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Nalla S, Huang K, Spangenberg J, Chen L, Jayabalan P. The demographic and disability characteristics of individuals who regularly attend an urban adaptive fitness center: An observational study. PM R 2022; 14:1454-1460. [PMID: 34617406 PMCID: PMC8983785 DOI: 10.1002/pmrj.12720] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 09/06/2021] [Accepted: 09/24/2021] [Indexed: 01/01/2023]
Abstract
INTRODUCTION While it is well known that regular physical activity provides significant physical and psychosocial health benefits, people with disabilities have disproportionately lower rates of exercise compared to the able-bodied population. Reduced levels of physical activity can put this population at an increased risk of chronic health conditions, highlighting the importance of ensuring that our communities have accessible adaptive fitness opportunities. OBJECTIVES To evaluate the demographic and disability characteristics in individuals who regularly attend a specialized urban adaptive fitness center, to provide foundational understanding about the population that uses such resources. DESIGN Cross-sectional study SETTING: Specialized urban adaptive fitness center PARTICIPANTS: Sixty-three (n = 63) participants who regularly attend an urban Adaptive Sports and Fitness Center INTERVENTION: Not applicable MAIN OUTCOME MEASURE: World Health Organization (WHO) Disability Assessment Schedule (WHODAS) 2.0, evaluating disability in six domains: cognition, mobility, self-care, getting along, life activities, and participation. Results were converted into scores ranging from 0 (no disability) to 100 (total disability) and compared to WHO published norms for the general population and a demographics intake form. RESULTS Participants with mean age of 52.9 ±14.3 years were grouped into three diagnostic categories: spinal cord injury (30.2%), traumatic brain injury/stroke (36.5%), and other neurologic disease/chronic medical disease (33.3%). A total of 45.9% live alone, 96.8% exercise at least twice/week, and 43.5% participate in adaptive sports. Participants travel 8.0 miles on average for attendance. WHODAS disability summary score was 26.48 (86th percentile). CONCLUSIONS Although adaptive fitness center participants had a higher level of disability than 80% to 90% of the general population, regular participation was realistic and feasible. Further understanding of the barriers in those who do not engage in such facilities is needed.
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Affiliation(s)
- Sindhoori Nalla
- Shirley Ryan AbilityLab, Chicago, Illinois, USA.,Department of Physical Medicine and Rehabilitation, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kevin Huang
- Shirley Ryan AbilityLab, Chicago, Illinois, USA.,Department of Physical Medicine and Rehabilitation, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Liqi Chen
- Biostatistics Collaboration Center, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
| | - Prakash Jayabalan
- Shirley Ryan AbilityLab, Chicago, Illinois, USA.,Department of Physical Medicine and Rehabilitation, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
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2
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Mayer JF, Sandberg CW, Mozeiko J, Madden EB, Murray LL. Cognitive and Linguistic Benefits of Aerobic Exercise: A State-of-the-Art Systematic Review of the Stroke Literature. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:785312. [PMID: 36188840 PMCID: PMC9397720 DOI: 10.3389/fresc.2021.785312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/06/2021] [Indexed: 12/03/2022]
Abstract
This systematic review aimed to determine how aerobic exercise affects cognition after stroke, with particular focus on aphasia and language improvement. Methodological quality was assessed with the PEDro+ scale with half of the 27 included studies rated as high quality. Data extraction focused on cognitive effects of aerobic exercise post-stroke, intervention characteristics, outcome measures, and participant characteristics. Whereas attention, memory, and executive functioning measures were common across the included studies, no study included a language-specific, performance-based measure. Seventeen studies reported positive cognitive effects, most frequently in the domains of attention, memory and executive functioning. Variability in outcome measures, intervention characteristics, and participant characteristics made it difficult to identify similarities among studies reporting positive cognitive effects of exercise or among those studies reporting null outcomes. Only three studies provided specific information about the number of individuals with aphasia included or excluded, who comprise approximately one-third of the stroke population. The review identified patent gaps in our understanding of how aerobic exercise may affect not only the cognitive domain of language post-stroke but also the broader cognitive functioning of individuals with post-stroke aphasia. Methodological limitations of the reviewed studies also warrant further examination of the direct impact of aerobic exercise on cognition post-stroke with careful attention to the selection and reporting of population, intervention, and outcomes.
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Affiliation(s)
- Jamie F. Mayer
- School of Allied Health and Communicative Disorders, Northern Illinois University, DeKalb, IL, United States
- *Correspondence: Jamie F. Mayer
| | - Chaleece W. Sandberg
- Department of Communication Sciences and Disorders, Penn State University, University Park, PA, United States
| | - Jennifer Mozeiko
- Department of Speech, Language and Hearing Science, University of Connecticut, Mansfield, CT, United States
| | - Elizabeth B. Madden
- School of Communication Science and Disorders, Florida State University, Tallahassee, FL, United States
| | - Laura L. Murray
- School of Communication Sciences and Disorders, Western University, London, ON, Canada
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Kanai M, Izawa KP, Kubo H, Nozoe M, Mase K, Shimada S. Association of Health Utility Score with Physical Activity Outcomes in Stroke Survivors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:ijerph18010251. [PMID: 33396274 PMCID: PMC7796267 DOI: 10.3390/ijerph18010251] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/27/2020] [Accepted: 12/28/2020] [Indexed: 12/22/2022]
Abstract
Health-related quality of life (HRQoL) after stroke tends to vary across studies or across stages of stroke. It is useful to use the health utility score to compare HRQoL across studies. Physical activity after stroke also tends to vary similarly. The purpose of the present study was to determine associations between the health utility score and physical activity outcomes in stroke survivors. This cross-sectional study recruited stroke survivors who could ambulate outside, free of assistance. We assessed the health utility score with the EuroQoL 5-Dimension 3-Level questionnaire. The physical activity outcomes were the number of steps taken and duration of moderate-to-vigorous physical activity (MVPA) as measured with an accelerometer. Multiple linear regression analyses were used to determine whether the physical activity outcomes were independently associated with the health utility score. Fifty patients (age: 68.0 years; 40 men, 10 women) were included. Multiple linear regression analysis showed the health utility score to be significantly associated with the number of steps taken (β = 0.304, p = 0.035) but not with MVPA. This is the first study to examine the association between the health utility score and objectively measured physical activity in stroke survivors. Promoting physical activity especially by increasing the number of steps taken might be a priority goal in improving a patient’s health utility score after stroke.
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Affiliation(s)
- Masashi Kanai
- Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women’s University, Kobe 658-0001, Japan; (M.K.); (M.N.); (K.M.)
- Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe 654-0142, Japan;
- Cardiovascular Stroke Renal Project (CRP), Kobe 654-0142, Japan
| | - Kazuhiro P. Izawa
- Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe 654-0142, Japan;
- Cardiovascular Stroke Renal Project (CRP), Kobe 654-0142, Japan
- Correspondence: ; Tel.: +81-78-796-4566
| | - Hiroki Kubo
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami 664-0028, Japan;
| | - Masafumi Nozoe
- Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women’s University, Kobe 658-0001, Japan; (M.K.); (M.N.); (K.M.)
| | - Kyoshi Mase
- Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women’s University, Kobe 658-0001, Japan; (M.K.); (M.N.); (K.M.)
| | - Shinichi Shimada
- Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe 654-0142, Japan;
- Cardiovascular Stroke Renal Project (CRP), Kobe 654-0142, Japan
- Department of Neurosurgery, Itami Kousei Neurosurgical Hospital, Itami 664-0028, Japan
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Borland RL, Hu N, Tonge B, Einfeld S, Gray KM. Participation in sport and physical activity in adults with intellectual disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2020; 64:908-922. [PMID: 33006215 DOI: 10.1111/jir.12782] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 08/10/2020] [Accepted: 09/02/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND People with intellectual disability face a number of barriers to participation in physical activity. This paper aimed to determine rates of sport and physical activity participation in an Australian sample of adults with intellectual disability, compared with rates of participation in the general Australian population. A secondary aim was to investigate factors that may contribute to participation of adults with intellectual disability. METHOD Participants were part of the Australian Child to Adult Development (ACAD) study, consisting of a community sample with intellectual disability (n = 305), groups of adults with autism (n = 94), Down syndrome (n = 64), fragile X syndrome (n = 52), Williams syndrome (n = 45), and Prader-Willi syndrome (n = 30). Participation in sport/physical activity was reported over the past 3 months. Rates of participation were reported for adults with intellectual disability and compared with rates in a general Australian population sample. The relationship between participation in physical activity and age, degree of intellectual disability, physical mobility, living situation, socio-economic disadvantage, and behaviour and emotional problems were also conducted. RESULTS Participants in the ACAD community sample with intellectual disability participated in sport/physical activity at lower rates than the general Australian population (42% compared with 71%). Having no physical mobility impairment was significantly associated with higher rates of participation. Those with Down syndrome participated in sport/physical activity at higher rates than the community sample with intellectual disability, while no difference in sport/physical activity participation was observed in the groups with autism or other syndromes. CONCLUSION Australian adults with intellectual disability participate in sport and physical activity at lower rates than the general population. Having a physical mobility impairment was associated with lower rates of participation. However, people living in supported accommodation were more likely to participate than those in other living situations. Having Down syndrome was associated with a higher participation rate than the community sample.
