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Peters J, Lauinger A, Mayr M, Ginell K, Abou L. Dual-Task Assessments for Predicting Future Falls in Neurologic Conditions: A Systematic Review. Am J Phys Med Rehabil 2024; 103:554-560. [PMID: 38466165 DOI: 10.1097/phm.0000000000002452] [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: 03/12/2024]
Abstract
ABSTRACT This review investigated the ability of dual-task tests to predict falls in people with neurological disorders. Databases were searched to identify prospective cohort studies that analyzed dual-task testing and falls in people with neurological disorders. Reviewers screened studies for eligibility and extracted key information like participant characteristics, intervention details, outcome measures, and significant outcomes. Reviewers assessed methodological quality of eligible studies using the Standard Quality Assessment Criteria. Eighteen studies of strong methodological qualified with 1750 participants were included in the review. Dual-task performances were predictive of future falls in people with Huntington's disease, spinal cord injury, and moderate cognitive impairment, although only one independent study was included for each disability type. In people with stroke, 37% of eligible studies showed dual-task assessments to be predictive of future falls. No dual-task tests predicted prospective falling in people with Alzheimer's or Parkinson's disease. Complex dual tasks seemed to be more predictive of fall risk than simpler dual tasks. Results suggest that disability type, severity of disability, and task complexity play a role in the predictive ability of dual-task assessments and future falling in neurological disorders. Future studies may benefit from using this review to guide the design of effective dual-task assessments and fall interventions.
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Affiliation(s)
- Joseph Peters
- From the Kansas City University College of Osteopathic Medicine, Kansas City University, Kansas City, Missouri (JP, MM); Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois (AL); and Department of Physical Medicine & Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan (KG, LA)
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Liu F, Yu H, Xu Q, Gong J, Huo M, Huang F. Risk Assessment of Falls Among Older Adults Based on Probe Reaction Time During Water-Carrying Walking. Clin Interv Aging 2024; 19:21-29. [PMID: 38204962 PMCID: PMC10777860 DOI: 10.2147/cia.s438904] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/28/2023] [Indexed: 01/12/2024] Open
Abstract
Purpose Falls are a significant factor affecting the health of older adults and are closely related to cognitive function. Adopting an effective method to evaluate the risk of falls in older adults is essential for improving their healthcare. This study combined cognitive and motor functions to determine a reliable probe reaction time during water-carrying walking. Patients and Methods We divided 100 community-dwelling older adults (aged 65 years and over) into two groups according to their fall history: the fall group and no-fall group. All subjects were tested on fall tasks using the timed up-and-go (TUG) test, 10-m walk timing test, trail marking test part-A (TMT-A), and water-carrying walking probe reaction time (P-RT). Results The fall group showed slower walking speeds and longer TUG, TMT-A, and P-RT times than the no-fall group. In the logistic regression analysis with falls as the dependent variable, water-carrying walking P-RT was identified as a useful factor, and the cut-off value of the water-carrying walking P-RT was 454 ms, which was evaluated using the receiver operating characteristic curve. Conclusion The P-RT of the water-carrying walking test was found to be credible and useful for evaluating the fall risk in older adults. Therefore, it is recommended that the P-RT-based dual-task be used as a predictive indicator of future falls in the older population.
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Affiliation(s)
- Fan Liu
- School of Health and Life Sciences, Binzhou Medical University, Yantai, People’s Republic of China
| | - Huan Yu
- School of Health and Life Sciences, Binzhou Medical University, Yantai, People’s Republic of China
| | - Qing Xu
- Yaitai Hospital, Binzhou Medical University, Yantai, People’s Republic of China
| | - Jianwei Gong
- School of Health and Life Sciences, Binzhou Medical University, Yantai, People’s Republic of China
| | - Ming Huo
- School of Health and Life Sciences, University of Health and Rehabilitation Sciences, Qingdao, People’s Republic of China
- Beijing Chaoyang Sanhuan Cancer Hospital, Beijing, 100122, People's Republic of China
| | - Fei Huang
- School of Health and Life Sciences, Binzhou Medical University, Yantai, People’s Republic of China
- School of Health and Life Sciences, University of Health and Rehabilitation Sciences, Qingdao, People’s Republic of China
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Levin C, Bachar-Kirshenboim Y, Rand D. Daily steps, walking tests, and functioning in chronic stroke; comparing independent walkers to device-users. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2024; 29:e2035. [PMID: 37432302 DOI: 10.1002/pri.2035] [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: 03/02/2023] [Revised: 06/04/2023] [Accepted: 06/26/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND AND PURPOSE Community mobility post-stroke is important for gaining independence in daily activities. Walking devices can facilitate mobility, but it remains unclear whether individuals who use a walking device walk as many daily steps as those who do not require a device. It is also unclear whether these groups differ in their independence in daily living. This study aimed (1) to compare daily steps, walking tests, and independence in basic and instrumental activities of daily living (IADL) six months post-stroke between individuals who walk independently and individuals who use a walking device, (2) within each group to assess correlations between daily steps and walking tests, independence in basic and IADL. METHODS Thirty-seven community-dwelling individuals with chronic stroke; 22 participants used a walking-device and 15 participants walked independently. Daily steps were calculated as a 3-day mean by hip accelerometers. Clinical walking tests included the 10-m-walk-test, Timed Up & Go and 'Walking While Talking'. Daily living was assessed using the Functional-Independence Measure and the IADL questionnaire. RESULTS Daily steps of the device-users were significantly lower than the independent-walkers (195-8068 versus 147-14010 steps/day) but independence in daily living was not significantly different. Different walking tests correlated with daily steps for device-users and independent-walkers. CONCLUSIONS This preliminary investigation in chronic stroke revealed that device-users walk significantly fewer daily steps but are as independent in daily living as independent-walkers. Clinicians should differentiate between individuals with and without a walking device and the use of different clinical walking tests to explain daily steps should be considered. Further research is needed to assess the impact of a walking device post-stroke.
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Affiliation(s)
- Chedva Levin
- Faculty of School of Life and Health Sciences, Nursing Department, The Jerusalem College of Technology-Lev Academic Center, Jerusalem, Israel
| | - Yishai Bachar-Kirshenboim
- Department of Occupational Therapy, School of Health Professions, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Debbie Rand
- Department of Occupational Therapy, School of Health Professions, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Davis AF, Klima DW, Leonard A, Miller SA. Floor-to-Stand Performance Among People Following Stroke. Phys Ther 2023; 103:pzad122. [PMID: 37690073 DOI: 10.1093/ptj/pzad122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 05/08/2023] [Accepted: 07/16/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVES Studies have examined floor-to-stand performance in varied adult populations both quantitatively and qualitatively. Despite an elevated risk of falls and inability to independently return to stand after a fall, few have examined the ability to stand from the floor in patients recovering from stroke. There were 2 objectives of the study: to identify the relationships between floor-to-stand performance using a timed supine-to-stand test (TSS) and physical performance measures of gait, balance, and balance confidence among persons in the subacute phase after stroke; and to analyze descriptive strategies used in the completion of the TSS. METHODS A cross-sectional design was implemented. Fifty-eight adults (mean age = 59.2 [standard deviation (SD) = 13.9] years; 34 [58.6%] men) who were in the subacute phase after ischemic or hemorrhagic stroke and who could stand from the floor with no more than supervision completed the TSS and physical performance assessments. RESULTS The median time to complete the TSS in our sample was 13.0 (interquartile range = 15.5) seconds. TSS time was significantly correlated with physical performance tests, including the Timed "Up & Go" Test (ρ = 0.70), gait speed (ρ = -0.67), Dynamic Gait Index (ρ = -0.52), and Activities-Specific Balance Confidence Scale (ρ = -0.43). Thirty-two percent of the variance in TSS time was attributed to Timed "Up & Go" Test time and the use of the quadruped position to transition to standing. Participants who used a gait device were more likely to use a chair during rise to stand. CONCLUSION The TSS demonstrates concurrent validity with physical performance measures. IMPACT Findings serve to improve functional mobility examination after stroke and to formulate effective treatment interventions to improve floor-to-stand performance.
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Affiliation(s)
- Angela F Davis
- Krannert School of Physical Therapy, University of Indianapolis, Indianapolis, Indiana, USA
| | - Dennis W Klima
- Department of Physical Therapy, University of Maryland Eastern Shore, Princess Anne, Maryland, USA
| | - Amanda Leonard
- Department of Rehabilitation, University of Maryland Rehabilitation & Orthopaedic Institute, Baltimore, Maryland, USA
| | - Stephanie A Miller
- Krannert School of Physical Therapy, University of Indianapolis, Indianapolis, Indiana, USA
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Del Castillo M, Mosteiro MA, Navarro J, Rivas ME, Gianella M, Ahumada M. [Incidence, circumstances and consequences of falls in subjects with stroke: One year of follow-up]. Rehabilitacion (Madr) 2023; 57:100809. [PMID: 37399639 DOI: 10.1016/j.rh.2023.100809] [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: 03/06/2022] [Revised: 01/25/2023] [Accepted: 04/01/2023] [Indexed: 07/05/2023]
Abstract
INTRODUCTION Falls are among the most frequent complications following stroke (CVA), and have a negative impact on rehabilitation. OBJECTIVES To study the incidence, circumstances, and consequences of falls in stroke patients up to 12months after starting outpatient kinetic treatment. MATERIALS AND METHODS Prospective design, case series. Consecutive sampling. Patients admitted to the day hospital between June 2019 and May 2020. Included: adults with a diagnosis of first supratentorial stroke and functional ambulatory category score ≥3. EXCLUSION CRITERIA other condition affecting locomotion. MAIN VARIABLES number of falls, circumstances, and consequences. Clinical, demographic, and functional characteristics were measured. RESULTS Twenty-one subjects were included, 13 suffered at least one fall. The subjects reported 41 falls: 15 were to the most affected side, 35 inside the home, 28 without the indicated equipment, they were alone when the event occurred on 29 occasions, and in two situations medical assistance was required. There were statistically significant differences (P<.05) in functional performance (balance, gait velocity) between those who fell and those who did not. No significant differences were found between gait endurance and falls. CONCLUSION More than half suffered a fall, alone, to the weaker side, and without the appropriate equipment. With this information the incidence could be reduced by preventive measures.
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Affiliation(s)
- M Del Castillo
- Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia (FLEINI), Buenos Aires, Argentina
| | - M A Mosteiro
- Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia (FLEINI), Buenos Aires, Argentina.
| | - J Navarro
- Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia (FLEINI), Buenos Aires, Argentina
| | - M E Rivas
- Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia (FLEINI), Buenos Aires, Argentina
| | - M Gianella
- Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia (FLEINI), Buenos Aires, Argentina
| | - M Ahumada
- Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia (FLEINI), Buenos Aires, Argentina
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Bhatt T, Dusane S, Gangwani R, Wang S, Kannan L. Motor adaptation and immediate retention to overground gait-slip perturbation training in people with chronic stroke: an experimental trial with a comparison group. Front Sports Act Living 2023; 5:1195773. [PMID: 37780126 PMCID: PMC10533933 DOI: 10.3389/fspor.2023.1195773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/21/2023] [Indexed: 10/03/2023] Open
Abstract
Background Perturbation-based training has shown to be effective in reducing fall-risk in people with chronic stroke (PwCS). However, most evidence comes from treadmill-based stance studies, with a lack of research focusing on training overground perturbed walking and exploring the relative contributions of the paretic and non-paretic limbs. This study thus examined whether PwCS could acquire motor adaptation and demonstrate immediate retention of fall-resisting skills following bilateral overground gait-slip perturbation training. Methods 65 PwCS were randomly assigned to either (i) a training group, that received blocks of eight non-paretic (NP-S1 to NP-S8) and paretic (P-S1 to P-S8) overground slips during walking followed by a mixed block (seven non-paretic and paretic slips each interspersed with unperturbed walking trials) (NP-S9/P-S9 to NP-S15/P-S15) or (ii) a control group, that received a single non-paretic and paretic slip in random order. The assessor and training personnel were not blinded. Immediate retention was tested for the training group after a 30-minute rest break. Primary outcomes included laboratory-induced slip outcomes (falls and balance loss) and center of mass (CoM) state stability. Secondary outcomes to understand kinematic contributors to stability included recovery strategies, limb kinematics, slipping kinematics, and recovery stride length. Results PwCS within the training group showed reduced falls (p < 0.01) and improved post-slip stability (p < 0.01) from the first trial to the last trial of both paretic and non-paretic slip blocks (S1 vs. S8). During the mixed block training, there was no further improvement in stability and slipping kinematics (S9 vs. S15) (p > 0.01). On comparing the first and last training trial (S1 vs. S15), post-slip stability improved on both non-paretic and paretic slips, however, pre-slip stability improved only on the non-paretic slip (p < 0.01). On the retention trials, the training group had fewer falls and greater post-slip stability than the control group on both non-paretic and paretic slips (p < 0.01). Post-slip stability on the paretic slip was lower than that on the non-paretic slip for both groups on retention trials (p < 0.01). Conclusion PwCS can reduce laboratory-induced slip falls and backward balance loss outcomes by adapting their post-slip CoM state stability after bilateral overground gait-slip perturbation training. Such reactive adaptations were better acquired and retained post-training in PwCS especially on the non-paretic slips than paretic slips, suggesting a need for higher dosage for paretic slips. Clinical registry number NCT03205527.
