1
|
Misaghian K, Lugo JE, Faubert J. Immediate fall prevention: the missing key to a comprehensive solution for falling hazard in older adults. Front Aging Neurosci 2024; 16:1348712. [PMID: 38638191 PMCID: PMC11024377 DOI: 10.3389/fnagi.2024.1348712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 03/18/2024] [Indexed: 04/20/2024] Open
Abstract
The world is witnessing an unprecedented demographic shift due to increased life expectancy and declining birth rates. By 2050, 20% of the global population will be over 60, presenting significant challenges like a shortage of caregivers, maintaining health and independence, and funding extended retirement. The technology that caters to the needs of older adults and their caregivers is the most promising candidate to tackle these issues. Although multiple companies and startups offer various aging solutions, preventive technology, which could prevent trauma, is not a big part of it. Trauma is the leading cause of morbidity, disability, and mortality in older adults, and statistics constitute traumatic fall accidents as its leading cause. Therefore, an immediate preventive technology that anticipates an accident on time and prevents it must be the first response to this hazard category to decrease the gap between life expectancy and the health/wellness expectancy of older adults. The article outlines the challenges of the upcoming aging crisis and introduces falls as one major challenge. After that, falls and their mechanisms are investigated, highlighting the cognitive functions and their relation to falls. Moreover, since understanding predictive cognitive mechanisms is critical to an effective prediction-interception design, they are discussed in more detail, signifying the role of cognitive decline in balance maintenance. Furthermore, the landscape of available solutions for falling and its shortcomings is inspected. Finally, immediate fall prevention, the missing part of a wholesome solution, and its barriers are introduced, and some promising methodologies are proposed.
Collapse
Affiliation(s)
- Khashayar Misaghian
- Sage-Sentinel Smart Solutions, Kunigami-gun, Okinawa, Japan
- OIST Innovation, Okinawa Institute of Science and Technology Graduate University, Onna, Okinawa, Japan
- Faubert Lab, School of Optometry, Université de Montréal, Montreal, QC, Canada
| | - Jesus Eduardo Lugo
- Sage-Sentinel Smart Solutions, Kunigami-gun, Okinawa, Japan
- Faubert Lab, School of Optometry, Université de Montréal, Montreal, QC, Canada
- Facultad de Ciencias Físico Matemáticas, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | - Jocelyn Faubert
- Sage-Sentinel Smart Solutions, Kunigami-gun, Okinawa, Japan
- Faubert Lab, School of Optometry, Université de Montréal, Montreal, QC, Canada
| |
Collapse
|
2
|
Marzolini S, Robertson AD, MacIntosh BJ, Corbett D, Anderson ND, Brooks D, Koblinsky N, Oh P. Effect of High-Intensity Interval Training and Moderate-Intensity Continuous Training in People With Poststroke Gait Dysfunction: A Randomized Clinical Trial. J Am Heart Assoc 2023; 12:e031532. [PMID: 37947080 PMCID: PMC10727274 DOI: 10.1161/jaha.123.031532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/03/2023] [Indexed: 11/12/2023]
Abstract
Background The exercise strategy that yields the greatest improvement in both cardiorespiratory fitness (V ̇ O 2 peak $$ \dot{\mathrm{V}}{\mathrm{O}}_{2\mathrm{peak}} $$ ) and walking capacity poststroke has not been determined. This study aimed to determine whether conventional moderate-intensity continuous training (MICT) or high-intensity interval training (HIIT) have different effects on V ̇ O 2 peak $$ \dot{\mathrm{V}}{\mathrm{O}}_{2\mathrm{peak}} $$ and 6-minute walk distance (6MWD). Methods and Results In this 24-week superiority trial, people with poststroke gait dysfunction were randomized to MICT (5 days/week) or HIIT (3 days/week with 2 days/week of MICT). MICT trained to target intensity at the ventilatory anaerobic threshold. HIIT trained at the maximal tolerable treadmill speed/grade using a novel program of 2 work-to-recovery protocols: 30:60 and 120:180 seconds. V̇O2 and heart rate was measured during performance of the exercise that was prescribed at 8 and 24 weeks for treatment fidelity. Main outcomes were change in V ̇ O 2 peak $$ \dot{\mathrm{V}}{\mathrm{O}}_{2\mathrm{peak}} $$ and 6MWD. Assessors were blinded to the treatment group for V ̇ O 2 peak $$ \dot{\mathrm{V}}{\mathrm{O}}_{2\mathrm{peak}} $$ but not 6MWD. Secondary outcomes were change in ventilatory anaerobic threshold, cognition, gait-economy, 10-meter gait-velocity, balance, stair-climb performance, strength, and quality-of-life. Among 47 participants randomized to either MICT (n=23) or HIIT (n=24) (mean age, 62±11 years; 81% men), 96% completed training. In intention-to-treat analysis, change in V ̇ O 2 peak $$ \dot{\mathrm{V}}{\mathrm{O}}_{2\mathrm{peak}} $$ for MICT versus HIIT was 2.4±2.7 versus 5.7±3.1 mL·kg-1·min-1 (mean difference, 3.2 [95% CI, 1.5-4.8]; P<0.001), and change in 6MWD was 70.9±44.3 versus 83.4±53.6 m (mean difference, 12.5 [95% CI, -17 to 42]; P=0.401). HIIT had greater improvement in ventilatory anaerobic threshold (mean difference, 2.07 mL·kg-1·min-1 [95% CI, 0.59-3.6]; P=0.008). No other between-group differences were observed. During V̇O2 monitoring at 8 and 24 weeks, MICT reached 84±14% to 87±18% of V ̇ O 2 peak $$ \dot{\mathrm{V}}{\mathrm{O}}_{2\mathrm{peak}} $$ while HIIT reached 101±22% to 112±14% of V ̇ O 2 peak $$ \dot{\mathrm{V}}{\mathrm{O}}_{2\mathrm{peak}} $$ (during peak bouts). Conclusions HIIT resulted in more than a 2-fold greater and clinically important change in V ̇ O 2 peak $$ \dot{\mathrm{V}}{\mathrm{O}}_{2\mathrm{peak}} $$ than MICT. Training to target (ventilatory anaerobic threshold) during MICT resulted in ~3 times the minimal clinically important difference in 6MWD, which was similar to HIIT. These findings show proof of concept that HIIT yields greater improvements in cardiorespiratory fitness than conventional MICT in appropriately screened individuals. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03006731.
Collapse
Affiliation(s)
- Susan Marzolini
- KITE Research Institute, Toronto Rehabilitation Institute, University Health NetworkTorontoONCanada
- Rehabilitation Sciences Institute, University of TorontoONCanada
- Faculty of Kinesiology and Physical Education, University of TorontoONCanada
| | | | - Bradley J. MacIntosh
- Sandra E Black Centre for Brain Resilience and Repair, Hurvitz Brain Sciences, Physical Sciences Platform, Sunnybrook Research InstituteTorontoONCanada
| | - Dale Corbett
- Department of Cellular and Molecular MedicineUniversity of OttawaONCanada
| | - Nicole D. Anderson
- Rotman Research Institute, Baycrest Academy for Research and EducationTorontoONCanada
| | - Dina Brooks
- KITE Research Institute, Toronto Rehabilitation Institute, University Health NetworkTorontoONCanada
- Rehabilitation Sciences Institute, University of TorontoONCanada
- McMaster University, Faculty of Health SciencesHamiltonONCanada
| | - Noah Koblinsky
- Rotman Research Institute, Baycrest Academy for Research and EducationTorontoONCanada
| | - Paul Oh
- KITE Research Institute, Toronto Rehabilitation Institute, University Health NetworkTorontoONCanada
| |
Collapse
|
3
|
Oh J, Crockett RA, Hsu CL, Dao E, Tam R, Liu-Ambrose T. Resistance Training Maintains White Matter and Physical Function in Older Women with Cerebral Small Vessel Disease: An Exploratory Analysis of a Randomized Controlled Trial. J Alzheimers Dis Rep 2023; 7:627-639. [PMID: 37483319 PMCID: PMC10357123 DOI: 10.3233/adr-220113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 05/17/2023] [Indexed: 07/25/2023] Open
Abstract
Background As the aging population grows, there is an increasing need to develop accessible interventions against risk factors for cognitive impairment and dementia, such as cerebral small vessel disease (CSVD). The progression of white matter hyperintensities (WMHs), a key hallmark of CSVD, can be slowed by resistance training (RT). We hypothesize RT preserves white matter integrity and that this preservation is associated with improved cognitive and physical function. Objective To determine if RT preserves regional white matter integrity and if any changes are associated with cognitive and physical outcomes. Methods Using magnetic resonance imaging data from a 12-month randomized controlled trial, we compared the effects of a twice-weekly 60-minute RT intervention versus active control on T1-weighted over T2-weighted ratio (T1w/T2w; a non-invasive proxy measure of white matter integrity) in a subset of study participants (N = 21 females, mean age = 69.7 years). We also examined the association between changes in T1w/T2w with two key outcomes of the parent study: (1) selective attention and conflict resolution, and (2) peak muscle power. Results Compared with an active control group, RT increased T1w/T2w in the external capsule (p = 0.024) and posterior thalamic radiations (p = 0.013) to a greater degree. Increased T1w/T2w in the external capsule was associated with an increase in peak muscle power (p = 0.043) in the RT group. Conclusion By maintaining white matter integrity, RT may be a promising intervention to counteract the pathological changes that accompany CSVD, while improving functional outcomes such as muscle power.
Collapse
Affiliation(s)
- Jean Oh
- Aging, Mobility, and Cognitive Health Laboratory, University of British Columbia, Vancouver, Canada
| | - Rachel A. Crockett
- Aging, Mobility, and Cognitive Health Laboratory, University of British Columbia, Vancouver, Canada
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
- Centre for SMART Aging at Vancouver Coastal Health, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Chun-Liang Hsu
- Aging, Mobility, and Cognitive Health Laboratory, University of British Columbia, Vancouver, Canada
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hung Hom, Hong Kong
- Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
- Centre for SMART Aging at Vancouver Coastal Health, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Elizabeth Dao
- Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, Canada
- Department of Radiology, University of British Columbia, Vancouver, Canada
- Centre for SMART Aging at Vancouver Coastal Health, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Roger Tam
- Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, Canada
- School of Biomedical Engineering, University of British Columbia, Vancouver, Canada
- Department of Radiology, University of British Columbia, Vancouver, Canada
- Centre for SMART Aging at Vancouver Coastal Health, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Teresa Liu-Ambrose
- Aging, Mobility, and Cognitive Health Laboratory, University of British Columbia, Vancouver, Canada
- Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
- Centre for SMART Aging at Vancouver Coastal Health, Vancouver Coastal Health Research Institute, Vancouver, Canada
| |
Collapse
|
4
|
Sakai K, Hosoi Y, Harada Y. Walking Ability Associated with Executive Dysfunction in Patients with Stroke: A Cross-Sectional Study. Brain Sci 2023; 13:brainsci13040627. [PMID: 37190592 DOI: 10.3390/brainsci13040627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 03/30/2023] [Accepted: 04/05/2023] [Indexed: 04/08/2023] Open
Abstract
Previous studies have shown an association between executive dysfunction and walking ability. However, it remains unclear whether the degree of executive dysfunction is associated with differences in walking ability in patients with stroke. The aim of this study was to investigate whether there are differences in walking ability according to executive dysfunction in patients with stroke. A total of 51 patients with stroke were enrolled in this study. Executive function was measured using the Trail Making Test (TMT) Part B, and walking ability was assessed using the 10 m walk test and the Timed Up and Go Test (TUGT). Cluster analysis was performed using the TMT Part B and compared within each cluster. TMT Part B was categorized into three groups (cluster 1: n = 20, cluster 2: n = 24, and cluster 3: n = 7). Cluster 1 was significantly better than clusters 2 and 3, and cluster 2 was significantly better than cluster 3. The 10 m walk time and TUGT of cluster 1 were significantly better than those of cluster 3. However, the 10 m walk time and TUGT of clusters 1 and 2 did not differ significantly. In conclusion, these findings may indicate differences in walking ability according to executive dysfunction.