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Affiliation(s)
- R L Borland
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - N Hu
- Population Child Health Research Group, School of Women's and Children's Health, University of New South Wales, Australia
| | - B Tonge
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
- Centre for Educational Development, Appraisal and Research, University of Warwick, Coventry, UK
| | - S Einfeld
- Centre for Disability Research and Policy, Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - K M Gray
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
- Centre for Educational Development, Appraisal and Research, University of Warwick, Coventry, UK
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Recovery of mobility function and life-space mobility after ischemic stroke: the MOBITEC-Stroke study protocol. BMC Neurol 2020; 20:348. [PMID: 32938425 PMCID: PMC7493846 DOI: 10.1186/s12883-020-01920-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 09/07/2020] [Indexed: 11/10/2022] Open
Abstract
Background Stroke is a major cause of disability and stroke incidence increases with age. Stroke frequently results in permanent limitations of mobility, and, consequently, the need for the help of others in activities of daily living. In order to optimize rehabilitative efforts and their functional outcomes, detailed knowledge of the functional recovery process, regarding mobility, is needed. Objectives of the MOBITEC-Stroke study are: 1.) To characterize mobility, including lower extremity physical function (LEPF) and life space (the geospatial extent of all of a person’s movements), and changes in mobility within the first year after stroke. 2.) To identify and characterize subgroups with different mobility trajectories. 3.) To evaluate whether changes in LEPF are associated with changes in life-space. 4.) To evaluate participants’ reasons for going outdoors, transportation use, and assistance needed for outdoor movement. Methods Patients with incident first stroke who live in their own homes (target N = 59, based on sample size calculation) will be included in this cohort study. At 3, 6, 9, and 12 months after stroke a battery of mobility tests will be performed at the study centre, including laboratory-based tests of balance and strength, and quantitative gait analysis. Life-space assessment (including 1-week GPS measurements) will be performed in participants’ real life. Semantic information on visited locations (reasons for going outdoors, transportation use, assistance needed) will be collected by using interactive digital maps. Linear mixed effects models will be used to model the trajectories of mobility measures for the total sample and for predefined subgroups. As an exploratory analysis, growth mixture models (GMMs) will be used to identify relevant subgroups with different trajectories. Linear mixed effect models will be used to test whether changes in LEPF parameters are associated with changes in life-space. Participants’ motivation for going outdoors, transportation use, and assistance needed for outdoor mobility will be analysed descriptively. Discussion A comprehensive and detailed knowledge of recovery patterns will enable the planning of targeted and adaptively tailored rehabilitation measures. Information about patients’ reasons for outdoor mobility will provide the opportunity to define individualized and patient-oriented rehabilitation goals. Trial registration ISRCTN85999967 (on 13 August 2020; retrospectively).
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Oga K, Yozu A, Kume Y, Seki H, Tsuchiya N, Nakai K, Matsushita A, Mutsuzaki H, Kohno Y. Robotic rehabilitation of the paralyzed upper limb for a stroke patient using the single-joint hybrid assistive limb: a case study assessed by accelerometer on the wrist. J Phys Ther Sci 2020; 32:192-196. [PMID: 32158083 PMCID: PMC7032986 DOI: 10.1589/jpts.32.192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 11/04/2019] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Recent studies have reported the effectiveness of robotic rehabilitation of
paralyzed upper limbs in stroke patients. For example, the Single-Joint Hybrid Assistive
Limb has been shown to improve upper limb impairments. However, limited data are available
on the effectiveness of robotic rehabilitation of the upper limb with regards to daily
living. In this case study, an accelerometer was adopted to examine whether rehabilitation
using the Single-Joint Hybrid Assistive Limb improved upper limb activity during daily
living in a stroke patient. [Participant and Methods] The participant was a 69-year-old
male diagnosed with stroke and left hemiparesis. The Single-Joint Hybrid Assistive Limb
was applied to the participant’s elbow on the paralyzed side. The participant wore an
accelerometer on each wrist to measure the activities of the upper limbs. Clinical tests
of the paralyzed upper limb were also performed. [Results] The activity of the paralytic
limb was significantly higher after Single-Joint Hybrid Assistive Limb intervention than
before the intervention. On the other hand, none of the results of the clinical tests
changed beyond a clinically important difference. [Conclusion] The Single-Joint Hybrid
Assistive Limb could be useful for promoting active use of a paralyzed upper limb in daily
living. In addition, an accelerometer could be especially useful for evaluating the
effects of robotic rehabilitation.
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Affiliation(s)
- Kenya Oga
- Department of Occupational Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Japan
| | - Arito Yozu
- Center for Medical Sciences, Ibaraki Prefectural University of Health Sciences: 4669-2 Ami, Ami-machi, Inashiki, Ibaraki 300-0394, Japan
| | - Yu Kume
- Department of Occupational Therapy, Doctorial Course in Health Sciences, Graduate School of Medicine, Akita University, Japan
| | - Hiroyuki Seki
- Department of Occupational Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Japan
| | - Nobuhito Tsuchiya
- Department of Occupational Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Japan
| | - Kei Nakai
- Faculty of Medicine, University of Tsukuba, Japan
| | - Akira Matsushita
- Neurorehabilitation, Ibaraki Prefectural University of Health Sciences Hospital, Japan
| | - Hirotaka Mutsuzaki
- Center for Medical Sciences, Ibaraki Prefectural University of Health Sciences: 4669-2 Ami, Ami-machi, Inashiki, Ibaraki 300-0394, Japan
| | - Yutaka Kohno
- Center for Medical Sciences, Ibaraki Prefectural University of Health Sciences: 4669-2 Ami, Ami-machi, Inashiki, Ibaraki 300-0394, Japan
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Gregor S, Vaughan-Graham J, Wallace A, Walsh H, Patterson KK. Structuring community-based adapted dance programs for persons post-stroke: a qualitative study. Disabil Rehabil 2020; 43:2621-2631. [PMID: 31905043 DOI: 10.1080/09638288.2019.1708978] [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] [Indexed: 10/25/2022]
Abstract
PURPOSE Dance improves physical, psychosocial, and cognitive function, while increasing community participation among community-dwelling individuals post-stroke. Yet little is known about how to structure community-based dance classes to optimize benefits and participation. This study aims to gain stakeholders' perspectives about how to optimally structure community-based dance classes for individuals with chronic stroke. METHODS A qualitative descriptive approach utilizing focus group methods was implemented. Two focus groups were undertaken with each of three stakeholder groups: persons post-stroke (n = 9), rehabilitation therapists (n = 6), and dance instructors (n = 8). Focus groups were audio-recorded and transcribed verbatim, providing the raw data. Analysis of the focus group transcripts were completed using the DEPICT model of collaborative qualitative analysis. RESULTS This study identified three main themes/topics requiring consideration when structuring community-based dance programs: the environment, flow of the class, and qualities of the dance instructor. The study findings highlight that the pedagogical skills and teaching philosophy of the dance instructor are integral for a successful dance program, as the dance instructor directly mediates both the environment and flow of classes. CONCLUSION Recommendations generated from our study can inform the development of community-based dance programs that are practical, optimize health benefits, and meet the needs and interests of people post-stroke.IMPLICATIONS FOR REHABILITATIONDance is an effective way to improve physical, psychosocial, and cognitive function for persons post-stroke while also promoting meaningful social relationships within the community.A dance instructor who is a skilled communicator and is willing to adapt to the needs of the class, is the most important factor for a successful dance class.Creating a safe and inviting environment for a dance program, includes both the physical and emotional aspects of environment facilitating individuals to create connections with others and feel more confident in themselves.The structure of a dance class, based on the abilities, interests, and goals of dancers, should include elements of predictability and variability to keep dancers progressing and motivated, and be two times a week for 3 months lasting 1-2 h.
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Affiliation(s)
- Sarah Gregor
- KITE Research Institute, University Health Network, Toronto, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Julie Vaughan-Graham
- KITE Research Institute, University Health Network, Toronto, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Aaron Wallace
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Hilary Walsh
- Department of Occupational Sciences & Occupational, Therapy - University of Toronto, Toronto, Canada
| | - Kara K Patterson
- KITE Research Institute, University Health Network, Toronto, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Canada
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Palumbo P, Becker C, Bandinelli S, Chiari L. Simulating the effects of a clinical guidelines screening algorithm for fall risk in community dwelling older adults. Aging Clin Exp Res 2019; 31:1069-1076. [PMID: 30341644 PMCID: PMC6661027 DOI: 10.1007/s40520-018-1051-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 09/27/2018] [Indexed: 01/05/2023]
Abstract
Background The current guidelines for fall prevention in community-dwelling older adults issued by the American Geriatrics Society and British Geriatrics Society (AGS/BGS) indicate an algorithm for identifying who is at increased risk of falling. The predictive accuracy of this algorithm has never been assessed, nor have the consequences that its introduction in clinical practice would bring about. Aims To evaluate this risk screening algorithm, estimating its predictive accuracy and its potential impact. Methods The analyses are based on 438 community-dwelling older adults, participating in the InCHIANTI study. We analysed different tests for gait and balance assessment. We compared the AGS/BGS algorithm with alternative strategies for fall prevention not based on fall risk evaluation. Results The AGS/BGS screening algorithm (using TUG, cut-off 13.5 s) has a sensitivity for single falls of 35.8% (95% confidence interval 23.2%–52.7%) and a specificity of 84.0% (79.3%–88.4%). It marks 18.0% (13.7%–22.4%) of the older population as at high risk. A policy of targeting people with preventive intervention regardless of their individual risk could be as effective as the policy based on risk screening but at the price of intervening on 17.3% (4.1%–34.0%) more people of the older population. Discussion This study is the first that validates and estimates the impact of the screening algorithm of these guidelines. Main limitations are related to some modelling assumptions. Conclusions The AGS/BGS screening algorithm has low sensitivity. Nevertheless, its adoption would bring benefits with respect to policies of preventive interventions that act regardless of individual risk assessment. Electronic supplementary material The online version of this article (10.1007/s40520-018-1051-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Pierpaolo Palumbo
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Viale del Risorgimento, 2, 40136, Bologna, Italy.
