Stroke rehabilitation research

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Stroke rehabilitation archive Dec 2007:-

Clinical analysis of risk factors for falls in home-living stroke patients using functional evaluation tools. Related Articles

Clinical analysis of risk factors for falls in home-living stroke patients using functional evaluation tools.

Arch Phys Med Rehabil. 2007 Dec;88(12):1601-5

Stroke rehabilitation research :- Authors: Wada N, Sohmiya M, Shimizu T, Okamoto K, Shirakura K

OBJECTIVES: To identify risk factors associated with falls in home-living stroke patients and to predict falls using patient information and functional evaluation tools. DESIGN: Cohort study. SETTING: Community. PARTICIPANTS: We recruited 101 home-living stroke patients who had hemiparesis and could walk independently with or without supporting devices. Disease duration ranged from 1 to 22 years (mean, 6.1 y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The score of each item of the Stroke Impairment Assessment Set (SIAS), and the FIM instrument, sex, age, duration of disease, stroke type, affected side of the body, frequency of rehabilitation, use of sedatives, and Mini-Mental State Examination score were evaluated and the occurrence of falls was observed prospectively for 12 months. RESULTS: Forty-five (44.6%) participants fell, 20 of whom fell repeatedly. A logistic model for predicting falls was refined until it included 4 predictors: memory score on the FIM, range of motion of the lower extremities on the SIAS, duration of disease, and affected side. The predictive value of the logistic model was 86.7%. CONCLUSIONS: Evaluation tools were useful for predicting falls and devising preventive strategies in the high-risk group of home-living stroke patients.

Stroke rehabilitation research PMID: 18047874 [PubMed - in process]Effectiveness of multidisciplinary rehabilitation services in postacute care: state-of-the-science. A review. Related Articles Stroke rehabilitation research

Effectiveness of multidisciplinary rehabilitation services in postacute care: state-of-the-science. A review.

Arch Phys Med Rehabil. 2007 Nov;88(11):1526-34

Stroke rehabilitation research :- Authors: Prvu Bettger JA, Stineman MG

OBJECTIVES: To summarize the efficacy of postacute rehabilitation and to outline future research strategies for increasing knowledge of its effectiveness. DATA SOURCES: English-language systematic reviews that examined multidisciplinary therapy-based rehabilitation services for adults, published in the last 25 years and available through Cochrane, Medline, or CINAHL databases. We excluded multidisciplinary biopsychosocial rehabilitation programs and mental health services. STUDY SELECTION: Using the search term rehabilitation, 167 records were identified in the Cochrane database, 1163 meta-analyses and reviews were identified in Medline, and 226 in CINAHL. The Medline and CINAHL search was further refined with 3 additional search terms: therapy, multidisciplinary, and interdisciplinary. In summary, we used 12 reviews to summarize the efficacy of multidisciplinary, therapy-based postacute rehabilitation; the 12 covered only 5 populations. DATA EXTRACTION: Two reviewers extracted information about study populations, sample sizes, study designs, the settings and timing of rehabilitation, interventions, and findings. DATA SYNTHESIS: Based on systematic reviews, the evidence for efficacy of postacute rehabilitation services across the continuum was strongest for stroke. There was also strong evidence supporting multidisciplinary inpatient rehabilitation for patients with rheumatoid arthritis, moderate to severe acquired brain injury, including traumatic etiologies, and for older adults. Heterogeneity limited our ability to conclude a benefit or a lack of a benefit for rehabilitation in other postacute settings for the other conditions in which systematic reviews had been completed. The efficacy of multidisciplinary rehabilitation services has not been systematically reviewed for many of the diagnostic conditions treated in rehabilitation. We did not complete a summary of findings from individual studies. CONCLUSIONS: Given the limitations and paucity of systematic reviews, information from carefully designed nonrandomized studies could be used to complement randomized controlled trials in the study of the effectiveness of postacute rehabilitation. Consequently, a stronger evidence base would become available with which to inform policy decisions, guide the use of services, and improve patient access and outcomes.

Stroke rehabilitation research PMID: 17964900 [PubMed - indexed for MEDLINE]Access to postacute rehabilitation. Related Articles Stroke rehabilitation research

Access to postacute rehabilitation.

