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Medina-Mirapeix F, Crisóstomo MJ, Gacto-Sánchez M, Escolar-Reina MP, Sánchez-Martínez MP, Martín-SanAgustín R, García-Vidal JA. The 5-STS is a prognostic factor of sub-acute stroke patients who will not become community walkers at discharge from rehabilitation. NeuroRehabilitation 2023; 53:367-375. [PMID: 37927285 DOI: 10.3233/nre-230161] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
BACKGROUND The recovery of community ambulation is a common concern among individuals after stroke. OBJECTIVES (1) To develop a potential readily applicable prognostic model able to correctly discriminate stroke patients who will not become independent community walkers at discharge; (2) To investigate the effects of early reassessment during the first month of treatment on the prediction accuracy of this model. METHODS This was a prospective cohort study. A consecutive sample of 80 patients at ≤60 days poststroke were assessed at baseline of outpatient physical rehabilitation and reassessed one month later. Non-functional community ambulation was measured. RESULTS Seventy-four patients were followed until discharge. Of these, 47 patients were non-functional community walkers at discharge. A prediction model based on baseline performance in the five repetition sit-to-stand [5-STS] test was able to discriminate those patients of the sample (Area-under-curve = 0.956), and again with data from reassessment (AUC = 0.952). A time of 21 s at baseline was a highly prognostic cut-off point for discrimination (sensitivity = 87.2% and 85.1%). The combined use of baseline and reassessment data improved sensitivity (98.1%)CONCLUSION:Early findings of the 5-STS among stroke patients is an independent prognostic factor associated with independent community walking at discharge. It could discriminate individuals who will not become community walkers at discharge.
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Logan A, Freeman J, Kent B, Pooler J, Creanor S, Enki D, Vickery J, Barton A, Marsden J. Functional standing frame programme early after severe sub-acute stroke (SPIRES): a randomised controlled feasibility trial. Pilot Feasibility Stud 2022; 8:50. [PMID: 35241176 PMCID: PMC8892736 DOI: 10.1186/s40814-022-01012-4] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 02/20/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Early mobilisation (> 24 h post-stroke) is recommended for people with stroke. However, there is a paucity of evidence about how to implement early mobilisation for people who have had a severe stroke. Prolonged standing and task-specific training (sit-to-stand repetitions) have separately been evaluated in the literature; however, these functionally linked tasks have not been evaluated in combination for people with severe sub-acute stroke. METHODS The objective was to determine the feasibility of conducting a randomised controlled trial (RCT) of a functional standing frame programme compared with usual physiotherapy for people with severe sub-acute stroke. An assessor-blinded feasibility RCT with nested qualitative component (interviews and focus group) and process evaluation was adopted. Participants were aged ≥ 18 years with new diagnosis of severe sub-acute stroke (modified Rankin Scale (mRS) 4/5) from four Stroke Rehabilitation Units across South West England. Participants were randomised to receive either: (1) functional standing frame programme (30 min. standing plus sit-to-stand repetitions) plus 15 min of usual physiotherapy daily (intervention); (2) usual physiotherapy (45 min) daily (control). Both programmes were protocolised to be undertaken a minimum of five sessions per week for 3 weeks. Feasibility indicators included process, resource, management, and safety. Adherence, fidelity, and acceptability of the trial and intervention were evaluated using data recorded by therapists, observation of intervention and control sessions, interviews and one focus group. Patient measures of motor impairment, activities/participation, and quality of life were carried out by blinded assessors at baseline, 3, 15, 29, and 55 weeks post-randomisation. RESULTS Forty-five participants (51-96 years; 42% male, mRS 4 = 80% 5 = 20%) were randomised (n = 22 to intervention). Twenty-seven (60%) participants were followed-up at all time points. Twelve participants (27%) died during the trial; no deaths were related to the trial. Adherence to the minimum number of sessions was low: none of the participants completed all 21 sessions, and only 8 participants (18%) across both groups completed ≥ 15 sessions, over the 3 weeks; 39% intervention; 51% control sessions were completed; mean session duration 39 min (SD 19) control, 37 min intervention (SD 11). Intervention group: mean standing time 13 min (SD 9); mean sit-to-stand repetitions/session 5 (SD 4). Interviews were conducted with 10 participants, four relatives and six physiotherapists. Five physiotherapists attended a focus group. CONCLUSIONS The majority of progression criteria for this feasibility trial were met. However, adherence to the interventions was unacceptably low. This aspect of the trial design needs to be addressed prior to moving to a definitive RCT of this standing frame intervention in people with severe sub-acute stroke. Solutions have been identified to address these concerns. TRIAL REGISTRATION International Standard Randomised Controlled Trial Number ISRCTN15412695 . Registration 19 December 2016.
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Affiliation(s)
- Angela Logan
- Faculty of Health, School of Health Professions, University of Plymouth, Plymouth, UK. .,Stroke Rehabilitation Unit, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.
