstacles, and step stairs up and down were also observed. Gait kinematics and Spatio-temporal parameters tended to get closer to the 50th percentile. CONCLUSIONS We observed positive changes in motor function of a teenager with cerebral palsy, with sustained increased scores at a 1-month Follow-up. Findings are suggestive that intensive rehabilitation programs using exergames with high customisation features are a potentially valuable rehabilitation tool for training balance in teenagers with Cerebral Palsy.Implications for rehabilitationExergames may be a useful for providing balance training for teenagers who have a mixed form of cerebral palsy.Exergames that require body displacement may be suitable for modulating gait kinematics and spatio-temporal parameters.The customisation of virtual rehabilitation tools seems to impact the motivation and effort of the user positively.
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Affiliation(s)
- Fábio Pereira
- Faculdade de Ciências Exatas e da Engenharia, Universidade da Madeira, Funchal, Portugal
- Madeira Interactive Technologies Institute, Universidade da Madeira, Funchal, Portugal
- NOVA Laboratory for Computer Science and Informatics, Caparica, Portugal
| | - Mónica S Cameirão
- Faculdade de Ciências Exatas e da Engenharia, Universidade da Madeira, Funchal, Portugal
- Madeira Interactive Technologies Institute, Universidade da Madeira, Funchal, Portugal
- NOVA Laboratory for Computer Science and Informatics, Caparica, Portugal
| | - Sergi Bermúdez I Badia
- Faculdade de Ciências Exatas e da Engenharia, Universidade da Madeira, Funchal, Portugal
- Madeira Interactive Technologies Institute, Universidade da Madeira, Funchal, Portugal
- NOVA Laboratory for Computer Science and Informatics, Caparica, Portugal
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Mischler B, Hilfiker R, Hund-Georgiadis M, Maguire C. Physical activity based on daily step-count in inpatient setting in stroke and traumatic brain injury patients in subacute stage: A cross-sectional observational study. NeuroRehabilitation 2023; 52:435-450. [PMID: 37005896 DOI: 10.3233/nre-220248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
BACKGROUND Daily step-count is important post-insult in the subacute phase to influence neuroplasticity, functional recovery and as a predictive factor for activity level one-year post event. OBJECTIVE Measure daily step-count in subacute patients follow-ing brain injury in an inpatient neurorehabilitation setting and compare these to evi-dence-based recommendations. METHODS 30 participants measured of daily step-count over a seven-day period, throughout the day to assess when and how activity varied. Step-counts were analyzed in sub-groups based on walking ability using the Functional Ambulation Categories (FAC). Correlations between steps-count and FAC level, walking speed, light touch, joint position sense, cognition, and fear of falling were calculated. RESULTS Median (IQR) daily steps for all patients was 2512 (568.5,4070.5). Not independently walkers took 336 (5–705), the value is below the recommendation. Participants walking with assistance took 700 (31–3080), significantly below recommended value (p = 0.002), independent walkers took 4093 (2327–5868) daily steps, significantly below recommended value (p = < 0.001). Step-count showed moderate to high and statistically-significant correlations: positive for walking speed, joint position sense, negative for fear of falling, and number of medications. CONCLUSIONS Only 10% of all participants reached the recommended daily steps. Interdisciplinary team-work and strategies to increase daily activity between therapies may be crucial to achieve recommended step-levels in subacute inpatient settings.
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Affiliation(s)
- Brigitte Mischler
- Center for Neurorehabilitation and Paraplegiology, REHAB Basel, Basel, Switzerland
- Bern University of Applied Science, Department of Health, Bern, Switzerland
| | - Roger Hilfiker
- Bern University of Applied Science, Department of Health, Bern, Switzerland
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne, Lausanne, Switzerland
| | | | - Clare Maguire
- Center for Neurorehabilitation and Paraplegiology, REHAB Basel, Basel, Switzerland
- Bern University of Applied Science, Department of Health, Bern, Switzerland
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3
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Grenier A, Viscogliosi C, Delli-Colli N, Mortenson WB, Macleod H, Lemieux-Courchesne AC, Provencher V. The Performance Assessment of Self-Care Skills to Predict Adverse Events Post-Discharge. Can J Occup Ther 2022; 89:190-200. [PMID: 35275507 DOI: 10.1177/00084174221084459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. The Performance Assessment of Self-Care Skills (PASS) is a standardized assessment of the ability to perform daily activities. Purposes. This preliminary exploratory study aimed to 1) explore the ability of four PASS tasks to predict adverse events (readmissions and injuries) in older adults following hospitalization; 2) compare PASS's predictive validity to that of a generic tool (SMAF) and OT clinical judgement. Method.Twenty-two older patients were assessed in hospital at discharge and at home one week later. Adverse events were documented for six months post-discharge. Sensitivity and specificity analyses (ROC curves, Fisher's exact tests) were performed. Findings. Two PASS tasks (telephone, medication), the SMAF-Social and OT clinical judgement could identify individuals at risk of readmission (AUC > 0.7; p < 0.05). Implications. Using the PASS to assess more cognitively demanding tasks could be a promising way to predict adverse events after discharge, as a complement to clinical judgment.