Arch Phys Med Rehabil. 2007 Nov;88(11):1488-93

Stroke rehabilitation research :- Authors: Buntin MB

Each year, more than 10 million Medicare beneficiaries are discharged from acute care hospitals into postacute care (PAC) settings, including inpatient rehabilitation facilities, skilled nursing facilities, and homes with services from home health agencies. These beneficiaries include very frail and vulnerable elders, many of whom have suffered from an acute event such as a stroke or a fall resulting in hip fracture, all of whom are judged unable to return to their homes without further care. Whether beneficiaries receive PAC and the type and intensity of care they receive is influenced not only by clinical factors, but by nonclinical factors including provider supply and financing, especially Medicare's methods of payment. This article provides a definition of PAC and discusses the wide cross-sectional variation in the use of postacute rehabilitation. It then discusses recent changes to PAC provider payment that have raised concerns about access to postacute rehabilitation, trends in the use of PAC, and what these trends imply about the appropriateness of PAC as it is now delivered. It concludes by identifying issues about the policy and research implications of recent developments and the PAC literature reviewed.

Stroke rehabilitation research PMID: 17964894 [PubMed - indexed for MEDLINE]Refusal to eat, capacity, and ethics in stroke patients: a report of 3 cases. Related Articles Stroke rehabilitation research

Refusal to eat, capacity, and ethics in stroke patients: a report of 3 cases.

Arch Phys Med Rehabil. 2007 Nov;88(11):1474-7

Stroke rehabilitation research :- Authors: Finestone HM, Blackmer J

Patients have the right to make decisions about their health care, including refusing a particular treatment or a life-sustaining activity such as eating. However, patients must be able to understand and appreciate the consequences of their actions. Brain injury caused by a stroke has the potential to affect people's capacity to understand and appreciate their particular medical condition or its consequences. The purpose of this report was to describe the unique medical and ethical challenges presented by 3 rehabilitating stroke patients who refused to eat. Two patients had left-hemisphere strokes, with resultant aphasia. The third patient had a right-brain stroke and was able to state his position verbally but denied many of the consequences of his stroke. The refusal to eat and, therefore, possible impending death forced the attending physiatrist and rehabilitation team members to reevaluate the issue of capacity in the stroke patient. None of the patients died, and oral intake varied from fair to poor. This report elucidates the particular diagnostic, management, legal, and ethical issues surrounding the difficult but likely not uncommon issue of refusal to eat in stroke patients. It highlights the concept of capacity, which guides clinical decision making in such patients, and suggests specific clinical courses of action to take.

Stroke rehabilitation research PMID: 17964891 [PubMed - indexed for MEDLINE]Reliability and validity of the dynamic gait index in persons with chronic stroke. Related Articles

Reliability and validity of the dynamic gait index in persons with chronic stroke.

Arch Phys Med Rehabil. 2007 Nov;88(11):1410-5

Stroke rehabilitation research :- Authors: Jonsdottir J, Cattaneo D

OBJECTIVE: To establish the test-retest and interrater reliability as well as the concurrent construct validity of the Dynamic Gait Index (DGI) as a measure for dynamic balance in people with chronic stroke. DESIGN: Cohort study. SETTING: Day hospital and ambulatory care at a rehabilitation center. PARTICIPANTS: A consecutive sample of 25 participants, at least 3 months poststroke and able to walk at least 10m with or without a walking aid, participated in the study. Two independent raters rated performances on the DGI. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The DGI was administered in 2 testing sessions 3 days apart. In the second session, the participants were rated by 2 raters. Intraclass correlation coefficients (ICCs), model 2,1, and the Bland and Altman method were used to analyze total scores and item scores. Concurrent construct validity was tested by correlating results to the Berg Balance Scale, the timed walking test, the Timed Up & Go test, and the Activities-specific Balance Confidence Scale. RESULTS: ICCs for test-retest and interrater reliability of total scores were good (.96, .96, respectively) whereas reliability for single item scores was moderate to good (range, .55-.93). The hypotheses for concurrent construct validity were confirmed with all measures (range, .68-.83). CONCLUSIONS: The DGI showed high reliability and showed evidence of concurrent validity with other balance and mobility scales. It is a useful clinical tool for evaluating dynamic balance in ambulatory people with chronic stroke.