| | - Clemens Becker
- Department of Clinical Gerontology, Robert Bosch Hospital, Stuttgart, Germany
| | | | - Lorenzo Chiari
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Viale del Risorgimento, 2, 40136, Bologna, Italy
- Health Sciences and Technologies Interdepartmental Center for Industrial Research, University of Bologna, Bologna, Italy
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Stuart M, Dromerick AW, Macko R, Benvenuti F, Beamer B, Sorkin J, Chard S, Weinrich M. Adaptive Physical Activity for Stroke: An Early-Stage Randomized Controlled Trial in the United States. Neurorehabil Neural Repair 2019; 33:668-680. [PMID: 31296113 DOI: 10.1177/1545968319862562] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background. As stroke survival improves, there is an increasing need for effective, low-cost programs to reduce deconditioning and improve mobility. Objective. To conduct a phase II trial examining whether the community-based Italian Adaptive Physical Activity exercise program for stroke survivors (APA-Stroke) is safe, effective, and feasible in the United States. Methods. In this single-blind, randomized controlled trial, 76 stroke survivors with mild to moderate hemiparesis >6 months were randomized to either APA-Stroke (N = 43) or Sittercise (N = 33). APA-Stroke is a progressive group exercise regimen tailored to hemiparesis that includes walking, strength, and balance training. Sittercise, a seated, nonprogressive aerobic upper body general exercise program, served as the control. Both interventions were 1 hour, 3 times weekly, in 5 community locations, supervised by exercise instructors. Results. A total of 76 participants aged 63.9 ± 1.2 years, mean months poststroke 61.8 ± 9.3, were included. There were no serious adverse events; completion rates were 58% for APA-Stroke, 70% for Sittercise. APA-Stroke participants improved significantly in walking speed. Sample size was inadequate to demonstrate significant between-group differences. Financial and logistical feasibility of the program has been demonstrated. Ongoing APA classes have been offered to >200 participants in county Senior Centers since study completion. Conclusion. APA-Stroke shows great promise as a low-cost, feasible intervention. It significantly increased walking speed. Safety and feasibility in the US context are demonstrated. A pivotal clinical trial is required to determine whether APA-Stroke should be considered standard of care.
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Affiliation(s)
- Mary Stuart
- 1 University of Maryland Baltimore County, Baltimore, MD, USA.,2 VA Health System, Baltimore, MD, USA.,3 University of Maryland, Baltimore, MD, USA
| | - Alexander W Dromerick
- 4 Georgetown University, Washington, DC, USA.,5 VA Health System, Washington, DC, USA.,6 Medstar National Rehabilitation Hospital, Washington, DC, USA
| | - Richard Macko
- 2 VA Health System, Baltimore, MD, USA.,3 University of Maryland, Baltimore, MD, USA
| | | | - Brock Beamer
- 2 VA Health System, Baltimore, MD, USA.,3 University of Maryland, Baltimore, MD, USA
| | | | - Sarah Chard
- 1 University of Maryland Baltimore County, Baltimore, MD, USA
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Belfiore P, Miele A, Gallè F, Liguori G. Adapted physical activity and stroke: a systematic review. J Sports Med Phys Fitness 2018; 58:1867-1875. [DOI: 10.23736/s0022-4707.17.07749-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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11
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Park D, Lee JH, Kang TW, Cynn HS. Effects of a 4-Week Self-Ankle Mobilization with Movement Intervention on Ankle Passive Range of Motion, Balance, Gait, and Activities of Daily Living in Patients with Chronic Stroke: A Randomized Controlled Study. J Stroke Cerebrovasc Dis 2018; 27:3451-3459. [PMID: 30193809 DOI: 10.1016/j.jstrokecerebrovasdis.2018.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 07/14/2018] [Accepted: 08/05/2018] [Indexed: 12/26/2022] Open
Abstract
GOAL To compare the effects of a 4-week self-ankle mobilization with movement training program with those of self-ankle mobilization with movement with a 10° inclined board in patients with chronic stroke. MATERIALS AND METHODS A randomized controlled assessor-blind trial was conducted. The patients were randomized into 2 arms. Subjects were 28 chronic stroke patients with hemiplegia. Both arms attended standard rehabilitation therapy for 30 minutes per session. In addition, self-ankle mobilization with movement and self-ankle mobilization with movement with a 10° inclined board trainings were performed 3 times per week for 4 weeks. Ankle dorsiflexion passive range of motion, static balance ability, Berg balance scale, gait parameters (walking speed, cadence, and step length), and activities of daily living were used to assess changes in motor function after training. FINDINGS After 4 weeks of training, all dependent variables were significantly improved in both arms as compared with their baseline values. Furthermore, relative to the self-ankle mobilization with movement arm, the self-ankle mobilization with movement with a 10° inclined board arm demonstrated significantly improved ankle dorsiflexion passive range of motion, static balance ability, gait speed, cadence, and affected-side step length. CONCLUSIONS Our results support the hypothesis that self-ankle mobilization with movement with a 10° inclined board combined with standard rehabilitation was superior to self-ankle mobilization with movement combined with standard rehabilitation with respect to the improvement in motor function in the patients with chronic stroke.
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Affiliation(s)
- Donghwan Park
- Department of Physical Therapy, Graduate School, Yonsei University, Wonju, Gangwon-do, Republic of Korea
| | - Ji-Hyun Lee
- Department of Physical Therapy, Graduate School, Yonsei University, Wonju, Gangwon-do, Republic of Korea
| | - Tae-Woo Kang
- Department of Physical Therapy, Graduate School, Yonsei University, Wonju, Gangwon-do, Republic of Korea
| | - Heon-Seock Cynn
- Department of Physical Therapy, Graduate School, Yonsei University, Wonju, Gangwon-do, Republic of Korea.
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12
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Llorens R, Noé E, Alcañiz M, Deutsch JE. Time since injury limits but does not prevent improvement and maintenance of gains in balance in chronic stroke. Brain Inj 2017; 32:303-309. [PMID: 29278927 DOI: 10.1080/02699052.2017.1418905] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To determine the influence of time since injury on the efficacy and maintenance of gains of rehabilitation of balance after stroke. METHOD Forty-seven participants were assigned to a least (6-12 months), a moderate (12-24 months), or a most chronic (>24 months) group. Participants trained for 20 one-hour sessions, administered three to five times a week, combining conventional physical therapy and visual feedback-based exercises that trained the ankle and hip strategies. Participants were assessed before, after the intervention, and one month later with a posturography test (Sway Speed and Limits of Stability) and clinical scales. RESULTS In contrast to other subjects, the most chronic participants failed to improve their sway and to maintain the benefits detected in the Limits of Stability after the intervention. Although all the participants improved in those clinical tests that better matched the trained skills, time since injury limited the improvement, and over all, the maintenance of gains. CONCLUSION Time since injury limits but does not prevent improvement in chronic stages post-stroke, and this effect appears to be more pronounced with maintaining gains. These findings support that training duration and intensity as well as type of therapy may need to be adjusted based on time post-stroke.
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Affiliation(s)
- Roberto Llorens
- a Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería , Universitat Politècnica de València , Valencia , Spain.,b Servicio de Neurorrehabilitación y Daño Cerebral de los Hospitales NISA , Fundación Hospitales NISA , Valencia , Spain
| | - Enrique Noé
- b Servicio de Neurorrehabilitación y Daño Cerebral de los Hospitales NISA , Fundación Hospitales NISA , Valencia , Spain
| | - Mariano Alcañiz
- a Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería , Universitat Politècnica de València , Valencia , Spain
| | - Judith E Deutsch
- c Rivers Lab, Department of Movement and Rehabilitation Sciences , Rutgers University-School of Professions , Newark , USA
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Kim M, Lee K, Cho J, Lee W. Diaphragm Thickness and Inspiratory Muscle Functions in Chronic Stroke Patients. Med Sci Monit 2017; 23:1247-1253. [PMID: 28284044 PMCID: PMC5358861 DOI: 10.12659/msm.900529] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background The aims of this study are to investigate the difference between the diaphragm thickness at end expiration and the thickness at total lung capacity (TLC), and to examine differences in inspiratory muscle function between stroke patients and healthy individuals. Material/Methods Forty-five stroke patients and 49 healthy volunteers were included in this study. Diaphragm thickness was measured at end expiration and at TLC by ultrasonography. The maximal inspiratory pressure (MIP), peak inspiratory flow (PIF), vital capacity (VC), and inspiratory muscle endurance (IME) were assess to evaluate inspiratory muscle function. Results In stroke patients, the diaphragm was significantly thinner on the affected side than the less affected side at end expiration and at TLC. The change between the thickness at end expiration and at TLC were also significant on both sides. Between groups, the difference in diaphragm thickness at end expiration was not significant, but at TLC, the diaphragms were significantly thicker in healthy individuals than on either side in stroke patients, and the change in diaphragm thickness was significantly greater for healthy individuals. Inspiratory muscle functions were also significantly greater in healthy individuals. MIP, PIF, and VC were positively correlated with the change in thickness in healthy individuals, and MIP was positively correlated with the change in thickness and IME in stroke patients. Conclusions Stroke patients showed decreases in the thickening ability of the diaphragm at TLC and in inspiratory muscle function. The change between the diaphragm thickness at end expiration and at TLC was positively correlated with MIP, PIF, and VC.
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Affiliation(s)
- Minkyu Kim
- Department of Physical Therapy, The Graduate School, Sahmyook University, Seoul, South Korea
| | - Kyeongbong Lee
- Department of Physical Therapy, The Graduate School, Sahmyook University, Seoul, South Korea
| | - Jieun Cho
- Department of Physical Therapy, The Graduate School, Sahmyook University, Seoul, South Korea
| | - Wanhee Lee
- Department of Physical Therapy, College of Health and Welfare, Sahmyook University, Seoul, South Korea
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Effect of Spinal Cord Stimulation on Gait in a Patient with Thalamic Pain. Case Rep Neurol Med 2016; 2016:8730984. [PMID: 27579198 PMCID: PMC4992542 DOI: 10.1155/2016/8730984] [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: 04/01/2016] [Revised: 06/17/2016] [Accepted: 07/04/2016] [Indexed: 11/29/2022] Open
Abstract
Thalamic pain is a central neuropathic pain disorder which occurs after stroke. Its severe chronic pain is often intractable to pharmacotherapies and affects the patients' activities of daily living (ADL) and quality of life (QOL). Recently, spinal cord stimulation (SCS) has been reported to be effective in relieving the pain of thalamic pain; however, the effect of SCS on gait performance in patients is unknown. Therefore, we evaluated the gait performance before and after SCS in a case with thalamic pain. A 73-year-old male with thalamic pain participated in this study. We evaluated the gait of the patient two times: before SCS insertion and after 6 days of SCS. At the second evaluation, we measured the gait in three conditions: stimulation off, comfortable stimulation, and strong stimulation. SCS succeeded in improving the pain from 7 to 2 on an 11-point numerical rating scale. Step frequency and the velocity of gait tended to increase between pre- and poststimulation periods. There were no apparent differences in gait among the three stimulation conditions (off, comfortable, and strong) at the poststimulation period. SCS may be effective on gait in patients with thalamic pain.