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Acuña SA, Tyler ME, Thelen DG. Individuals with Chronic Mild-to-Moderate Traumatic Brain Injury Exhibit Decreased Neuromuscular Complexity During Gait. Neurorehabil Neural Repair 2022; 36:317-327. [PMID: 35321610 DOI: 10.1177/15459683221081064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Synergy analysis provides a means of quantifying the complexity of neuromuscular control during gait. Prior studies have shown evidence of reduced neuromuscular complexity during gait in individuals with neurological disorders associated with stroke, cerebral palsy, and Parkinson's disease. OBJECTIVE The purpose of this study was to investigate neuromuscular complexity during gait in individuals who experienced a prior traumatic brain injury (TBI) that resulted in chronic balance deficits. METHODS We measured and analyzed lower extremity electromyographic data during treadmill and overground walking for 44 individuals with residual balance deficits from a mild-to-moderate TBI at least 1 year prior. We also tested 20 unimpaired controls as a comparison. Muscle synergies were calculated for each limb using non-negative matrix factorization of the activation patterns for 6 leg muscles. We quantified neuromuscular complexity using Walk-DMC, a normalized metric of the total variance accounted for by a single synergy, in which a Walk-DMC score of 100 represents normal variance accounted for. We compared group average synergy structures and inter-limb similarity using cosine similarity. We also quantified each individual's gait and balance using the Sensory Organization Test, the Dynamic Gait Index, and the Six-Minute Walk Test. RESULTS Neuromuscular complexity was diminished for individuals with a prior TBI. Walk-DMC averaged 92.8 ± 12.3 for the TBI group during overground walking, which was significantly less than seen in controls (100.0 ± 10.0). Individuals with a prior TBI exhibited 13% slower overground walking speeds than controls and reduced performance on the Dynamic Gait Index (18.5 ± 4.7 out of 24). However, Walk-DMC measures were insufficient to stratify variations in assessments of gait and balance performance. Group average synergy structures were similar between groups, although there were considerable between-group differences in the inter-limb similarity of the synergy activation vectors. CONCLUSIONS Individuals with gait and balance deficits due to a prior TBI exhibit evidence of decreased neuromuscular complexity during gait. Our results suggest that individuals with TBI exhibit similar muscle synergy weightings as controls, but altered control of the temporal activation of these muscle weightings.
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Affiliation(s)
- Samuel A Acuña
- Department of Bioengineering, 3298George Mason University, Fairfax, VA, USA.,Center for Adaptive Systems of Brain-Body Interactions, 3298George Mason University, Fairfax, VA, USA.,Department of Mechanical Engineering, 5228University of Wisconsin-Madison, Madison, WI, USA
| | - Mitchell E Tyler
- Department of Biomedical Engineering, 5228University of Wisconsin-Madison, Madison, WI, USA.,Department of Kinesiology, 5228University of Wisconsin-Madison, Madison, WI, USA
| | - Darryl G Thelen
- Department of Mechanical Engineering, 5228University of Wisconsin-Madison, Madison, WI, USA.,Department of Biomedical Engineering, 5228University of Wisconsin-Madison, Madison, WI, USA.,Department of Orthopedics and Rehabilitation, 5228University of Wisconsin-Madison, Madison, WI, USA
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Adjunct Non-Elastic Hip Taping Improves Gait Stability in Cane-Assisted Individuals with Chronic Stroke: A Randomized Controlled Trial. J Clin Med 2022; 11:jcm11061553. [PMID: 35329877 PMCID: PMC8954645 DOI: 10.3390/jcm11061553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/05/2022] [Accepted: 03/07/2022] [Indexed: 02/04/2023] Open
Abstract
Cane-assisted individuals with chronic stroke may perform with an abnormal gait pattern. One of the important factors of gait training for cane-assisted individuals is inducing improvement in lower limb muscle activity of the paretic side. Non-elastic taping on the hip may be used as an adjunct therapy for improving gait. The objective of this study was to investigate effects of non-elastic hip taping combined with exercise on gait in cane-assisted individuals with chronic stroke. This study is a single-blinded, randomized controlled trial. A total of 21 cane-assisted ambulators with chronic stroke were enrolled. Participants in both groups received a therapeutic exercise program, with the experimental and control groups having adjunct non-elastic taping and sham taping on the hip, respectively. The gait, Berg Balance Scale, 6-min walk test, and Fall Efficacy Scale–International were measured at pre-intervention, post-intervention, and 1-month follow-up. The experimental group resulted in significantly better performance in double-support time compared with the control group. Furthermore, the experimental group showed a significant improvement in double-support time and spatial symmetry at post-intervention and 1-month follow-up compared with pre-intervention. This study demonstrated that non-elastic hip taping combined with exercise could improve gait stability in cane-assisted ambulators. Non-elastic hip taping would be a useful adjunct to rehabilitation strategies for individuals with chronic stroke.
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Joubran K, Bar-Haim S, Shmuelof L. Dynamic balance recovery in chronic acquired brain injury participants following a perturbation training. Int J Rehabil Res 2021; 44:350-357. [PMID: 34739006 DOI: 10.1097/mrr.0000000000000485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Acquired brain injury (ABI) is defined as a damage to the brain that occurs after birth. Subjects post-ABI frequently suffer from dynamic balance impairments that persist years after the injury. This study aimed to investigate the effect of a perturbation method using mechatronic shoes that introduce unexpected balance perturbations on the recovery of dynamic balance and gait velocity in chronic ABI participants. In an intervention trial, 35 chronic ABI participants (stroke and traumatic brain injury) participated in 22 sessions of perturbation training, twice a week for 3 months. Dynamic balance was assessed pre- and post-training using Community Balance and Mobility Scale (CB&M). Gait velocity was also assessed in the stroke participants using the 10 Meter Walking Test (10MWT). Dynamic balance improved significantly post-training (P = 0.001). This improvement was greater than the improvement that was observed in a sub-group that was tested twice before training (P = 0.04). Sixteen participants (45.7%) out of 35 met or exceeded minimal detectable change (MDC) of the CB&M Scale. Self-paced velocity also improved significantly (P = 0.02) but only two participants (9.5%) out of 21 exceeded the MDC of 10MWT post-stroke. Our results suggest that unexpected balance perturbation training using mechatronic shoes leads to an improvement in dynamic balance and gait velocity in chronic ABI participants. The advantage of perturbation training using mechatronic shoes with respect to conventional balance training should be further examined.