Stroke rehabilitation research PMID: 17964880 [PubMed - indexed for MEDLINE]Effects of robot-aided bilateral force-induced isokinetic arm training combined with conventional rehabilitation on arm motor function in patients with chronic stroke. Related Articles Stroke rehabilitation research

Effects of robot-aided bilateral force-induced isokinetic arm training combined with conventional rehabilitation on arm motor function in patients with chronic stroke.

Arch Phys Med Rehabil. 2007 Oct;88(10):1332-8

Stroke rehabilitation research :- Authors: Chang JJ, Tung WL, Wu WL, Huang MH, Su FC

OBJECTIVE: To analyze the effects of conventional rehabilitation combined with bilateral force-induced isokinetic arm movement training on paretic upper-limb motor recovery in patients with chronic stroke. DESIGN: Single-cohort, pre- and postretention design. SETTING: Rehabilitation department at a medical university. PARTICIPANTS: Twenty subjects who had unilateral strokes at least 6 months before enrolling in the study. INTERVENTION: A training program (40min/session, 3 sessions/wk for 8wk) consisting of 10 minutes of conventional rehabilitation and 30 minutes of robot-aided, bilateral force-induced, isokinetic arm movement training to improve paretic upper-limb motor function. MAIN OUTCOME MEASURES: The interval of pretest, post-test, and retention test was set at 8 weeks. Clinical arm motor function (Fugl-Meyer Assessment [FMA], upper-limb motor function, Frenchay Arm Test, Modified Ashworth Scale), paretic upper-limb strength (grip strength, arm push and pull strength), and reaching kinematics analysis (peak velocity, percentage of time to peak velocity, movement time, normalized jerk score) were used as outcome measures. RESULTS: After comparing the sets of scores, we found that the post-test and retention test in arm motor function significantly improved in terms of grip (P=.009), push (P=.001), and pull (P=.001) strengths, and FMA upper-limb scale (P<.001). Reaching kinematics significantly improved in terms of movement time (P=.015), peak velocity (P=.035), percentage of time to peak velocity (P=.004), and normalized jerk score (P=.008). Improvement in reaching ability was not sustained in the retention test. CONCLUSIONS: Preliminary results showed that conventional rehabilitation combined with robot-aided, bilateral force-induced, isokinetic arm training might enhance the recovery of strength and motor control ability in the paretic upper limb of patients with chronic stroke.

Stroke rehabilitation research PMID: 17908578 [PubMed - indexed for MEDLINE]Predictive validity and responsiveness of the functional ambulation category in hemiparetic patients after stroke. Related Articles

Predictive validity and responsiveness of the functional ambulation category in hemiparetic patients after stroke.

Arch Phys Med Rehabil. 2007 Oct;88(10):1314-9

Stroke rehabilitation research :- Authors: Mehrholz J, Wagner K, Rutte K, Meissner D, Pohl M

OBJECTIVE: To determine the reliability, concurrent and predictive validity, and responsiveness of the Functional Ambulation Category (FAC) in hemiparetic patients after stroke. DESIGN: Prospective cohort. SETTING: An early rehabilitation center for patients with neurologic disorders. PARTICIPANTS: Fifty-five nonambulatory patients after first-ever stroke, with duration of illness between 30 and 60 days, were included. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: FAC, Rivermead Mobility Index (RMI), walking velocity, step length, and six-minute walking test (6MWT) were assessed at the beginning, after 2 and 4 weeks of rehabilitation, and again 6 months later. After 6 months, community ambulation was also assessed. Test-retest and interrater reliability, concurrent, discriminant, and predictive validity and responsiveness of the FAC were calculated. RESULTS: Based on video examinations, high test-retest reliability (Cohen kappa=.950) and interrater reliability (kappa=.905) were found. FAC scores at the beginning and after 2 weeks, 3 weeks, and 6 months correlated highly with the RMI (Spearman rho=.686, rho=.787, rho=.825, rho=.893, respectively), distance walked in the 6MWT (rho=.949, rho=.937, rho=.931, rho=.906, respectively), walking velocity (rho=.952, rho=.939, rho=.902, rho=.901, respectively), and step length (rho=.952, rho=.932, rho=.896, rho=.877, respectively) at the same time points (all P<.001). The RMI, walking velocity, step length, and distance walked in the 6MWT differed for each FAC category (P<.001). After 4 weeks of rehabilitation, an FAC score of 4 or higher predicted community ambulation at 6 months with 100% sensitivity and 78% specificity. FAC scores changed significantly between the first 2 and second 2 weeks (Wilcoxon z=8.7, z=7.9, respectively; both P<.001) of the inpatient rehabilitation program. CONCLUSIONS: The FAC has excellent reliability, good concurrent and predictive validity, and good responsiveness in patients with hemiparesis after stroke.