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Affiliation(s)
- Tanvi Bhatt
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, IL, United States
| | - Shamali Dusane
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, IL, United States
- Ph.D. program in Rehabilitation Sciences, Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, IL, United States
| | - Rachana Gangwani
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, IL, United States
- MS program in Rehabilitation Sciences, Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, IL, United States
| | - Shuaijie Wang
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, IL, United States
| | - Lakshmi Kannan
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, IL, United States
- Ph.D. program in Rehabilitation Sciences, Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, IL, United States
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Freire B, Bochehin do Valle M, Lanferdini FJ, Foschi CVS, Abou L, Pietta-Dias C. Cut-off score of the modified Ashworth scale corresponding to walking ability and functional mobility in individuals with chronic stroke. Disabil Rehabil 2023; 45:866-870. [PMID: 35171052 DOI: 10.1080/09638288.2022.2037753] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To determine the optimal cut-off score for the Modified Ashworth Scale (MAS) corresponding to unfavorable outcomes for mobility and walking ability. METHODS The level of plantar flexor muscle spasticity and the 10-meter walking test (10mWT), timed up and go (TUG), and five time sit-to-stand (FTSTS) outcomes were evaluated in individuals after stroke. The correlation between MAS and the tests was investigated, and the optimal cut-off score, sensitivity, and specificity were evaluated through receiver operating characteristic (ROC) curve. RESULTS Twenty-one participants with chronic stroke and plantar flexors spasticity (11 men; 10 women; mean age = 57.6 ± 12.5 years) participated in the study. Significant correlations between MAS and 10mWT (r= -0.45; p < 0.05), MAS and TUG (r = 0.48; p < 0.05) were found. The optimal cut-off scores were MAS > 2 for unfavorable 10mWT (sensitivity = 100%; specificity = 54.5%; ROC = 0.782) and MAS ≤ 2 for favorable TUG outcomes (sensitivity = 55.5%; specificity = 91.6%; ROC = 0.782). CONCLUSIONS This study revealed that moderate level of plantar flexors spasticity results in the highest sensitivity to predict poor gait speed performance and the highest specificity to predict good mobility performance in individuals after stroke. These findings will help clinicians in their evidence-based decision making on the role of spasticity for mobility and walking ability.Implications for rehabilitationModerate level of spasticity (MAS <2) is the optimal cut-off score for 10mWT and TUG tests.Reducing the level of spasticity of plantar flexors below this cut-off point might be associated with an increased walking speed in this population.MAS <2 might not limit walking and mobility in individuals after stroke.Calf muscles spasticity might not compromise five time sit-to-stand (FTSTS) performances and might be related to a smaller influence on the sit to stand task.
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Affiliation(s)
- Bruno Freire
- Health and Sports Sciences Center, Santa Catarina State University, Florianópolis, Brazil
| | | | - Fabio Juner Lanferdini
- Exercise Research Laboratory, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Libak Abou
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Caroline Pietta-Dias
- Exercise Research Laboratory, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Aloraini SM, Abu Mismar AA, Aloqaily HF, Aldaihan MM. Balance assessment tools and their psychometric properties among individuals post-stroke: a systematic review. PHYSICAL THERAPY REVIEWS 2023. [DOI: 10.1080/10833196.2023.2168850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Saleh M. Aloraini
- Department of Physical Therapy, College of Medical Rehabilitation, Qassim University, Saudi Arabia
| | - Arwa A. Abu Mismar
- Department of Physical Therapy, College of Medical Rehabilitation, Qassim University, Saudi Arabia
| | - Haifa F. Aloqaily
- Department of Physical Therapy, College of Medical Rehabilitation, Qassim University, Saudi Arabia
| | - Mishal M. Aldaihan
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Saudi Arabia
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Anjos JM, Neto MG, de Araújo Tapparelli Y, Tse G, Biondi-Zoccai G, de Souza Lima Bitar Y, Roever L, Duraes AR. Efficacy and safety of very early mobilization after thrombolysis in acute ischemic stroke: a randomized clinical trial. J Neurol 2023; 270:843-850. [PMID: 36219243 PMCID: PMC9552146 DOI: 10.1007/s00415-022-11411-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Stroke has a deleterious impact on human health due to its high incidence, degree of disabling sequelae and mortality, constituting one of the main causes of death and disability worldwide. OBJECTIVES This study aimed to assess the efficacy and safety of very early mobilization (VEMG) after thrombolysis in functional recovery in patients with acute ischemic stroke. METHODS The present study was an open, prospective, randomized study, with no blinded outcome, carried out in the stroke unit of a tertiary referral hospital located in Salvador-Bahia, Brazil. The primary outcome was the level of functional independence. Secondary outcomes were functional mobility, balance, complications within 7 days of hospitalization and 90 days after hospital discharge, and length of stay. OUTCOMES A total of 104 patients with ischemic stroke who received thrombolytic treatment between August 2020 and July 2021 were prospectively recruited to the study. Of these, 51 patients received VEMG within 24 h of the ictus and another 53 patients receiving usual care (UCG) with mobilization 24 h after the ictus. When compared to the usual care, the VEMG group was not associated with a significant reduction in the risk of the primary outcome (relative risk [95% confidence intervals]: 0.74 [0.339-1.607]) or any of the secondary outcomes. CONCLUSION In this study, the strategy of early mobilization after thrombolysis in ischemic stroke was safe, but without evidence of short-term benefit. Brazilian Registry of Clinical Trials under the registry (registry number: RBR-8bgcs3).
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Affiliation(s)
- Jorge Motta Anjos
- Post-graduate Program in Medicine and Health, PPgMS/UFBA-Salvador-BA, Brazil.
| | | | | | - Gayr Tse
- Epidemiology Research Unit, Cardiovascular Analytics Group, China-UK Collaboration, Hong Kong, China
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, People's Republic of China
- Kent and Medway Medical School, Canterbury, Kent, UK
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | | | - Leonardo Roever
- Department of Clinical Research, Federal University of Uberlandia, Uberlândia, Brazil
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Ojha R, Ezung C, Chalageri PH, Chandy BR, Isaac J, Marimuthu S, Jeyaseelan L, Tharion G. Ankle dorsiflexion assist using a single sensor-based FES: Results from clinical study on patients with stroke. J Neurosci Rural Pract 2023; 14:48-54. [PMID: 36891092 PMCID: PMC9945029 DOI: 10.25259/jnrp-2022-8-6-(2766)] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 12/04/2022] [Indexed: 01/04/2023] Open
Abstract
Objective Ankle foot orthosis (AFO) commonly prescribed to manage foot-drop following stroke restricts ankle mobility. Commercially available functional electrical stimulation (FES) is an expensive alternative to achieve desired dorsiflexion during swing phase of the gait cycle. An in-house cost-effective innovative solution was designed and developed to address this problem.The aim of the study was to compare spatiotemporal gait characteristics of patients with foot-drop following stroke using commercially available FES against in-house developed versatile single sensor-based FES. Material and Methods Ten patients with cerebrovascular accident of at least 3 months duration and ambulant with/without AFO were recruited prospectively. They were trained with Device-1 (Commercial Device) and Device-2 (In-house developed, Re-Lift) for 7 h over 3 consecutive days with each device. Outcome measures included timed-up-and-go-test (TUG), six-minute-walk-test (6MWT), ten-meter-walk-test (10MWT), physiological cost index (PCI), instrumented gait analysis derived spatiotemporal parameters, and patient satisfaction feedback questionnaire. We calculated intraclass correlation between devices and median interquartile range. Statistical analysis included Wilcoxon-signed-rank-test and F-test (P < 0.05 was considered statistically significant). Bland Altman and scatter plots were plotted for both devices. Results Intraclass correlation coefficient for 6MWT (0.96), 10MWT (0.97), TUG test (0.99), and PCI (0.88) reflected high agreement between the two devices. Scatter plot and Bland Altman plots for the outcome parameters showed good correlation between two FES devices. Patient satisfaction scores were equal for both Device-1 and Device-2. There was statistically significant change in swing phase ankle dorsiflexion. Conclusions The study demonstrated good correlation between commercial FES and Re-Lift suggestive of the utility of low-cost FES device in clinical setting.
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Affiliation(s)
- Rajdeep Ojha
- Center for Advanced Technology Enabled Rehabilitation (CATER), Department of Physical Medicine and Rehabilitation, Christian Medical College, Vellore, Tamil Nadu, India
| | - Chenithung Ezung
- Department of Physical Medicine and Rehabilitation, Christian Institute of Health Sciences and Research Hospital, Dimapur, Nagaland, India
| | - Prashanth H. Chalageri
- Department of Physical Medicine and Rehabilitation, Christian Medical College Vellore, Tamil Nadu, India
| | - Bobeena Rachel Chandy
- Department of Physical Medicine and Rehabilitation, Christian Medical College Vellore, Tamil Nadu, India
| | - Joyce Isaac
- Department of Physical Medicine and Rehabilitation, Christian Medical College Vellore, Tamil Nadu, India
| | - S. Marimuthu
- Department of Biostatistics, Christian Medical College Vellore, Tamil Nadu, India
| | - Lakshamanan Jeyaseelan
- Department of Biostatistics, College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - George Tharion
- Department of Physical Medicine and Rehabilitation, Christian Medical College Vellore, Tamil Nadu, India
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Plummer P, Feld JA, Mercer VS, Ni P. Brief composite mobility index predicts post-stroke fallers after hospital discharge. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:979824. [PMID: 36275923 PMCID: PMC9583924 DOI: 10.3389/fresc.2022.979824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/12/2022] [Indexed: 11/06/2022]
Abstract
Introduction Community-dwelling, ambulatory stroke survivors fall at very high rates in the first 3-6 months. Current inpatient clinical assessments for fall risk have inadequate predictive accuracy. We found that a pre-discharge obstacle-crossing test has excellent specificity (83%) but lacks acceptable sensitivity (67%) for identifying would-be fallers and non-fallers post discharge. Hypothesis We assessed the hypothesis that combining the obstacle-crossing test with other highly discriminatory fall risk factors would compensate for the obstacle test's fair sensitivity and yield an instrument with superior prediction accuracy. Methods 45 ambulatory stroke survivors (60 ± 11 years old, 15 ± 11 days post stroke) being discharged home completed a battery of physical performance-based and self-reported measures 1-5 days prior to discharge. After discharge, participants were prospectively followed and classified as fallers (≥1 fall) or non-fallers at 3 months. Pre-discharge measures with the largest effect sizes for differentiating fallers and non-fallers were combined into a composite index. Several variations of the composite index were examined to optimize accuracy. Results A 4-item discharge composite index significantly predicted fall status at 3-months. The goodness of fit of the regression model was significantly better than the obstacle-crossing test alone, χ 2(1) = 6.036, p = 0.014. Furthermore, whereas the obstacle-crossing test had acceptable overall accuracy (AUC 0.78, 95% CI, 0.60-0.90), the composite index had excellent accuracy (AUC 0.85, 95% CI, 0.74-0.96). Combining the obstacle-crossing test with only the step test produced a model of equivalent accuracy (AUC 0.85, 95% CI, 0.73-0.96) and with better symmetry between sensitivity and specificity (0.71, 0.83) than the 4-item composite index (0.86, 0.67). This 2-item index was validated in an independent sample of n = 30 and with bootstrapping 1,000 samples from the pooled cohorts. The 4-item index was internally validated with bootstrapping 1,000 samples from the derivation cohort plus n = 9 additional participants. Conclusion This study provides convincing proof-of-concept that strategic aggregation of performance-based and self-reported mobility measures, including a novel and demanding obstacle-crossing test, can predict post-discharge fallers with excellent accuracy. Further instrument development is warranted to construct a brief aggregate tool that will be pragmatic for inpatient use and improve identification of future post-stroke fallers before the first fall.
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Affiliation(s)
- Prudence Plummer
- Department of Physical Therapy, Cognitive-Motor Behavior Laboratory, MGH Institute of Health Professions, Boston, MA, United States,Correspondence: Prudence Plummer
| | - Jody A. Feld
- Department of Orthopaedic Surgery, Duke University, Durham, NC, United States
| | - Vicki S. Mercer
- Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Pengsheng Ni
- School of Public Health, Biostatistics and Epidemiology Data Analytic Center, Boston University, Boston, MA, United States
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12
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Itoh S, Ogino T, Kawakami K, Miyake K, Iyoda H, Imaizumi H, Nakajima M, Kitahara H, Sonoda S. Gait evaluation in stroke hemiplegic patients using short physical performance battery. J Stroke Cerebrovasc Dis 2022; 31:106704. [PMID: 36037677 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/28/2022] [Accepted: 08/04/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Falls can occur daily in stroke patients and appropriate independence assessments for fall prevention are required. Although previous studies evaluated the short physical performance battery (SPPB) in stroke patients, the relationship between SPPB and fall prediction and walking independence remains unclear. Therefore, we aimed to verify whether SPPB is a predictor of walking independence. MATERIALS AND METHODS The present study included 105 hemiplegic stroke patients who were admitted to the rehabilitation ward and gave consent to participate. Cross-sectional physical function and functional independence measure cognitive (FIM-C) evaluation were conducted in hemiplegic stroke patients. Logistic regression analysis using the increasing variable method (likelihood ratio) was performed to extract factors for walking independence. Cutoff values were calculated for the extracted items using the receiver operating-characteristic (ROC) curve. RESULTS Among 86 participants included in the final analysis, 36 were independent walkers and 50 were dependent walkers. In the logistic regression analysis, SPPB and FIM-C were extracted as factors for walking independence. The cutoff value was 7 [area under the curve (AUC), 0.94; sensitivity, 0.83; specificity, 0.73)] for SPPB and 32 (AUC, 0.83; sensitivity, 0.69; specificity, 0.57) for FIM-C in ROC analysis CONCLUSIONS: SPPB and FIM-C were extracted as factors for walking independence. Although SPPB alone cannot determine independent walking, combined assessment of SPPB with cognitive function may enable more accurate determination of walking independence.