Collapse
Affiliation(s)
- Katsuya Sakai
- Department of Physical Therapy, Faculty of Health Sciences, Tokyo Metropolitan University, Tokyo 116-8551, Japan
| | - Yuichiro Hosoi
- Department of Rehabilitation of Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
- Department of Sports Health Sciences, Ritsumeikan University, Kusatsu 525-3760, Japan
| | - Yusuke Harada
- Department of Rehabilitation, Reiwa Rehabilitation Hospital, Chiba 260-0026, Japan
- Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo 116-8551, Japan
| |
Collapse
|
5
|
Bergqvist M, Möller MC, Björklund M, Borg J, Palmcrantz S. The impact of visuospatial and executive function on activity performance and outcome after robotic or conventional gait training, long-term after stroke-as part of a randomized controlled trial. PLoS One 2023; 18:e0281212. [PMID: 36893079 PMCID: PMC9997896 DOI: 10.1371/journal.pone.0281212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 12/22/2022] [Indexed: 03/10/2023] Open
Abstract
INTRODUCTION Visuospatial and executive impairments have been associated with poor activity performance sub-acute after stroke. Potential associations long-term and in relation to outcome of rehabilitation interventions need further exploration. AIMS To explore associations between visuospatial and executive function and 1) activity performance (mobility, self-care and domestic life) and 2) outcome after 6 weeks of conventional gait training and/or robotic gait training, long term (1-10 years) after stroke. METHODS Participants (n = 45), living with stroke affecting walking ability and who could perform the items assessing visuospatial/executive function included in the Montreal Cognitive Assessment (MoCA Vis/Ex) were included as part of a randomized controlled trial. Executive function was evaluated using ratings by significant others according to the Dysexecutive Questionnaire (DEX); activity performance using 6-minute walk test (6MWT), 10-meter walk test (10MWT), Berg balance scale, Functional Ambulation Categories, Barthel Index and Stroke Impact Scale. RESULTS MoCA Vis/Ex was significantly associated with baseline activity performance, long-term after stroke (r = .34-.69, p < .05). In the conventional gait training group, MoCA Vis/Ex explained 34% of the variance in 6MWT after the six-week intervention (p = 0.017) and 31% (p = 0.032) at the 6 month follow up, which indicate that a higher MoCA Vis/Ex score enhanced the improvement. The robotic gait training group presented no significant associations between MoCA Vis/Ex and 6MWT indicating that visuospatial/executive function did not affect outcome. Rated executive function (DEX) presented no significant associations to activity performance or outcome after gait training. CONCLUSION Visuospatial/executive function may significantly affect activity performance and the outcome of rehabilitation interventions for impaired mobility long-term after stroke and should be considered in the planning of such interventions. Patients with severely impaired visuospatial/executive function may benefit from robotic gait training since improvement was seen irrespective of visuospatial/executive function. These results may guide future larger studies on interventions targeting long-term walking ability and activity performance. TRIAL REGISTRATION clinicaltrials.gov (NCT02545088) August 24, 2015.
Collapse
Affiliation(s)
- Maria Bergqvist
- Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden
| | - Marika C Möller
- Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Martin Björklund
- Department of Community Medicine and Rehabilitation Physiotherapy, Umeå University, Umeå, Sweden
| | - Jörgen Borg
- Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Susanne Palmcrantz
- Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| |
Collapse
|
6
|
Yu H, Liu S, Dai P, Wang Z, Liu C, Zhang H. Effects of Repetitive Transcranial Magnetic Stimulation on Gait and Postural Control Ability of Patients with Executive Dysfunction after Stroke. Brain Sci 2022; 12:brainsci12091185. [PMID: 36138921 PMCID: PMC9497186 DOI: 10.3390/brainsci12091185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 08/22/2022] [Accepted: 08/29/2022] [Indexed: 11/16/2022] Open
Abstract
Objective: To assess the effects of repetitive transcranial magnetic stimulation (rTMS) on the gait and postural control ability of patients with executive dysfunction (ED) after stroke. Methods: A total of 18 patients with ED after stroke were randomly assigned into two groups, including an experimental group and a sham group. Patients in both groups received routine rehabilitation therapy, and patients in the experimental group underwent rTMS on the left dorsolateral prefrontal cortex (DLPFC) for 2 weeks (5 HZ, 80%MT, 1200 pulses). In the sham group, patients experienced sham stimulation treatment, in which the coil was placed vertically with the head. Before and after treatment, patients in both groups were subjected to Montreal cognitive assessment (MoCA) scoring, Fugl−Meyer assessment of lower extremity (L-FMA), Stroop color-word test (SCWT), gait analysis, foot plantar pressure test, 10-m walking test (10MWT), Berg balance scale (BBS), and timed up and go test (TUGT). In the SCWT, it was attempted to record the time of each card (SCWT-T), the correct number (SCWT-C), Stroop interference effect-time (SIE-T), and SIE correct count (SIE-C). The TUGT was categorized into four stages: getting up (GT), walking straight (WT), turning around (TT), and sitting down (ST), in which the total time of TUGT was calculated. Results: After two weeks of treatment, the evaluation indexes were improved in the two groups, some of which were statistically significant. In the experimental group, SCWT-T, SIE-T, SIE-C, GT, WT, TT, ST, and TUGT were significantly improved after treatment (p < 0.05). SCWT-C, L-FMA score, 10MWT, GT, WT, stride length, step width, foot plantar pressure, pressure center curve, and activities of daily living were not statistically different from those before treatment (p > 0.05). After treatment, SCWT-T, SIE-C, SIE-T, BBS score, TT, and ST in the experimental group were significantly shorter than those before treatment, with statistical differences (p < 0.05). Compared with the sham group, SCWT-C, L-FMA score, 10MWT, GT, WT, TUGT, stride length, step width, foot plantar pressure, pressure center curve, and motor skills were not significantly improved (p > 0.05). Conclusion: It was revealed that post-stroke rTMS treatment of patients with ED could improve executive function, improve postural control function, and reduce the risk of falling. In addition, rTMS of DLPFC could be a therapeutic target for improving postural control ability and reducing the risk of falling.
Collapse
Affiliation(s)
- Huixian Yu
- Department of Rehabilitation Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing 100060, China
- School of Rehabilitation, China Rehabilitation Research Center, Capital Medical University, Beijing 100068, China
| | - Sihao Liu
- Department of Rehabilitation Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing 100060, China
| | - Pei Dai
- Department of Rehabilitation Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing 100060, China
- School of Rehabilitation, China Rehabilitation Research Center, Capital Medical University, Beijing 100068, China
| | - Zhaoxia Wang
- Department of Rehabilitation Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing 100060, China
| | - Changbin Liu
- Department of Rehabilitation Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing 100060, China
| | - Hao Zhang
- School of Rehabilitation, China Rehabilitation Research Center, Capital Medical University, Beijing 100068, China
- Correspondence: ; Tel./Fax: +86-010-8756-9345
| |
Collapse
|
7
|
Djurovic O, Mihaljevic O, Radovanovic S, Kostic S, Vukicevic M, Brkic BG, Stankovic S, Radulovic D, Vukomanovic IS, Radevic SR. Risk Factors Related to Falling in Patients after Stroke. Iran J Public Health 2021; 50:1832-1841. [PMID: 34722379 PMCID: PMC8542823 DOI: 10.18502/ijph.v50i9.7056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 04/11/2021] [Indexed: 11/24/2022]
Abstract
Background: The aim of this study was to identify the risk factors associated with falling in post stroke patients. Methods: This retrospective case-control study included 561 neurology patients hospitalized for a stroke and divided into two groups: falling patients and non-falling patients. They referred to the Special Hospital for Cerebrovascular Diseases “Sveti Sava” in Belgrade, Serbia, from 2018–2019. Logistic regression analysis was applied to examine socio-economic factors associated with predictors of unmet healthcare needs. Results: A significant difference was seen in the length of hospitalization of falling patients compared to the non-falling (P<0.001). We established statistically significant differences in mental status (P<0.001), sensibility (P=0.016), depressed mood (P<0.001), early (P=0.001) and medium insomnia (P=0.042), psychomotor slowness (P=0.030), somatic anxiety (P=0.044) and memory (P<0.001). Conclusion: Cerebrovascular disease distribution and the degree of neurological deficit primarily altered mental status, which could be recognized as one of the more important predictors for falling after stroke. The identification of risk factors may be a first step toward the design of intervention programs for preventing a future fall among hospitalized stroke patients.
Collapse
Affiliation(s)
- Olivera Djurovic
- Special Hospital for Cerebrovascular Diseases "Sveti Sava", Belgrade, Serbia
| | - Olgica Mihaljevic
- Department of Pathophysiology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Snezana Radovanovic
- Department of Social Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Smiljana Kostic
- Military Medical Academy, Neurology Clinic, Belgrade, Serbia
| | - Marjana Vukicevic
- Special Hospital for Cerebrovascular Diseases "Sveti Sava", Belgrade, Serbia
| | | | - Snezana Stankovic
- Special Hospital for Cerebrovascular Diseases "Sveti Sava", Belgrade, Serbia
| | - Danijela Radulovic
- Primary Health Care and Public Health, Faculty of Medicine, University East Sarajevo, Sarajevo, Republic of Srpska, Bosnia and Herzegovina
| | - Ivana Simic Vukomanovic
- Department of Social Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Svetlana R Radevic
- Department of Social Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| |
Collapse
|
8
|
Louie DR, Mortenson WB, Durocher M, Schneeberg A, Teasell R, Yao J, Eng JJ. Efficacy of an exoskeleton-based physical therapy program for non-ambulatory patients during subacute stroke rehabilitation: a randomized controlled trial. J Neuroeng Rehabil 2021; 18:149. [PMID: 34629104 PMCID: PMC8502504 DOI: 10.1186/s12984-021-00942-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/27/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Individuals requiring greater physical assistance to practice walking complete fewer steps in physical therapy during subacute stroke rehabilitation. Powered exoskeletons have been developed to allow repetitious overground gait training for individuals with lower limb weakness. The objective of this study was to determine the efficacy of exoskeleton-based physical therapy training during subacute rehabilitation for walking recovery in non-ambulatory patients with stroke. METHODS An assessor-blinded randomized controlled trial was conducted at 3 inpatient rehabilitation hospitals. Patients with subacute stroke (< 3 months) who were unable to walk without substantial assistance (Functional Ambulation Category rating of 0 or 1) were randomly assigned to receive exoskeleton-based or standard physical therapy during rehabilitation, until discharge or a maximum of 8 weeks. The experimental protocol replaced 75% of standard physical therapy sessions with individualized exoskeleton-based sessions to increase standing and stepping repetition, with the possibility of weaning off the device. The primary outcome was walking ability, measured using the Functional Ambulation Category. Secondary outcomes were gait speed, distance walked on the 6-Minute Walk Test, days to achieve unassisted gait, lower extremity motor function (Fugl-Meyer Assessment), Berg Balance Scale, Patient Health Questionnaire, Montreal Cognitive Assessment, and 36-Item Short Form Survey, measured post-intervention and after 6 months. RESULTS Thirty-six patients with stroke (mean 39 days post-stroke) were randomized (Exoskeleton = 19, Usual Care = 17). On intention-to-treat analysis, no significant between-group differences were found in the primary or secondary outcomes at post-intervention or after 6 months. Five participants randomized to the Exoskeleton group did not receive the protocol as planned and thus exploratory as-treated and per-protocol analyses were undertaken. The as-treated analysis found that those adhering to exoskeleton-based physical therapy regained independent walking earlier (p = 0.03) and had greater gait speed (p = 0.04) and 6MWT (p = 0.03) at 6 months; however, these differences were not significant in the per-protocol analysis. No serious adverse events were reported. CONCLUSIONS This study found that exoskeleton-based physical therapy does not result in greater improvements in walking independence than standard care but can be safely administered at no detriment to patient outcomes. Clinical Trial Registration The Exoskeleton for post-Stroke Recovery of Ambulation (ExStRA) trial was registered at ClinicalTrials.gov (NCT02995265, first registered: December 16, 2016).