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Affiliation(s)
- Katherin Joubran
- Department of Cognitive and Brain Sciences, Ben-Gurion University of the Negev
- Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev
| | - Simona Bar-Haim
- Department of Physical Therapy, Recanati School for Community Health Professions, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Lior Shmuelof
- Department of Cognitive and Brain Sciences, Ben-Gurion University of the Negev
- Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev
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Kahn MB, Clark RA, Mentiplay BF, Bower KJ, Olver J, Williams G. Potential contributing factors to upper limb associated reactions in people with acquired brain injury: an exploratory study. Disabil Rehabil 2021; 44:3816-3824. [PMID: 33617385 DOI: 10.1080/09638288.2021.1887945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To determine which potential contributing factors are associated with upper limb associated reaction (AR) expression in individuals with acquired brain injury (ABI). METHODS Forty-two participants underwent three-dimensional motion analysis at self-selected walking speed to generate the AR outcome measure, quantifying their upper limb kinematic deviation compared to healthy controls. Clinical assessment included: upper and lower limb hypertonicity, spasticity and strength, balance, dynamic walking stability, arm and leg function, anxiety, arm pain/discomfort, and fear of falling. RESULTS Significant, moderate-to-strong correlations (r = 0.42-0.74, p < 0.05) existed between upper limb ARs and both hypertonicity and spasticity of the upper limb muscles and the knee extensors. Significant, moderate correlations to ARs (r = 0.42-0.59, p < 0.05) existed for balance, dynamic stability, upper limb strength, and arm function. The severity of AR was significantly different between those with and without hypertonicity of the four tested upper limb muscles, elbow and long finger flexor spasticity, knee extensor spasticity, and reduced dynamic stability (p < 0.05; effect sizes ≥0.80). However, these contributing factors were not present in all participants. CONCLUSIONS Associated reactions are complex and multi-factorial. There were several significant correlations indicating that factors may influence AR severity. While positive upper motor neuron syndrome features should be prioritised for clinical assessment, these factors are not prerequisites for ARs.IMPLICATIONS FOR REHABILITATIONUpper limb associated reactions are a complex and multi-factorial phenomenon.Upper limb muscle hypertonicity and spasticity should be prioritised for assessment; however, they are not prerequisites for associated reactions.Hypertonicity and spasticity should be differentiated as they may have differing relationships to associated reactions.Knee extensor hypertonicity and spasticity, postural stability, upper limb strength, and arm function may also be contributing factors to consider.
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Affiliation(s)
- Michelle B Kahn
- Department of Physiotherapy, Epworth Rehabilitation, Epworth Healthcare, Melbourne, Australia.,School of Health and Sport Sciences, University of Sunshine Coast, Sunshine Coast, Australia
| | - Ross A Clark
- School of Health and Sport Sciences, University of Sunshine Coast, Sunshine Coast, Australia
| | - Benjamin F Mentiplay
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia
| | - Kelly J Bower
- School of Physiotherapy, The University of Melbourne, Melbourne, Australia
| | - John Olver
- Epworth Monash Rehabilitation Unit (EMReM), Melbourne, Australia
| | - Gavin Williams
- Department of Physiotherapy, Epworth Rehabilitation, Epworth Healthcare, Melbourne, Australia.,School of Physiotherapy, The University of Melbourne, Melbourne, Australia
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Cesar GM, Buster TW, Burnfield JM. Test-retest reliability and minimal detectable change of the computerized dynamic posturography PROPRIO for adults with chronic traumatic brain injury. Disabil Rehabil 2019; 43:2038-2044. [PMID: 31724889 DOI: 10.1080/09638288.2019.1688872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE Balance deficits after brain injury, including reactive recovery from unexpected perturbations, can persist well after rehabilitation is concluded. While traditional clinical assessments are practical, the anticipatory nature of the tasks may mask perceptible balance control. Computerized dynamic posturography can directly quantify capacity to respond to unexpected, external perturbations. This study examined the reliability of the computerized dynamic posturography assessment with the device PROPRIO® 4000 in adults with traumatic brain injury and created the minimal detectable change for its standardized test. METHODS Ten adults (ages 21-55 years) with chronic (average 10 ± 6 years post-injury) severe (loss of consciousness 2-75 days) brain injury performed three trials of the Propriotest® on two separate days. The average of three trials and the best scores were used separately for analysis. Test-retest reliability was verified using Intraclass Correlation Coefficients with 95% confidence interval and standard error of measurement in relation to the Intraclass Correlation Coefficients at 95%. The minimal detectable change was calculated at 95% confidence level (minimal detectable change95) and Bland-Altman plots were created to express agreement between measurement days. RESULTS The results exhibited excellent reliability for both average (Intraclass Correlation Coefficient of 0.969, standard error of measurement 50.9 points) and best (Intraclass Correlation Coefficient of 0.985, standard error of measurement 31.3 points) scores, with average and best minimal detectable change95 of 141.0 and 86.7 points, respectively. CONCLUSIONS Clinicians and rehabilitation researchers can use these findings to determine if a Propriotest® change score represents a true post-treatment effect with adults with chronic brain injury.IMPLICATIONS FOR REHABILITATIONAfter brain injury, balance deficits are common and can persist well after completion of rehabilitation programs.Computerized dynamic posturography allows for objective quantification of one's capacity to respond to external perturbations.The device PROPRIO® 4000 provides reliable quantification of balance deficits of community dwelling individuals who have experienced a severe traumatic brain injury.The minimal detectable change scores created can assist clinicians and rehabilitation researchers detect whether a change in balance score represents a true effect of an intervention at post-treatment.