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Affiliation(s)
- Shota Itoh
- Department of Rehabilitation, Fujita Health University Nanakuri Memorial Hospital, 424-1, Oodoricho, Tsu, Mie 514-1295, Japan.
| | - Takahiro Ogino
- Department of Rehabilitation, Fujita Health University Nanakuri Memorial Hospital, 424-1, Oodoricho, Tsu, Mie 514-1295, Japan
| | - Kenji Kawakami
- Department of Rehabilitation, Fujita Health University Nanakuri Memorial Hospital, 424-1, Oodoricho, Tsu, Mie 514-1295, Japan
| | - Kosuke Miyake
- Department of Rehabilitation, Fujita Health University Nanakuri Memorial Hospital, 424-1, Oodoricho, Tsu, Mie 514-1295, Japan
| | - Honoka Iyoda
- Department of Rehabilitation, Fujita Health University Nanakuri Memorial Hospital, 424-1, Oodoricho, Tsu, Mie 514-1295, Japan
| | - Hidenori Imaizumi
- Department of Rehabilitation, Fujita Health University Nanakuri Memorial Hospital, 424-1, Oodoricho, Tsu, Mie 514-1295, Japan
| | - Misaki Nakajima
- Department of Rehabilitation, Fujita Health University Nanakuri Memorial Hospital, 424-1, Oodoricho, Tsu, Mie 514-1295, Japan
| | - Haruna Kitahara
- Department of Rehabilitation, Fujita Health University Nanakuri Memorial Hospital, 424-1, Oodoricho, Tsu, Mie 514-1295, Japan
| | - Shigeru Sonoda
- Department of Rehabilitation, Fujita Health University Nanakuri Memorial Hospital, 424-1, Oodoricho, Tsu, Mie 514-1295, Japan; Department of Rehabilitation Medicine II, School of Medicine, Fujita Health University Tsu, Mie, Japan
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13
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Abdollahi M, Whitton N, Zand R, Dombovy M, Parnianpour M, Khalaf K, Rashedi E. A Systematic Review of Fall Risk Factors in Stroke Survivors: Towards Improved Assessment Platforms and Protocols. Front Bioeng Biotechnol 2022; 10:910698. [PMID: 36003532 PMCID: PMC9394703 DOI: 10.3389/fbioe.2022.910698] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/22/2022] [Indexed: 11/26/2022] Open
Abstract
Background/Purpose: To prevent falling, a common incident with debilitating health consequences among stroke survivors, it is important to identify significant fall risk factors (FRFs) towards developing and implementing predictive and preventive strategies and guidelines. This review provides a systematic approach for identifying the relevant FRFs and shedding light on future directions of research. Methods: A systematic search was conducted in 5 popular research databases. Studies investigating the FRFs in the stroke community were evaluated to identify the commonality and trend of FRFs in the relevant literature. Results: twenty-seven relevant articles were reviewed and analyzed spanning the years 1995–2020. The results confirmed that the most common FRFs were age (21/27, i.e., considered in 21 out of 27 studies), gender (21/27), motion-related measures (19/27), motor function/impairment (17/27), balance-related measures (16/27), and cognitive impairment (11/27). Among these factors, motion-related measures had the highest rate of significance (i.e., 84% or 16/19). Due to the high commonality of balance/motion-related measures, we further analyzed these factors. We identified a trend reflecting that subjective tools are increasingly being replaced by simple objective measures (e.g., 10-m walk), and most recently by quantitative measures based on detailed motion analysis. Conclusion: There remains a gap for a standardized systematic approach for selecting relevant FRFs in stroke fall risk literature. This study provides an evidence-based methodology to identify the relevant risk factors, as well as their commonalities and trends. Three significant areas for future research on post stroke fall risk assessment have been identified: 1) further exploration the efficacy of quantitative detailed motion analysis; 2) implementation of inertial measurement units as a cost-effective and accessible tool in clinics and beyond; and 3) investigation of the capability of cognitive-motor dual-task paradigms and their association with FRFs.
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Affiliation(s)
- Masoud Abdollahi
- Industrial and Systems Engineering Department, Rochester Institute of Technology, Rochester, NY, United States
| | - Natalie Whitton
- Industrial and Systems Engineering Department, Rochester Institute of Technology, Rochester, NY, United States
| | - Ramin Zand
- Department of Neurology, Geisinger Neuroscience Institute, Danville, PA, United States
| | - Mary Dombovy
- Department of Rehabilitation and Neurology, Unity Hospital, Rochester, NY, United States
| | - Mohamad Parnianpour
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Kinda Khalaf
- Department of Biomedical Engineering, Khalifa University of Science and Technology, and Health Engineering Innovation Center, Abu Dhabi, United Arab Emirates
| | - Ehsan Rashedi
- Industrial and Systems Engineering Department, Rochester Institute of Technology, Rochester, NY, United States
- *Correspondence: Ehsan Rashedi,
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14
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Lanza MB, Gray VL. The effects of stroke on weight transfer before voluntary lateral and forward steps. Front Neurol 2022; 13:891439. [PMID: 35937060 PMCID: PMC9355404 DOI: 10.3389/fneur.2022.891439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 07/04/2022] [Indexed: 11/18/2022] Open
Abstract
There is a higher rate of falls in the first year after a stroke, and the ability to step in different directions is essential for avoiding a fall and navigating small spaces where falls commonly occur. The lateral transfer of weight is important for stabilizing the body before initiating a step. Hence, understanding the ability to control lateral weight transfer (WT) in different step directions might help understand falls in individuals with stroke. The present study aimed to compare the WT characteristics (onset time, duration, mediolateral center of pressure (ML COP) velocity, and ML COP displacement) and hip abduction torque preceding a lateral and forward voluntary step between individuals with stroke (paretic and non-paretic leg) and controls. Twenty individuals with stroke and ten controls performed voluntary choice reaction tests in the lateral and forward directions. Ten trials (five on each side-right and left) were performed for each step direction. The overall primary findings were that (1) the WT before a lateral step was shorter and initiated earlier, with a larger ML COP displacement and greater hip abductor torque in the stepping leg than the forward step, (2) there was greater hip abductor produced in the stance leg before a forward step than a lateral step, (3) the WT before the lateral step took longer to initiate and was slower to execute in individuals with stroke regardless of the leg (4) the WT before the forward step had more differences in the paretic than the non-paretic leg. Thus, for the first time, it was shown that the WT characteristics and hip abduction torque during the WT are different according to step direction and also appear to be impaired in individuals with stroke. These results have implications for understanding the direction that individuals with stroke are more susceptible to being unable to recover balance and are at risk of falling.
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Affiliation(s)
- Marcel Bahia Lanza
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, United States
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15
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Yoo YJ, Lim SH. Assessment of Lower Limb Motor Function, Ambulation, and Balance After Stroke. BRAIN & NEUROREHABILITATION 2022; 15:e17. [PMID: 36743203 PMCID: PMC9833471 DOI: 10.12786/bn.2022.15.e17] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/04/2022] [Accepted: 07/06/2022] [Indexed: 11/08/2022] Open
Abstract
Restoration of ambulation is important for stroke patients. Valid and reliable methods are required for the assessment of lower limb functional status. We reviewed the psychometric properties of methods employed to assess lower extremity motor function, ambulation, and balance, with a focus on stroke patients. We define "motor function" as the ability to produce bodily movements when the brain, motor neurons, and muscles interact. "Ambulation" is defined as the ability to walk with or without a personal assistive device, and "balance" as the ability to maintain stability (without falling) during various physical activities. The Motricity Index and Fugl-Meyer Assessment of Lower Extremities assess the motor function of the lower limbs. The Functional Ambulation Category, 10-m Walk Test, and 6-minute Walk Test assess ambulation. The Berg Balance Scale, Timed Up and Go Test, Functional Reach Test, and Trunk Impairment Scale explore balance. All these tests exhibit high-level validity and have good inter-rater and test-retest reliabilities. However, only 3 methods have been formally translated into Korean. The methods discussed here can be used for standardized assessment, personalized goal setting, rehabilitation planning, and estimation of therapeutic efficacy.
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Affiliation(s)
- Yeun Jie Yoo
- Department of Rehabilitation Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seong Hoon Lim
- Department of Rehabilitation Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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16
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Feld JA, Goode AP, Mercer VS, Plummer P. Utility of an obstacle-crossing test to classify future fallers and non-fallers at hospital discharge after stroke: A pilot study. Gait Posture 2022; 96:179-184. [PMID: 35667230 PMCID: PMC9535661 DOI: 10.1016/j.gaitpost.2022.05.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 05/25/2022] [Accepted: 05/29/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Existing clinical assessments of balance and functional mobility have poor predictive accuracy for prospectively identifying post-stroke fallers, which may be due to a lack of ecological complexity that is typical of community-based fall incidents. RESEARCH QUESTION Does an obstacle-crossing test at hospital discharge predict fall status of ambulatory stroke survivors 3 months after discharge? METHODS Ambulatory stroke survivors being discharged home completed an obstacle-crossing test at hospital discharge. Falls were tracked prospectively for 3 months after discharge. Logistic regression examined the relationship between obstacle-crossing at discharge (pass/fail) and fall status (faller/non-faller) at 3 months post discharge. RESULTS 45 participants had discharge obstacle test and 3-month fall data. 21 (47 %) participants experienced at least one fall during follow-up, with 52 % of the falls occurring within the first month after discharge. Of the 21 fallers, 14 failed the obstacle-crossing test (67 % sensitivity). Among the 24 non-fallers, 20 passed the obstacle-crossing test (83 % specificity). The area under the receiver operating characteristic curve was 0.75 (95 % CI 0.60-0.90). Individuals who failed the obstacle-crossing test were 10.00 (95 % CI: 2.45-40.78) times more likely to fall in the first 3 months after discharge. The unadjusted logistic regression model correctly classified 76 % of the subjects. After adjusting for age, sex, days post stroke, and post-stroke disability, the odds ratio remained significant at 6.93 (95 % CI: 1.01-47.52) and correctly classified 79.5% of the participants. SIGNIFICANCE The obstacle-crossing test may be a useful discharge assessment to identify ambulatory stroke survivors being discharged home who are likely to fall in the first 3 months post discharge. Modifications to improve the obstacle-crossing test sensitivity should be explored further.
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Affiliation(s)
- Jody A. Feld
- Department of Orthopaedic Surgery, Duke University School of Medicine, DUMC 104002, Durham, NC, 27710, USA
| | - Adam P. Goode
- Department of Orthopaedic Surgery, Duke University School of Medicine, DUMC 104002, Durham, NC, 27710, USA
| | - Vicki S. Mercer
- Department of Allied Health Sciences, University of North Carolina at Chapel Hill, CB# 7135, Bondurant Hall 3022, Chapel Hill, NC, 27599, USA
| | - Prudence Plummer
- Department of Physical Therapy, MGH Institute of Health Professions, 36 1st Avenue, Boston, MA, 02129, USA
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17
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Assessing the risk for falls among Portuguese community-dwelling stroke survivors. Are we using the better tools? Observational study. Porto Biomed J 2022; 7:e160. [PMID: 35801217 PMCID: PMC9257293 DOI: 10.1097/j.pbj.0000000000000160] [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: 12/09/2020] [Revised: 03/09/2021] [Accepted: 06/07/2021] [Indexed: 11/25/2022] Open
Abstract
This study assesses the estimation of the risk for falls among community-dwelling stroke survivors referred for ambulatory physiotherapy and explores factors that affect the risk.