Collapse
Affiliation(s)
- Dennis R Louie
- Department of Physical Therapy, University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.,Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - W Ben Mortenson
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.,Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Melanie Durocher
- Glenrose Rehabilitation Hospital, Alberta Health Services, Edmonton, AB, Canada
| | - Amy Schneeberg
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Robert Teasell
- Parkwood Institute, St. Joseph's Health Care, London, ON, Canada.,Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Jennifer Yao
- GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, BC, Canada.,Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Janice J Eng
- Department of Physical Therapy, University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada. .,Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.
| |
Collapse
|
9
|
Ahmad Ainuddin H, Romli MH, Hamid TA, Salim MSF, Mackenzie L. Stroke Rehabilitation for Falls and Risk of Falls in Southeast Asia: A Scoping Review With Stakeholders' Consultation. Front Public Health 2021; 9:611793. [PMID: 33748063 PMCID: PMC7965966 DOI: 10.3389/fpubh.2021.611793] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/27/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Research on rehabilitation for falls after stroke is warranted. However, published evidence on fall interventions with stroke survivors is limited and these are mainly international studies that may be less relevant for Southeast Asia. Objective: This review aims to systematically identify literature related to stroke rehabilitation for falls and risk of falls in Southeast Asia. Methods: A scoping review with stakeholders' consultation was implemented. An electronic search was conducted up to December 2020 on 4 databases (Medline, CINAHL, Scopus, ASEAN Citation Index). Only original studies conducted in Southeast Asia were selected. Results: The initial search yielded 3,112 articles, however, only 26 were selected in the final analysis. Most of the articles focused on physical rehabilitation and implemented conventional therapies. While the literature may reflect practice in Southeast Asia, stakeholders perceived that the literature was inadequate to show true practice, was not informative and missed several aspects such as functional, cognitive, and psychological interventions in managing falls. Individual-centric interventions dominated the review while community-based and environmental-focused studies were limited. Majority of the articles were written by physiotherapists while others were from physicians, occupational therapists, and an engineer but few from other healthcare practitioners (i.e., speech therapists, psychologists) or disciplines interested in falls. Conclusions: Falls prevention among stroke survivors has received a lack of attention and is perceived as an indirect goal in stroke rehabilitation in Southeast Asia. More innovative research adopted from falls research with older people is needed to advance falls prevention and intervention practice with stroke survivors.
Collapse
Affiliation(s)
- Husna Ahmad Ainuddin
- Center of Occupational Therapy Studies, Faculty of Health Sciences, Universiti Teknologi MARA Selangor, Selangor, Malaysia
- Department of Rehabilitation Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Muhammad Hibatullah Romli
- Department of Rehabilitation Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang, Malaysia
| | - Tengku Aizan Hamid
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang, Malaysia
| | - Mazatulfazura S. F. Salim
- Department of Rehabilitation Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Lynette Mackenzie
- Discipline of Occupational Therapy, Faculty of Medicine and Health, School of Health Sciences, University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
10
|
Cheng DKY, Dagenais M, Alsbury-Nealy K, Legasto JM, Scodras S, Aravind G, Takhar P, Nekolaichuk E, Salbach NM. Distance-limited walk tests post-stroke: A systematic review of measurement properties. NeuroRehabilitation 2021; 48:413-439. [PMID: 33967070 PMCID: PMC8293643 DOI: 10.3233/nre-210026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 03/15/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND Improving walking capacity is a key objective of post-stroke rehabilitation. Evidence describing the quality and protocols of standardized tools for assessing walking capacity can facilitate their implementation. OBJECTIVE To synthesize existing literature describing test protocols and measurement properties of distance-limited walk tests in people post-stroke. METHODS Electronic database searches were completed in 2017. Records were screened and appraised for quality. RESULTS Data were extracted from 43 eligible articles. Among the 12 walk tests identified, the 10-metre walk test (10mWT) at a comfortable pace was most commonly evaluated. Sixty-three unique protocols at comfortable and fast paces were identified. Walking pace and walkway surface, but not walkway length, influenced walking speed. Intraclass correlation coefficients for test-retest reliability ranged from 0.80-0.99 across walk tests. Measurement error values ranged from 0.04-0.40 and 0.06 to 0.20 for the 10mWT at comfortable and fast and paces, respectively. Across walk tests, performance was most frequently correlated with measures of strength, balance, and physical activity (r = 0.26-0.8, p < 0.05). CONCLUSIONS The 10mWT has the most evidence of reliability and validity. Findings indicate that studies that include people with severe walking deficits, in acute and subacute phases of recovery, with improved quality of reporting, are needed.
Collapse
Affiliation(s)
- Darren Kai-Young Cheng
- Department of Physical Therapy, University of Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Canada
| | | | - Kyla Alsbury-Nealy
- Department of Physical Therapy, University of Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Canada
| | - Jean Michelle Legasto
- Department of Physical Therapy, University of Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Canada
| | - Stephanie Scodras
- Department of Physical Therapy, University of Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Canada
| | - Gayatri Aravind
- Michener Institute of Education, University Health Network, Canada
| | - Pam Takhar
- Department of Physical Therapy, University of Toronto, Canada
| | - Erica Nekolaichuk
- Gerstein Science Information Centre, University of Toronto, Toronto, ON, Canada
| | - Nancy Margaret Salbach
- Department of Physical Therapy, University of Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Canada
| |
Collapse
|
11
|
Abstract
Neurological diseases, particularly in the context of aging, have serious impacts on quality of life and can negatively affect bone health. The brain-bone axis is critically important for skeletal metabolism, sensory innervation, and endocrine cross-talk between these organs. This review discusses current evidence for the cellular and molecular mechanisms by which various neurological disease categories, including autoimmune, developmental, dementia-related, movement, neuromuscular, stroke, trauma, and psychological, impart changes in bone homeostasis and mass, as well as fracture risk. Likewise, how bone may affect neurological function is discussed. Gaining a better understanding of brain-bone interactions, particularly in patients with underlying neurological disorders, may lead to development of novel therapies and discovery of shared risk factors, as well as highlight the need for broad, whole-health clinical approaches toward treatment.
Collapse
Affiliation(s)
- Ryan R. Kelly
- Research Services, Ralph H. Johnson VA Medical Center, Charleston, SC, United States
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Sara J. Sidles
- Research Services, Ralph H. Johnson VA Medical Center, Charleston, SC, United States
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Amanda C. LaRue
- Research Services, Ralph H. Johnson VA Medical Center, Charleston, SC, United States
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC, United States
| |
Collapse
|
12
|
Breloff SP, Bachman JL, Lugade VA, Stuka AD. THE EFFECT OF BLOOD GLUCOSE ON QUIET STANDING BALANCE IN YOUNG HEALTHY INDIVIDUALS. Biomed Eng (Singapore) 2020; 32. [PMID: 32831529 DOI: 10.4015/s1016237220500167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Falling is one of the leading causes of accidental injury and death among elderly adults and construction workers, with costs exceeding US$31 billion each year. Having good balance reduces the likelihood of falling - therefore it is important to determine which possible factors might influence balance. The purpose of this study was to determine if consuming three different types of breakfast altered blood glucose levels in such a way that young healthy individual's balance control was compromised. Balance was then measured while the subjects completed single- and dual-task standing trials with eyes open and closed. Although changing blood glucose did alter quiet standing balance - as measured by the separation distance between the COG and COP, the velocity of the COM, and the total distance traveled by the COG and COP along the anterior-posterior (AP) and medial-lateral (ML) axes - the results were contradictory to what was hypothesized. Subjects with lower blood glucose swayed less than those with higher blood glucose. This could potentially be due to the habitual skipping of breakfast in young adults. Though the changing of blood glucose did influence quiet standing balance of young healthy adults, it was not in a way which increased the risk of falling.
Collapse
Affiliation(s)
- Scott P Breloff
- National Institute for Occupational Safety and Health 1095 Willowdale Road, MS L-2027 Morgantown, WV 26505, USA.,The University of Scranton Scranton, PA 18510, USA
| | | | | | | |
Collapse
|
13
|
Verstraeten S, Mark RE, Dieleman J, van Rijsbergen M, de Kort P, Sitskoorn MM. Motor Impairment Three Months Post Stroke Implies A Corresponding Cognitive Deficit. J Stroke Cerebrovasc Dis 2020; 29:105119. [PMID: 32912505 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 06/06/2020] [Accepted: 06/29/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND While both motor and cognitive impairment are common after stroke, the focus of (early) treatment has always been on motor deficit. AIMS The objective of the current study was to explore the link between motor and cognitive performance in stroke patients and to examine whether motor performance is associated with cognitive functioning at three months post stroke. METHODS In both stroke patients (n = 142) and controls (n = 135), with the groups matched on age, gender and premorbid IQ, motor functioning was evaluated using both objective (Purdue Pegboard Test) and subjective measures (specific items from the Frenchay Activities Index and Barthel Index). Cognition, specifically information processing speed, working memory and cognitive flexibility, was assessed using objective tasks. The data were analyzed using Pearson product-moment correlation coefficients and logistic regression. RESULTS Significant correlations between motor and cognitive functioning were found in stroke patients. The objective motor task was stronger than subjective measures in statistically explaining and predicting cognitive deficit, irrespective of stroke severity. CONCLUSIONS We conclude that motor impairment at three months post-stroke should serve as a 'red flag' for professionals: cognitive impairment is likely and should also be evaluated.
Collapse
Affiliation(s)
- Sonja Verstraeten
- Department of Medical Psychology, Máxima Medical Center, The Netherlands.
| | - Ruth E Mark
- Department of Cognitive Neuropsychology, Tilburg University, The Netherlands
| | | | | | | | | |
Collapse
|
14
|
Cheng DK, Nelson M, Brooks D, Salbach NM. Validation of stroke-specific protocols for the 10-meter walk test and 6-minute walk test conducted using 15-meter and 30-meter walkways. Top Stroke Rehabil 2019; 27:251-261. [DOI: 10.1080/10749357.2019.1691815] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Darren K. Cheng
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Michelle Nelson
- Lunenfeld-Tanenbaum Research Institute-Sinai Health System, Bridgepoint Collaboratory for Research and Innovation, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Dina Brooks
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Canada
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Nancy M. Salbach
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| |
Collapse
|
15
|
Peters S, Eng JJ, Liu-Ambrose T, Borich MR, Dao E, Amanian A, Boyd LA. Brain activity associated with Dual-task performance of Ankle motor control during cognitive challenge. Brain Behav 2019; 9:e01349. [PMID: 31265216 PMCID: PMC6710191 DOI: 10.1002/brb3.1349] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 05/24/2019] [Accepted: 06/08/2019] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Skilled Ankle motor control is frequently required while performing secondary cognitively demanding tasks such as socializing and avoiding obstacles while walking, termed "Dual tasking." It is likely that Dual-task performance increases demand on the brain, as both motor and cognitive systems require neural resources. The purpose of this study was to use functional MRI to understand which brain regions are involved in resolving Dual-task interference created by requiring high levels of Ankle motor control during a cognitive task. METHODS Using functional MRI, brain activity was measured in sixteen young adults during performance of visually cued Ankle plantar flexion to a target (Ankle task), a cognitive task (Flanker task), and both tasks simultaneously (Dual task). RESULTS Dual-task performance did not impact the Ankle task (p = 0.78), but did affect behavior on the Flanker task. Response times for both the congruent and incongruent conditions during the Flanker task were significantly longer (p < 0.001, p = 0.050, respectively), and accuracy for the congruent condition decreased during Dual tasking (p < 0.001). Activity in 3 brain regions was associated with Dual-task Flanker performance. Percent signal change from baseline in Brodmann area (BA) 5, BA6, and the left caudate correlated with performance on the Flanker task during the Dual-task condition (R2 = 0.261, p = 0.04; R2 = -0.258, p = 0.04; R2 = 0.303, p = 0.03, respectively). CONCLUSIONS Performance of Ankle motor control may be prioritized over a cognitive task during Dual-task performance. Our work advances Dual-task research by elucidating patterns of whole brain activity for Dual tasks that require Ankle motor control during a cognitive task.