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Affiliation(s)
- Guilherme M Cesar
- Institute for Rehabilitation Science and Engineering, Madonna Rehabilitation Hospitals, Lincoln, NE, USA
| | - Thad W Buster
- Institute for Rehabilitation Science and Engineering, Madonna Rehabilitation Hospitals, Lincoln, NE, USA
| | - Judith M Burnfield
- Institute for Rehabilitation Science and Engineering, Madonna Rehabilitation Hospitals, Lincoln, NE, USA
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Huang WY, Tuan SH, Li MH, Liu XY, Hsu PT. Immediate effects of a novel walking assist device with auxiliary illuminator on patients after acute strokes. Hong Kong Physiother J 2019; 39:115-124. [PMID: 31889762 PMCID: PMC6900335 DOI: 10.1142/s1013702519500100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 04/02/2019] [Accepted: 04/08/2019] [Indexed: 11/18/2022] Open
Abstract
Background: Many patients after acute stage of stroke are present with abnormal gait pattern due to weakness or hypertonicity of the affected limbs. Facilitation of normal gait is a primary goal of rehabilitation on these patients. Objective: We aimed to investigate whether walking assist device with auxiliary illuminator (quad-cane with laser) providing visual feedback during ambulation could improve parameters of gait cycle immediately among patients with subacute and chronic stroke. Methods: This was a cross-sectional study and 30 participants (male 23, female 7, group 1) with mean age 60.20±11.12 years were recruited. Among them, 22 used ankle-foot orthosis [(AFO), group 2] and 8 did not use AFO (group 3) at usual walking. All the participants walked along a strait corridor with even surface for 20 m without and with using a quad-cane with laser, respectively. A gait analyzer (Reha-Watch1 system) was used to measure the changes of the parameters of gait cycle, including stride length, cadence, gait speed, stance phase, swing phase, duration of single support and double support, the angle between toes and the ground at the time of toe-off (the toe-off angle) and the angle between calcaneus and the ground at the time of heel-strike (the heel-strike angle), before and with the use of a quad-cane with laser. Results: The increase in the heel-strike angle reached a significant difference in groups 1 2, and 3 (p=0.02,<0.01, and =0.05, respectively). However, the stride length, the gait speed, the cadence, percentage of the stance phase, swing phase, single-support phase, and double-support phase in a gait cycle, and the toe-off angle showed no significant change with the use of quad-cane with laser. Conclusion: Patients after acute stroke had an immediate and significant increase in the heel-stroke angle by using a quad-cane with laser during ambulation, which might help the patients to reduce knee hyperextension moment and lessen the pressure of heel at loading phase.
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Affiliation(s)
- Wan-Yun Huang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,National Cheng Kung University, Institute of Allied Health Sciences, Tainan, Taiwan
| | - Sheng-Hui Tuan
- Department of Rehabilitation Medicine, Cishan Hospital, Ministry of Health and Welfare, Kaohsiung, Taiwan
| | - Min-Hui Li
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Graduate Institute of Aerospace and Undersea Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Xin-Yu Liu
- Department of Kinesiology, Health, and Leisure Studies, National University of Kaohsiung, Kaohsiung, Taiwan
| | - Pei-Te Hsu
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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Chen JL, Wang RY, Lee CS, Chen YJ, Yang YR. Immediate effect of hip taping on balance and walking ability in cane-dependent ambulators with chronic stroke: a randomized controlled trial. Eur J Phys Rehabil Med 2018; 55:156-161. [PMID: 30160436 DOI: 10.23736/s1973-9087.18.05300-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Previous studies showed that cane-dependent post-stroke ambulators have poor balance and gait performance. Adhesive taping on the hip may be used as a therapeutic modality for improving range of motion and muscle activity in individuals with stroke. AIM The objective of this study was to investigate the immediate effect of the hip extensor and abductor taping on balance and walking ability in cane-dependent ambulators with chronic stroke. DESIGN This study was a single-blinded, randomized controlled trial. SETTING Outpatients from a hospital rehabilitation department. POPULATION Twenty-eight cane-dependent ambulators with chronic stroke were recruited. METHODS Participants were randomized into either the control group with sham tape (N.=14) or experimental group with non-elastic tape (N.=14). The Berg Balance Scale, gait speed, 6-minute walk test, and Fall Efficacy Scale were measured with and without taping. RESULTS After taping, participants in the experimental group showed significant improvement in the Berg Balance Scale, gait speed, and 6-minute walk test. Furthermore, experimental group showed significant improvement in the Berg Balance Scale and 6-minute walk test compared with sham taping control group. CONCLUSIONS Non-elastic tape could immediately improve balance, gait speed, and endurance in cane-dependent ambulators with chronic stroke. CLINICAL REHABILITATION IMPACT Non-elastic tape may be a useful adjunct to current rehabilitation strategies for individuals with chronic stroke.