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18
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Roostaei M, Raji P, Kalantari KK, Faghihzadeh E, Fragala-Pinkham M. Effect of upper extremity constraints on functional and dynamic postural control in children with hemiplegic cerebral palsy. Dev Neurorehabil 2022; 25:281-288. [PMID: 34971522 DOI: 10.1080/17518423.2021.2020351] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To compare the effects of upper extremity constraints on functional and dynamic postural control in children with hemiplegic cerebral palsy. MATERIALS AND METHODS Twelve children with hemiplegic cerebral palsy and 12 typically developing children ages 5 to 12 years (GMFCS I-II) were evaluated with the Timed Up and Go (TUG) and Biodex Balance System during three upper extremity (UE) conditions: 1) Free UEs (no constraints), 2) Simple UE constraint (unaffected/dominant UE constrained with a sling), and 3) Difficult UE constraint (Simple constraint plus the other UE holding cup of water). RESULTS The UE condition had significant effects on Overall Stability Index (OSI) (F(2,44) = 24.899, p < .001), Medial-Lateral Stability Index (MLSI) (F(2,44) = 4.380, p = .018), Anterior-Posterior Stability Index (F(2,44) = 6.187, p = .004), and TUG scores (F(2,44) = 113.372, p < .001). Group was significant for OSI (F(1,22) = 7.906, p = .010), MLSI (F(1,22) = 13.113, p = .002), and TUG (F(1,22) = 36.282, p < .001). CONCLUSIONS The upper extremity appears to have a role in maintaining functional balance and postural stability in children with hemiplegic cerebral palsy and should be considered during intervention programs.
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Affiliation(s)
- Meysam Roostaei
- Department of Occupational Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Parvin Raji
- Department of Occupational Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Khosro Khademi Kalantari
- Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elham Faghihzadeh
- Department of Biostatistics and Epidemiology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Maria Fragala-Pinkham
- Department of Physical Therapy and Occupational Therapy, Boston Children's Hospital, Boston, MA, USA
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19
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Klomjai W, Aneksan B. A randomized sham-controlled trial on the effects of dual-tDCS "during" physical therapy on lower limb performance in sub-acute stroke and a comparison to the previous study using a "before" stimulation protocol. BMC Sports Sci Med Rehabil 2022; 14:68. [PMID: 35428346 PMCID: PMC9013129 DOI: 10.1186/s13102-022-00463-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 04/04/2022] [Indexed: 11/26/2022] Open
Abstract
Background Dual-transcranial direct current stimulation (tDCS) has been used to rebalance the cortical excitability of both hemispheres following unilateral-stroke. Our previous study showed a positive effect from a single-session of dual-tDCS applied before physical therapy (PT) on lower limb performance. However, it is still undetermined if other timings of brain stimulation (i.e., during motor practice) induce better effects. The objective of this study was to examine the effect of a single-session of dual-tDCS “during” PT on lower limb performance in sub-acute stroke and then compare the results with our previous data using a “before” stimulation paradigm. Method For the current “during” protocol, 19 participants were participated in a randomized sham-controlled crossover trial. Dual-tDCS over the M1 of both cortices (2 mA) was applied during the first 20 min of PT. The Timed Up and Go and Five-Times-Sit-To-Stand tests were assessed at pre- and post-intervention and 1-week follow-up. Then, data from the current study were compared with those of the previous “before” study performed in a different group of 19 subjects. Both studies were compared by the difference of mean changes from the baseline. Results Dual-tDCS “during” PT and the sham group did not significantly improve lower limb performance. By comparing with the previous data, performance in the “before” group was significantly greater than in the “during” and sham groups at post-intervention, while at follow-up the “before” group had better improvement than sham, but not greater than the “during” group. Conclusion A single-session of dual-tDCS during PT induced no additional advantage on lower limb performance. The “before” group seemed to induce better acute effects; however, the benefits of the after-effects on motor learning for both stimulation protocols were probably not different. Trial registration Current randomized controlled trials was prospectively registered at the clinicaltrials.gov, registration number: NCT04051671. The date of registration was 09/08/2019.
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Affiliation(s)
- Wanalee Klomjai
- Neuro Electrical Stimulation Laboratory (NeuE), Faculty of Physical Therapy, Mahidol University, Salaya, Nakhon Pathom, 73170, Thailand.,Faculty of Physical Therapy, Mahidol University, 999 Phuttamonthon 4 Road, Salaya, Nakhon Pathom, 73170, Thailand
| | - Benchaporn Aneksan
- Neuro Electrical Stimulation Laboratory (NeuE), Faculty of Physical Therapy, Mahidol University, Salaya, Nakhon Pathom, 73170, Thailand. .,Faculty of Physical Therapy, Mahidol University, 999 Phuttamonthon 4 Road, Salaya, Nakhon Pathom, 73170, Thailand.
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20
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Sjöholm H, Hägg S, Nyberg L, Lind J, Kammerlind AS. Exploring possible risk factors for time to first fall and 6-month fall incidence in persons with acute stroke. SAGE Open Med 2022; 10:20503121221088093. [PMID: 35387151 PMCID: PMC8977710 DOI: 10.1177/20503121221088093] [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: 08/03/2021] [Accepted: 02/25/2022] [Indexed: 11/15/2022] Open
Abstract
Objectives: The aim was to explore how the time to the first fall and 6-month fall incidence relates to rapidly and easily collected data in persons with acute stroke. Methods: Out of consecutively admitted patients with stroke at three stroke units, 284 with at least one follow-up were included in this prospective cohort study. During 6 months following discharge, participants reported falls using a diary and monthly phone calls. Data about participants’ characteristics, functions, and activities were collected during hospital stay and analyzed in relation to time to first fall by Cox regression and fall incidence by negative binomial regression. Results: Use of ⩾9 medications, paresis in arms, paresis in legs (National Institutes of Health Stroke Scale), impaired protective reactions in sitting (Postural Reactions Test), and limitations in self-care (Barthel Index) were decisive risk factors for time to first fall. Limitations in mobility (Step Test, 30-s Chair Stand Test) were decisive risk factors for high fall incidence (p < 0.0005). Conclusion: Several easily collected participant characteristics, functions, and activities were identified as risk factors for falls. The findings emphasize the width of assessments that can be used for the identification of individuals at risk for falls and that the risk factors vary in different strata of the population. These results are important when developing multivariate risk models. The risk factors differed in part when analyzing the time to the first fall and 6-month fall incidence.
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Affiliation(s)
- Hanna Sjöholm
- Rehabilitation Center in Jönköping, Region Jönköping County, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Staffan Hägg
- Futurum, Region Jönköping County, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Lars Nyberg
- Department of Health, Learning and Technology, Luleå University of Technology, Luleå, Sweden
| | - Jonas Lind
- Department of Internal Medicine in Jönköping, Region Jönköping County, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Ann-Sofi Kammerlind
- Futurum, Region Jönköping County, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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21
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Gu X, Zeng M, Cui Y, Fu J, Li Y, Yao Y, Shen F, Sun Y, Wang Z, Deng D. Aquatic strength training improves postural stability and walking function in stroke patients. Physiother Theory Pract 2022:1-10. [PMID: 35285397 DOI: 10.1080/09593985.2022.2049939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Xudong Gu
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Jiaxing University, the Second Hospital of Jiaxing City, Jiaxing City, ZJ, China
| | - Ming Zeng
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Jiaxing University, the Second Hospital of Jiaxing City, Jiaxing City, ZJ, China
| | - Yao Cui
- Department of Physical Therapy, Beijing Bo’ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Jianming Fu
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Jiaxing University, the Second Hospital of Jiaxing City, Jiaxing City, ZJ, China
| | - Yan Li
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Jiaxing University, the Second Hospital of Jiaxing City, Jiaxing City, ZJ, China
| | - Yunhai Yao
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Jiaxing University, the Second Hospital of Jiaxing City, Jiaxing City, ZJ, China
| | - Fang Shen
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Jiaxing University, the Second Hospital of Jiaxing City, Jiaxing City, ZJ, China
| | - Ya Sun
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Jiaxing University, the Second Hospital of Jiaxing City, Jiaxing City, ZJ, China
| | - Zhongli Wang
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Jiaxing University, the Second Hospital of Jiaxing City, Jiaxing City, ZJ, China
| | - Dingyi Deng
- Department of Rehabilitation, Qianjiang Central Hospital, Qianjiang City Hubei Province, China
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22
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Tsang CSL, Miller T, Pang MYC. Association between fall risk and assessments of single-task and dual-task walking among community-dwelling individuals with chronic stroke: A prospective cohort study. Gait Posture 2022; 93:113-118. [PMID: 35134650 DOI: 10.1016/j.gaitpost.2022.01.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 12/21/2021] [Accepted: 01/24/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Falling and fall-related injuries are common among community-dwelling individuals with chronic stroke. Falls often occur during dual-task walking scenarios. Accurate fall prediction is critical for formulating effective fall prevention strategies. RESEARCH QUESTIONS Can dual-task walking tests and corresponding single-task tests predict falls among individuals with chronic stroke? Are dual-task walking tests involving visuospatial cognition more effective in predicting falls than those involving other cognitive domains? METHODS Ninety-three individuals with stroke (age: 62.4 ± 6.7 years; stroke duration: 5.6 ± 4.5 years) participated in this prospective cohort study. Two mobility tasks (level-ground walking and obstacle-crossing) were performed with and without two cognitive tasks (auditory clock test and auditory Stroop test). Demographic information and clinical measures of depression, motor function, walking speed and balance were collected. Monthly telephone interviews were conducted to collect data on fall incidence, related circumstances and injuries incurred during a 12-month follow-up period. Multivariate logistic regression analysis was performed to identify predictive factors associated with future risk of falls. RESULTS Thirty-six participants (39%) reported one or more falls during the follow-up period. The regression model including reaction time during the auditory clock task performance while negotiating obstacles correctly classified the fall status of 80% of the participants (72% future fallers and 84% non-fallers). Performance did not differ between fallers and non-fallers on any other measures tested. SIGNIFICANCE Dual-task assessment combining an auditory clock task with an obstacle-crossing task has potential clinical utility for identifying future fall risk among people with chronic stroke.
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Affiliation(s)
- Charlotte S L Tsang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Tiev Miller
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Marco Y C Pang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong.
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23
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Ojha R, Sannyasi G, Prakash N, Isaac J, Maheswari V, Mahasampath GS, Tharion G. Gait Characteristics Following Stroke: A Prospective Crossover Study to Compare Ankle-Foot Orthosis with Functional Electrical Stimulation. Neurol India 2022; 70:1830-1835. [DOI: 10.4103/0028-3886.359240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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24
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Degree and pattern of dual-task interference during walking vary with component tasks in people after stroke: a systematic review. J Physiother 2022; 68:26-36. [PMID: 34953757 DOI: 10.1016/j.jphys.2021.12.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 10/22/2021] [Accepted: 12/09/2021] [Indexed: 12/30/2022] Open
Abstract
QUESTIONS What are the degree and pattern of dual-task interference during walking in people after stroke? How do these vary with disease chronicity and different component tasks in people after stroke? How does dual-task interference differ between people after stroke and people without stroke? DESIGN Systematic review with meta-analysis of studies reporting gait-related dual-task interference. PARTICIPANTS People after stroke and people without stroke. OUTCOME MEASURES Measures of walking and secondary (cognitive or manual) task performance under dual-task conditions relative to those under single-task conditions. RESULTS Seventy-six studies (2,425 people after stroke and 492 people without stroke) were included. Manual and mental tracking tasks imposed the greatest dual-task interference on gait speed, although there was substantial uncertainty in these estimates. Among mental tracking tasks, the apparently least-complex task (serial 1 subtractions) induced the greatest dual-task interference (-0.17 m/s, 95% CI -0.24 to -0.10) on gait speed, although there was substantial uncertainty in these estimates. Mutual interference (decrement in both walking and secondary component task performances during dual-tasking) was the most common dual-task interference pattern. The results of the sensitivity analyses for studies involving people with chronic stroke were similar to the results of the primary analyses. The amount of dual-task interference from a mental tracking or manual task during walking was similar between people with or without stroke. CONCLUSIONS The degree and pattern of dual-task interference vary with the choice of component tasks. When evaluating limitations to functional mobility during dual-tasking conditions and in planning interventions accordingly, clinicians should select dual-task assessments that correspond to the daily habits and physical demands of people after stroke. REGISTRATION CRD42017059004.
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Kooncumchoo P, Namdaeng P, Hanmanop S, Rungroungdouyboon B, Klarod K, Kiatkulanusorn S, Luangpon N. Gait Improvement in Chronic Stroke Survivors by Using an Innovative Gait Training Machine: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:224. [PMID: 35010482 PMCID: PMC8750435 DOI: 10.3390/ijerph19010224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/17/2021] [Accepted: 12/22/2021] [Indexed: 06/14/2023]
Abstract
Chronic stroke leads to the impairment of lower limb function and gait performance. After in-hospital rehabilitation, most individuals lack continuous gait training because of the limited number of physical therapists. This study aimed to evaluate the effects of a newly invented gait training machine (I-Walk) on lower limb function and gait performance in chronic stroke individuals. Thirty community-dwelling chronic stroke individuals were allocated to the I-Walk machine group (n = 15) or the overground gait training (control) group (n = 15). Both groups received 30 min of upper limb and hand movement and sit-to-stand training. After that, the I-Walk group received 30 min of I-Walk training, while the control followed a 30-minute overground training program. All the individuals were trained 3 days/week for 8 weeks. The primary outcome of the motor recovery of lower limb impairment was measured using the Fugl-Meyer Assessment (FMA). The secondary outcomes for gait performance were the 6-minute walk test (6 MWT), the 10-meter walk test (10 MWT), and the Timed Up and Go (TUG). The two-way mixed-model ANOVA with the Bonferroni test was used to compare means within and between groups. The post-intervention motor and sensory subscales of the FMA significantly increased compared to the baseline in both groups. Moreover, the 6 MWT and 10 MWT values also improved in both groups. In addition, the mean difference of TUG in the I-Walk was higher than the control. The efficiency of I-Walk training was comparable to overground training and might be applied for chronic stroke gait training in the community.