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Effect of Aerobic Exercise Interventions on Mobility among Stroke Patients: A Systematic Review. Am J Phys Med Rehabil 2016; 95:214-24. [PMID: 26544857 DOI: 10.1097/phm.0000000000000416] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this systematic review was to examine studies that examined the effectiveness of aerobic exercise interventions on mobility in long-term stroke survivors. DESIGN The authors searched electronic databases for randomized control trials between January 1995 and December 2014 investigating aerobic exercise interventions and mobility in stroke survivors after the subacute phase (>6 mos). Mobility was measured using objective functional fitness tests: 6-minute walk, 10-meter walk, and up-n-go. RESULTS Nine randomized control trials that compared aerobic exercise with a control group among stroke survivors (mean age, 56.95-68 yrs) were identified. Aerobic interventions lasted between 2 and 6 mos and primarily involved walking. Using the Comprehensive Meta-analysis software, it was found that two of the three mobility outcomes showed small to moderate effect sizes favoring the aerobic exercise group: 6-minute walk (g = 0.366, P < 0.001) and 10-meter walk (g = 0.411, P = 0.002), while the up-n-go test was not significant (g = -0.150, P = 0.330). CONCLUSION These findings demonstrate that stroke survivors may continue to benefit from aerobic exercise after the subacute phase. Future research needs to examine the precise dose and recommendation for aerobic exercise, test other exercise modalities, and use larger samples to thoroughly determine long-term exercise effects on mobility in this population.
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Decreased tidal volume may limit cardiopulmonary performance during exercise in subacute stroke. J Cardiopulm Rehabil Prev 2016; 35:334-41. [PMID: 26034936 DOI: 10.1097/hcr.0000000000000119] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE The aim of this retrospective study was to determine whether pulmonary function was reduced at submaximal and peak exercise in subacute stroke (SG) when compared with sedentary adults (CON). METHODS Ten individuals with subacute stroke and 10 sedentary, age- and gender-matched adults performed cardiopulmonary exercise testing (CPET), using a recumbent stepper. We used independent t tests to determine between-group differences at peak effort. We used repeated-measures analysis of variance with Test Minute (minutes 1-6) as the within-subject factor and Group (SG, CON) as the between-subject factor to assess cardiopulmonary submaximal performance. RESULTS The SG had significantly lower values (P < .05) for oxygen uptake, minute ventilation ((Equation is included in full-text article.)E), and tidal volume (VT) than CON at peak effort of the CPET. During CPET submaximal effort, we report a significant main effect for Test Minute and Group for VT and respiratory rate but no main effect of Group for (Equation is included in full-text article.)E. To maintain adequate (Equation is included in full-text article.)E during submaximal effort and decreased VT, higher respiratory rate was observed. CONCLUSIONS These results suggest that diminished VT in subacute stroke patients may limit performance during submaximal and peak effort of CPET. Rehabilitation professionals should consider methods for improving pulmonary function during stroke rehabilitation.
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Cleveland S, Driver S, Swank C, Macklin S. Classifying physical activity research following stroke using the behavioral epidemiologic framework. Top Stroke Rehabil 2015; 22:289-98. [PMID: 26258454 DOI: 10.1179/1074935714z.0000000043] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Stroke is a significant public health issue in the USA and a need emerges to better understand how to reduce an individual's co-morbidity risk. Physical activity is one approach to improving the health of individuals and comprehensive literature supports increased activity as a means to reduce risk of morbidity and mortality. One approach to examining whether research in a field is addressing a public health issue is through application of the behavioral epidemiological framework. OBJECTIVE To classify physical activity research for individuals following stroke into distinct phases so that efforts can be made to systematically address gaps and disseminate evidence-based practice. METHODS Specific key words were identified and then searched through EBSCO host, PubMed, and Google Scholar. Physical activity and stroke literature from 2000-2014 was categorized into one of five discrete phases. Research in Phase 1 identified associations between activity and health; Phase 2 established valid measures of activity; Phase 3 examined determinants of behavior; Phase 4 evaluated activity interventions; and Phase 5 disseminated evidence-based practice. RESULTS A comprehensive review of literature identified 202 articles with 70% categorized in Phase 1 (n = 141), 11% in Phase 2 (n = 23), 10% in Phase 3 (n = 20), 8% in Phase 4 (n = 15), and 1% in Phase 5 (n = 3). CONCLUSION Findings suggest that physical activity research for individuals following stroke is in the early stages of development with less than 10% of research evaluating or disseminating interventions.
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Protocol variations and six-minute walk test performance in stroke survivors: a systematic review with meta-analysis. Stroke Res Treat 2015; 2015:484813. [PMID: 25685596 PMCID: PMC4320847 DOI: 10.1155/2015/484813] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 12/18/2014] [Accepted: 12/18/2014] [Indexed: 11/17/2022] Open
Abstract
Objective. To investigate the use of the six-minute walk test (6MWT) for stroke survivors, including adherence to 6MWT protocol guidelines and distances achieved. Methods. A systematic search was conducted from inception to March 2014. Included studies reported a baseline (intervention studies) or first instance (observational studies) measure for the 6MWT performed by stroke survivors regardless of time after stroke. Results. Of 127 studies (participants n = 6,012) that met the inclusion criteria, 64 were also suitable for meta-analysis. Only 25 studies made reference to the American Thoracic Society (ATS) standards for the 6MWT, and 28 reported using the protocol standard 30 m walkway. Thirty-nine studies modified the protocol walkway, while 60 studies did not specify the walkway used. On average, stroke survivors walked 284 ± 107 m during the 6MWT, which is substantially less than healthy age-matched individuals. The meta-analysis identified that changes to the ATS protocol walkway are associated with reductions in walking distances achieved. Conclusion. The 6MWT is now widely used in stroke studies. The distances achieved by stroke patients indicate substantially compromised walking ability. Variations to the standard 30 m walkway for the 6MWT are common and caution should be used when comparing the values achieved from studies using different walkway lengths.
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Lee DK, Kim JS, Kim TH, Oh JS. Comparison of the electromyographic activity of the tibialis anterior and gastrocnemius in stroke patients and healthy subjects during squat exercise. J Phys Ther Sci 2015; 27:247-9. [PMID: 25642084 PMCID: PMC4305574 DOI: 10.1589/jpts.27.247] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 08/19/2014] [Indexed: 12/03/2022] Open
Abstract
[Purpose] The purpose of this study was to compare the EMG activity of the tibialis
anterior (TA) and gastrocnemius (GCM) during the downward, maintenance, and upward phases
of the squat exercise and during passive ankle dorsiflexion range of motion between stroke
patients and healthy subjects. [Subjects] Fifteen hemiplegic (8 males, 7 females) and 15
healthy subjects (4 males, 11 females) volunteered for this study. [Methods] All subjects
performed a double-leg squat exercise with the knee joint flexed to 30°. Surface
electromyography (EMG) signals were recorded from the TA and GCM on the paretic or
nondominant side. Passive ankle dorsiflexion range of motion (DF PROM) was measured using
a goniometer in the knee-extended prone position. [Results] In the downward and
maintenance phases, TA activity was significantly higher in stroke patients compared with
healthy subjects. In the upward phase, GCM activity was significantly lower in stroke
patients compared with healthy subjects. Ankle DF PROM was significantly lower in stroke
patients compared with healthy subjects. [Conclusion] The observed EMG patterns should be
taken into consideration to inform and enhance therapy for stroke patients.
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Affiliation(s)
- Dong-Kyu Lee
- Department of Rehabilitation Science, Graduate School, Inje University, Republic of Korea
| | - Jun-Seok Kim
- Department of Physical Therapy, Graduate School, Inje University, Republic of Korea
| | - Tae-Hoon Kim
- Department of Occupational Therapy, Dongseo University, Republic of Korea
| | - Jae-Seop Oh
- Department of Physical Therapy, College of Biomedical Science and Engineering, Inje University, Republic of Korea
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Chinchai P, Bunyamark T, Sirisatayawong P. Effects of caregiver education in stroke rehabilitation on the quality of life of stroke survivors. WORLD FEDERATION OF OCCUPATIONAL THERAPISTS BULLETIN 2014. [DOI: 10.1179/otb.2010.61.1.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Immink MA, Hillier S, Petkov J. Randomized controlled trial of yoga for chronic poststroke hemiparesis: motor function, mental health, and quality of life outcomes. Top Stroke Rehabil 2014; 21:256-71. [PMID: 24985393 DOI: 10.1310/tsr2103-256] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE To assess the efficacy of yoga for motor function, mental health, and quality of life outcomes in persons with chronic poststroke hemiparesis. METHOD Twenty-two individuals participated in a randomized controlled trial involving assessment of task-orientated function, balance, mobility, depression, anxiety, and quality of life domains before and after either a 10-week yoga intervention (n = 11) or no treatment (n = 11). RESULTS The yoga intervention did not result in any significant improvements in objective motor function measures, however there was a significant improvement in quality of life associated with perceived motor function (P = .0001) and improvements in perceived recovery approached significance (P = .072). Memory-related quality of life scores significantly improved after yoga intervention (P = .022), and those participating in the intervention exhibited clinically relevant decreases in state and trait anxiety. CONCLUSIONS Preliminary results offer promise for yoga as an intervention to address mental health and quality of life in persons with stroke-related activity limitations. There is a need to more rigorously evaluate these yoga benefits with a larger randomized controlled trial, which, based on this preliminary trial, is feasible.