Collapse
Affiliation(s)
- Sue Peters
- Faculty of Medicine, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Janice J Eng
- Faculty of Medicine, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Teresa Liu-Ambrose
- Faculty of Medicine, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael R Borich
- School of Medicine, Division of Physical Therapy, Emory University, Atlanta, Georgia
| | - Elizabeth Dao
- Graduate Program in Rehabilitation Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ameen Amanian
- Faculty of Applied Science, Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lara A Boyd
- Faculty of Medicine, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
16
|
Abstract
Muscle coordination is often impaired after stroke, leading to deficits in the control of walking and balance. In this study, we examined features of muscle coordination associated with reduced walking performance in chronic stroke survivors using motor module (a.k.a. muscle synergy) analysis. We identified differences between stroke survivors and age-similar neurotypical controls in the modular control of both overground walking and standing reactive balance. In contrast to previous studies that demonstrated reduced motor module number poststroke, our cohort of stroke survivors did not exhibit a reduction in motor module number compared with controls during either walking or reactive balance. Instead, the pool of motor modules common to walking and reactive balance was smaller, suggesting reduced generalizability of motor module function across behaviors. The motor modules common to walking and reactive balance tended to be less variable and more distinct, suggesting more reliable output compared with motor modules specific to either behavior. Greater motor module generalization in stroke survivors was associated with faster walking speed, more normal step length asymmetry, and narrower step widths. Our work is the first to show that motor module generalization across walking and balance may help to distinguish important and clinically relevant differences in walking performance across stroke survivors that would have been overlooked by examining only a single behavior. Finally, because similar relationships between motor module generalization and walking performance have been demonstrated in healthy young adults and individuals with Parkinson's disease, this suggests that motor module generalization across walking and balance may be important for well-coordinated walking. NEW & NOTEWORTHY This is the first work to simultaneously examine neuromuscular control of walking and standing reactive balance in stroke survivors. We show that motor module generalization across these behaviors (i.e., recruiting common motor modules) is reduced compared with controls and is associated with slower walking speeds, asymmetric step lengths, and larger step widths. This is true despite no between-group differences in module number, suggesting that motor module generalization across walking and balance is important for well-coordinated walking.
Collapse
Affiliation(s)
- Jessica L Allen
- Department of Chemical and Biomedical Engineering, West Virginia University , Morgantown, West Virginia
| | - Trisha M Kesar
- Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University School of Medicine , Atlanta, Georgia
| | - Lena H Ting
- Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University School of Medicine , Atlanta, Georgia.,Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology , Atlanta, Georgia
| |
Collapse
|
17
|
Chung SH, Kim JH, Yong SY, Lee YH, Park JM, Kim SH, Lee HC. Effect of Task-Specific Lower Extremity Training on Cognitive and Gait Function in Stroke Patients: A Prospective Randomized Controlled Trial. Ann Rehabil Med 2019; 43:1-10. [PMID: 30852865 PMCID: PMC6409654 DOI: 10.5535/arm.2019.43.1.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 08/22/2018] [Indexed: 02/04/2023] Open
Abstract
Objective To elucidate the effect of task-specific lower extremity training (TSLET) on cognitive and gait function in stroke patients. Methods Thirty-eight patients were assigned to either the TSLET group or the control group. The individuals of TSLET group went through a TSLET plus conventional physical therapy. The control group received two sessions of conventional physical therapy. The primary outcome involved the assessment with visual and auditory digit span test. The secondary outcome was evaluated by the Korean version of Mini-Mental State Examination (K-MMSE) and Global Deterioration Scale (GDS) for cognitive function, Berg Balance Scale (BBS), Time Up and Go Test (TUG), 10 meters Walking Test (10mWT), 6 minutes Walking Test (6MWT), and Korean version of Modified Barthel Index (K-MBI) for gait, balance, and functional ability. Results After intervention (3 weeks) and 2 weeks of follow-up, the TSLET group showed statistically significant improvement in the visual digit span test backwards compared with the control group. In secondary outcome, a significant improvement was observed in GDS, BBS, TUG, and 10mWT in the TSLET group. There was no significant difference between the two groups concerning visual digit span test forward, auditory forward and backward digit span tests, K-MMSE, 6MWT, and K-MBI. Conclusion TSLET could be a useful alternative strategy for improving cognitive and gait function in stroke patients.
Collapse
Affiliation(s)
- Sae Hoon Chung
- Department of Rehabilitation Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Ji Hyun Kim
- Department of Rehabilitation Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Sang Yeol Yong
- Department of Rehabilitation Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Young Hee Lee
- Department of Rehabilitation Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jung Mee Park
- Department of Rehabilitation Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Sung Hoon Kim
- Department of Rehabilitation Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Hi Chan Lee
- Department of Rehabilitation Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| |
Collapse
|
18
|
Adachi T, Kamiya K, Kono Y, Iwatsu K, Shimizu Y, Honda I, Yamada S. Estimation of reduced walking speed using simple measurements of physical and psychophysiological function in community-dwelling elderly people: a cross-sectional and longitudinal study. Aging Clin Exp Res 2019; 31:59-66. [PMID: 29594823 DOI: 10.1007/s40520-018-0938-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 03/23/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Early detection of reduced mobility function is important in elderly people. Usual walking speed is useful to assess mobility function, but is often not feasible in a community setting. AIMS This study aimed to explore a simple surrogate indicator of usual walking speed in elderly people. METHODS The participants were 516 community-dwelling elderly people. As a baseline survey, the usual walking speed and candidates of surrogate indicators including physical function and psychophysiological function were measured. After 2 years, the occurrence of mobility limitation was assessed. RESULTS In cross-sectional analysis, a linear regression model with maximum step length, age, and sex presented the most favourable adjusted R2 of 0.426 for estimating usual walking speed. Maximum step length (MSL) also showed good predictive accuracy for usual walking speed < 0.8 m/s {area under the curve [AUC] 0.908 [95% confidence interval (CI) 0.811, 1.000]} and < 1.0 m/s [AUC 0.883 (95% CI) 0.832, 0.933)] in receiver-operating characteristic (ROC) analysis. In longitudinal analysis, the predictive accuracy of MSL for mobility limitation [AUC 0.813 (95% CI 0.752, 0.874)] was similar to that of usual walking speed [AUC 0.808 (95% CI 0.747, 0.869)] in ROC analysis. CONCLUSIONS AND DISCUSSION The results of this study suggest that MSL may serve as a simple surrogate indicator of UWS in elderly people.
Collapse
Affiliation(s)
- Takuji Adachi
- Program in Physical and Occupational Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kuniyasu Kamiya
- Department of Hygiene and Public Health, Osaka Medical College, Takatsuki, Japan
| | - Yuji Kono
- Department of Rehabilitation, Fujita Health University Banbuntane Hotokukai Hospital, Nagoya, Japan
| | - Kotaro Iwatsu
- Department of Rehabilitation, Hirakata Kohsai Hospital, Hirakata, Japan
| | - Yuko Shimizu
- Department of Rehabilitation Science, Nagoya University Graduate School of Medicine, 1-1-20, Daiko-minami, Higashi-ku, Nagoya, 461-8673, Japan
| | - Ikumi Honda
- Department of Nursing, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Sumio Yamada
- Department of Rehabilitation Science, Nagoya University Graduate School of Medicine, 1-1-20, Daiko-minami, Higashi-ku, Nagoya, 461-8673, Japan.
| |
Collapse
|
19
|
Kitamura H, Yamada S, Adachi T, Shibata K, Tamaki M, Okawa Y, Usui A. Effect of Perioperative Neuromuscular Electrical Stimulation in Patients Undergoing Cardiovascular Surgery: A Pilot Randomized Controlled Trial. Semin Thorac Cardiovasc Surg 2018; 31:361-367. [PMID: 30395965 DOI: 10.1053/j.semtcvs.2018.10.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 10/30/2018] [Indexed: 11/11/2022]
Abstract
A randomized, controlled trial was conducted to examine the effects of perioperative neuromuscular electrical stimulation on muscle proteolysis and physical function using blinded assessment of physical function. Consecutive patients undergoing cardiovascular surgery were screened for eligibility as study subjects. Participants were randomly assigned to receive either neuromuscular electrical stimulation or the usual postoperative mobilization program. The intervention group received neuromuscular electrical stimulation on bilateral legs 8 times before and after surgery. The primary outcomes were the mean 3-methylhistidine concentration corrected for urinary creatinine content from baseline to postoperative day 6, and knee extensor isometric muscle strength on postoperative day 7. Secondary outcomes were usual walking speed and grip strength. Physical therapists blinded to patient allocation performed measurements of physical function. Of 498 consecutive patients screened for eligibility, 119 participants (intervention group, n = 60; control group, n = 59) were enrolled. In the overall subjects, there were no differences in any outcomes between the intervention and control groups. The results demonstrated no significant effects of neuromuscular electrical stimulation on muscle proteolysis and physical function after cardiovascular surgery, suggesting the need to explore indications for neuromuscular electrical stimulation and to clarify the effects in terms of the dose-response relationship.
Collapse
Affiliation(s)
- Hideki Kitamura
- Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Japan
| | - Sumio Yamada
- Department of Health Science, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Takuji Adachi
- Program in Physical and Occupational Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenichi Shibata
- Program in Physical and Occupational Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Cardiac Rehabilitation, Nagoya Heart Center, Nagoya, Japan
| | - Mototsugu Tamaki
- Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Japan
| | - Yasuhide Okawa
- Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Japan
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| |
Collapse
|
20
|
Redfern MS, Chambers AJ, Sparto PJ, Furman JM, Jennings JR. Inhibition and decision-processing speed are associated with performance on dynamic posturography in older adults. Exp Brain Res 2019; 237:37-45. [PMID: 30302490 DOI: 10.1007/s00221-018-5394-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 10/04/2018] [Indexed: 10/28/2022]
Abstract
Changes in cognition due to age have been associated with falls and reduced standing postural control. Sensory integration is one component of postural control that may be influenced by certain aspects of cognitive functioning. This study investigated associations between measures of cognitive function and sensory integration capabilities for healthy young and older adults. Dynamic posturography was performed using the Equitest Sensory Organization Test (SOT) protocol to evaluate sensory integration during standing using sway-referencing of the platform and/or visual scene to alter somatosensory and visual inputs. The Equilibrium Score was used as a measure of sway. Cognitive testing examined aspects of cognitive function that have been associated with falls in older adults. A correlational analysis investigated associations between the cognitive measures and postural sway during the altered sensory conditions of the SOT. For older subjects only, slower decision-processing speed was associated with increased sway during SOT conditions whenever somatosensation was altered. Reduced perceptual inhibition was associated with increased sway whenever somatosensation was intact, and particularly when vision was altered in the presence of somatosensation. Visuospatial construct ability was associated with sway only when the eyes were closed during altered somatosensation. Task-switching was associated with sway only when vision and somatosensation were intact. With increased age, deficits in decision speed and inhibition appear associated with the sensory integration crucial for balance maintenance. Associations are modulated by the availability of somatosensation and vision. These associations define situations and individual differences in aspects of cognition that may relate to situational loss of balance in older adults.
Collapse
|
21
|
Peters S, Brown KE, Garland SJ, Staines WR, Handy TC, Boyd LA. Suppression of somatosensory stimuli during motor planning may explain levels of balance and mobility after stroke. Eur J Neurosci 2018; 48:3534-3551. [PMID: 30151944 DOI: 10.1111/ejn.14136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 08/10/2018] [Accepted: 08/16/2018] [Indexed: 12/01/2022]
Abstract
The ability to actively suppress, or gate, irrelevant sensory information is required for safe and efficient walking in sensory-rich environments. Both motor attention and motor planning alter somatosensory evoked potentials (SEPs) in healthy adults. This study's aim was to examine the effect of motor attention on processing of irrelevant somatosensory information during plantar flexion motor planning after stroke. Thirteen healthy older adults and 11 individuals with stroke participated. Irrelevant tibial nerve stimulation was delivered while SEPs were recorded over Cz, overlaying the leg portion of the sensorimotor cortex at the vertex of the head. Three conditions were tested in both legs: (1) Rest, (2) Attend To, and (3) Attend Away from the stimulated limb. In conditions 2 and 3, relevant vibration cued voluntary plantar flexion movements of the stimulated (Attend To) or non-stimulated (Attend Away) leg. SEP amplitudes were averaged during motor planning per condition. Individuals with stroke did not show attention-mediated gating of the N40 component associated with irrelevant somatosensory information during motor planning. It may be that dysfunction in pathways connecting to area 3b explains the lack of attention-mediated gating of the N40. Also, attention-mediated gating during motor planning explained significant and unique variance in a measure of community balance and mobility combined with response time. Thus, the ability to gate irrelevant somatosensory information appears important for stepping in both older adults and after stroke. Our data suggest that therapies that direct motor attention could positively impact walking after stroke.