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Affiliation(s)
- Jyue-Liang Chen
- Department of Rehabilitation Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Ray-Yau Wang
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan
| | - Chun-Shou Lee
- Section of Physical Therapy, Department of Rehabilitation Medicine, Renai Branch of Taipei City Hospital, Taipei, Taiwan
| | - Yun-Ju Chen
- Section of Physical Therapy, Department of Rehabilitation Medicine, Zhongxing Branch of Taipei City Hospital, Taipei, Taiwan
| | - Yea-Ru Yang
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan - .,Preventive Medicine Research Center, National Yang-Ming University, Taipei, Taiwan
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11
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Acuña SA, Tyler ME, Danilov YP, Thelen DG. Abnormal muscle activation patterns are associated with chronic gait deficits following traumatic brain injury. Gait Posture 2018; 62:510-517. [PMID: 29684885 PMCID: PMC5998824 DOI: 10.1016/j.gaitpost.2018.04.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 03/21/2018] [Accepted: 04/10/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Gait and balance disorders are common among individuals who have experienced a mild to moderate traumatic brain injury (TBI). However, little is known about how the neuromuscular control of gait is altered following a TBI. RESEARCH QUESTION Investigate the relationship between lower limb muscle activation patterns and chronic gait deficits in individuals who previously experienced a mild to moderate TBI. METHODS Lower extremity electromyographic (EMG) signals were collected bilaterally during treadmill and overground walking in 44 ambulatory individuals with a TBI >1 year prior and 20 unimpaired controls. Activation patterns of TBI muscles were cross-correlated with normative data from control subjects to assess temporal phasing of muscle recruitment. Clinical assessments of gait and balance were performed using dynamic posturography, the dynamic gait index, six-minute walk test, and preferred walking speed. RESULTS TBI subjects exhibited abnormal activation patterns in the tibialis anterior, medial gastrocnemius, and rectus femoris muscles during both overground and treadmill walking. Activation patterns of the vastus lateralis and soleus muscles did not differ from normal. There was considerable heterogeneity in performance on clinical balance and gait assessments. Abnormal muscle activation patterns were significantly correlated with variations in the dynamic gait index among the TBI subjects. SIGNIFICANCE Individuals who have experienced a prior TBI do exhibit characteristic changes in the temporal coordination of select lower extremity muscles, which may contribute to impairments during challenging walking tasks.
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Affiliation(s)
- Samuel A Acuña
- Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Mitchell E Tyler
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Yuri P Danilov
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Darryl G Thelen
- Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, WI, USA; Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA; Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA.
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12
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Austin HM, Balendra N, Langenderfer JE, Ustinova KI. Decomposition of leg movements during overground walking in individuals with traumatic brain injury. Brain Inj 2018; 32:739-746. [PMID: 29494269 DOI: 10.1080/02699052.2018.1444203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Walking requires precise coordination of bilateral lower extremity motions at all joints. This ability can be affected by traumatic brain injury (TBI). The study investigated inter-joint coordination of lower extremities during overground walking after TBI. METHODS Ten individuals with post-injury ataxia, postural stability and gait abnormalities, as well as 10 sex- and age-matched control subjects were involved in the study. Participants walked at self-selected speed in three experimental conditions: normal walking without any additional task; walking with a narrow base of support, and walking while holding a cup full of water. Inter-joint coordination was analysed as the percentage of gait cycle during which the leg movement was decomposed with 0% indicating simultaneous motion of the two joints (i.e. hip-knee, knee-ankle, and hip-ankle) through the entire gait cycle or 100% indicating motion of only one joint. Decomposition was calculated for each pair of joints and for the left and right leg separately. RESULTS Participants with TBI showed greater decomposition indices and poorer inter-joint coordination respectively than control individuals for all joint pairs (p < 0.01). Walking with the narrower base of support or with a cup, increased movement decomposition in the TBI group, but not in the control group. CONCLUSION The results revealed post-injury gait impairment that manifests as decomposition of multi-joint motions of the lower extremities during overground walking.
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Affiliation(s)
- H M Austin
- a Department of Physical Therapy , Central Michigan University , Mt. Pleasant , MI , USA
| | - N Balendra
- a Department of Physical Therapy , Central Michigan University , Mt. Pleasant , MI , USA
| | - J E Langenderfer
- b School of Engineering and Technology , Central Michigan University , Mt. Pleasant , MI , USA
| | - K I Ustinova
- a Department of Physical Therapy , Central Michigan University , Mt. Pleasant , MI , USA
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Outcome Measures for Persons With Moderate to Severe Traumatic Brain Injury: Recommendations From the American Physical Therapy Association Academy of Neurologic Physical Therapy TBI EDGE Task Force. J Neurol Phys Ther 2017; 40:269-80. [PMID: 27576089 DOI: 10.1097/npt.0000000000000145] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE The use of standardized outcome measures (OMs) is essential in assessing the effectiveness of physical therapy (PT) interventions. The purposes of this article are (1) to describe the process used by the TBI EDGE task force to assess the psychometrics and clinical utility of OMs used with individuals with moderate to severe traumatic brain injury (TBI); (2) to describe the consensus recommendations for OM use in clinical practice, research, and professional (entry-level) PT education; and (3) to make recommendations for future work. METHODS An 8-member task force used a modified Delphi process to develop recommendations on the selection of OMs for individuals with TBI. A 4-point rating scale was used to make recommendations based on practice setting and level of ambulation. Recommendations for appropriateness for research use and inclusion in entry-level education were also provided. RESULTS The TBI EDGE task force reviewed 88 OMs across the International Classification of Functioning, Disability, and Health (ICF) domains: 15 measured body functions/structure only, 21 measured activity only, 23 measured participation only, and 29 OMs covered more than 1 ICF domain. DISCUSSION AND CONCLUSIONS Recommendations made by the TBI EDGE task force provide clinicians, researchers, and educators with guidance for the selection of OMs. The use of these recommendations may facilitate identification of appropriate OMs in the population with moderate to severe TBI. TBI EDGE task force recommendations can be used by clinicians, researchers, and educators when selecting OMs for their respective needs. Future efforts to update the recommendations are warranted in order to ensure that recommendations remain current and applicable.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A140).