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Affiliation(s)
- Maarten A Immink
- School of Health Sciences, University of South Australia, Adelaide, South Australia
| | - Susan Hillier
- International Centre for Allied Health Evidence, School of Health Sciences, University of South Australia, Adelaide, South Australia
| | - John Petkov
- School of Health Sciences, University of South Australia, Adelaide, South Australia
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Pollock A, Baer G, Campbell P, Choo PL, Forster A, Morris J, Pomeroy VM, Langhorne P. Physical rehabilitation approaches for the recovery of function and mobility following stroke. Cochrane Database Syst Rev 2014; 2014:CD001920. [PMID: 24756870 PMCID: PMC6465059 DOI: 10.1002/14651858.cd001920.pub3] [Citation(s) in RCA: 206] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Various approaches to physical rehabilitation may be used after stroke, and considerable controversy and debate surround the effectiveness of relative approaches. Some physiotherapists base their treatments on a single approach; others use a mixture of components from several different approaches. OBJECTIVES To determine whether physical rehabilitation approaches are effective in recovery of function and mobility in people with stroke, and to assess if any one physical rehabilitation approach is more effective than any other approach.For the previous versions of this review, the objective was to explore the effect of 'physiotherapy treatment approaches' based on historical classifications of orthopaedic, neurophysiological or motor learning principles, or on a mixture of these treatment principles. For this update of the review, the objective was to explore the effects of approaches that incorporate individual treatment components, categorised as functional task training, musculoskeletal intervention (active), musculoskeletal intervention (passive), neurophysiological intervention, cardiopulmonary intervention, assistive device or modality.In addition, we sought to explore the impact of time after stroke, geographical location of the study, dose of the intervention, provider of the intervention and treatment components included within an intervention. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (last searched December 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 12, 2012), MEDLINE (1966 to December 2012), EMBASE (1980 to December 2012), AMED (1985 to December 2012) and CINAHL (1982 to December 2012). We searched reference lists and contacted experts and researchers who have an interest in stroke rehabilitation. SELECTION CRITERIA Randomised controlled trials (RCTs) of physical rehabilitation approaches aimed at promoting the recovery of function or mobility in adult participants with a clinical diagnosis of stroke. Outcomes included measures of independence in activities of daily living (ADL), motor function, balance, gait velocity and length of stay. We included trials comparing physical rehabilitation approaches versus no treatment, usual care or attention control and those comparing different physical rehabilitation approaches. DATA COLLECTION AND ANALYSIS Two review authors independently categorised identified trials according to the selection criteria, documented their methodological quality and extracted the data. MAIN RESULTS We included a total of 96 studies (10,401 participants) in this review. More than half of the studies (50/96) were carried out in China. Generally the studies were heterogeneous, and many were poorly reported.Physical rehabilitation was found to have a beneficial effect, as compared with no treatment, on functional recovery after stroke (27 studies, 3423 participants; standardised mean difference (SMD) 0.78, 95% confidence interval (CI) 0.58 to 0.97, for Independence in ADL scales), and this effect was noted to persist beyond the length of the intervention period (nine studies, 540 participants; SMD 0.58, 95% CI 0.11 to 1.04). Subgroup analysis revealed a significant difference based on dose of intervention (P value < 0.0001, for independence in ADL), indicating that a dose of 30 to 60 minutes per day delivered five to seven days per week is effective. This evidence principally arises from studies carried out in China. Subgroup analyses also suggest significant benefit associated with a shorter time since stroke (P value 0.003, for independence in ADL).We found physical rehabilitation to be more effective than usual care or attention control in improving motor function (12 studies, 887 participants; SMD 0.37, 95% CI 0.20 to 0.55), balance (five studies, 246 participants; SMD 0.31, 95% CI 0.05 to 0.56) and gait velocity (14 studies, 1126 participants; SMD 0.46, 95% CI 0.32 to 0.60). Subgroup analysis demonstrated a significant difference based on dose of intervention (P value 0.02 for motor function), indicating that a dose of 30 to 60 minutes delivered five to seven days a week provides significant benefit. Subgroup analyses also suggest significant benefit associated with a shorter time since stroke (P value 0.05, for independence in ADL).No one physical rehabilitation approach was more (or less) effective than any other approach in improving independence in ADL (eight studies, 491 participants; test for subgroup differences: P value 0.71) or motor function (nine studies, 546 participants; test for subgroup differences: P value 0.41). These findings are supported by subgroup analyses carried out for comparisons of intervention versus no treatment or usual care, which identified no significant effects of different treatment components or categories of interventions. AUTHORS' CONCLUSIONS Physical rehabilitation, comprising a selection of components from different approaches, is effective for recovery of function and mobility after stroke. Evidence related to dose of physical therapy is limited by substantial heterogeneity and does not support robust conclusions. No one approach to physical rehabilitation is any more (or less) effective in promoting recovery of function and mobility after stroke. Therefore, evidence indicates that physical rehabilitation should not be limited to compartmentalised, named approaches, but rather should comprise clearly defined, well-described, evidenced-based physical treatments, regardless of historical or philosophical origin.
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Affiliation(s)
- Alex Pollock
- Glasgow Caledonian UniversityNursing, Midwifery and Allied Health Professions Research UnitBuchanan HouseCowcaddens RoadGlasgowUKG4 0BA
| | - Gillian Baer
- Queen Margaret UniversityDepartment of PhysiotherapyQueen Margaret University DriveEdinburghUKEH21 6UU
| | - Pauline Campbell
- Glasgow Caledonian UniversityNursing, Midwifery and Allied Health Professions Research UnitBuchanan HouseCowcaddens RoadGlasgowUKG4 0BA
| | - Pei Ling Choo
- Glasgow Caledonian UniversitySchool of Health & Life SciencesGlasgowUK
| | - Anne Forster
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust/University of LeedsAcademic Unit of Elderly Care and RehabilitationTemple Bank House, Bradford Royal InfirmaryDuckworth LaneBradfordUKBD9 6RJ
| | - Jacqui Morris
- University of DundeeSchool of Nursing and Midwifery11 Airlie PlaceDundeeUKDD1 4HJ
| | - Valerie M Pomeroy
- University of East AngliaSchool of Rehabilitation SciencesNorwichUKNR4 7TJ
| | - Peter Langhorne
- University of GlasgowAcademic Section of Geriatric Medicine3rd Floor, Centre BlockRoyal InfirmaryGlasgowUKG4 0SF
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Pollock A, Baer G, Campbell P, Choo PL, Forster A, Morris J, Pomeroy VM, Langhorne P. Physical rehabilitation approaches for the recovery of function and mobility following stroke. Hippokratia 2014. [PMID: 24756870 DOI: 10.1002/14651858.cd001920.pub3#sthash.keppcclr.dpuf] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Various approaches to physical rehabilitation may be used after stroke, and considerable controversy and debate surround the effectiveness of relative approaches. Some physiotherapists base their treatments on a single approach; others use a mixture of components from several different approaches. OBJECTIVES To determine whether physical rehabilitation approaches are effective in recovery of function and mobility in people with stroke, and to assess if any one physical rehabilitation approach is more effective than any other approach.For the previous versions of this review, the objective was to explore the effect of 'physiotherapy treatment approaches' based on historical classifications of orthopaedic, neurophysiological or motor learning principles, or on a mixture of these treatment principles. For this update of the review, the objective was to explore the effects of approaches that incorporate individual treatment components, categorised as functional task training, musculoskeletal intervention (active), musculoskeletal intervention (passive), neurophysiological intervention, cardiopulmonary intervention, assistive device or modality.In addition, we sought to explore the impact of time after stroke, geographical location of the study, dose of the intervention, provider of the intervention and treatment components included within an intervention. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (last searched December 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 12, 2012), MEDLINE (1966 to December 2012), EMBASE (1980 to December 2012), AMED (1985 to December 2012) and CINAHL (1982 to December 2012). We searched reference lists and contacted experts and researchers who have an interest in stroke rehabilitation. SELECTION CRITERIA Randomised controlled trials (RCTs) of physical rehabilitation approaches aimed at promoting the recovery of function or mobility in adult participants with a clinical diagnosis of stroke. Outcomes included measures of independence in activities of daily living (ADL), motor function, balance, gait velocity and length of stay. We included trials comparing physical rehabilitation approaches versus no treatment, usual care or attention control and those comparing different physical rehabilitation approaches. DATA COLLECTION AND ANALYSIS Two review authors independently categorised identified trials according to the selection criteria, documented their methodological quality and extracted the data. MAIN RESULTS We included a total of 96 studies (10,401 participants) in this review. More than half of the studies (50/96) were carried out in China. Generally the studies were heterogeneous, and many were poorly reported.Physical rehabilitation was found to have a beneficial effect, as compared with no treatment, on functional recovery after stroke (27 studies, 3423 participants; standardised mean difference (SMD) 0.78, 95% confidence interval (CI) 0.58 to 0.97, for Independence in ADL scales), and this effect was noted to persist beyond the length of the intervention period (nine studies, 540 participants; SMD 0.58, 95% CI 0.11 to 1.04). Subgroup analysis revealed a significant difference based on dose of intervention (P value < 0.0001, for independence in ADL), indicating that a dose of 30 to 60 minutes per day delivered five to seven days per week is effective. This evidence principally arises from studies carried out in China. Subgroup analyses also suggest significant benefit associated with a shorter time since stroke (P value 0.003, for independence in ADL).We found physical rehabilitation to be more effective than usual care or attention control in improving motor function (12 studies, 887 participants; SMD 0.37, 95% CI 0.20 to 0.55), balance (five studies, 246 participants; SMD 0.31, 95% CI 0.05 to 0.56) and gait velocity (14 studies, 1126 participants; SMD 0.46, 95% CI 0.32 to 0.60). Subgroup analysis demonstrated a significant difference based on dose of intervention (P value 0.02 for motor function), indicating that a dose of 30 to 60 minutes delivered five to seven days a week provides significant benefit. Subgroup analyses also suggest significant benefit associated with a shorter time since stroke (P value 0.05, for independence in ADL).No one physical rehabilitation approach was more (or less) effective than any other approach in improving independence in ADL (eight studies, 491 participants; test for subgroup differences: P value 0.71) or motor function (nine studies, 546 participants; test for subgroup differences: P value 0.41). These findings are supported by subgroup analyses carried out for comparisons of intervention versus no treatment or usual care, which identified no significant effects of different treatment components or categories of interventions. AUTHORS' CONCLUSIONS Physical rehabilitation, comprising a selection of components from different approaches, is effective for recovery of function and mobility after stroke. Evidence related to dose of physical therapy is limited by substantial heterogeneity and does not support robust conclusions. No one approach to physical rehabilitation is any more (or less) effective in promoting recovery of function and mobility after stroke. Therefore, evidence indicates that physical rehabilitation should not be limited to compartmentalised, named approaches, but rather should comprise clearly defined, well-described, evidenced-based physical treatments, regardless of historical or philosophical origin.