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Affiliation(s)
- Patcharee Kooncumchoo
- Department of Physical Therapy, Faculty of Allied Health Sciences, Thammasat University, Pathumthani 12120, Thailand; (P.K.); (P.N.); (S.H.)
- Center of Excellence in Creative Engineering Design and Development, Thammasat University, Pathumthani 12120, Thailand;
| | - Phuwarin Namdaeng
- Department of Physical Therapy, Faculty of Allied Health Sciences, Thammasat University, Pathumthani 12120, Thailand; (P.K.); (P.N.); (S.H.)
| | - Somrudee Hanmanop
- Department of Physical Therapy, Faculty of Allied Health Sciences, Thammasat University, Pathumthani 12120, Thailand; (P.K.); (P.N.); (S.H.)
| | - Bunyong Rungroungdouyboon
- Center of Excellence in Creative Engineering Design and Development, Thammasat University, Pathumthani 12120, Thailand;
- Department of Mechanical Engineering, Faculty of Engineering, Thammasat University, Pathumthani 12120, Thailand
| | - Kultida Klarod
- Department of Physical Therapy, Faculty of Allied Health Sciences, Burapha University, Chonburi 20131, Thailand; (K.K.); (S.K.)
| | - Sirirat Kiatkulanusorn
- Department of Physical Therapy, Faculty of Allied Health Sciences, Burapha University, Chonburi 20131, Thailand; (K.K.); (S.K.)
| | - Nongnuch Luangpon
- Department of Physical Therapy, Faculty of Allied Health Sciences, Burapha University, Chonburi 20131, Thailand; (K.K.); (S.K.)
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Persson CU, Hansson PO. Determinants of falls after stroke based on data on 5065 patients from the Swedish Väststroke and Riksstroke Registers. Sci Rep 2021; 11:24035. [PMID: 34911990 PMCID: PMC8674218 DOI: 10.1038/s41598-021-03375-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 12/01/2021] [Indexed: 11/09/2022] Open
Abstract
We aimed to identify determinants in acute stroke that are associated with falls during the stroke unit stay. In order to enable individualized preventive actions, this knowledge is fundamental. Based on local and national quality register data on an unselected sample of 5065 stroke patients admitted to a stroke unit at a Swedish university hospital, univariable and multivariable logistic regression analyses were performed. The dependent variable was any fall during stroke unit stay. The independent variables related to function, activity, personal factors, time to assessment, comorbidities and treatments. Determinants of falls were: being male (odds ratio (OR) 2.25, 95% confidence interval (95% CI) 1.79–2.84), haemorrhagic stroke (OR 1.39, 95% CI 1.05–1.86), moderate stroke symptoms according to the National Institutes of Health Stroke Scale (NIHSS score 2–5 vs. NIHSS score 0–1) (OR 1.43, 95% CI 1.08–1.90), smoking (OR 1.70, 95% CI 1.29–2.25), impaired postural control in walking (OR 4.61, 95% CI 3.29–6.46), impaired postural control in standing (OR 1.60, 95% CI 1.25–2.05), stroke-related arm- and hand problems, OR 1.45, 95% CI 1.11–1.91), impaired cognition (OR 1.43, 95% CI 1.04–1.95), and urinary tract infection (OR 1.91, 95% CI 1.43–2.56). The findings from this study are useful in clinical practice and might help to improve patient safety after stroke.
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Affiliation(s)
- Carina U Persson
- Department of Clinical Neuroscience, Rehabilitation Medicine, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Per Dubbsgatan 14, 3rd Fl, Gothenburg, Sweden. .,Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital/Östra, Gothenburg, Region Västra Götaland, Sweden.
| | - Per-Olof Hansson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Medicine, Geriatrics and Emergency Medicine, Sahlgrenska University Hospital/Östra, Gothenburg, Region Västra Götaland, Sweden
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Young HJ, Mehta T, Herman C, Baidwan NK, Lai B, Rimmer JH. The Effects of a Movement-to-Music (M2M) Intervention on Physical and Psychosocial Outcomes in People Poststroke: A Randomized Controlled Trial. Arch Rehabil Res Clin Transl 2021; 3:100160. [PMID: 34977542 PMCID: PMC8683867 DOI: 10.1016/j.arrct.2021.100160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To investigate the effects of a 12-week movement-to-music (M2M) intervention on physical and psychosocial outcomes in people poststroke. DESIGN Two-arm randomized controlled trial. SETTING A community-based fitness facility. PARTICIPANTS Participants (N=47) with stroke between 18 and 65 years old were randomized to M2M (n=23) or waitlist control (n=24). INTERVENTIONS Participants in M2M completed 3 60-minute exercise sessions per week for 12 weeks. Controls received biweekly educational newsletters via mail. MAIN OUTCOME MEASURES Primary outcomes included Six-Minute Walk Test (6MWT, in meters), Five Times Sit-to-Stand Test (FTSST, in seconds) and Timed Up and Go (TUG, in seconds). Secondary outcomes were self-reported measures using Patient-Reported Outcomes Measurement Information System Fatigue and Pain Interference Short Form 8a. Outcomes were collected at baseline and postintervention. Analyses involved descriptive statistics and adjusted linear mixed models. RESULTS Mixed models adjusted for the respective baseline values and demographic variables showed that M2M participants had longer 6MWT distance (least square mean difference [LSM], 14.5; 95% confidence interval [CI], -12.9 to 42.0), more FTSST time (LSM, 2.0; 95% CI, -4.5 to 8.5), and less fatigue (LSM, -3.0; 95% CI, -7.2 to 1.2) compared with controls postintervention. When controlling for baseline TUG and demographic variables, there was a larger increase in 6MWT distance (LSM, 37.9; 95% CI, -22.7 to 98.6), lower FTSST time (LSM, -6.1; 95% CI, -18.5 to 6.2), and decrease in fatigue (LSM, -6.5; 95% CI, -13.1 to 0.2) in the M2M group compared with controls. Moderate effect sizes were observed for improving 6MWT (d=0.6), FTSST (d=-0.6), and fatigue (d=-0.6). There was no group difference in change in TUG time and pain interference, with trivial effect sizes (d=-0.1). CONCLUSION M2M may be a valuable exercise form for adults with stroke. Future studies are needed to determine optimal exercise doses for improving health and function in this population.
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Key Words
- 6MWT, Six-Minute Walk Test
- AEs, adverse events
- BMI, body mass index
- CI, confidence interval
- Dance
- Exercise
- FTSST, Five Times Sit to Stand Test
- ICC, intraclass correlation coefficient
- LSM, least square means
- M2M, movement-to-music
- MCID, minimally clinically important difference
- PROMIS, Patient-Reported Outcomes Measurement Information System
- Physical performance
- Quality of life
- RPE, Rating of Perceived Exertion
- Rehabilitation
- Stroke
- TUG, Timed Up and Go
- WC, waitlist control
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Affiliation(s)
- Hui-Ju Young
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Tapan Mehta
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama, United States
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Cassandra Herman
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Navneet Kaur Baidwan
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Byron Lai
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama, United States
- Division of Pediatric and Rehabilitation Medicine, School of University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - James H. Rimmer
- UAB/Lakeshore Research Collaborative, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama, United States
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Boissoneault C, Rose DK, Grimes T, Waters MF, Khanna A, Datta S, Daly JJ. Trajectories of stroke recovery of impairment, function, and quality of life in response to 12-month mobility and fitness intervention. NeuroRehabilitation 2021; 49:573-584. [PMID: 34806625 DOI: 10.3233/nre-210147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Gait deficits and functional disability are persistent problems for many stroke survivors, even after standard neurorehabilitation. There is little quantified information regarding the trajectories of response to a long-dose, 12-month intervention. OBJECTIVE We quantified treatment response to an intensive neurorehabilitation mobility and fitness program. METHODS The 12-month neurorehabilitation program targeted impairments in balance, limb coordination, gait coordination, and functional mobility, for five chronic stroke survivors. We obtained measures of those variables every two months. RESULTS We found statistically and clinically significant group improvement in measures of impairment and function. There was high variation across individuals in terms of the timing and the gains exhibited. CONCLUSIONS Long-duration neurorehabilitation (12 months) for mobility/fitness produced clinically and/or statistically significant gains in impairment and function. There was unique pattern of change for each individual. Gains exhibited late in the treatment support a 12-month intervention. Some measures for some subjects did not reach a plateau at 12 months, justifying further investigation of a longer program (>12 months) of rehabilitation and/or maintenance care for stroke survivors.
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Affiliation(s)
- Catherine Boissoneault
- Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Dorian K Rose
- Department of Physical Therapy College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA.,Brain Rehabilitation Research Center, North Florida/South Georgia VA Medical Center, Gainesville, FL, USA
| | - Tyler Grimes
- Department of Biostatistics, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Michael F Waters
- Neurovascular Division and Stroke Program, Department of Neurology, Barrow Neurological Institute at Dignity Health St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Anna Khanna
- Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Somnath Datta
- Department of Biostatistics, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Janis J Daly
- Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, USA.,Department of Physical Therapy College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA.,Brain Rehabilitation Research Center, North Florida/South Georgia VA Medical Center, Gainesville, FL, USA
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Experiences of stroke survivors and measurement of post stroke participation and activity across seasons-A mixed methods approach. PLoS One 2021; 16:e0259307. [PMID: 34714877 PMCID: PMC8555779 DOI: 10.1371/journal.pone.0259307] [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: 05/25/2021] [Accepted: 10/15/2021] [Indexed: 11/29/2022] Open
Abstract
Participation and activity post stroke can be limited due to adverse weather conditions. This study aimed to: Quantify and compare summer and winter participation and activity, and explore how community dwelling people with stroke describe their feelings about their level of participation and activity by season. This embedded mixed-methods observational study took place in a city with weather extremes. Community dwelling individuals at least one year post-stroke, able to walk ≥50 metres +/- a walking aide were included. Evaluations and interviews occurred at participants’ homes in two seasons: Reintegration to Normal living Index (RNL), Activities-specific Balance Confidence (ABC) and descriptive outcomes. Participants wore activity monitors for one week each season. Analysis included descriptive statistics, non-parametric tests and an inductive approach to content analysis. Thirteen individuals participated in quantitative evaluation with eight interviewed. Mean age 61.5 years, 62% female and mean 6.2 years post-stroke. No differences between winter-summer values of RNL, ABC, or activity monitor outcomes. However, participants felt they could do more and were more independent in summer. The winter conditions such as ice, snow, cold and wind restricted participation and limited activities. Nonetheless, many participants were active and participated despite the winter challenges by finding other ways to be active, and relying on social supports and personal motivation. The qualitative findings explained unexpected quantitative results. Participants described many challenges with winter weather, but also ways they had discovered to participate and be active despite these challenges. Changes to future studies into seasonal differences are suggested.
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Determinants of Physical Activity at 90 Days After Acute Stroke or Transient Ischemic Attack in Patients With Home Discharge: A Pilot Study. J Aging Phys Act 2021; 30:646-652. [PMID: 34615739 DOI: 10.1123/japa.2021-0254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/02/2021] [Accepted: 09/08/2021] [Indexed: 11/18/2022]
Abstract
The aim was to identify the barriers to achieving premorbid physical activity in patients with home discharge after acute minor stroke or transient ischemic attack. Fifty-six patients (median age, 72 years) were analyzed. We assessed total physical activity in the premorbid condition and at 90 days after onset using the International Physical Activity Questionnaire. The patients were divided into two groups according to changes in total physical activity until 90 days after onset: decreased activity (n = 16) and nondecreased activity (n = 40) groups. Outcome measures were examined at discharge. The decreased activity group took significantly longer to perform the timed up and go test (median, 7.19 vs. 6.52 s) and contained more apathetic patients (44% vs. 15%). Apathy at discharge (relative risk 6.05, 95% confidence interval [1.33, 27.6]) was a significant determinant of decreased physical activity. Apathy is a barrier to the restoration of premorbid physical activity in stroke survivors.