Collapse
Affiliation(s)
- Sue Peters
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Katlyn E Brown
- Graduate Programs in Rehabilitation Sciences, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - S Jayne Garland
- Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - W Richard Staines
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | - Todd C Handy
- Department of Psychology, Faculty of Arts, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lara A Boyd
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
22
|
Ramnath U, Rauch L, Lambert EV, Kolbe-Alexander TL. The relationship between functional status, physical fitness and cognitive performance in physically active older adults: A pilot study. PLoS One 2018; 13:e0194918. [PMID: 29630625 PMCID: PMC5890973 DOI: 10.1371/journal.pone.0194918] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 03/13/2018] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE Ageing is associated with a progressive decline in physical function and cognitive performance which could result in a shift from an independent to a more dependent lifestyle. The aim of this research study was to assess the fitness, functional performance and cognitive ability in independently living older South Africans and to determine which fitness parameters and functional performance tests best explain the variance in cognitive function. DESIGN Descriptive observational study. PARTICIPANTS Older adults with a mean age 71±4.7 years (n = 70; 28 men and 42 women) were recruited. Sixty percent of the sample completed at least secondary schooling and more than two-thirds were taking medication for a chronic medical condition. MEASUREMENTS Self-reported physical activity was assessed using the Yale Physical Activity Survey. Fitness tests included the 6-minute walk test and Bicep Curls. The functional performance tests were; Static and Dynamic balance, Timed Up and Go, Sit to Stand, Grip strength and Functional Reach. The Stroop Task and 6-Item cognitive impairment test were used to measure cognitive performance. Bivariate and multivariate analyses were conducted between performance on the novel cognitive Stroop Task and functional and cognitive tests. RESULTS We found significant relationships between the number of correct responses on the Stroop Task and scores on the 6-Item Cognitive Impairment test (-0.520, p < 0.01) and grip strength (r = 0.42, p< 0.01). The number of incorrect responses was inversely associated with functional reach (r = -0.445, p< 0.01). The final regression model included: age, dynamic balance, right arm grip strength and the score on the 6-item cognitive impairment test, and explained 44% of the variance in performance of the Stroop Task. CONCLUSIONS The results of this study showed that measures of physical function were associated with cognitive performance even in highly functioning older South African adults. Further research is needed to determine the extent to which exercise training can improve functional capacity and the effect on cognitive performance.
Collapse
Affiliation(s)
- U. Ramnath
- Department of Human Biology, Division of Exercise Science and Sports Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - L. Rauch
- Department of Human Biology, Division of Exercise Science and Sports Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - E. V. Lambert
- Department of Human Biology, Division of Exercise Science and Sports Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - T. L. Kolbe-Alexander
- Department of Human Biology, Division of Exercise Science and Sports Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- School of Health and Well-being, University of Southern Queensland, Ipswich, Australia
| |
Collapse
|
23
|
Shiri V, Emami M, Shiri E. Investigating the Relationship Between Selective Attention and Cognitive Flexibility With Balance in Patients With Relapsing-Remitting Multiple Sclerosis. J Rehabil 2018. [DOI: 10.21859/jrehab.18.4.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
24
|
Adachi T, Kono Y, Iwatsu K, Shimizu Y, Yamada S. Duration of moderate to vigorous daily activity is negatively associated with slow walking speed independently from step counts in elderly women aged 75 years or over: A cross-sectional study. Arch Gerontol Geriatr 2018; 74:94-9. [DOI: 10.1016/j.archger.2017.10.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 10/02/2017] [Accepted: 10/03/2017] [Indexed: 12/25/2022]
|
25
|
Falck RS, Wilcox S, Best JR, Chandler JL, Liu-Ambrose T. The Association Between Physical Performance and Executive Function in a Sample of Rural Older Adults from South Carolina, USA. Exp Aging Res 2017; 43:192-205. [PMID: 28230419 DOI: 10.1080/0361073x.2017.1276379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Mobility and executive functions (EFs) decline with age, although associations between mobility and EFs are less clear. This study examined relationships between different mobility measures and EFs among rural older adults. METHODS This cross-sectional study recruited 56 older adults (60+ years) in rural South Carolina. Mobility was assessed via gait speed, timed up-and-go, chair stand, and as a composite physical performance score (PPS). EFs was assessed via Trail Making Test, semantic fluency, and phonemic fluency. Bivariate analyses were performed and regressions were calculated controlling for appropriate covariates, with PPS as the independent variable and each EF test as the dependent variable. RESULTS Mean age was 74.22 years (SD = 8.02), 80.40% were female and 64.71% were white. Bivariate analysis revealed associations between gait speed and Trail Making Test (r = -.33; p = .03), between timed up-and-go and Trail Making Test (r = .34; p = .01), and between PPS and Trail Making Test (r = -.33; p = .03). The regression models indicated higher PPS was associated with better performance on Trail Making Test (β = -1.12; p < 0.01), phonemic fluency (β = 0.68; p = .01), and semantic fluency (β = 0.81; p = .02). CONCLUSIONS In a rural setting, mobility is associated with multiple EF processes. Higher mobility and physical ability are desired for maintaining EFs capability.
Collapse
Affiliation(s)
- Ryan S Falck
- a Department of Physical Therapy , University of British Columbia , Vancouver , British Columbia , Canada
| | - Sara Wilcox
- b Department of Exercise Science , University of South Carolina , Columbia , South Carolina , USA
| | - John R Best
- a Department of Physical Therapy , University of British Columbia , Vancouver , British Columbia , Canada
| | - Jessica L Chandler
- b Department of Exercise Science , University of South Carolina , Columbia , South Carolina , USA
| | - Teresa Liu-Ambrose
- c Aging, Mobility, and Cognitive Neuroscience Laboratory, Department of Physical Therapy, Faculty of Medicine , University of British Columbia , Vancouver , British Columbia , Canada
| |
Collapse
|
26
|
Salbach NM, OʼBrien KK, Brooks D, Irvin E, Martino R, Takhar P, Chan S, Howe JA. Considerations for the Selection of Time-Limited Walk Tests Poststroke: A Systematic Review of Test Protocols and Measurement Properties. J Neurol Phys Ther 2017; 41:3-17. [PMID: 27977516 DOI: 10.1097/npt.0000000000000159] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND PURPOSE Systematic reviews of research evidence describing the quality and methods for administering standardized outcome measures are essential to developing recommendations for their clinical application. The purpose of this systematic review was to synthesize the research literature describing test protocols and measurement properties of time-limited walk tests in people poststroke. METHODS Following an electronic search of 7 bibliographic data-bases, 2 authors independently screened titles and abstracts. One author identified eligible articles, and performed quality appraisal and data extraction. RESULTS Of 12 180 records identified, 43 articles were included. Among 5 walk tests described, the 6-minute walk test (6MWT) was most frequently evaluated (n = 36). Only 5 articles included participants in the acute phase (<1 month) poststroke. Within tests, protocols varied. Walkway length and walking aid, but not turning direction, influenced 6MWT performance. Intraclass correlation coefficients for reliability were 0.68 to 0.71 (12MWT) and 0.80 to 1.00 (2-, 3-, 5- and 6MWT). Minimal detectable change values at the 90% confidence level were 11.4 m (2MWT), 24.4 m (5MWT), and 27.7 to 52.1 m (6MWT; n = 6). Moderate-to-strong correlations (≥0.5) between 6MWT distance and balance, motor function, walking speed, mobility, and stair capacity were consistently observed (n = 33). Moderate-to-strong correlations between 5MWT performance and walking speed/independence (n = 1), and between 12MWT performance and balance, motor function, and walking speed (n = 1) were reported. DISCUSSION AND CONCLUSIONS Strong evidence of the reliability and construct validity of using the 6MWT poststroke exists; studies in the acute phase are lacking. Because protocol variations influence performance, a standardized 6MWT protocol poststroke for use across the care continuum is needed.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A150).
Collapse
Affiliation(s)
- Nancy M Salbach
- Department of Physical Therapy (N.M.S., K.K.O'B., D.B., P.T., J.-A.H.) and Department of Speech-Language Pathology (R.M.), Faculty of Medicine, University of Toronto, Canada; Institute for Work & Health, Toronto, Canada (E.I.); Allied Health Program, Toronto Western Hospital, University Health Network, Canada (S.C.); and Toronto Rehabilitation Institute, University Health Network, Canada (N.M.S., D.B., J.-A.H.)
| | | | | | | | | | | | | | | |
Collapse
|
27
|
Tan KM, Tan MP. Stroke and Falls-Clash of the Two Titans in Geriatrics. Geriatrics (Basel) 2016; 1:geriatrics1040031. [PMID: 31022824 PMCID: PMC6371176 DOI: 10.3390/geriatrics1040031] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 11/20/2016] [Accepted: 11/26/2016] [Indexed: 12/12/2022] Open
Abstract
Both stroke and falls are common conditions affecting the older adult. Despite stroke being considered a well-established major risk factor for falls, there remains no evidence for effective prevention strategies for falls specifically for stroke survivors. Previous observational studies evaluating falls risk factors in stroke have mainly been uncontrolled and found similar risk factors for stroke populations compared to general older populations. Specific risk factors, however, are likely to play a greater role in stroke survivors including unilateral weakness, hemisensory or visual neglect, impaired coordination, visual field defects, perceptual difficulties and cognitive issues. In addition, individuals with stroke are also more likely to have other associated risk factors for falls including diabetes, falls risk increasing drugs, atrial fibrillation, and other cardiovascular risk factors. While anticoagulation is associated with increased risk of intracranial bleeding after a fall, the risk of suffering a further stroke due to atrial fibrillation outweigh the risk of bleeding from a recurrent fall. Similarly, while blood pressure lowering medications may be linked to orthostatic hypotension which in turn increases the risk of falls, the benefit of good blood pressure control in terms of secondary stroke prevention outweighs the risk of falls. Until better evidence is available, the suggested management approach should then be based on local resources, and published evidence for fall prevention. Multicomponent exercise and individually tailored multifactorial interventions should still be considered as published evidence evaluating the above have included stroke patients in their study population.
Collapse
Affiliation(s)
- Kit Mun Tan
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia.
- Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia.
| | - Maw Pin Tan
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia.
- Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia.
| |
Collapse
|
28
|
Pedreira da Fonseca E, da Silva Ribeiro NM, Pinto EB. Therapeutic Effect of Virtual Reality on Post-Stroke Patients: Randomized Clinical Trial. J Stroke Cerebrovasc Dis 2016; 26:94-100. [PMID: 27693404 DOI: 10.1016/j.jstrokecerebrovasdis.2016.08.035] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 08/15/2016] [Accepted: 08/23/2016] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES The study aimed to check the therapeutic effect of virtual reality associated with conventional physiotherapy on gait balance and the occurrence of falls after a stroke. METHODS This was a randomized, blinded clinical trial conducted with post-stroke patients, randomized into two groups-treatment group and control group-and subjected to balance assessments by the Dynamic Gait Index and investigation of falls before and after 20 intervention sessions. Statistically significant difference was considered at P < .05. RESULTS We selected 30 patients, but there were three segment losses, resulting in a total of 13 patients in the control group and 14 in the treatment group. There was an improvement in gait balance and reduced occurrence of falls in both groups. After intervention, the differences in gait balance in the control group (P = .047) and the reduction in the occurrence of falls in the treatment group (P = .049) were significant. However, in intergroup analysis, there was no difference in the two outcomes. CONCLUSIONS Therapy with games was a useful tool for gait balance rehabilitation in post-stroke patients, with repercussions on the reduction of falls.
Collapse
Affiliation(s)
- Erika Pedreira da Fonseca
- Católica University of Salvador, Salvador, Bahia, Brazil; Bahia School of Medicine and Public Health, Salvador, Brazil.
| | | | | |
Collapse
|
29
|
Lord SR, Delbaere K, Gandevia SC. Use of a physiological profile to document motor impairment in ageing and in clinical groups. J Physiol 2016; 594:4513-23. [PMID: 26403457 PMCID: PMC4983617 DOI: 10.1113/jp271108] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 07/24/2015] [Indexed: 11/08/2022] Open
Abstract
Ageing decreases exercise performance and is frequently accompanied by reductions in cognitive performance. Deterioration in the physiological capacity to stand, locomote and exercise can manifest itself as falling over and represents a significant deterioration in sensorimotor control. In the elderly, falling leads to serious morbidity and mortality with major societal costs. Measurement of a suite of physiological capacities that are required for successful motor performance (including vision, muscle strength, proprioception and balance) has been used to produce a physiological profile assessment (PPA) which has been tracked over the age spectrum and in different diseases (e.g. multiple sclerosis, Parkinson's disease). As well as measures of specific physiological capacities, the PPA generates an overall 'score' which quantitatively measures an individual's cumulative risk of falling. The present review collates data from the PPA (and the physiological capacities it measures) as well as its use in strategies to reduce falls in the elderly and those with different diseases. We emphasise that (i) motor impairment arises via reductions in a wide range of sensorimotor abilities; (ii) the PPA approach not only gives a snapshot of the physiological capacity of an individual, but it also gives insight into the deficits among groups of individuals with particular diseases; and (iii) deficits in seemingly restricted and disparate physiological domains (e.g. vision, strength, cognition) are funnelled into impairments in tasks requiring upright balance. Motor impairments become more prevalent with ageing but careful physiological measurement and appropriate interventions offer a way to maximise health across the lifespan.