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Affiliation(s)
- Alex Pollock
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Buchanan House, Cowcaddens Road, Glasgow, UK, G4 0BA
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Taricco M, Dallolio L, Calugi S, Rucci P, Fugazzaro S, Stuart M, Pillastrini P, Fantini MP, Taricco M, Bassi E, Bernucci C, Gaudenzi N, Kopliku B, Manigrasso V, Morara M, Dallolio L, Calugi S, Fantini MP, Pillastrini P, Rucci P, Fugazzaro S, Gandini M, Piccinelli B, Zanichelli FS, Tedeschi C, Testoni S. Impact of Adapted Physical Activity and Therapeutic Patient Education on Functioning and Quality of Life in Patients With Postacute Strokes. Neurorehabil Neural Repair 2014; 28:719-28. [DOI: 10.1177/1545968314523837] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective. The aim of this study was to assess whether the combination of Adapted Physical Activity (APA) and Therapeutic Patient Education (TPE) improves function and quality of life in survivors of strokes. Methods. This nonrandomized controlled study enrolled patients with mild to moderate hemiparesis referred to 2 physical medicine and rehabilitation units in Emilia-Romagna, Italy, 3 to 18 months after a single unilateral mild to moderate stroke. The experimental group (n = 126) received 16 APA sessions and 3 sessions of TPE, and the control group (n = 103) received usual care; 86.9% completed treatment. The main outcome measure was a 4-month change in gait endurance (that corresponds to 2 months after intervention in the experimental group), and secondary outcomes included the Short Physical Performance Battery, Berg Balance Scale, Barthel Index, Geriatric Depression Scale, 12-item Short-Form Health Survey, and Caregiver Strain Index. Changes in scores at 4 months were compared between groups using analysis of variance and controlling for group imbalance by means of the propensity score. Results. Gait endurance, physical performance, balance, and the physical component of the quality of life score increased significantly at 4 months in the APA group and remained stable in the control group. The propensity-adjusted between-group change was significant for these scores at P < .01. Conclusions. Our results confirm that it is feasible and potentially effective to implement APA programs for elderly patients with complex clinical conditions as early as 3 months after a stroke and suggest that, when combined with TPE, the effects of a postrehabilitation APA program are relatively enduring.
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Affiliation(s)
| | - Laura Dallolio
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum–University of Bologna, Bologna, Italy
| | - Simona Calugi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum–University of Bologna, Bologna, Italy
| | - Paola Rucci
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum–University of Bologna, Bologna, Italy
| | - Stefania Fugazzaro
- Istituto di Ricerca e Cura a Carattere Scientifico - Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Mary Stuart
- Health Administration and Policy Program, Baltimore County, Maryland, USA
| | - Paolo Pillastrini
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum–University of Bologna, Bologna, Italy
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum–University of Bologna, Bologna, Italy
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Singh DKA, Mohd Nordin NA, Aziz NAA, Lim BK, Soh LC. Effects of substituting a portion of standard physiotherapy time with virtual reality games among community-dwelling stroke survivors. BMC Neurol 2013; 13:199. [PMID: 24330250 PMCID: PMC4029492 DOI: 10.1186/1471-2377-13-199] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 12/04/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Evidence indicates that the continuation of therapy among community-dwelling stroke survivors improves physical function. Community rehabilitation programmes often face limitations in terms of resources. It is imperative to include new motivational interventions to encourage some level of non-clinician management. The aim of this study was to determine whether there were any changes in physical function and activities of daily living when substituting a portion of the standard physiotherapy time with virtual reality games among community-dwelling stroke survivors. METHODS In this controlled trial, the experimental group received 30 minutes of virtual reality balance games in addition to 90 minutes of standard physiotherapy. The control group continued with their two hours of routine standard physiotherapy. Both groups received 12 therapy sessions: two-hour sessions twice per week for six continuous weeks. Changes in physical function, activities of daily living and balance ability were assessed using the Timed Up and Go test, 30-second Sit to Stand test, Timed Ten-Metre Walk test, Six-Minute Walk test and the Barthel Index, and static balance was assessed using a probalance board. RESULTS Twenty-eight participants completed post-intervention assessments. The results showed a significant within-subject effect on the Timed Up and Go test: F (1, 26) = 5.83, p = 0.02; and the 30-second Sit to Stand test; F (1, 26) = 13.50, p = 0.001. The between-subject effect was not significant (p > 0.05) for any of the outcome measurements. CONCLUSION Substituting a portion of the standard physiotherapy time with virtual reality games was equally effective in maintaining physical function outcomes and activities of daily living among community-dwelling stroke survivors. TRIAL REGISTRATION Australia and New Zealand Clinical Trials Register, ACTRN12613000478718.
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Affiliation(s)
- Devinder Kaur Ajit Singh
- Physiotherapy Programme, School of Rehabilitation Sciences, Faculty of Health Sciences, Jalan Raja Muda Aziz, Universiti Kebangsaan Malaysia, 50300 Kuala Lumpur, Malaysia
| | - Nor Azlin Mohd Nordin
- Physiotherapy Programme, School of Rehabilitation Sciences, Faculty of Health Sciences, Jalan Raja Muda Aziz, Universiti Kebangsaan Malaysia, 50300 Kuala Lumpur, Malaysia
| | - Noor Azah Abd Aziz
- Department of Family Medicine, Medical Faculty, University Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia
| | - Beng Kooi Lim
- Physiotherapy Programme, School of Rehabilitation Sciences, Faculty of Health Sciences, Jalan Raja Muda Aziz, Universiti Kebangsaan Malaysia, 50300 Kuala Lumpur, Malaysia
| | - Li Ching Soh
- Physiotherapy Programme, School of Rehabilitation Sciences, Faculty of Health Sciences, Jalan Raja Muda Aziz, Universiti Kebangsaan Malaysia, 50300 Kuala Lumpur, Malaysia
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Mandy A, Walton C, Michaelis J. Comparison of activities of daily living (ADLs) in two different one arm drive wheelchairs: a study of individuals/participants with hemiplegia. Disabil Rehabil Assist Technol 2013; 10:108-12. [PMID: 24131370 DOI: 10.3109/17483107.2013.845612] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIMS This pilot study measured activities of daily living performance in individuals/participants with hemiplegia propelling both a standard dual handrim Action 3 wheelchair and a standard Action 3 wheelchair with a Neater Uni-Wheelchair kit attachment. The kit consists of a steerable front. RESEARCH QUESTIONS Does the use of the NUW affect the performance quality of activities of daily living in individuals/participants with hemiplegia. Is there a difference in the motor and process skills during activities of daily living performance, and in the time taken to complete the activities. METHODS Four individuals/participants with hemiplegia were used in a cross over, repeated measures trial. Assessment of Motor and Process Skills of users undertaking making a bed and laying a table "Swedish style", tasks were measured and time taken to complete each task were recorded. RESULTS Bed making completion time was quicker in the Neater Uni-wheelchair (p < 0.03). Motor skills were significantly higher than the process ability skills (p < 0.05). CONCLUSION Activities of daily living tasks in the Neater Uni-wheelchair were completed more efficiently with no loss in quality of motor and process skills performance. This suggests that the Neater Uni-wheelchair is a viable alternative to current one arm drive provision. Implications for Rehabilitation Inappropriate wheelchair provision can result in capacity limitation and poorer quality of ADL motor skill as well-lowered process performance skill. AMPS can help to explain motor and process skill differences in complex activities.
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Affiliation(s)
- Anne Mandy
- Clinical Research Centre, University of Brighton , Eastbourne , UK
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27
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Schmid AA, Van Puymbroeck M, Altenburger PA, Miller KK, Combs SA, Page SJ. Balance is associated with quality of life in chronic stroke. Top Stroke Rehabil 2013; 20:340-6. [PMID: 23893833 DOI: 10.1310/tsr2004-340] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate the association between balance and quality of life (QOL) in chronic stroke survivors by (1) examining the associations between balance and QOL scores; (2) identifying the frequency of balance impairment and poststroke falls; and (3) determining the differences in QOL scores between persons with and those without balance impairment. METHODS This is a secondary analysis of a cross-sectional study. People who had a stroke more than 6 months earlier from 3 Midwest states were included in the study if they met the following criteria: were referred to occupational or physical therapy for poststroke physical deficits; had self-reported stroke-related physical deficits; completed all stroke-related rehabilitation; had residual functional disability; had a score of ≥4 out of 6 on the short 6-item Mini-Mental State Examination; and were between 50 and 85 years old (n = 59). The main outcome measures included the Berg Balance Scale (BBS) to assess balance and the Stroke Specific Quality of Life Scale (SS-QOL) to assess QOL. Number of falls since stroke was self-reported. RESULTS Mean BBS score was 44 ± 8 and mean SS-QOL score was 46 ± 8; these scores were significantly correlated (r = .394, P = .002). Seventy-six percent of the sample reported a fall since stroke. Persons with balance impairment (BBS score ≤46; n = 29; 49%) had an average BBS score of 39 ± 7 and significantly worse SS-QOL scores than those without balance impairment (42 ± 8 vs 49 ± 7; P = .001). CONCLUSION In the chronic stroke population, balance impairment and fall risk are associated with lower QOL scores. If balance can be improved and maintained into the chronic phases of stroke, it is likely that individuals will benefit with improved QOL.