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Effects of Aquatic Exercise and Land-Based Exercise on Cardiorespiratory Fitness, Motor Function, Balance, and Functional Independence in Stroke Patients-A Meta-Analysis of Randomized Controlled Trials. Brain Sci 2021; 11:brainsci11081097. [PMID: 34439716 PMCID: PMC8394174 DOI: 10.3390/brainsci11081097] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 11/24/2022] Open
Abstract
The aim of this study was to evaluate the efficacy of aquatic exercise (AE) and land-based exercise (LE) on cardiorespiratory fitness, motor function, balance, and functional independence in stroke patients. Design: Through searching PubMed, Embase, Cochrane Library, Web of Science, CNKI, VIP and Wanfang Database, only randomized controlled trials (RCTs) were collected to study the effects of AE and LE on cardiorespiratory fitness, motor function, balance, and functional independence in patients with stroke. The included studies were evaluated for methodological quality by the Cochrane bias risk assessment tool, and statistical analysis was carried out by the Review Manage 5.3 and Stata 15.1 software. Results: The RCTs were collected between the earliest available date and April 2021. Eleven RCTs were included, including five studies with low risk and six studies with moderate risk. The total sample size used in the study was 369, which included 187 patients undertaking AE and 182 patients undertaking LE. The results of the meta-analysis showed that AE can significantly improve patients’ Berg Balance Scale (BBS) (MD = 5.19, 95% CI: 2.66 to 7.71, p < 0.0001), peak oxygen uptake (VO2peak) (MD = 3.49, 95% CI: 0.17 to 6.8, p = 0.04), Fugl–Meyer Assessment (FMA) (MD = 3.84, 95% CI: 1.64 to 6.04, p = 0.0006), and Functional Independence Measure (FIM) (MD = 6.1, 95% CI: 4.05 to 8.15, p < 0.00001). However, there was no statistically significant difference between the two exercise modes in the Timed Up and Go Test (TUGT) (MD = −2.52, 95% CI: −5.95 to 0.91, p = 0.15) or the Functional Ambulation Category scale (FAC) (MD = 0.28, 95% CI: −0.21 to 0.76, p = 0.26). Conclusion: Based on the improvement in the Berg Balance Scale, peak oxygen uptake, Fugl–Meyer Assessment, and Functional Independence Measure, we can state that aquatic exercise offers better advantages than land-based exercise for patients’ balance, motor function, cardiorespiratory fitness, and functional independence.
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Liu WJ, Lin LF, Chiang SL, Lu LH, Chen CY, Lin CH. Impacts of Stroke on Muscle Perceptions and Relationships with the Motor and Functional Performance of the Lower Extremities. SENSORS 2021; 21:s21144740. [PMID: 34300480 PMCID: PMC8309499 DOI: 10.3390/s21144740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/06/2021] [Accepted: 07/08/2021] [Indexed: 11/16/2022]
Abstract
Stroke results in paretic limb disabilities, but few studies have investigated the impacts of stroke on muscle perception deficits in multiaxis movements and related functional changes. Therefore, this study aimed to investigate stroke-related changes in muscle perceptions using a multiaxis ankle haptic interface and analyze their relationships with various functions. Sixteen stroke patients and 22 healthy participants performed active reproduction tests in multiaxis movements involving the tibialis anterior (TA), extensor digitorum longus (EDL), peroneus longus, and flexor digitorum longus (FDL) of the ankle joint. The direction error (DE), absolute error (AE), and variable error (VE) were calculated. The lower extremity of Fugl-Meyer Assessment (FMA-LE), Barthel Index (BI), Postural Assessment Scale for Stroke Patients, Tinetti Performance-Oriented Mobility Assessment (POMA), and 10-m walk test (10MWT) were evaluated. VE of EDL for the paretic ankle was significantly lower than that for the nonparetic ankle (p = 0.009). AE of TA, EDL, and FDL and VE of EDL and FDL of muscle perceptions were significantly lower in healthy participants than in stroke patients (p < 0.05 for both). DE of TA for the paretic ankle was moderately correlated with FMA-LE (r = -0.509) and POMA (r = -0.619) scores. AE and VE of EDL for the paretic ankle were moderately correlated with the 10MWT score (r = 0.515 vs. 0.557). AE of FDL for the paretic ankle was also moderately correlated with BI (r = -0.562). This study indicated poorer accuracy and consistency in muscle perception for paretic ankles, which correlated with lower limb functions of stroke patients.
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Affiliation(s)
- Wan-Ju Liu
- Master Program in Long-Term Care, College of Nursing, Taipei Medical University, Taipei 110, Taiwan;
| | - Li-Fong Lin
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235, Taiwan;
| | - Shang-Lin Chiang
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei 114, Taiwan;
| | - Liang-Hsuan Lu
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei 112, Taiwan;
| | - Chao-Ying Chen
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong 999077, China;
| | - Chueh-Ho Lin
- Master Program in Long-Term Care, College of Nursing, Taipei Medical University, Taipei 110, Taiwan;
- Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan
- Correspondence: ; Tel./Fax: +886-2-27361661 (ext. 6325)
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Yuen M, Ouyang HX, Miller T, Pang MYC. Baduanjin Qigong Improves Balance, Leg Strength, and Mobility in Individuals With Chronic Stroke: A Randomized Controlled Study. Neurorehabil Neural Repair 2021; 35:444-456. [PMID: 33825587 DOI: 10.1177/15459683211005020] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Effective and sustainable exercise training methods for improving balance poststroke are needed. OBJECTIVE To evaluate the effect of Baduanjin Qigong for improving balance after stroke. METHODS This was a single-blinded randomized controlled study in which only the assessor was blinded. Fifty-eight people with chronic stroke (mean age: 62.5 ± 11.8 years) were randomly assigned to the experimental (n = 29) or control group (n = 29). The experimental group underwent 8 weeks of supervised Baduanjin training (3 sessions per week). This was followed by home-based practice of the same exercises 3 days a week for another 8 weeks. The control group underwent 2 sessions of supervised conventional fitness training in the first week, followed by home-based exercise practice 3 days a week until the end of week 16. All outcomes were measured at baseline, week 8, and week 16. RESULTS Significantly greater improvements in the Mini-Balance Evaluation Systems Test (Mini-BESTest), composite equilibrium score (Sensory Organization Test), 5 Times Sit to Stand, and Timed Up and Go test were detected at week 8 in the experimental group than in the control group (P < .017). Further improvement in the Mini-BESTest was observed from week 8 to 16 in the experimental group (P < .001). Other outcomes (Limit of Stability, Fall-Efficacy Scale, Modified Barthel Index, Stroke-Specific Quality of Life) showed no significant results. CONCLUSION Baduanjin is effective in improving balance, leg strength, and mobility and is a safe and sustainable form of home-based exercise for people with chronic stroke.
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Affiliation(s)
- Mandy Yuen
- Queen Elizabeth Hospital, Kowloon, Hong Kong.,Hong Kong Polytechnic University, Hong Kong
| | - H X Ouyang
- Hong Kong Polytechnic University, Hong Kong
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Khan F, Chevidikunnan MF. Prevalence of Balance Impairment and Factors Associated with Balance among Patients with Stroke. A Cross Sectional Retrospective Case Control Study. Healthcare (Basel) 2021; 9:healthcare9030320. [PMID: 33805643 PMCID: PMC7998930 DOI: 10.3390/healthcare9030320] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/07/2021] [Accepted: 03/11/2021] [Indexed: 11/16/2022] Open
Abstract
Stroke is a major cause of disability worldwide, and balance impairments are common disabling factors in patients with stroke, leading to falls. Thus, the study objectives were as follows: (i) To find the prevalence of balance impairment among patients with stroke. (ii) To find out the factors associated with balance impairment in patients with stroke. This cross-sectional retrospective case control study involved eighty-one post stroke patients with a mean age of 58.36 ± 14.06, recruited from six hospitals, who underwent an assessment of balance, walking speed, depression and isometric strength of the ankle and knee. These patients were later categorized into subjects with good balance (<45) in the Berg balance scale (BBS) and those with poor balance (≥45), as cases and controls, to assess the factors associated with balance impairment using binary logistic regression. The prevalence of balance impairment among patients with stroke was 48.1%. The reduction in power of knee flexors (OR = 0.858), knee extensors (OR = 0.880) and ankle dorsiflexors (OR = 0.820) was found to be significantly associated with balance impairment, along with speed (OR = 1.187 (95% CI = 1.100, 1.280)), depression (OR = 1.331 (95% CI = 1.055-1.679)) and activities of daily living (OR = 0.313 (95% CI = 0.150-0.650)). In summary, around half of the patients with stroke exhibited balance impairments, with females being more prone.
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Affiliation(s)
- Fayaz Khan
- Correspondence: ; Tel.: +966-533-034-058
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Ishige S, Wakui S, Miyazawa Y, Naito H. Psychometric properties of a short version of the Activities-specific Balance Confidence scale-Japanese (Short ABC-J) in community-dwelling people with stroke. Physiother Theory Pract 2021; 38:1756-1769. [PMID: 33678113 DOI: 10.1080/09593985.2021.1888342] [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
Background and Purpose: The Activities-specific Balance Confidence (ABC) scale has been widely used as patient-reported outcome measures for community stroke rehabilitation and its short version is beginning to be used. This study aimed to assess the psychometric properties of the short version of the ABC scale-Japanese (Short ABC-J).Methods: Eighty-four participants with chronic stroke (mean age was 66.4 ± 9.7 years, mean time post stroke was 4.7 ± 3.5 years) including 66 test-retest samples were analyzed. The Short ABC-J was assessed with the ABC-J, the Falls Efficacy Scale-International (FES-I), the Berg Balance Scale (BBS), and the Timed Up and Go Test (TUG-T). Results: The internal consistency was good (Cronbach's alpha 0.90), reproducibility was excellent [intra-class correlation coefficient (ICC2,1) 0.92], and levels of absolute reliability were acceptable (standard error of measurement and minimal detectable change 8.32 and 23.07, respectively). Concurrent, convergent, and discriminative validity were supported for the FES-I, ABC-J, BBS, and TUG-T (all |rho| > 0.60, p < .001), and identifying balance and mobility (the area under the curve estimates ≥ 0.80) and discriminative power of the Short ABC-J were better than those of the FES-I and equal to or better than those of ABC-J. Conclusion: The Short ABC-J has good psychometric properties and is a valid and reliable measure of balance self-efficacy in Japanese community-dwelling people with chronic stroke. Further replication studies as well as other psychometric studies are needed.
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Affiliation(s)
- Satomi Ishige
- Graduate School of Health and Sports Science, Juntendo University, Inzai-city, Chiba, Japan.,Department of Rehabilitation, Ushioda General Hospital, Yokohama-city, Kanagawa, Japan
| | - Sawako Wakui
- Graduate School of Health and Sports Science, Juntendo University, Inzai-city, Chiba, Japan
| | - Yumi Miyazawa
- Department of Neurology, Ushioda General Hospital, Yokohama-city, Kanagawa, Japan
| | - Hisashi Naito
- Graduate School of Health and Sports Science, Juntendo University, Inzai-city, Chiba, Japan
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Kurul R, Cankaya T, Yildirim NU. Kinesio taping techniques for ankle stabilisation in patients with stroke: a single-blinded randomised controlled study. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2021. [DOI: 10.12968/ijtr.2019.0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/AimsAnkle proprioception and neuromuscular feedback from this region provides the sensory input needed for balance. The aim of this study was to investigate the effects of repeated correction taping applied on the ankle and peroneus longus and peroneus brevis muscles on balance and gait in patients with stroke.MethodsA total of 61 patients with stroke with a mean age of 62.25 ± 7.04 years were included in this study. The patients were randomly divided into two groups. The control group (n=30) received 1 hour of rehabilitation, which took place during weekdays over the course of 2 weeks. The intervention group (n=31) received 1 hour of daily rehabilitation as well as having kinesio tape applied to their ankle. Both groups were assessed with the Balance Evaluating Systems Test, Timed Up and Go Test, Functional Reach Test, Tetrax Balance System and Barthel Index. Clinical assessments were performed at baseline, immediately after the first application, 1 week and 2 weeks later, following the first taping.ResultsThere was a significant improvement in the Balance Evaluating Systems and Functional Reach Tests scores between the first and last measurements in favour of the intervention group (P<0.05). There were no significant changes between baseline and immediately after assessment for all measurements (P>0.05). There was no significant difference in Tetrax scores, Timed Up and Go Test and Barthel Index scores (P>0.05).ConclusionsIn this study, it was found that dynamic balance was improved by taping the peroneus longus and peroneus brevis muscles, but the static balance did not change. One week of kinesio taping would be beneficial; however, prolonged use would not provide further improvement.
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Affiliation(s)
- Ramazan Kurul
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bolu Abant Izzet Baysal University, Bolu, Turkey
| | - Tamer Cankaya
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bolu Abant Izzet Baysal University, Bolu, Turkey
| | - Necmiye Un Yildirim
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Saglık Bilimleri University, Ankara, Turkey
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Silva SBCA, Hruschka ACCB, Moraes AG, Leal JC, Silva MLD, Paz LPDS. Effectiveness of hippotherapy and therapeutic horseback riding on balance in hemiparetic patients after stroke. FISIOTERAPIA EM MOVIMENTO 2021. [DOI: 10.1590/fm.2021.34201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: Stroke is one of the leading causes of disability and death worldwide. Individuals who suffered stroke present numerous functional limitations. Hippo-therapy (HPOT) is proposed as capable of promoting the recovery of postural balance in patients with neurological impairment. Objective: To analyze published articles, seeking the effects of HPOT on changes in postural balance, through the Berg Balance Scale (BBS), in individuals with stroke. Methods: We conducted a systematic review and meta-analysis of studies published on the electronic databases PubMed, VHL, SCIELO, Cochrane, SCOPUS, WoS, and Cinahl. Keywords: "hippotherapy", "horseback riding" and "stroke" linked by the OR and AND boolean operators. The research was restricted to clinical trials in an adult population with a history of stroke. Results: Four articles were included in this meta-analysis, which used HPOT as an intervention to improve postural balance. Three studies used a mechanical device (horseback riding), and the horse. The age ranged from 61 to 71 years, being more predominant the male sex. Sessions ranged from 6 to 12 weeks of 20 to 30 minutes per session. Quality analysis using the PEDro scale demonstrated scores ranging from 6 to 8 points in the selected studies. Overall, treatment with mechanical and conventional therapy resulted in an improvement in the total BBS score. As compared with conventional therapy just studies with horseback riding was superior to conventional therapy to improve postural balance in hemiparetic stroke patients. Conclusion: There are few studies of high quality; then, it is not possible to evaluate the effectiveness of HPOT using a horse or a mechanic simulator in patients with stroke when compared with conventional therapy. Future studies could clarify if HPOT has potential benefits as a complementary therapeutic strategy to conventional physiotherapy to promote the improvement of postural balance after stroke.
