The Use of Home Therapy Programmes for Improving Recovery of the Upper Limb following Stroke

The effectiveness of home therapy programmes for facilitating recovery of stroke patients' reaching movements was tested. Twenty-two patients were visited regularly at home for approximately 9 weeks following their discharge from a rehabilitation unit. Twelve patients were assessed and provided with a programme of exercises, while 10 were visited for assessment only. The home therapy group's performance on a peg transfer test improved significantly more than that of the control group. Compliance rates with the programmes were high. These results lead to suggestions for further evaluation of home therapy.

Methodology of a stroke rehabilitation trial

The effectiveness of rehabilitation after stroke remains largely unproven. Attempts have been made to evalute domiciliary therapy,1 community stroke teams2 and the intensity of therapy,3 but much of the evidence is inconclusive. We have been engaged in a randomized comparison trial of day hospital and home physiotherapy for elderly stroke patients discharged from hospital. This paper describes the background to the study and the pilot work from which the methodology was determined.

Competence and performance in activities of daily living of patients following rehabilitation from stroke

Indices of activities of daily living (ADL) are commonly criticized for failing to yield other than functional information. We suggest an alternative approach in which tested functional ability (ADL competence) is distinguished from actual behaviour (ADL performance). A method of making these assessments, based on the Australian ADL Index, was trialled in a longitudinal study involving 130 patients admitted for rehabilitation following stroke. Twelve months after discharge from rehabilitation the total ADL performance score was higher, that is to say worse, than the total ADL competence score; further, there was no significant agreement between the competence and performance ratings for nine of the 17 activities. It appears that ADL competence and ADL performance can be distinguished both theoretically and empirically. Two case studies illustrate the usefulness of the performance assessment. We recommend the ADL performance assessment as an outcome measure in rehabilitation.

Recovery of motor function after stroke

The natural history of recovery of motor function after stroke is described using data from a 1-year community-based study in Auckland, New Zealand. Of 680 patients, 88% presented with a hemiparesis; the proportion of survivors with a persisting deficit declined to 71% at 1 month and 62% at 6 months after the onset of the stroke. At onset, there were equal proportions of people with mild, moderate, and severe motor deficits, but the majority (76%) of those who survived 6 months had either no or only a mild deficit. Recovery of motor function was associated with the stroke severity but not with age or sex; patients with a mild motor deficit at onset were 10 times more likely to recover their motor function than those with a severe stroke. Our results confirm the reasonably optimistic outcome for survivors of stroke and further suggest that recovery of motor function is confined to patients whose motor deficit at onset is either mild or moderate.

Rehabilitation after brain damage: an overview

This paper takes stock of recent additions to knowledge about rehabilitation after brain damage, and then explores the requirements for future research in this area.

Repeatability and validity of a modified activities of daily living (ADL) index in studies of chronic disability

In order to measure disability in a randomised controlled trial of different intensities of rehabilitation following stroke, a modification of existing methods has been developed; it makes use of 17 items of activities of daily living (ADL) which are rated on a three-point scale, and it has been subjected to tests of repeatability and validity. While some activities (e.g. use of taps, ascending or descending stairs) are either redundant or repetitive, others provide independent measures of disability. There was no significant inter-observer variability; the assessors disagreed on 78 (3.7%) out of a total of 2,125 paired observations. In a study of short-term within-patient variability, different scores were assigned on 49 (14.4%) out of a total of 340 observations made on two separate occasions. Minor differences (mainly in activities involving equipment e.g. cookers) emerged when scores obtained in hospital were compared with those obtained at home, but the two sets of scores were still highly correlated (r = 0.962. There was, however, considerable discrepancy between the hospital scores and those derived from the patients' own estimates of their activities at home, the latter falling below actual capabilities as indicated by the hospital scores. A clinical validation of the index showed a significant association between the hospital ADL scores and the extent of cerebral lesions determined by the number of neurological deficits. This modified ADL index is sufficiently repeatable and valid for the assessment of patients with moderate disability as a result of stroke and other chronic diseases; in most circumstances, it can probably be simplified to include only five or six items.