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Affiliation(s)
- Arlene A Schmid
- Roudebush Veterans Administration (VA) Medical Center, Health Services Research and Development (HSR&D) Center on Implementing Evidence-Based Practice, Indianapolis, IN, USA
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Pundik S, Holcomb J, McCabe J, Daly JJ. Enhanced life-role participation in response to comprehensive gait training in chronic stroke survivors*. Disabil Rehabil 2012; 34:2264-71. [DOI: 10.3109/09638288.2012.696875] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
BACKGROUND Further clarification is needed with regard to the degree of atrophy in individual muscle groups and its possible relationship to joint torque deficit poststroke. OBJECTIVE The purpose of this study was to investigate quadriceps and hamstring muscle volume and strength deficits of the knee extensors and flexors in people with chronic hemiparesis compared with a control group. DESIGN This was a cross-sectional study. METHODS Thirteen individuals with hemiparesis due to chronic stroke (hemiparetic group) and 13 individuals who were healthy (control group) participated in this study. Motor function, quadriceps and hamstring muscle volume, and maximal concentric and eccentric contractions of the knee extensors and flexors were assessed. RESULTS Only the quadriceps muscle of the paretic limb showed reduced muscle volume (24%) compared with the contralateral (nonparetic) limb. There were no differences in muscle volume between the hemiparetic and control groups. The peak torque of the paretic-limb knee extensors and flexors was reduced in both contraction modes and velocities compared with the nonparetic limb (36%-67%) and with the control group (49%-75%). The nonparetic limb also showed decreased extensor and flexor peak torque compared with the control group (17%-23%). Power showed similar deficits in strength (12%-78%). There were significant correlations between motor function and strength deficits (.54-.67). LIMITATIONS Magnetic resonance imaging coil length did not allow measurement of the proximal region of the thigh. CONCLUSIONS There were different responses between quadriceps and hamstring muscle volumes in the paretic limb that had quadriceps muscle atrophy only. However, both paretic and nonparetic limbs showed knee extensor and flexor torque and power reduction.
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Pundik S, Holcomb J, McCabe J, Daly JJ. Enhanced life-role participation in response to comprehensive gait training in chronic-stroke survivors. Disabil Rehabil 2012; 34:1535-9. [DOI: 10.3109/09638288.2011.650308] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Borschmann K. Exercise protects bone after stroke, or does it? A narrative review of the evidence. Stroke Res Treat 2011; 2012:103697. [PMID: 22007349 PMCID: PMC3189587 DOI: 10.1155/2012/103697] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Revised: 07/27/2011] [Accepted: 08/15/2011] [Indexed: 11/18/2022] Open
Abstract
Physical inactivity contributes to accelerated bone loss after stroke, leading to heightened fracture risk, increased mortality, and reduced independence. This paper sought to summarise the evidence for the use of physical activity to protect bone in healthy adults and adults with stroke, and to identify international recommendations regarding any means of bone protection after stroke, in order to guide rehabilitation practice and future research. A search was undertaken, which identified 12 systematic reviews of controlled trials which investigated the effect of physical activity on bone outcomes in adults. Nine reviews included healthy adults and three included adults with stroke. Twenty-five current international stroke management guidelines were identified. High-impact loading exercise appears to have a site-specific effect on the microarchitecture of healthy postmenopausal women, and physical activity has a small effect on enhancing or maintaining bone mineral density in chronic stroke patients. It is not known whether this translates to reduce fracture risk. Most guidelines included recommendations for early mobilisation after stroke and falls prevention. Two recommendations were identified which advocated exercise for the prevention bone loss after stroke, but supporting evidence was limited. Research is required to determine whether targeted physical activity can protect bone from early after stroke, and whether this can reduce fracture risk.
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Affiliation(s)
- Karen Borschmann
- Florey Neuroscience Institutes, 245 Burgundy Street, Heidelberg VIC 3084, Australia
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Borschmann K, Pang MYC, Bernhardt J, Iuliano-Burns S. Stepping towards prevention of bone loss after stroke: a systematic review of the skeletal effects of physical activity after stroke. Int J Stroke 2011; 7:330-5. [PMID: 21967614 DOI: 10.1111/j.1747-4949.2011.00645.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Bone loss after stroke is pronounced, and contributes to increased fracture risk. People who fracture after stroke experience reduced mobility and increased mortality. Physical activity can maintain or improve bone mineral density and structure in healthy older adults, likely reducing fracture risk. The purpose of this systematic review was to investigate the skeletal effects of physical activity in adults affected by stroke. A search of electronic databases was undertaken. Selection criteria of trials were • prospective and controlled • physical activity-based intervention • participants with history of stroke, and • bone-related outcome measures. Effect sizes were calculated for outcomes of paretic and nonparetic limbs. Three of 349 identified records met the inclusion criteria. Small effect sizes were found in favor of physical activity in adults with chronic stroke (n=95, 40% female, average age 63·8 years, more than one-year poststroke). Patients in intervention groups had significantly higher changes in femoral neck bone mineral density, tibial cortical thickness and trabecular bone mineral content of the paretic limb, compared with controls (P<0·05). It is not known whether these benefits reduced fracture risk. There are limited studies investigating the skeletal effect of physical activity for adults poststroke. Given the increased risk of, and poor outcomes following a fracture after stroke, randomized trials are warranted to investigate the benefits of physical activity on bone, after stroke. Interventions are likely to be beneficial if implemented soon after stroke, when bone loss appears to be rapid and pronounced.
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Affiliation(s)
- Karen Borschmann
- Melbourne Brain Centre, Florey Neuroscience Institutes, Heidelberg, Vic., Australia.
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Stuart M, Papini D, Benvenuti F, Nerattini M, Roccato E, Macellari V, Stanhope S, Macko R, Weinrich M. Methodological issues in monitoring health services and outcomes for stroke survivors: a case study. Disabil Health J 2011; 3:271-81. [PMID: 21057665 DOI: 10.1016/j.dhjo.2009.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Obtaining comprehensive health outcomes and health services utilization data on stroke patients has been difficult. This research grew out of a memorandum of understanding between the NIH and the ISS (its Italian equivalent) to foster collaborative research on rehabilitation. OBJECTIVE The purpose of this study was to pilot a methodology using administrative data to monitor and improve health outcomes for stroke survivors in Tuscany. METHODS This study used qualitative and quantitative methods to study health resources available to and utilized by stroke survivors during the first 12 months post-stroke in two Italian health authorities (AUSL10 and 11). Mortality rates were used as an outcome measure. RESULTS Number of inpatient days, number of prescriptions, and prescription costs were significantly higher for patients in AUSL 10 compared to AUSL 11. There was no significant difference between mortality rates. CONCLUSION Using administrative data to monitor process and outcomes for chronic stroke has the potential to save money and improve outcomes. However, measures of functional impairment and more sensitive outcome measures than mortality are important. Additional recommendations for enhanced data collection and reporting are discussed.
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Affiliation(s)
- Mary Stuart
- Health Administration and Policy Program, University of Maryland, Baltimore County, Baltimore, Maryland, USA.
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Garrett R, Immink MA, Hillier S. Becoming connected: the lived experience of yoga participation after stroke. Disabil Rehabil 2011; 33:2404-15. [DOI: 10.3109/09638288.2011.573058] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Bashton D, Mandy A, Haines D, Cameron J. Comparison of activities of daily living in two different one arm drive wheelchairs: a controlled trial. Disabil Rehabil Assist Technol 2011; 7:75-81. [PMID: 21495914 DOI: 10.3109/17483107.2011.574247] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIMS This pilot study measured activities of daily living (ADLs) in users propelling both a standard dual handrim Action 3 wheelchair and a standard Action 3 wheelchair with a Neater Uni-Wheelchair (NUW) kit attachment. The kit consists of a steerable front castor and a single pushrim propelling both rear wheels via a differential. HYPOTHESIS There would be a difference in the efficiency of ADL skill performance, speed and heart rate. METHODS Twenty non-disabled participants simulating hemiplegia were used in a cross over, repeated measures trial. Assessment of Motor and Process Skills (AMPS) of users undertaking making a bed and laying a table 'Swedish style', tasks, were measured. Heart rate at rest and post-task and time taken to complete each task were recorded. RESULTS Heart rate when laying the table was lower in the NUW (p < 0.005) and task completion time was quicker (p < 0.0001). There was no difference in motor and process ability skills. CONCLUSION ADL tasks in the NUW were completed more efficiently with no loss in quality of motor and process skills performance. This suggests that the NUW is a viable alternative to current one arm drive provision.