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Ziegl A, Hayn D, Kastner P, Löffler K, Weidinger L, Brix B, Goswami N, Schreier G. Quantitative falls risk assessment in elderly people: results from a clinical study with distance based timed up-and-go test recordings. Physiol Meas 2020; 41:115006. [PMID: 33086193 DOI: 10.1088/1361-6579/abc352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE A third of people over 65 years experiences at least one fall a year. The Timed Up-and-Go (TUG) test is commonly used to assess gait and balance and to evaluate an individual's risk of falling. APPROACH We conducted a clinical study with 46 older participants for evaluating the fall risk assessment capabilities of an ultra-sound based TUG test device. The fall protocols over a period of one year were used to classify participants as fallers and non-fallers. For frailty evaluation, state-of-the-art questionnaires were used. Fall recordings were compared to six TUG test measurements that were recorded in fallers and non-fallers. MAIN RESULTS TUG test data were available for 39 participants (36 f, age 84.2 ± 8.2, BMI 26.0 ± 5.1). Twenty-three participants did fall at least once within the fall screening period. We fitted two different regression and probability models into a region of interest of the distance over time curve as derived from the TUG device. We found that the coefficient of determination for Gaussian bell-shaped curves (p < 0.05, AUC = 0.71) and linear regression lines (p < 0.02, AUC = 0.74) significantly separated fallers from non-fallers. Subtasks of the TUG test like the sit-up time showed near significance (p < 0.07, AUC = 0.67). SIGNIFICANCE We found that specific features calculated from the TUG distance over time curve were significantly different between fallers and non-fallers in our study population. Automatic recording and analysis of TUG measurements could, therefore, reduce time of measurements and improve precision as compared to other methods currently being used in the assessments of fall risk.
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Affiliation(s)
- Andreas Ziegl
- AIT Austrian Institute of Technology GmbH, Graz, Austria. Institute of Neural Engineering, Graz University of Technology, Graz, Austria
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Pui Kei C, Mohd Nordin NA, Abdul Aziz AF. The effectiveness of home-based therapy on functional outcome, self-efficacy and anxiety among discharged stroke survivors. Medicine (Baltimore) 2020; 99:e23296. [PMID: 33217861 PMCID: PMC7676535 DOI: 10.1097/md.0000000000023296] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Stroke survivors are commonly at risk of functional decline following discharge from rehabilitation, which increase their susceptibility to falls, dependency in activities of daily living and emotional disturbances. To combat these, continued therapy is important. Home-based therapy (HBT) has been shown to be useful in maintaining functional performance and quality of life of chronic stroke survivors. However, evidence on its effectiveness remains limited, while no studies are available to date which report the benefit of HBT on stroke survivors self-efficacy and emotional status. Therefore, this study aims to assess the effectiveness of post-discharge HBT in comparison to usual practice on functional outcome (mobility and gait speed), self-efficacy and anxiety level among stroke survivors. METHODS This is an assessor-blinded randomized control trial comparing 2 types of intervention which are HBT (experimental group) and usual practice (UP) (control group). Based on sample size calculation using GPower, a total number of 42 participants will be recruited and allocated into either the HBT or the UP group. Participants in HBT group will receive a set of structured exercise therapy consisting of progressive strengthening, balance and task-related exercises. While participants in UP group will receive a usual "intervention" practised by rehabilitation professional prior to discharging stroke patients from their care. Both groups are advised to perform the given interventions for 3 times per week for 12 weeks under the supervision of their caregiver. Outcomes of interventions will be measured using timed up and go test (for mobility), ten-meter walk test (for gait speed), stroke self-efficacy questionnaire (for self-efficacy) and hospital anxiety and depression scale (for anxiety level). All data will be analyzed using descriptive and inferential statistics. DISCUSSION This study will provide the information on the effectiveness of HBT in comparison to UP among stroke population who are discharged from rehabilitation. Findings from the study will enable rehabilitation professionals to design effective discharge care plan for stroke survivors in combating functional decline when no longer receiving hospital-based therapy. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry, ACTRN12619001182189 (last updated 22/11/2019).
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Affiliation(s)
- Chong Pui Kei
- Physiotherapy Program, Center for Rehabilitation and Special Needs Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia
- Physiotherapy Unit, Hospital Rehabilitasi Cheras
| | - Nor Azlin Mohd Nordin
- Physiotherapy Program, Center for Rehabilitation and Special Needs Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia
| | - Aznida Firzah Abdul Aziz
- Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras Kuala Lumpur, Malaysia
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Nascimento LR, da Silva LA, Araújo Barcellos JVM, Teixeira-Salmela LF. Ankle-foot orthoses and continuous functional electrical stimulation improve walking speed after stroke: a systematic review and meta-analyses of randomized controlled trials. Physiotherapy 2020; 109:43-53. [PMID: 33120054 DOI: 10.1016/j.physio.2020.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Indexed: 10/23/2022]
Abstract
BACKGROUND Foot-drop is a common impairment after stroke, which reduces walking ability. OBJECTIVE To examine the efficacy of interventions aimed at reducing foot-drop, i.e., ankle-foot orthoses and functional electrical stimulation, on walking speed and balance after stroke. DATA SOURCES MEDLINE, EMBASE, Cochrane, PsycINFO, and PEDro databases. ELIGIBILITY CRITERIA The review included only parallel, randomized trials. Participants were ambulatory adults after stroke. The experimental interventions were the use of an ankle-foot orthosis or functional electrical stimulation. DATA SYNTHESIS Outcome data related to walking speed and balance were extracted from the eligible trials and combined in random-effects meta-analyses. The quality of trials was assessed by the PEDro scores and the quality of evidence was determined according the Grading of Recommendations Assessment, Development, and Evaluation system. RESULTS Eleven trials involving 1135 participants were included. The mean PEDro score of the trials was 5.8 (ranging from 4 to 7). Ankle-foot orthoses (MD 0.24m/s; 95% CI 0.06 to 0.41) and functional electrical stimulation (MD 0.09m/s; 95% CI 0.03 to 0.14) significantly increased walking speed, compared with no intervention/placebo. Results regarding balance were inconclusive. Ankle-foot orthoses were not superior to functional electrical stimulation for improving walking speed (MD 0.00m/s; 95% CI -0.06 to 0.05) or balance (MD 0.27 points on the Berg Balance Scale; 95% CI -0.85 to 1.39) after stroke. CONCLUSIONS This systematic review provided moderate-quality evidence that both ankle-foot orthoses and functional electrical stimulation improve walking speed after stroke, but the effects on balance remain unclear. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42019130988.
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Affiliation(s)
- Lucas Rodrigues Nascimento
- Center of Health Sciences, Discipline of Physical Therapy, Universidade Federal do Espírito Santo (UFES), Vitória, ES, Brazil; NeuroGroup, Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.
| | - Layla Alvarenga da Silva
- Center of Health Sciences, Discipline of Physical Therapy, Universidade Federal do Espírito Santo (UFES), Vitória, ES, Brazil.
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Stroke Severity and Maximum Inspiratory Pressure are Independently Associated with Functional Mobility in Individuals After Stroke. J Stroke Cerebrovasc Dis 2020; 29:105375. [PMID: 33039768 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105375] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 09/12/2020] [Accepted: 09/27/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Clinical changes after stroke can contribute to reduced mobility and negatively affect the survival of these individuals. The objective of this study was to verify factors associated with functional mobility in stroke individuals. METHODS Crosssectional study carried out with stroke individuals in an outpatient clinic. Demographic and clinical data were collected and the following measures were applied: National Institute of Health Stroke Scale (NIHSS), modified Barthel Index, Trunk Impairment Scale, Functional Reach Test, Timed Up and Go Test, and the International Physical Activity Questionnaire. Respiratory muscle strength was assessed by measuring the maximum inspiratory pressure (MIP) and the maximum expiratory pressure (MEP).Variables with p < .05 in univariate logistic regression analysis were included in the multivariate logistic regression model, using the backward stepwise method. RESULTS 53 individuals were enrolled with a mean age of 55 years (±13.43). 51% were male and the median NIHSS score was 2.25 (0-13). The final multivariate model included NIHSS (OR = 1.872; 95% CI 1.167-3.006; p = 0.009), physical therapy treatment (OR = 15.467; 95% CI 1.838-130.178; p = 0.012) and MIP (OR = 1.078; 95% CI 1.024-1.135; p = 0.004). CONCLUSION Stroke severity and inspiratory muscle strength were factros associated with functional mobility in individuals after stroke, regardless stroke time.
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Protocol for a Randomized Controlled Trial of CI Therapy for Rehabilitation of Upper Extremity Motor Deficit: The Bringing Rehabilitation to American Veterans Everywhere Project. J Head Trauma Rehabil 2020; 34:268-279. [PMID: 30608308 DOI: 10.1097/htr.0000000000000460] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Constraint-induced movement therapy (CI therapy) has been shown to reduce disability for individuals with upper extremity (UE) hemiparesis following different neurologic injuries. This article describes the study design and methodological considerations of the Bringing Rehabilitation to American Veterans Everywhere (BRAVE) Project, a randomized controlled trial of CI therapy to improve the motor deficit of participants with chronic and subacute traumatic brain injury. Our CI therapy protocol comprises 4 major components: (1) intensive training of the more-affected UE for target of 3 hour/day for 10 consecutive weekdays, (2) a behavioral technique termed shaping during training, (3) a "transfer package," 0.5 hour/day, of behavioral techniques to transfer therapeutic gains from the treatment setting to the life situation, and (4) prolonged restraint of use of the UE not being trained. The primary endpoint is posttreatment change on the Motor Activity Log, which assesses the use of the more-affected arm outside the laboratory in everyday life situations. Data from a number of secondary outcome measures are also being collected and can be categorized as physical, genomic, biologic, fitness, cognitive/behavioral, quality of life, and neuroimaging measures.
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Slip-Fall Predictors in Community-Dwelling, Ambulatory Stroke Survivors: A Cross-sectional Study. J Neurol Phys Ther 2020; 44:248-255. [PMID: 32815890 DOI: 10.1097/npt.0000000000000331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND PURPOSE Considering the multifactorial nature and the often-grave consequences of falls in people with chronic stroke (PwCS), determining measurements that best predict fall risk is essential for identifying those who are at high risk. We aimed to determine measures from the domains of the International Classification of Functioning, Disability and Health (ICF) that can predict laboratory-induced slip-related fall risk among PwCS. METHODS Fifty-six PwCS participated in the experiment in which they were subjected to an unannounced slip of the paretic leg while walking on an overground walkway. Prior to the slip, they were given a battery of tests to assess fall risk factors. Balance was assessed using performance-based tests and instrumented measures. Other fall risk factors assessed were severity of sensorimotor impairment, muscle strength, physical activity level, and psychosocial factors. Logistic regression analysis was performed for all variables. The accuracy of each measure was examined based on its sensitivity and specificity for fall risk prediction. RESULTS Of the 56 participants, 24 (43%) fell upon slipping while 32 (57%) recovered their balance. The multivariate logistic regression analysis model identified dynamic gait stability, hip extensor strength, and the Timed Up and Go (TUG) score as significant laboratory-induced slip-fall predictors with a combined sensitivity of 75%, a specificity of 79.2%, and an overall accuracy of 77.3%. DISCUSSION AND CONCLUSIONS The results indicate that fall risk measures within the ICF domains-body, structure, and function (dynamic gait stability and hip extensor strength) and activity limitation (TUG)-could provide a sensitive laboratory-induced slip-fall prediction model in PwCS.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A323).
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Guimarães M, Monteiro MM, Matos RT, Furtado MC, Maia HF, Almeida LRS, Filho JO, Pinto EB. External validation of the recurrent falls risk scale in community-dwelling stroke individuals. J Stroke Cerebrovasc Dis 2020; 29:104985. [PMID: 32807417 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 05/14/2020] [Accepted: 05/15/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To externally validate the Recurrent Fall Risk Scale (ReFR) in community-dwelling stroke survivors. METHODS Cohort of stroke survivors with independent gait ability recruited from a reference outpatient stroke clinic. Besides sociodemographic and clinical data, the following scales were used: Modified Barthel Index (mBI), ReFR scale and National Institutes of Health Stroke Scale (NIHSS). Participants were followed up for 12 months to record the incidence of falls. Accuracy of the ReFR scale was measured by the area under the ROC curve. RESULTS One hundred and thirteen individuals were recruited between April 2016 and November 2016: mean age 54 years (± 14), 55% women, median time since the last stroke 24 months (range 12 -48 months), posterior vascular territory affected in 35% of the sample. Median NIHSS was 3 (range 1 to 6), median mBI 49 (range 46-50), median ReFR 3 (range 2 to 5). During the follow-up period, 32 (33%) subjects had at least one fall and 18 (19%) were recurrent fallers (two or more falls). The accuracy of ReFR scale was 0.67 (95% CI = 0.54-0.79), p = 0.026. CONCLUSION This study externally validated the ReFR as a tool to predict recurrent falls in individuals after stroke.