Collapse
Affiliation(s)
- S. R. Lord
- Neuroscience Research AustraliaUniversity of New South WalesBarker StreetRandwick, SydneyNew South Wales2031Australia
| | - K. Delbaere
- Neuroscience Research AustraliaUniversity of New South WalesBarker StreetRandwick, SydneyNew South Wales2031Australia
| | - S. C. Gandevia
- Neuroscience Research AustraliaUniversity of New South WalesBarker StreetRandwick, SydneyNew South Wales2031Australia
| |
Collapse
|
30
|
Bhatt T, Subramaniam S, Varghese R. Examining interference of different cognitive tasks on voluntary balance control in aging and stroke. Exp Brain Res 2016; 234:2575-84. [PMID: 27302401 DOI: 10.1007/s00221-016-4662-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 04/26/2016] [Indexed: 11/26/2022]
Abstract
This study compared the effect of semantic and working memory tasks when each was concurrently performed with a voluntary balance task to evaluate the differences in the resulting cognitive-motor interference (CMI) between healthy aging and aging with stroke. Older stroke survivors (n = 10), older healthy (n = 10) and young adults (n = 10) performed the limits of stability, balance test under single task (ST) and dual task (DT) with two different cognitive tasks, word list generation (WLG) and counting backwards (CB). Cognitive ability was evaluated by recording the number of words and digits counted while sitting (ST) and during balance tasks (DT). The balance and cognitive costs were computed using [(ST-DT)/ST] × 100 for all the variables. Across groups, the balance cost was significantly higher for the older stroke survivors group in the CB condition than older healthy (p < 0.05) and young adult groups (p < 0.05) but was similar between these two groups for the WLG task. Similarly, the cognitive cost was significantly higher in older stroke survivors than in older healthy (p < 0.05) and young adults (p < 0.01) for both the cognitive tasks. The working memory task resulted in greater CMI than the semantic one, and this difference seemed to be most apparent in older stroke survivors. Young adults showed the least CMI, with a similar performance on the two memory tasks. On the other hand, healthy aging and stroke impact both semantic and working memory. Stroke-related cognitive deficits may further significantly decrease working memory function.
Collapse
Affiliation(s)
- Tanvi Bhatt
- Department of Physical Therapy, University of Illinois at Chicago, 1919, W Taylor St, Chicago, IL, 60612, USA.
| | - Savitha Subramaniam
- Department of Physical Therapy, University of Illinois at Chicago, 1919, W Taylor St, Chicago, IL, 60612, USA
| | - Rini Varghese
- Department of Physical Therapy, University of Illinois at Chicago, 1919, W Taylor St, Chicago, IL, 60612, USA
| |
Collapse
|
31
|
Goh HT, Nadarajah M, Hamzah NB, Varadan P, Tan MP. Falls and Fear of Falling After Stroke: A Case-Control Study. PM R 2016; 8:1173-80. [PMID: 27268565 DOI: 10.1016/j.pmrj.2016.05.012] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 05/13/2016] [Accepted: 05/19/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Falls are common after stroke, with potentially serious consequences. Few investigations have included age-matched control participants to directly compare fall characteristics between older adults with and without stroke. Further, fear of falling, a significant psychological consequence of falls, has only been examined to a limited degree as a risk factor for future falls in a stroke population. OBJECTIVE To compare the fall history between older adults with and without a previous stroke and to identify the determinants of falls and fear of falling in older stroke survivors. DESIGN Case-control observational study. SETTING Primary teaching hospital. PARTICIPANTS Seventy-five patients with stroke (mean age ± standard deviation, 66 ± 7 years) and 50 age-matched control participants with no previous stroke were tested. METHODS Fall history, fear of falling, and physical, cognitive, and psychological function were assessed. A χ2 test was performed to compare characteristics between groups, and logistic regression was performed to determine the risk factors for falls and fear of falling. MAIN OUTCOME MEASURES Fall events in the past 12 months, Fall Efficacy Scale-International, Berg Balance Scale, Functional Ambulation Category, Fatigue Severity Scale, Montreal Cognitive Assessment, and Patient Healthy Questionnaire-9 were measured for all participants. Fugl-Meyer Motor Assessment was used to quantify severity of stroke motor impairments. RESULTS Twenty-three patients and 13 control participants reported at least one fall in the past 12 months (P = .58). Nine participants with stroke had recurrent falls (≥2 falls) compared with none of the control participants (P < .01). Participants with stroke reported greater concern for falling than did nonstroke control participants (P < .01). Female gender was associated with falls in the nonstroke group, whereas falls in the stroke group were not significantly associated with any measured outcomes. Fear of falling in the stroke group was associated with functional ambulation level and balance. Functional ambulation level alone explained 22% of variance in fear of falling in the stroke group. CONCLUSIONS Compared with persons without a stroke, patients with stroke were significantly more likely to experience recurrent falls and fear of falling. Falls in patients with stroke were not explained by any of the outcome measures used, whereas fear of falling was predicted by functional ambulation level. This study has identified potentially modifiable risk factors with which to devise future prevention strategies for falls in patients with stroke. LEVEL OF EVIDENCE III.
Collapse
|
32
|
Saverino A, Waller D, Rantell K, Parry R, Moriarty A, Playford ED. The Role of Cognitive Factors in Predicting Balance and Fall Risk in a Neuro-Rehabilitation Setting. PLoS One 2016; 11:e0153469. [PMID: 27115880 PMCID: PMC4846032 DOI: 10.1371/journal.pone.0153469] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 03/30/2016] [Indexed: 12/03/2022] Open
Abstract
Introduction There is a consistent body of evidence supporting the role of cognitive functions, particularly executive function, in the elderly and in neurological conditions which become more frequent with ageing. The aim of our study was to assess the role of different domains of cognitive functions to predict balance and fall risk in a sample of adults with various neurological conditions in a rehabilitation setting. Methods This was a prospective, cohort study conducted in a single centre in the UK. 114 participants consecutively admitted to a Neuro-Rehabilitation Unit were prospectively assessed for fall accidents. Baseline assessment included a measure of balance (Berg Balance Scale) and a battery of standard cognitive tests measuring executive function, speed of information processing, verbal and visual memory, visual perception and intellectual function. The outcomes of interest were the risk of becoming a faller, balance and fall rate. Results Two tests of executive function were significantly associated with fall risk, the Stroop Colour Word Test (IRR 1.01, 95% CI 1.00–1.03) and the number of errors on part B of the Trail Making Test (IRR 1.23, 95% CI 1.03–1.49). Composite scores of executive function, speed of information processing and visual memory domains resulted in 2 to 3 times increased likelihood of having better balance (OR 2.74 95% CI 1.08 to 6.94, OR 2.72 95% CI 1.16 to 6.36 and OR 2.44 95% CI 1.11 to 5.35 respectively). Conclusions Our results show that specific subcomponents of executive functions are able to predict fall risk, while a more global cognitive dysfunction is associated with poorer balance.
Collapse
Affiliation(s)
- A. Saverino
- Therapy and Rehabilitation Services, National Hospital for Neurology & Neurosurgery, London, United Kingdom
- Institute of Rehabilitation, Fondazione Salvatore Maugeri, Genova, Italy
- Wolfson Neurorehabilitation Centre, St Georges Hospital, London, United Kingdom
| | - D. Waller
- Therapy and Rehabilitation Services, National Hospital for Neurology & Neurosurgery, London, United Kingdom
| | - K. Rantell
- Research Support Centre, Joint UCL/UCLH/Royal Free Hospital, London, United Kingdom
- Institute of Neurology, University College London, London, United Kingdom
| | - R. Parry
- Therapy and Rehabilitation Services, National Hospital for Neurology & Neurosurgery, London, United Kingdom
| | - A. Moriarty
- Therapy and Rehabilitation Services, National Hospital for Neurology & Neurosurgery, London, United Kingdom
| | - E. D. Playford
- Therapy and Rehabilitation Services, National Hospital for Neurology & Neurosurgery, London, United Kingdom
- Institute of Neurology, University College London, London, United Kingdom
- * E-mail:
| |
Collapse
|
33
|
Maeda N, Urabe Y, Murakami M, Itotani K, Kato J. Discriminant analysis for predictor of falls in stroke patients by using the Berg Balance Scale. Singapore Med J 2016; 56:280-3. [PMID: 25678051 DOI: 10.11622/smedj.2015033] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION An observational study was carried out to estimate the strength of the relationships among balance, mobility and falls in hemiplegic stroke inpatients. The objective was to examine factors that may aid in the prediction of the likelihood of falls in stroke patients. METHODS A total of 53 stroke patients (30 male, 23 female) aged 67.0 ± 11.1 years were interviewed regarding their fall history. Physical performance was assessed using the Berg Balance Scale (BBS) and the Functional Independence Measure (FIM) scale. Variables that differed between fallers and non-fallers were identified, and a discriminant function analysis was carried out to determine the combination of variables that effectively predicted fall status. RESULTS Of the 53 stroke patients, 19 were fallers. Compared with the non-fallers, the fallers scored low on the FIM, and differed with respect to age, time from stroke onset, length of hospital stay, Brunnstrom recovery stage and admission BBS score. Discriminant analysis for predicting falls in stroke patients showed that admission BBS score was significantly related to the likelihood of falls. Moreover, discriminant analysis showed that the use of a significant BBS score to classify fallers and non-fallers had an accuracy of 81.1%. The discriminating criterion between the two groups was a score of 31 points on the BBS. CONCLUSION The results of this study suggest that BBS score is a strong predictor of falls in stroke patients. As balance is closely related to the risk of falls in hospitalised stroke patients, BBS might be useful in the prediction of falls.
Collapse
Affiliation(s)
- Noriaki Maeda
- Department of Sport Rehabilitation, Graduate of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yukio Urabe
- Department of Sport Rehabilitation, Graduate of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Masahito Murakami
- Department of Physical Therapy, Faculty of Rehabilitation, Kobe International University, Kobe, Hyogo, Japan
| | - Keisuke Itotani
- Department of Physical Therapy, Faculty of Rehabilitation, Kobe International University, Kobe, Hyogo, Japan
| | - Junichi Kato
- Department of Internal Medicine, Hyogo Prefectural Rehabilitation Center at Nishi-harima, Tatsuno, Japan
| |
Collapse
|
34
|
Verrel J, Lisofsky N, Kühn S, Lindenberger U. Normal aging increases postural preparation errors: Evidence from a two-choice response task with balance constraints. Gait Posture 2016; 44:143-8. [PMID: 27004648 DOI: 10.1016/j.gaitpost.2015.12.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 10/26/2015] [Accepted: 12/01/2015] [Indexed: 02/02/2023]
Abstract
Correlational studies indicate an association between age-related decline in balance and cognitive control, but these functions are rarely addressed within a single task. In this study, we investigate adult age differences in a two-choice response task with balance constraints under three levels of response conflict. Sixteen healthy young (20-30 years) and 16 healthy older adult participants (59-74 years) were cued symbolically (letter L vs. R) to lift either the left or the right foot from the floor in a standing position. Response conflict was manipulated by task-irrelevant visual stimuli showing congruent, incongruent, or no foot lift movement. Preparatory weight shifts (PWS) and foot lift movements were recorded using force plates and optical motion capture. Older adults showed longer response times (foot lift) and more PWS errors than younger adults. Incongruent distractors interfered with performance (greater response time and PWS errors), but this compatibility effect did not reliably differ between age groups. Response time effects of age and compatibility were strongly reduced or absent in trials without PWS errors, and for the onset of the first (erroneous) PWS in trials with preparation error. In addition, in older adults only, compatibility effects in the foot lift task correlated significantly with compatibility effects in the Flanker task. The present results strongly suggest that adult age differences in response latencies in a task with balance constraints are related to age-associated increases in postural preparation errors rather than being an epiphenomenon of general slowing.