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Park SH, Lee YS. The Diagnostic Accuracy of the Berg Balance Scale in Predicting Falls. West J Nurs Res 2016; 39:1502-1525. [DOI: 10.1177/0193945916670894] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
This study aimed to evaluate the predictive validity of the Berg Balance Scale (BBS) as a screening tool for fall risks among those with varied levels of balance. A total of 21 studies reporting predictive validity of the BBS of fall risk were meta-analyzed. With regard to the overall predictive validity of the BBS, the pooled sensitivity and specificity were 0.72 and 0.73, respectively; the accuracy curve area was 0.84. The findings showed statistical heterogeneity among studies. Among the sub-groups, the age group of those younger than 65 years, those with neuromuscular disease, those with 2+ falls, and those with a cutoff point of 45 to 49 showed better sensitivity with statistically less heterogeneity. The empirical evidence indicates that the BBS is a suitable tool to screen for the risk of falls and shows good predictability when used with the appropriate criteria and applied to those with neuromuscular disease.
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Renfro M, Maring J, Bainbridge D, Blair M. Fall Risk Among Older Adult High-Risk Populations: a Review of Current Screening and Assessment Tools. CURRENT GERIATRICS REPORTS 2016. [DOI: 10.1007/s13670-016-0181-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Buster TW, Chernyavskiy P, Harms NR, Kaste EG, Burnfield JM. Computerized dynamic posturography detects balance deficits in individuals with a history of chronic severe traumatic brain injury. Brain Inj 2016; 30:1249-55. [DOI: 10.1080/02699052.2016.1183822] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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McKechnie D, Pryor J, Fisher MJ. Falls and fallers in traumatic brain injury (TBI) rehabilitation settings: an integrative review. Disabil Rehabil 2015; 37:2291-9. [PMID: 25613355 DOI: 10.3109/09638288.2014.1002578] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To critically appraise the research literature on the nature of falls and fallers in traumatic brain injury (TBI) rehabilitation settings. METHOD An integrative review of the literature using thematic analysis was undertaken. Papers identified via a systematic search strategy were independently appraised by two reviewers. A data extraction instrument was developed to record results and to aid identification of themes in the literature. Critical Appraisal Skills Programme instruments were utilised to conduct a methodological critique of the papers included. RESULTS Thirteen studies were identified as having between 4% and 100% TBI patients in their study cohorts. From these papers, up to 71% of falls took place in a patient's bedroom occurring in peaks and troughs over a 24-h period. With some divergent results, nine themes were identified describing faller characteristics including: (1) functional mobility impairments; (2) dizziness; (3) bladder and bowel dysfunction; (4) certain medications and number of medications prescribed; (5) executive functioning; (6) patient age; (7) fear of falling; (8) coma length following TBI; and (9) Functional Independence Measure (FIM™) total score, subscale scores and particular individual items. CONCLUSIONS Being a multifactorial phenomenon, falls are a complex clinical issue. Despite the heterogeneity of diagnosis related groups (DRGs) in the included studies, TBI patients were identified as a high falls risk patient population in several studies. Implications for Rehabilitation Due to multisystem impairments, falls in the traumatic brain injury (TBI) rehabilitation context are a multifactorial and significant clinical issue. When interpreting and generalising results from research into falls, clinicians need to be mindful that falls and faller characteristics may be dependent on study setting and patient population. There is need for context specific research into faller characteristics following a TBI; particularly in relation to post-traumatic amnesia.
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Affiliation(s)
- Duncan McKechnie
- a Sydney Nursing School, The University of Sydney , Sydney , New South Wales , Australia .,b Brain Injury Unit , Royal Rehab , Sydney , New South Wales , Australia , and
| | - Julie Pryor
- a Sydney Nursing School, The University of Sydney , Sydney , New South Wales , Australia .,c Nursing Research and Development , Royal Rehab , Sydney , New South Wales , Australia
| | - Murray J Fisher
- a Sydney Nursing School, The University of Sydney , Sydney , New South Wales , Australia .,c Nursing Research and Development , Royal Rehab , Sydney , New South Wales , Australia
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Kim O, Kim JH. Falls and Use of Assistive Devices in Stroke Patients with Hemiparesis: Association with Balance Ability and Fall Efficacy. Rehabil Nurs 2014; 40:267-74. [PMID: 25042606 DOI: 10.1002/rnj.173] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2014] [Indexed: 02/01/2023]
Abstract
PURPOSE This study investigates balance ability and the fall efficacy with regard to the experiences of stroke patients with hemiparesis. METHODS The experience of falling, the use of assistive devices, and each disease-related characteristic were assessed using face-to-face interviews and a self-reported questionnaire. The Berg Balance Scale and Fall Efficacy Scale were used to measure balance ability and confidence. RESULTS The fall efficacy was significantly lower in participants who had experienced falls than those who had not. The participants who used assistive devices exhibited low balance ability and fall efficacy compared to those who did not use assistive devices. CONCLUSIONS Stroke patients with fall experience and walking aids might be considered at increased risk of falling. CLINICAL RELEVANCE Preventive measures for individuals using walking aids may be beneficial in reducing the fall rate of community-dwelling stroke patients.