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Affiliation(s)
- Moema Guimarães
- Motor Behavior and Neurorehabilitation Research Group, Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil.
| | - Ms Maiana Monteiro
- Motor Behavior and Neurorehabilitation Research Group, Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil
| | - Rafael Tito Matos
- Motor Behavior and Neurorehabilitation Research Group, Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil
| | - Ms Cláudia Furtado
- Motor Behavior and Neurorehabilitation Research Group, Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil
| | - Helena Fraga Maia
- Public Health Universidade do Estado da Bahia - UNEB, Salvador, Bahia, Brazil
| | - Lorena R S Almeida
- Motor Behavior and Neurorehabilitation Research Group, Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil; Movement Disorders and Parkinson's Disease Clinic, Roberto Santos General Hospital/SESAB, Salvador, Bahia, Brazil
| | | | - Elen Beatriz Pinto
- Motor Behavior and Neurorehabilitation Research Group, Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil; Stroke Clinic of the Federal University of Bahia, Brazil
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Innovative Long-Dose Neurorehabilitation for Balance and Mobility in Chronic Stroke: A Preliminary Case Series. Brain Sci 2020; 10:brainsci10080555. [PMID: 32824012 PMCID: PMC7464211 DOI: 10.3390/brainsci10080555] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/08/2020] [Accepted: 08/13/2020] [Indexed: 01/18/2023] Open
Abstract
(1) Objective: The objective was two-fold: (a) test a protocol of combined interventions; (b) administer this combined protocol within the framework of a six-month, intensive, long-duration program. The array of interventions was designed to target the treatment-resistant impairments underlying persistent mobility dysfunction: weakness, balance deficit, limb movement dyscoordination, and gait dyscoordination. (2) Methods: A convenience sample of eight chronic stroke survivors (>4 months post stroke) was enrolled. Treatment was 5 days/week, 1-2.5 h/day for 6 months, as follows: strengthening exercise, balance training, limb/gait coordination training, and aerobic exercise. Outcome measures: Berg Balance Scale (BBS), Fugl-Meyer Lower Limb Coordination (FM), gait speed, 6 Minute Walk Test (6MWT), Timed up and Go (TUG), Functional Independence Measure (FIM), Craig Handicap Assessment Rating Tool (CHART), and personal milestones. Pre-/post-treatment comparisons were conducted using the Permutation Test, suitable for ordinal measures and small sample size. (3) Results: For the group, there was a statistically (p ≤ 0.04) significant improvement in balance, limb movement coordination (FM), gait speed, functional mobility (TUG), and functional activities (FIM). There were measurable differences (minimum detectible change: MDC) in BBS, FM, gait speed, 6MWT, and TUG. There were clinically significant milestones achieved for selected subjects according to clinical benchmarks for the BBS, 6MWT, gait speed, and TUG, as well as achievement of personal milestones of life role participation. Effect sizes (Cohen's D) ranged from 0.5 to 1.0 (with the exception of the (6MWT)). After six months of treatment, the above array of gains were beyond that reported by other published studies of chronic stroke survivor interventions. Personal milestones included: walking to mailbox, gardening/yardwork, walking a distance to neighbors, return to driving, membership at a fitness center, vacation trip to the beach, swimming at local pool, returning to work, housework, cooking meals. (4) Conclusions: Stroke survivors with mobility dysfunction were able to participate in the long-duration, intensive program, with the intervention array targeted to address impairments underlying mobility dysfunction. There were either clinically or statistically significant improvements in an array of measures of impairment, functional mobility, and personal milestone achievements.
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Nascimento LR, Flores LC, de Menezes KK, Teixeira-Salmela LF. Water-based exercises for improving walking speed, balance, and strength after stroke: a systematic review with meta-analyses of randomized trials. Physiotherapy 2020; 107:100-110. [DOI: 10.1016/j.physio.2019.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Indexed: 11/25/2022]
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Samuelsson CM, Hansson PO, Persson CU. Determinants of Recurrent Falls Poststroke: A 1-Year Follow-up of the Fall Study of Gothenburg. Arch Phys Med Rehabil 2020; 101:1541-1548. [PMID: 32497600 DOI: 10.1016/j.apmr.2020.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 05/17/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To identify the occurrence of recurrent falls and the determinants in the acute phase poststroke that are associated with recurrent falls within the first year poststroke. DESIGN Prospective follow-up study. SETTING Stroke unit and community. PARTICIPANTS Patients (N=504) with acute stroke. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The dependent variable was recurrent falls, defined as ≥2 falls, within the first year poststroke. The independent baseline variables were related to function, activity, participation, personal and environmental factors, and comorbidity and were assessed within 4 days after admission to a stroke unit. Fall data were registered at the stroke unit, and self-reported fall data were collected during follow-up using a standardized questionnaire. Determinants of recurrent falls were identified using univariable and multivariable logistic regression analyses. RESULTS Within 12 months poststroke, 95 of 348 participants (27%) had experienced recurrent falls. Poor postural control (odds ratio [OR] 5.85; 95% confidence interval [CI], 2.84-12.02; P<.0001), moderate postural control (OR 2.41; 95% CI, 1.21-4.80; P=.012), and using a walking aid in the acute phase (OR 2.51; 95% CI, 1.45-4.36; P=.0010) are statistically significant determinants that are associated with recurrent falls within the first year poststroke. The determinant of using a walking aid appears to be primarily driven by those younger than 80 years. In addition to impaired postural control and using a walking aid, a fall at the stroke unit is a determinant associated with recurrent falls after discharge within 6 months poststroke. CONCLUSIONS More than 1 in 4 individuals with stroke experienced recurrent falls within the first year poststroke. Impaired postural control, using a walking aid in the acute phase, and fall during hospitalization are determinants associated with recurrent falls during follow-up. The determinants differ somewhat at different ages.
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Affiliation(s)
- Carina M Samuelsson
- Region Västra Götaland, Department of Physiotherapy, Sahlgrenska University Hospital/Östra, Gothenburg; Rehabilitation Medicine, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg.
| | - Per-Olof Hansson
- Region Västra Götaland, Department of Medicine, Geriatrics and Emergency Medicine, Sahlgrenska University Hospital/Östra, Gothenburg; Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Carina U Persson
- Region Västra Götaland, Department of Physiotherapy, Sahlgrenska University Hospital/Östra, Gothenburg; Rehabilitation Medicine, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg
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Tsang CSL, Pang MYC. Association of subsequent falls with evidence of dual-task interference while walking in community-dwelling individuals after stroke. Clin Rehabil 2020; 34:971-980. [DOI: 10.1177/0269215520923700] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: The aim of this study was to examine the fall predictive value of single-task walking tests and extent of interference observed in dual-task walking tests in ambulatory individuals post stroke. Design: This is an observational study with prospective cohort. Setting: The study was conducted at the university laboratory. Participants: A total of 91 community-dwelling individuals with chronic stroke participated in the study. Main outcome measures: Time required to complete a 10-m walk test with and without obstacle negotiation was measured in isolation and in conjunction with performance of a verbal fluency task (category naming). Fall incidence, circumstances, and related injuries were recorded by monthly telephone calls for 12 months. Results: A total of 91 individuals (mean (SD) age = 62.7 (8.3) years; mean (SD) post-stroke duration = 8.8 (5.3) years) participated in the study; 29 (32%) of them reported at least one fall during the follow-up period, with a total of 71 fall episodes. There was a significant difference in obstacle-crossing time under single-task (mean difference = 8.3 seconds) and dual-task (mean difference = 7.4 seconds) conditions, and also the degree of interference in mobility performance (increased dual-task obstacle-crossing time relative to the single-task obstacle-crossing time; mean difference = 3.3%) between the fallers and the non-fallers ( P < 0.05). After adjusting for the effects of other relevant factors, a greater degree of interference in mobility performance remained significantly associated with a decreased risk of falling (adjusted odds ratio = 0.951, 95% CI = 0.907–0.997, P = 0.037). Conclusion: The degree of mobility interference during dual-task obstacle-crossing was the most effective in predicting falls among all the single-task and dual-task walking measure parameters tested. This simple dual-task walking assessment has potential clinical utility in identifying people post stroke at high risk of future falls.
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Affiliation(s)
- Charlotte Sau Lan Tsang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Marco Yiu Chung Pang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
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Campo M, Toglia J, Batistick-Aufox H, O'Dell MW. Standardized Outcome Measures in Stroke Rehabilitation and Falls After Discharge: A Cohort Study. PM R 2020; 13:265-273. [PMID: 32358887 DOI: 10.1002/pmrj.12396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 04/14/2020] [Accepted: 04/22/2020] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Individuals with stroke discharged from inpatient rehabilitation units (IRUs) are at increased risk for falls. In IRUs, standardized outcome measures (SOMs) have been used to predict falls, but the results have been mixed. OBJECTIVE To examine the relationship between SOMs and the risk of falls in individuals with stroke within 6 months of discharge from an IRU. DESIGN Prospective cohort study with 6-month follow-up. SETTING IRU that was part of a large, urban academic medical center. PARTICIPANTS Individuals with stroke who underwent rehabilitation. MAIN OUTCOME MEASURES Self-reported falls within 6 months of discharge. RESULTS The study included 105 participants who were discharged to their homes after inpatient rehabilitation and who responded to a 6-month follow-up (57% response rate) phone call. Twenty-nine participants (28%) reported falling. Significant odds ratios (ORs), adjusted for age, sex, and stroke severity, were found for the following measures: Berg Balance Scale (OR 0.95, 95% confidence interval [CI] 0.92-0.99), Activity Measure for Post-Acute Care basic mobility (OR 0.89, 95% CI 0.81-0.97), Motricity Index (OR 0.96, 95% CI 0.94-0.98), Functional Independence Measure mobility subscale (OR 0.89, 95% CI 0.80-0.98), and Trunk Control Test (OR 0.97, 95% CI 0.95-0.99). Areas under the curve ranged from .64 to .71. In samples of 82 to 90 patients who could complete the tests, gait speed, the Functional Reach Test, the 6-minute Walk Test, and Timed Up and Go did not result in significant ORs. CONCLUSIONS At discharge, SOMs were associated with the odds of falls within 6 months. The multifactorial nature of falls will continue to make prediction challenging but SOMs can be helpful. Lower extremity strength deserves more attention as a risk factor.
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Affiliation(s)
- Marc Campo
- School of Health and Natural Sciences, Mercy College, Dobbs Ferry, NY
| | - Joan Toglia
- School of Health and Natural Sciences, Mercy College, Dobbs Ferry, NY
| | | | - Michael W O'Dell
- Clinical Rehabilitation Medicine, Weill Cornell Medicine, New York City, NY
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Mobility Disorders in Stroke, Parkinson Disease, and Multiple Sclerosis: A Multicenter Cross-Sectional Study. Am J Phys Med Rehabil 2020; 99:41-47. [PMID: 31343501 DOI: 10.1097/phm.0000000000001272] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aims of the study were to compare mobility in multiple sclerosis, Parkinson disease, and stroke, and to quantify the relationship between mobility and participation restrictions. DESIGN This is a multicenter cross-sectional study. Included were compliant subjects with Parkinson disease, multiple sclerosis, and stroke seen for rehabilitation, with no comorbidities interfering with mobility. Functional scales were applied to each subject to investigate gait speed (10-meter walking test), balance while maintaining body position (Berg Balance Scale), dynamic balance and mobility (Timed Up and Go and Dynamic Gait Index), and participation (Community Integration Questionnaire). RESULTS Two hundred ninety-nine patients (111 multiple sclerosis, 94 Parkinson disease, and 94 stroke) were enrolled. Stroke had the slowest gait speed (mean gait speed = 0.9 m/sec) compared with Parkinson disease (1.1 m/sec), and multiple sclerosis (1.2 m/sec) (P < 0.001). Multiple sclerosis was more limited than Parkinson disease and stroke in dynamic balance both in the Timed Up and Go Test (multiple sclerosis = 16.7 secs, Parkinson disease = 11.4 secs, stroke = 14.0 secs; P < 0.001) and Dynamic Gait Index (multiple sclerosis = 11.6 points, Parkinson disease = 12.9 points, stroke = 13.6 points; P = 0.03); ability to maintain balance and body position (Berg Balance Scale) was more affected in stroke and Parkinson disease than multiple sclerosis (multiple sclerosis = 42.6 points, Parkinson disease = 39.4 points, stroke = 39.7 points; P = 0.03). Balance disorders were associated with participation restrictions but not gait speed. CONCLUSIONS Neurological conditions have differing impacts on gait and balance, leading to different levels of participation restriction.
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