Collapse
Affiliation(s)
- Julius Verrel
- Department of Lifespan Psychology, Max Planck Institute for Human Development,Berlin, Germany.
| | - Nina Lisofsky
- Department of Lifespan Psychology, Max Planck Institute for Human Development,Berlin, Germany
| | - Simone Kühn
- Department of Lifespan Psychology, Max Planck Institute for Human Development,Berlin, Germany
| | - Ulman Lindenberger
- Department of Lifespan Psychology, Max Planck Institute for Human Development,Berlin, Germany
| |
Collapse
|
35
|
Hasan SMM, Rancourt SN, Austin MW, Ploughman M. Defining Optimal Aerobic Exercise Parameters to Affect Complex Motor and Cognitive Outcomes after Stroke: A Systematic Review and Synthesis. Neural Plast 2016; 2016:2961573. [PMID: 26881101 PMCID: PMC4736968 DOI: 10.1155/2016/2961573] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 11/27/2015] [Accepted: 11/29/2015] [Indexed: 01/21/2023] Open
Abstract
Although poststroke aerobic exercise (AE) increases markers of neuroplasticity and protects perilesional tissue, the degree to which it enhances complex motor or cognitive outcomes is unknown. Previous research suggests that timing and dosage of exercise may be important. We synthesized data from clinical and animal studies in order to determine optimal AE training parameters and recovery outcomes for future research. Using predefined criteria, we included clinical trials of stroke of any type or duration and animal studies employing any established models of stroke. Of the 5,259 titles returned, 52 articles met our criteria, measuring the effects of AE on balance, lower extremity coordination, upper limb motor skills, learning, processing speed, memory, and executive function. We found that early-initiated low-to-moderate intensity AE improved locomotor coordination in rodents. In clinical trials, AE improved balance and lower limb coordination irrespective of intervention modality or parameter. In contrast, fine upper limb recovery was relatively resistant to AE. In terms of cognitive outcomes, poststroke AE in animals improved memory and learning, except when training was too intense. However, in clinical trials, combined training protocols more consistently improved cognition. We noted a paucity of studies examining the benefits of AE on recovery beyond cessation of the intervention.
Collapse
Affiliation(s)
- S. M. Mahmudul Hasan
- Recovery & Performance Laboratory, Faculty of Medicine, Memorial University, L.A. Miller Centre, Room 400, 100 Forest Road, St. John's, NL, Canada A1A 1E5
| | - Samantha N. Rancourt
- Recovery & Performance Laboratory, Faculty of Medicine, Memorial University, L.A. Miller Centre, Room 400, 100 Forest Road, St. John's, NL, Canada A1A 1E5
| | - Mark W. Austin
- Recovery & Performance Laboratory, Faculty of Medicine, Memorial University, L.A. Miller Centre, Room 400, 100 Forest Road, St. John's, NL, Canada A1A 1E5
| | - Michelle Ploughman
- Recovery & Performance Laboratory, Faculty of Medicine, Memorial University, L.A. Miller Centre, Room 400, 100 Forest Road, St. John's, NL, Canada A1A 1E5
| |
Collapse
|
36
|
Kim J, Kim Y, Yang KI, Kim DE, Kim SA. The Relationship Between Sleep Disturbance and Functional Status in Mild Stroke Patients. Ann Rehabil Med 2015; 39:545-52. [PMID: 26361590 PMCID: PMC4564701 DOI: 10.5535/arm.2015.39.4.545] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 12/12/2014] [Indexed: 11/20/2022] Open
Abstract
Objective To investigate the sleep state of mild stroke patients and relationship between sleep disturbance and functional status. Methods A total of 80 acute stroke patients were enrolled in this study. The criteria for inclusion in the study was as following: 1) first stroke, 2) cognitive function preserved enough to perform the test (Mini Mental State Examination ≥24), 3) good functional levels (Modified Rankin Scale ≤3), 4) upper extremity motor function preserved enough to perform occupational tests (hand strength test, Purdue pegboard test, 9-hole peg test, and Medical Research Council score ≥3), and 5) less than 2 weeks between the stroke and the assessment. Quality of sleep was assessed by using Pittsburg Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), and Stanford Sleepiness Scale (SSS). Activities of daily living was assessed by using the Modified Barthel Index (MBI) and depressed mood was assessed by using the Beck Depression Inventory (BDI). Gross and fine motor function of the upper extremity was assessed by using hand strength test (Jamar dynamometer), Purdue pegboard test, and the 9-hole peg test. Results The results of the occupational assessment were fine in the good sleepers. The PSQI, ESS, and ISI were correlated with some of the assessment tools (BDI, MBI, Purdue pegboard, 9-hole peg, and hand strength). Conclusion In conclusion, this study emphasizes that sleep disturbance can affect the functional status in mild acute stroke patients. Therefore, clinicians must consider sleep status in stroke patients and need to work to control it.
Collapse
Affiliation(s)
- Jinil Kim
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Yuntae Kim
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Kwang Ik Yang
- Sleep Disorders Center, Department of Neurology, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Doh-Eui Kim
- Sleep Disorders Center, Department of Neurology, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Soo A Kim
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| |
Collapse
|
37
|
Ursin MH, Bergland A, Fure B, Tørstad A, Tveit A, Ihle-Hansen H. Balance and Mobility as Predictors of Post-Stroke Cognitive Impairment. Dement Geriatr Cogn Dis Extra 2015. [PMID: 26195976 PMCID: PMC4483489 DOI: 10.1159/000381669] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background The number of patients with cognitive impairment following stroke is increasing due to the rise in the number of stroke survivors. Health authorities highlight the need for prediction and early diagnostics. The aims of this study were to investigate if balance and mobility may predict cognitive impairment 1 year after stroke. Methods The participants were patients with first-ever stroke or transient ischaemic attack (TIA). The exclusion criteria were pre-stroke cognitive impairment and dementia. Measurements of balance comprised the Berg Balance Scale (BBS) and the Figure of Eight test (Fig8). Mobility was measured by maximum walking speed and the Timed Up and Go test. Dementia and mild cognitive impairment were merged into a main outcome: cognitive impairment. Unadjusted and adjusted multivariate logistic regression models were performed. Results One hundred and eighty subjects performed balance and mobility measures at baseline, and 158 participated in the follow-up; 13 died and 9 did not complete the follow-up. Two variables made a significant contribution in the adjusted analyses (Fig8, BBS). The strongest predictor of cognitive impairment was Fig8 with an odds ratio of 1.06. Conclusion The results of Fig8 and BBS measured in the acute phase of stroke were predictors of cognitive impairment 1 year later in this cohort of first-ever stroke or TIA.
Collapse
Affiliation(s)
- Marie Helene Ursin
- Bærum Hospital, Vestre Viken, Gjettum, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Astrid Bergland
- Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Brynjar Fure
- The Norwegian Knowledge Centre for the Health Services, Oslo, Norway
| | - Audhild Tørstad
- Bærum Hospital, Vestre Viken, Gjettum, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Arnljot Tveit
- Bærum Hospital, Vestre Viken, Gjettum, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Hege Ihle-Hansen
- Bærum Hospital, Vestre Viken, Gjettum, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| |
Collapse
|
38
|
Frost Y, Weingarden H, Zeilig G, Nota A, Rand D. Self-Care Self-Efficacy Correlates with Independence in Basic Activities of Daily Living in Individuals with Chronic Stroke. J Stroke Cerebrovasc Dis 2015; 24:1649-55. [PMID: 25997978 DOI: 10.1016/j.jstrokecerebrovasdis.2015.03.054] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 01/18/2015] [Accepted: 03/23/2015] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND (1) To characterize the self-care self-efficacy (SCSE) of community dwelling individuals with chronic stroke and (2) to determine the contribution of SCSE to the independence in basic and instrumental activities of daily living (BADL and IADL) and the participation of individuals with chronic stroke. SCSE is the confidence in one's own ability to perform self-care activities. METHODS This cross-sectional study included fifty community-dwelling individuals mean (SD) age 59.8 (9.3) years, mean (SD) 3.1 (1.7) years post-stroke who were able to walk at least 10 meters. SCSE was assessed using the Stroke Self-Efficacy Questionnaire (SSEQ), BADL was assessed by the Functional Independence Measure (FIM) (interview), the IADL questionnaire assessed IADL and the Physical Activity Scale for Individuals with Physical Disabilities (PASIPD) assessed participation. Correlation and regression analyses were performed after controlling for grip strength, executive functions and gait speed, factors known to influence independence in daily living. RESULTS The mean SCSE level was moderate-high (70%). Significant moderate correlations were found between SCSE to independence in BADL (r = .596, P < .001), IADL (r = .567, P < .001) and participation (r = .340, P < .005). SCSE of our cohort explained 7.4% of the variance of the individual's independence in BADL after controlling for executive functions and gait speed, but did not contribute to their independence in IADL and participation. CONCLUSIONS Higher SCSE of individuals with chronic stroke contributes to more independence in BADL. Additional questionnaires regarding self efficacy for IADL should be developed and investigated.
Collapse
Affiliation(s)
- Yael Frost
- Department of Occupational Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Neurological Head Trauma Rehabilitation, The Chaim Sheba Medical Center at Tel-HaShomer, Ramat Gan, Israel
| | - Harold Weingarden
- Department of Neurological Rehabilitation, The Chaim Sheba Medical Center, Tel-HaShomer, Ramat Gan & Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gabi Zeilig
- Department of Neurological Rehabilitation, The Chaim Sheba Medical Center, Tel-HaShomer, Ramat Gan & Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ayala Nota
- Occupational Therapy Services, The Chaim Sheba Medical Center, Tel-HaShomer, Ramat Gan, Israel
| | - Debbie Rand
- Department of Occupational Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| |
Collapse
|
39
|
Hayes S, Donnellan C, Stokes E. Executive dysfunction and balance function post-stroke: A cross-sectional study. Physiotherapy 2015; 102:64-70. [PMID: 26031841 DOI: 10.1016/j.physio.2015.03.3719] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 03/20/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES This study investigated the: (1) prevalence of executive dysfunction (ED); (2) demographic and clinical differences between participants with ED and without ED and; (3) independent association between executive function (EF) and balance post-stroke. DESIGN Prospective observational cross-sectional study. SETTING Four large acute hospitals. PARTICIPANTS Convenience sample of people with first stroke. MAIN OUTCOME Balance function. SECONDARY OUTCOMES EF, stroke severity, depression and global cognition. METHODS Descriptive statistics were used to report the prevalence of ED post-stroke. Comparisons of demographic and clinical characteristics were made between participants with ED and participants without ED using independent t-tests. Hierarchical multiple linear regression analysis determined the association between EF and balance post-stroke. RESULTS Participant (n=100) age ranged from 31 to 98 years, time since stroke ranged from 4 to 180 days and the participants reported formal education ranging from 7 to 21 years. Participants with ED had more severe strokes (BADS) [median (IQR) vs. median (IQR), p-value] [(44 (16) vs. (51 (7), p<0.01], poorer global cognition [24 (6) vs. 29 (2), p<0.01] and poorer balance [29 (40) vs. 46.5 (17), p<0.01] in comparison with participants without ED. Age (β=-0.24, p<0.05), years in education, (β=-0.21, p<0.05), stroke severity (β=0.71, p<0.01), time since stroke, (β=-0.17, p<0.01) and EF (β=0.19, p<0.05) were independently associated with balance post-stroke. The total variance in balance explained by the model was 72%. CONCLUSIONS ED is independently associated with balance post-stroke. Physiotherapists should consider this when developing rehabilitation strategies to improve balance post-stroke.