| | - Jennifer Freeman
- Faculty of Health, School of Health Professions, University of Plymouth, Plymouth, UK
| | - Bridie Kent
- Faculty of Health, School of Health Professions, University of Plymouth, Plymouth, UK
| | - Jill Pooler
- Faculty of Health, School of Health Professions, University of Plymouth, Plymouth, UK
| | - Siobhan Creanor
- Peninsula Clinical Trials Unit, Faculty of Health, University of Plymouth, Plymouth, UK.,Medical Statistics, Faculty of Health, University of Plymouth, Plymouth, UK.,Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Doyo Enki
- Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
| | - Jane Vickery
- Peninsula Clinical Trials Unit, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Andrew Barton
- NIHR Research Design Service, Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - Jonathan Marsden
- Faculty of Health, School of Health Professions, University of Plymouth, Plymouth, UK
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Burdea G, Kim N, Polistico K, Kadaru A, Roll D, Grampurohit N. Novel integrative rehabilitation system for the upper extremity: Design and usability evaluation. J Rehabil Assist Technol Eng 2021; 8:20556683211012885. [PMID: 34422282 PMCID: PMC8373277 DOI: 10.1177/20556683211012885] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 04/08/2021] [Indexed: 01/23/2023] Open
Abstract
PURPOSE Design and test the usability of a novel virtual rehabilitation system for bimanual training of gravity supported arms, pronation/supination, grasp strengthening, and finger extension. METHODS A robotic rehabilitation table, therapeutic game controllers, and adaptive rehabilitation games were developed. The rehabilitation table lifted/lowered and tilted up/down to modulate gravity loading. Arms movement was measured simultaneously, allowing bilateral training. Therapeutic games adapted through a baseline process. Four healthy adults performed four usability evaluation sessions each, and provided feedback using the USE questionnaire and custom questions. Participant's game play performance was sampled and analyzed, and system modifications made between sessions. RESULTS Participants played four sessions of about 50 minutes each, with training difficulty gradually increasing. Participants averaged a total of 6,300 arm repetitions, 2,200 grasp counts, and 2,100 finger extensions when adding counts for each upper extremity. USE questionnaire data averaged 5.1/7 rating, indicative of usefulness, ease of use, ease of learning, and satisfaction with the system. Subjective feedback on the custom evaluation form was 84% favorable. CONCLUSIONS The novel system was well-accepted, induced high repetition counts, and the usability study helped optimize it and achieve satisfaction. Future studies include examining effectiveness of the novel system when training patients acute post-stroke.
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Affiliation(s)
- Grigore Burdea
- Bright Cloud International Corp, Corporate Laboratories, North
Brunswick, NJ, USA
- Department of Electrical and Computer Engineering, Rutgers – The
State University of New Jersey, Piscataway, NJ, USA
| | - Nam Kim
- Bright Cloud International Corp, Corporate Laboratories, North
Brunswick, NJ, USA
| | - Kevin Polistico
- Bright Cloud International Corp, Corporate Laboratories, North
Brunswick, NJ, USA
| | - Ashwin Kadaru
- Bright Cloud International Corp, Corporate Laboratories, North
Brunswick, NJ, USA
| | - Doru Roll
- Bright Cloud International Corp, Corporate Laboratories, North
Brunswick, NJ, USA
| | - Namrata Grampurohit
- Bright Cloud International Corp, Corporate Laboratories, North
Brunswick, NJ, USA
- Department of Occupational Therapy, Jefferson University,
Philadelphia, PA, USA
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Thant AA, Wanpen S, Nualnetr N, Puntumetakul R, Chatchawan U, Hla KM, Khin MT. Effects of task-oriented training on upper extremity functional performance in patients with sub-acute stroke: a randomized controlled trial. J Phys Ther Sci 2019; 31:82-87. [PMID: 30774211 PMCID: PMC6348189 DOI: 10.1589/jpts.31.82] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 08/06/2018] [Accepted: 10/24/2018] [Indexed: 11/26/2022] Open
Abstract
[Purpose] The present study aimed to determine the effects of a task-oriented training on
paretic upper extremity functional performance in patients with subacute stroke.
[Participants and Methods] Twenty-eight subacute stroke sufferers (mean age: 50.07,
standard deviation 9.31 years; mean time since stroke 11.11, standard deviation 6.73
weeks) were randomly allocated to task-oriented training (n=14) or conventional exercise
program (n=14) group. They were trained as a hospital-based, individualized training 1
hour a session, 5 sessions a week for 4 weeks. Wolf Motor Function Test (primary outcome),
motor portion of Fugl-Meyer assessment upper extremity, and hand function domain of Stroke
Impact Scale were assessed at baseline, after 2 and 4 weeks of training. [Results] All
participants completed their training programs. At all post-training assessments, the
task-oriented training group showed significantly more improvements in all outcomes than
the conventional exercise program group. No serious adverse effects were observed during
or after the training. [Conclusion] Task-oriented training produced statistically
significant and clinically meaningful improvements of paretic upper extremity functional
performance in patients with subacute stroke. These beneficial effects were observed after
2 weeks (10 hours) of training. Future investigation is warranted to confirm and expand
these findings.
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Affiliation(s)
- Aye Aye Thant
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University: 123 Mittraphap Rd., Mueang District, Khon Kaen, 40002, Thailand.,Department of Physiotherapy, University of Medical Technology-Yangon, Myanmar
| | - Sawitri Wanpen
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University: 123 Mittraphap Rd., Mueang District, Khon Kaen, 40002, Thailand.,Research Center in Back, Neck, Other Joint Pain & Human Performance, Khon Kaen University, Thailand
| | - Nomjit Nualnetr
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University: 123 Mittraphap Rd., Mueang District, Khon Kaen, 40002, Thailand
| | - Rungthip Puntumetakul
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University: 123 Mittraphap Rd., Mueang District, Khon Kaen, 40002, Thailand.,Research Center in Back, Neck, Other Joint Pain & Human Performance, Khon Kaen University, Thailand
| | - Uraiwan Chatchawan
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University: 123 Mittraphap Rd., Mueang District, Khon Kaen, 40002, Thailand.,Research Center in Back, Neck, Other Joint Pain & Human Performance, Khon Kaen University, Thailand
| | - Khin Myo Hla
- Department of Physical Medicine and Rehabilitation, Yangon General Hospital, Myanmar
| | - Myo Thuzar Khin
- Department of Physiotherapy, University of Medical Technology-Yangon, Myanmar
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