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Affiliation(s)
- Daisy Bashton
- Hackney NHS Trust, Community Learning Disabilities Service, London, UK
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The effect of balance training on balance performance in individuals poststroke: a systematic review. J Neurol Phys Ther 2010; 34:127-37. [PMID: 20716987 DOI: 10.1097/npt.0b013e3181ef764d] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND PURPOSE Stroke is a leading cause of long-term disability, and impaired balance after stroke is strongly associated with future function and recovery. Until recently there has been limited evidence to support the use of balance training to improve balance performance in this population. Information about the optimum exercise dosage has also been lacking. This review evaluated recent evidence related to the effect of balance training on balance performance among individuals poststroke across the continuum of recovery. On the basis of this evidence, we also provide recommendations for exercise prescription in such programs. METHODS A systematic search was performed on literature published between January 2006 and February 2010, using multiple combinations of intervention (eg, "exercise"), population (eg, "stroke"), and outcome (eg, "balance"). Criteria for inclusion of a study was having at least 1 standing balance exercise in the intervention and 1 study outcome to evaluate balance. RESULTS Twenty-two published studies met the inclusion criteria. We found moderate evidence that balance performance can be improved following individual, "one-on-one" balance training for participants in the acute stage of stroke, and either one-on-one balance training or group therapy for participants with subacute or chronic stroke. Moderate evidence also suggests that in the acute stage, intensive balance training for 2 to 3 times per week may be sufficient, whereas exercising for 90 minutes or more per day, 5 times per week may be excessive. DISCUSSION AND CONCLUSIONS This review supports the use of balance training exercises to improve balance performance for individuals with moderately severe stroke. Future high-quality, controlled studies should investigate the effects of balance training for individuals poststroke who have severe impairment, additional complications/comorbidities, or specific balance lesions (eg, cerebellar or vestibular). Optimal training dosage should also be further explored. Studies with long-term follow-up are needed to assess outcomes related to participation in the community and reduction of fall risk.
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Rose D, Paris T, Crews E, Wu SS, Sun A, Behrman AL, Duncan P. Feasibility and effectiveness of circuit training in acute stroke rehabilitation. Neurorehabil Neural Repair 2010; 25:140-8. [PMID: 21051764 DOI: 10.1177/1545968310384270] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Task-specificity, repetition and progression are key variables in the acquisition of motor skill however they have not been consistently implemented in post-stroke rehabilitation. OBJECTIVE To evaluate the effectiveness of a stroke rehabilitation plan of care that incorporated task-specific practice, repetition and progression to facilitate functional gain compared to standard physical therapy for individuals admitted to an inpatient stroke unit. METHODS Individuals participated in either a circuit training (CTPT) model (n = 72) or a standard (SPT) model (n = 108) of physical therapy, 5 days/week. Each 60 minute circuit training session, delivered according to severity level, consisted of four functional mobility tasks. Daily exercise logs documented both task repetition and progression. RESULTS The CTPT model was successfully implemented in an acute rehabilitation setting. The CTPT group showed a significantly greater improved change in gait speed from hospital admission to discharge than the SPT group (0.21 ± 0.25 m/sec vs. 0.13 ± 0.22 m/sec; p = 0.03). The difference between groups occurred primarily among those who were ambulatory upon admission. There were no significant differences between the two cohorts at 90 days post-stroke as measured by the FONE-FIM, SF-36 and living location. CONCLUSIONS Therapy focused on systematically progressed functional tasks can be successfully implemented in an inpatient rehabilitation stroke program. This circuit-training model resulted in greater gains in gait velocity over the course of inpatient rehabilitation compared to the standard model of care. Community-based services following hospital discharge to maintain these gains should be included in the continuum of post-stroke care.
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Affiliation(s)
- Dorian Rose
- Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA.
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Chard SE, Stuart M. An Ecological Perspective on the Community Translation of Exercise Research for Older Adults. J Appl Gerontol 2010. [DOI: 10.1177/0733464810385814] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Regular exercise lowers the risk of disease progression for many chronic illnesses, but older adults experience relatively low rates of exercise. Although multiple intervention studies indicate that community-based programs can facilitate exercise participation, whether this research has resulted in widespread targeted exercise programs within communities is unknown. This study seeks to understand the ecological context of exercise for older adults through a cross-sectional survey of community exercise facilities within a mid-Atlantic city. The findings highlight the limited nature of the existing exercise infrastructure and reveal gaps in the community translation of research evidence regarding exercise adherence. An expansion in the availability of community exercise programs for older adults and more uniform policies to support older adult exercise are needed.
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Billinger SA, Guo LX, Pohl PS, Kluding PM. Single limb exercise: pilot study of physiological and functional responses to forced use of the hemiparetic lower extremity. Top Stroke Rehabil 2010; 17:128-39. [PMID: 20542855 DOI: 10.1310/tsr1702-128] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE Stroke-related deficits can impede both functional performance and walking tolerance. Individuals with hemiparesis rely on the stronger limb during exercise and functional tasks. The single limb exercise (SLE) intervention was a unique training protocol that focused only on the hemiparetic limb. Our objective was to determine the effect of the SLE intervention on cardiorespiratory fitness parameters. METHODS Twelve participants (5 male) with a mean age of 60.6 +/- 14.5 years and 69.1 +/- 82.2 months post stroke participated in the training intervention. All participants performed SLE using the hemiparetic leg three times a week for 4 weeks. The nonhemiparetic limb served as the control limb and did not engage in SLE. Peak oxygen uptake (VO2 peak) and oxygen uptake (VO2) were measured at baseline and post intervention in all 12 participants. At pre and post intervention, gait velocity was assessed in a subset of participants (n = 7) using the 10-m fast-walk test. RESULTS After the 4-week SLE training intervention, significant improvements were found for VO2 during submaximal work effort (P = .009) and gait velocity (n = 7) (P = .001). Peak oxygen uptake did not increase (P = .41) after the training intervention. CONCLUSION These data suggest that SLE training was an effective method for improving oxygen uptake and reducing energy expenditure during submaximal effort. Unilateral exercise focused on the hemiparetic leg may be an effective intervention strategy to consider for stroke rehabilitation.
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Affiliation(s)
- Sandra A Billinger
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, Kansas, USA
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Balady GJ, Arena R, Sietsema K, Myers J, Coke L, Fletcher GF, Forman D, Franklin B, Guazzi M, Gulati M, Keteyian SJ, Lavie CJ, Macko R, Mancini D, Milani RV. Clinician's Guide to cardiopulmonary exercise testing in adults: a scientific statement from the American Heart Association. Circulation 2010; 122:191-225. [PMID: 20585013 DOI: 10.1161/cir.0b013e3181e52e69] [Citation(s) in RCA: 1298] [Impact Index Per Article: 92.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Langhammer B, Stanghelle JK. Exercise on a treadmill or walking outdoors? A randomized controlled trial comparing effectiveness of two walking exercise programmes late after stroke. Clin Rehabil 2009; 24:46-54. [DOI: 10.1177/0269215509343328] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To evaluate spatial and temporal gait characteristics and endurance late after stroke in people who had received two different walking exercises. A secondary aim was to compare the outcomes in relation to length of time exercising and number of exercise occasions between the two. Design: A randomized controlled trial. Setting: A private rehabilitation centre. Subjects: Thirty-nine people with stroke entered the study, and five dropped out. Interventions: Treadmill training versus walking outdoors. Main measures: Six-Minute Walk Test, a 10-metre walk test and pulse rates at rest and in activity. Results: There were significant differences in favour of the treadmill group in Six-Minute Walk Test distance (P = 0.04), Six-Minute Walk Test speed (P = 0.03), 10-m walking speed (P = 0.03), bilateral stride length (right leg; P =0.009, left leg; P =0.003) and step width (P = 0.01), indicating more symmetrical use of the legs in the treadmill group (1.02—1.10 m versus 0.97—0.92 m). There were no significant differences between groups in cadence (P = 0.78). All participants complied 100% with their respective programmes. Exercise frequency did not differ between the groups but significantly less time was spent exercising on the treadmill compared with walking exercise outdoors (107 versus 316 minutes, P =0.002). There were no differences in use of assistive aids between the groups on arrival at the clinic or at departure. Conclusion: The results indicate that treadmill walking improves spatial and temporal gait characteristics more effectively than walking outdoors.
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Affiliation(s)
- Birgitta Langhammer
- Physiotherapy Programme, Faculty of Health, Oslo University College/Sunnaas Rehabilitation Hospital,
| | - Johan K Stanghelle
- Sunnaas Rehabilitation Hospital, Faculty of Medicine, University of Oslo, Oslo, Norway
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Stuart M, Benvenuti F, Macko R, Taviani A, Segenni L, Mayer F, Sorkin JD, Stanhope SJ, Macellari V, Weinrich M. Community-based adaptive physical activity program for chronic stroke: feasibility, safety, and efficacy of the Empoli model. Neurorehabil Neural Repair 2009; 23:726-34. [PMID: 19318465 DOI: 10.1177/1545968309332734] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine whether Adaptive Physical Activity (APA-stroke), a community-based exercise program for participants with hemiparetic stroke, improves function in the community. METHODS Nonrandomized controlled study in Tuscany, Italy, of participants with mild to moderate hemiparesis at least 9 months after stroke. Forty-nine participants in a geographic health authority (Empoli) were offered APA-stroke (40 completed the study). Forty-four control participants in neighboring health authorities (Florence and Pisa) received usual care (38 completed the study). The APA intervention was a community-based progressive group exercise regimen that included walking, strength, and balance training for 1 hour, thrice a week, in local gyms, supervised by gym instructors. No serious adverse clinical events occurred during the exercise intervention. Outcome measures included the following: 6-month change in gait velocity (6-Minute Timed Walk), Short Physical Performance Battery (SPPB), Berg Balance Scale, Stroke Impact Scale (SIS), Barthel Index, Hamilton Rating Scale for Depression, and Index of Caregivers Strain. RESULTS After 6 months, the intervention group improved whereas controls declined in gait velocity, balance, SPPB, and SIS social participation domains. These between-group comparisons were statistically significant at P<.00015. Individuals with depressive symptoms at baseline improved whereas controls were unchanged (P<.003). Oral glucose tolerance tests were performed on a subset of participants in the intervention group. For these individuals, insulin secretion declined 29% after 6 months (P=.01). CONCLUSION APA-stroke appears to be safe, feasible, and efficacious in a community setting.
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Affiliation(s)
- Mary Stuart
- Health Administration and Policy Program, University of Maryland, Baltimore County, Baltimore, Maryland 21250, USA.
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