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Affiliation(s)
- Oksoo Kim
- Division of Nursing, College of Health Sciences, Ewha Womans University, Seoul, Korea
| | - Jung-Hee Kim
- Department of Nursing, College of Health Sciences, Dankook University, Cheonan, Korea
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Murphy MP, Carmine H, Kolakowsky-Hayner S. Modifiable and Nonmodifiable Risk Factors for Falls After Traumatic Brain Injury: An Exploratory Investigation With Implications for Medication Use. Rehabil Nurs 2014; 39:113-22. [DOI: 10.1002/rnj.89] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2013] [Indexed: 11/10/2022]
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Peters DM, Jain S, Liuzzo DM, Middleton A, Greene J, Blanck E, Sun S, Raman R, Fritz SL. Individuals with chronic traumatic brain injury improve walking speed and mobility with intensive mobility training. Arch Phys Med Rehabil 2014; 95:1454-60. [PMID: 24769069 DOI: 10.1016/j.apmr.2014.04.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 04/10/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To determine the feasibility and impact of different dosages of Intensive Mobility Training (IMT) on mobility, balance, and gait speed in individuals with chronic traumatic brain injury (TBI). DESIGN Prospective, single group design with 3-month follow-up. SETTING University research laboratory. PARTICIPANTS Volunteer sample of participants with chronic TBI (N=10; ≥3 mo post-TBI; able to ambulate 3.05 m with or without assistance; median age, 35.4 y; interquartile range, 23.5-46 y; median time post-TBI, 9.91 y; interquartile range, 6.3-14.2 y). Follow-up data were collected for all participants. INTERVENTIONS Twenty days (5 d/wk for 4 wk), with 150 min/d of repetitive, task-specific training equally divided among balance; gait training; and strength, coordination, and range. MAIN OUTCOME MEASURES Pain and fatigue were recorded before and after each session to assess feasibility. Treatment outcomes were assessed before training (pre), after 10 sessions (interim), after 20 sessions (post), and at 3-months follow-up and included the Berg Balance Scale and gait speed. RESULTS Participants averaged 150.1±2.7 minutes per session. Median presession and postsession pain scores were 0 (out of 10) for 20 sessions; median presession fatigue scores ranged from 0 to 2.5 (out of 10); and postsession scores ranged from 3 to 5.5 (out of 10). Four outcome measures demonstrated significant improvement from the pretest to interim, with 7 out of 10 participants exceeding the minimal detectable change (MDC) for fast walking speed. At the posttest, 2 additional measures were significant, with more participants exceeding the MDCs. Changes in fast walking speed and Timed Up and Go test were significant at follow-up. CONCLUSIONS Limited fluctuations in pain and fatigue scores indicate feasibility of IMT in this population. Participants demonstrated improvements in walking speed, mobility, and balance postintervention and maintained gains in fast walking speed and mobility at 3 months.
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Affiliation(s)
- Denise M Peters
- Physical Therapy Program, Department of Exercise Science, University of South Carolina, Columbia, SC.
| | - Sonia Jain
- Division of Biostatistics and Bioinformatics, Department of Family and Preventive Medicine, University of California, San Diego, San Diego, CA
| | - Derek M Liuzzo
- Physical Therapy Program, Department of Exercise Science, University of South Carolina, Columbia, SC
| | - Addie Middleton
- Physical Therapy Program, Department of Exercise Science, University of South Carolina, Columbia, SC
| | - Jennifaye Greene
- Physical Therapy Program, Department of Exercise Science, University of South Carolina, Columbia, SC
| | - Erika Blanck
- Department of Cell Biology and Anatomy, School of Medicine, University of South Carolina, Columbia, SC
| | - Shelly Sun
- Biostatistics Research Center, University of California, San Diego, San Diego, CA
| | - Rema Raman
- Department of Family and Preventive Medicine, University of California, San Diego, San Diego, CA; Department of Neurosciences, University of California, San Diego, San Diego, CA
| | - Stacy L Fritz
- Physical Therapy Program, Department of Exercise Science, University of South Carolina, Columbia, SC
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Rosario ER, Kaplan SE, Khonsari S, Patterson D. Predicting and Assessing Fall Risk in an Acute Inpatient Rehabilitation Facility. Rehabil Nurs 2014; 39:86-93. [DOI: 10.1002/rnj.114] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2013] [Indexed: 11/11/2022]
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Relationships Among Measures of Balance, Gait, and Community Integration in People With Brain Injury. J Head Trauma Rehabil 2014; 29:117-24. [DOI: 10.1097/htr.0b013e3182864f2f] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Saverino A, Moriarty A, Playford D. The risk of falling in young adults with neurological conditions: a systematic review. Disabil Rehabil 2013; 36:963-77. [DOI: 10.3109/09638288.2013.829525] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Dual-task training for balance and mobility in a person with severe traumatic brain injury: a case study. J Neurol Phys Ther 2013; 37:37-43. [PMID: 23364169 DOI: 10.1097/npt.0b013e318282a20d] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Attentional impairments following severe traumatic brain injury (TBI) are common and can lead to decreased functional mobility and balance, as well as deficits in previously automatic movements such as walking and stair climbing. The purpose of this case study was to determine the feasibility and potential value of incorporating a cognitive-motor dual-task training program into physical therapy for a patient with a severe TBI. CASE DESCRIPTION The patient was a 26-year-old woman who sustained a severe TBI during a motor vehicle accident 46 days prior to physical therapy evaluation. On the 8-level Rancho Los Amigos Cognitive Function Scale, her functioning was classified as level IV. She had impairments in attention, functional mobility, and balance, all of which limited her ability to participate in activities of daily living. INTERVENTION : Physical therapy was provided over 26 days within the inpatient rehabilitation setting. Interventions included mobility tasks such as walking, balancing, and stair climbing. Mobility training was paired with specific secondary cognitive and motor tasks. OUTCOMES Dual-task training may have contributed to improvements on outcome measures designed to test divided attention including the Walking While Talking Test and Trail Making Test and a greater rate of improvement in walking speed and time to descend stairs when compared to the baseline phase. DISCUSSION Addition of cognitive-motor dual-task training to standard physical therapy in the inpatient rehabilitation setting appears to be feasible and may have value for improving function in individuals with severe TBI. VIDEO ABSTRACT AVAILABLE (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A41) for more insights from the authors.