Collapse
Affiliation(s)
- Sara Hayes
- Department of Clinical Therapies, University of Limerick, Limerick, Ireland.
| | - Claire Donnellan
- School of Medicine, Royal College of Surgeons in Ireland, Medical University in Bahrain, Al Sayh, Bahrain.
| | - Emma Stokes
- Discipline of Physiotherapy, Trinity Centre for Health Sciences, St. James's Hospital, Dublin 8, Ireland.
| |
Collapse
|
40
|
Abstract
Stroke is a leading cause of disability worldwide. Cognitive functions and, in particular, executive function, are commonly affected after stroke, leading to impairments in performance of daily activities, decrease in social participation and in quality of life. Appropriate assessment and understanding of executive dysfunction are important, firstly to develop better rehabilitation strategies for executive functions per se and secondly to consider executive function abilities on rehabilitation strategies in general. The purpose of this review was to identify the most widely used assessment tools of executive dysfunction for patients with stroke, and their psychometric properties. We systematically reviewed manuscripts published in English in databases from 1999 to 2015. We identified 35 publications. The most frequently used instruments were the Stroop, Digit Span and Trail making tests. Psychometric properties were described for the Executive Function Performance Test, Executive Clock Drawing Task, Chinese Frontal Assessment Battery and Virtual Action Planning — Supermarket, and two subtests of the Cambridge Cognitive Examination — Revised. There is a paucity of tools to reliably measure executive dysfunction after stroke, despite the fact that executive dysfunction is frequent. Identification of the best tools for executive dysfunction assessment is necessary to address important gaps in research and in clinical practice.
Collapse
Affiliation(s)
- Juliana Conti
- Neurostimulation Laboratory, Neurology Clinical Division. Hospital das Clínicas/Sao Paulo University
| | - Annette Sterr
- School of Psychology, University of Surrey, Guildford, UK and Visiting Professor, Neurostimulation Laboratory
| | | | - Adriana B Conforto
- Neurostimulation Laboratory, Neurology Clinical Division. Hospital das Clínicas/Sao Paulo University ; Hospital Israelita Albert Einstein, São Paulo, Brazil
| |
Collapse
|
41
|
Tellier M, Rochette A. Falling Through the Cracks: A Literature Review to Understand the Reality of Mild Stroke Survivors. Top Stroke Rehabil 2015; 16:454-62. [DOI: 10.1310/tsr1606-454] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
42
|
Liu-Ambrose T, Eng JJ. Exercise training and recreational activities to promote executive functions in chronic stroke: a proof-of-concept study. J Stroke Cerebrovasc Dis 2015; 24:130-7. [PMID: 25440324 PMCID: PMC4486380 DOI: 10.1016/j.jstrokecerebrovasdis.2014.08.012] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 03/25/2014] [Accepted: 08/01/2014] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Stroke survivors represent a target population in need of intervention strategies to promote cognitive function and prevent dementia. Both exercise and recreational activities are promising strategies. We assessed the effect of a 6-month exercise and recreation program on executive functions in adults with chronic stroke. METHODS A 6-month ancillary study within a multicentre randomized trial. Twenty-eight chronic stroke survivors (ie, ≥ 12 months since an index stroke) were randomized to 1 of 2 experimental groups: intervention (INT; n = 12) or delayed intervention (D-INT; n = 16). Participants of the INT group received a 6-month community-based structured program that included 2 sessions of exercise training and 1 session of recreation and leisure activities per week. Participants of the D-INT group received usual care. The primary outcome measure was the Stroop Test, a cognitive test of selective attention and conflict resolution. Secondary cognitive measures included set shifting and working memory. Mood, functional capacity, and general balance and mobility were additional secondary outcome measures. RESULTS Compared with the D-INT group, the INT group significantly improved selective attention and conflict resolution (P = .02), working memory (P = .04), and functional capacity (P = .02) at the end of the 6-month intervention period. Improved selective attention and conflict resolution was significantly associated with functional capacity at 6 months (r = .39; P = .04). CONCLUSIONS This is the first randomized study to demonstrate that an exercise and recreation program can significantly benefit executive functions in community-dwelling chronic stroke survivors who are mildly cognitively impaired-a population at high-risk for dementia and functional decline. Thus, clinicians should consider prescribing exercise and recreational activities in the cognitive rehabilitation of chronic stroke survivors.
Collapse
Affiliation(s)
- Teresa Liu-Ambrose
- Aging, Mobility, and Cognitive Neuroscience Laboratory, University of British Columbia, Vancouver, British Columbia, Canada; Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada; Brain Research Centre, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Janice J Eng
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada; Rehab Research Laboratory, GF Strong Rehab Centre, Vancouver, British Columbia, Canada
| |
Collapse
|
43
|
Mentiplay BF, Adair B, Bower KJ, Williams G, Tole G, Clark RA. Associations between lower limb strength and gait velocity following stroke: A systematic review. Brain Inj 2014; 29:409-22. [DOI: 10.3109/02699052.2014.995231] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
44
|
Campbell GB, Whyte EM, Sereika SM, Dew MA, Reynolds CF, Butters MA. Reliability and validity of the Executive Interview (EXIT) and Quick EXIT among community dwelling older adults. Am J Geriatr Psychiatry 2014; 22:1444-51. [PMID: 24119860 PMCID: PMC3980173 DOI: 10.1016/j.jagp.2013.08.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 08/27/2013] [Accepted: 08/30/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To investigate the psychometric properties of the Executive Interview (EXIT) and Quick EXIT in community dwelling older adults. DESIGN Secondary analysis of data obtained as part of a longitudinal study of cognitive function in late-life depression. SETTING A university hospital. PARTICIPANTS Community-dwelling adults (N = 422), aged 59 years and older, with current or recent history of non-psychotic unipolar major depression, and never-depressed comparison subjects. MEASUREMENTS The EXIT and other measures of executive control functions (ECF), non-executive cognitive domains, and global cognitive function. We calculated Quick EXIT scores from the EXIT. RESULTS The EXIT demonstrated high inter-rater reliability (Intraclass correlation coefficient = 0.978, F(7, 21) = 174.85, p <0.001), and both the EXIT and Quick EXIT demonstrated moderate internal consistency (α = 0.66 and α = 0.68, respectively). Both tests also demonstrated acceptable convergent validity against several standard tests of ECF (rs -0.399 to 0.322, except for the Trail Making Test B, where rs was 0.057 to 0.063) as well as against measures of multifactorial cognitive function (rs -0.432 to 0.491). Both tests, however, demonstrated inconsistent discriminant validity against a variety of standard non-ECF tests (rs -0.013 to 0.376). CONCLUSIONS Both the EXIT and the Quick EXIT have adequate reliability and appear to require ECF in this population. However, both the EXIT and the Quick EXIT also reflect non-ECF domains. The EXIT and Quick EXIT should be considered to be measures of global cognitive function rather than pure ECF measures. Given similar reliability and validity, the Quick EXIT is recommended clinically as it is briefer and less burdensome than the full EXIT.
Collapse
Affiliation(s)
- Grace B. Campbell
- University of Pittsburgh School of Nursing Department of Acute/Tertiary Care
| | - Ellen M. Whyte
- University of Pittsburgh School of Medicine, Department of Psychiatry,University of Pittsburgh School of Medicine, Department of Physical Medicine and Rehabilitation
| | - Susan M. Sereika
- University of Pittsburgh School of Nursing Department of Health and Community Systems,University of Pittsburgh Graduate School of Public Health, Department of Biostatistics,University of Pittsburgh Graduate School of Public Health, Department of Epidemiology
| | - Mary Amanda Dew
- University of Pittsburgh School of Medicine, Department of Psychiatry,University of Pittsburgh Graduate School of Public Health, Department of Biostatistics,University of Pittsburgh Graduate School of Public Health, Department of Epidemiology,University of Pittsburgh Department of Psychology
| | | | - Meryl A. Butters
- University of Pittsburgh School of Medicine, Department of Psychiatry
| |
Collapse
|
45
|
Hayes S, Donnellan C, Stokes E. Executive dysfunction post-stroke: an insight into the perspectives of physiotherapists. Disabil Rehabil 2014; 37:1817-24. [DOI: 10.3109/09638288.2014.980915] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
46
|
Hajjar I, Marmerelis V, Shin DC, Chui H. Assessment of cerebrovascular reactivity during resting state breathing and its correlation with cognitive function in hypertension. Cerebrovasc Dis 2014; 38:10-6. [PMID: 25171390 DOI: 10.1159/000365349] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 06/17/2014] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Hypertension is associated with cognitive deficits, particularly executive function, and decreased cerebral microvascular responsiveness to CO2 (CO2 vasoreactivity). The relation between CO2 vasoreactivity and executive function is not known. Protocols to assess CO2 vasoreactivity are cumbersome and require inhaling a CO2-enriched gas. We explored the ability to measure CO2 vasoreactivity using end-tidal CO2 fluctuations during normal breathing and the association of this measure with cognitive function in hypertension. METHODS Executive function (Trail-Making Test parts A/B), memory, attention and blood flow velocity (BFV) in the middle cerebral artery using transcranial Doppler were measured in hypertensive subjects who were tapered off their treatment for 3 weeks. BFV was measured while sitting and normally breathing for 5 min, followed by breathing 5% CO2 gas and hyperventilation for 2 min each. We calculated CO2 vasoreactivity as the rate of BFV change from hypoventilation to hyperventilation, and as a model-derived measure using the normal breathing data. The latter was derived using nonlinear principal dynamic modes (PDM), which modelled the dynamic effect of fluctuations in end-tidal CO2 and blood pressure upon BFV during normal room-air respiration. Multiple regression analyses were used to correlate cerebral hemodynamics with cognitive measures. RESULTS Data were collected from 41 individuals with hypertension (mean age 71 years, 24% African Americans, 61% women, off antihypertensive therapy). Lower CO2 vasoreactivity was associated with a worse executive function test score using both calculation methods: p value using the hyper/hypoventilation data was 0.04 and from the PDM analysis was 0.009. PDM calculations showed a stronger correlation with executive function (0.41 vs. 0.21 using the hyper/hypoventilation data). There were no associations with memory or attention measures. There was a weak but statistically significant correlation between the two calculation methods of CO2 vasoreactivity (R(2) = 14%, p = 0.02). CONCLUSION This study suggests that the decrease in CO2 vasoreactivity in hypertension is associated with lower executive function. This may offer new insight into the vascular underpinning of cognitive decline in hypertension. We demonstrate that calculating CO2 vasoreactivity is possible during normal breathing. If replicated in future studies, this may offer a more convenient clinical way to assess CO2 vasoreactivity in hypertension and cognitive disorders.
Collapse
Affiliation(s)
- Ihab Hajjar
- Division of Geriatrics and General Internal Medicine, Department of Medicine, Emory University, Atlanta, Ga., USA
| | | | | | | |
Collapse
|
47
|
wednesday 4 June 2014. Br J Occup Ther 2014; 77:17-45. [DOI: 10.1177/03080226140770s802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
48
|
Chin LF, Wang JYY, Ong CH, Lee WK, Kong KH. Factors affecting falls in community-dwelling individuals with stroke in Singapore after hospital discharge. Singapore Med J 2014; 54:569-75. [PMID: 24154582 DOI: 10.11622/smedj.2013202] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION This study aimed to investigate the factors affecting the incidence of falls among individuals with stroke living in the community one year after discharge from a rehabilitation hospital in Singapore. METHODS A cross-sectional telephone survey of individuals with stroke living in the community was carried out one year after discharge. The interview covered aspects such as incidence and circumstances of fall, use of walking aids, and presence of environmental obstacles. Each participant's case record was retrospectively reviewed using discharge Fugl-Meyer (FM) assessment of the upper and lower limbs, functional independence measure (FIM) and Berg Balance Scale (BBS). RESULTS A total of 126 individuals with stroke were interviewed. Overall, 24% fell in the year following their discharge. Factors associated with falls were longer length of hospital stay, lower BBS and lower-limb FM scores, and lower discharge FIM scores for the Bladder and Bowel Management, Transfer, Mobility, Communication, and Social Cognition domains (p < 0.05). The fallers were more likely to use walking aids, and required help with basic activities of daily living after discharge (p < 0.05). Multivariate logistic regression analysis revealed that only the Transfer domain was an independent factor for falls. CONCLUSION Discharge FIM outcomes, especially for the Transfer domain, can be used to identify communitydwelling individuals with stroke who have a high fall risk after discharge. Identification of such individuals will enable early fall prevention management, which will in turn minimise fall events in the community.
Collapse
Affiliation(s)
- Lay Fong Chin
- Tan Tock Seng Rehabilitation Centre, 17 Ang Mo Kio Avenue 9, Singapore 569766.
| | | | | | | | | |
Collapse
|
49
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| | | | | | | | | | | |
Collapse
|
50
|
Hayes S, Donnellan C, Stokes E. Associations between executive function and physical function poststroke: a pilot study. Physiotherapy 2013; 99:165-71. [DOI: 10.1016/j.physio.2012.05.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Accepted: 05/22/2012] [Indexed: 10/27/2022]
|