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Sartor-Glittenberg C, Brickner L. A multidimensional physical therapy program for individuals with cerebellar ataxia secondary to traumatic brain injury: a case series. Physiother Theory Pract 2013; 30:138-48. [PMID: 23886039 DOI: 10.3109/09593985.2013.819952] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The purpose of this case series is to describe changes in impairments and activity limitations in three individuals with severe cerebellar ataxia from traumatic brain injury (TBI) who participated in a long-term, multidimensional physical therapy program. A secondary purpose is to document use of a climbing wall for these persons. Each of the individuals had a TBI, severe ataxia and was admitted to a transitional neuro-rehabilitation day treatment program. The first person, a 22-year-old, was 6 years post injury and had 127 individual physical therapy sessions over 12 months. The second person, a 16-year-old, was 5½ months post injury and had 187 individual therapy sessions over 19 months. The third person, a 20-year-old, was 6 months post injury and had 89 individual therapy sessions over 23 months. An integrative treatment approach was used, and the individuals participated in activities to minimize ataxia and improve mobility. Each of them made gains in coordination, balance, balance confidence, endurance and mobility. The three individuals with cerebellar ataxia participated in a long-term, individualized, multidimensional physical therapy treatment program, and made improvements in all areas of impairment and activity limitations. This study reinforces the need for long-term, multidimensional physical therapy for individuals with ataxia.
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Major MJ, Fatone S, Roth EJ. Validity and reliability of the Berg Balance Scale for community-dwelling persons with lower-limb amputation. Arch Phys Med Rehabil 2013; 94:2194-202. [PMID: 23856150 DOI: 10.1016/j.apmr.2013.07.002] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 07/02/2013] [Accepted: 07/03/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the validity and reliability of the Berg Balance Scale (BBS) for use in people with lower-limb amputation. DESIGN Cross-sectional study. SETTING Research laboratory. PARTICIPANTS Individuals (N=30; age, 54±12y; 20 men) with unilateral transtibial (n=13), unilateral transfemoral (n=14), or bilateral (n=3) lower-limb amputation of dysvascular (n=7), traumatic (n=14), infectious (n=6), or congenital (n=3) origin. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES BBS, 2-minute walk test, L test, Prosthesis Evaluation Questionnaire-Mobility Subscale, Activities-specific Balance Confidence Scale, and Frenchay Activities Index; self-reported descriptors were also collected, including frequency of prosthesis use, number of falls in 12 months before the visit, fear of falling, and daily mobility aid use. RESULTS The BBS had high interrater reliability (intraclass correlation coefficient =.945) and internal consistency (α=.827). Relations between the BBS scores and those of other outcome measures were all statistically significant (P≤.001). Significant group differences in BBS scores were observed for fear of falling (P=.008) and mobility aid use (P<.001), but not for multiple (≥2) falls in the previous 12 months (P=.381). BBS items involving reaching forward, turning 360°, tandem standing, and standing on 1 leg had relatively greater frequencies of lower scores across participants. CONCLUSIONS The BBS appears to be a valid and reliable clinical instrument for assessing balance in individuals with lower-limb amputation, but it may not be able to discriminate between individuals with greater or lesser fall risk. Limitations in prosthetic motion and control may be responsible for the challenges experienced on items of lower performance. Future studies would be useful to assess the responsiveness of the BBS to interventions aimed at improving balance in individuals with lower-limb amputation.
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Affiliation(s)
- Matthew J Major
- Northwestern University Prosthetics-Orthotics Center, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL.
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Chee JN, Gage WH, McIlroy WE, Zabjek KF. Foot placement patterns of female rollator users with multiple sclerosis in the community. Disabil Rehabil 2012; 35:27-35. [DOI: 10.3109/09638288.2012.687028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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D'Orio VL, Foley FW, Armentano F, Picone MA, Kim S, Holtzer R. Cognitive and motor functioning in patients with multiple sclerosis: Neuropsychological predictors of walking speed and falls. J Neurol Sci 2012; 316:42-6. [DOI: 10.1016/j.jns.2012.02.003] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Revised: 01/30/2012] [Accepted: 02/01/2012] [Indexed: 11/26/2022]
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Tuomela J, Paltamaa J, Häkkinen A. Reliability of the Dynamic Gait Index (Finnish version) in individuals with neurological disorders. Disabil Rehabil 2012; 34:1657-64. [DOI: 10.3109/09638288.2012.660602] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Cronin GW, Steenerson RL. Disequilibrium of Aging: Response to a 3-Month Program of Vestibular Therapy. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2011. [DOI: 10.3109/02703181.2010.544845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Williams G, Galna B, Morris ME, Olver J. Spatiotemporal Deficits and Kinematic Classification of Gait Following a Traumatic Brain Injury. J Head Trauma Rehabil 2010; 25:366-74. [DOI: 10.1097/htr.0b013e3181cd3600] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Williams G, Morris ME, Schache A, McCrory PR. Incidence of Gait Abnormalities After Traumatic Brain Injury. Arch Phys Med Rehabil 2009; 90:587-93. [DOI: 10.1016/j.apmr.2008.10.013] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2008] [Revised: 09/26/2008] [Accepted: 10/01/2008] [Indexed: 11/15/2022]
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Clark R, Kraemer T. Clinical Use of Nintendo Wii™ Bowling Simulation to Decrease Fall Risk in an Elderly Resident of a Nursing Home. J Geriatr Phys Ther 2009; 32:174-80. [DOI: 10.1519/00139143-200932040-00006] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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