Stroke rehabilitation research PMID: 17908575 [PubMed - indexed for MEDLINE]Mobility assistive device utilization in a prospective study of patients with first-ever stroke. Related Articles Stroke rehabilitation research

Mobility assistive device utilization in a prospective study of patients with first-ever stroke.

Arch Phys Med Rehabil. 2007 Oct;88(10):1268-75

Stroke rehabilitation research :- Authors: Jutai J, Coulson S, Teasell R, Bayley M, Garland J, Mayo N, Wood-Dauphinee S

OBJECTIVE: To estimate the extent to which clinical and functional features of stroke were related to the use of mobility assistive technology devices. DESIGN: Longitudinal study of quality of life after stroke. SETTING: Hospitals, rehabilitation centers, and universities in Ontario and Quebec. PARTICIPANTS: Subjects (N=316) with confirmed initial stroke were included in this analysis. Fifty-eight percent of the overall sample were men (n=184). The mean age of this sample at the time of the stroke +/- standard deviation was 65.3+/-15.3 years (range, 19-96y). One hundred thirty-five patients received a mobility assistive device poststroke, and 181 did not. INTERVENTION: Assistive devices for mobility (canes, walkers, wheelchairs). MAIN OUTCOME MEASURES: Assistive device use and mobility capacity. RESULTS: Mobility device nonusers were less physically disabled than device users on a variety of measures. Poor physical functioning but good cognition were reliably associated with mobility device use. Use of multiple mobility assistive devices was more often associated with poorer physical functioning than was single device use. For single device users, wheelchair use was predicted by cognition, functional independence, and stroke recovery. Cane users, compared with walker users, had better mobility and were less physically impaired by stroke. CONCLUSIONS: Patients were well matched to device type based on their mobility capacity. The findings of this study suggest that assistive device prescription-outcome relationships in stroke can be effectively and meaningfully modeled.

Stroke rehabilitation research PMID: 17908568 [PubMed - indexed for MEDLINE]Dual-task exercise improves walking ability in chronic stroke: a randomized controlled trial. Related Articles Stroke rehabilitation research

Dual-task exercise improves walking ability in chronic stroke: a randomized controlled trial.

Arch Phys Med Rehabil. 2007 Oct;88(10):1236-40

Stroke rehabilitation research :- Authors: Yang YR, Wang RY, Chen YC, Kao MJ

OBJECTIVE: To examine the effectiveness of a dual-task-based exercise program on walking ability in subjects with chronic stroke. DESIGN: Single-blind randomized controlled trial. SETTING: General community. PARTICIPANTS: Twenty-five subjects with chronic stroke who were at least limited community ambulatory subjects (a minimum gait velocity, 58cm/s). INTERVENTIONS: Participants were randomized into a control group (n=12) or experimental group (n=13). Subjects in the control group did not receive any rehabilitation training. Subjects in the experimental group underwent a 4-week ball exercise program. MAIN OUTCOME MEASURES: Gait performance was measured under single task (preferred walking) and tray-carrying task. Gait parameters of interest were walking speed, cadence, stride time, stride length, and temporal symmetry index. RESULTS: The experimental group showed significant improvement in all selected gait measures except for temporal symmetry index under both task conditions. In the control group, there were no significant changes over the 4-week period for all selected measures. There was a significant difference between groups for all selected gait variables except for temporal symmetry index under both task conditions. CONCLUSIONS: The dual-task-based exercise program is feasible and beneficial for improving walking ability in subjects with chronic stroke.

Stroke rehabilitation research PMID: 17908563 [PubMed - indexed for MEDLINE]Use of cardiac rehabilitation by Medicare beneficiaries after myocardial infarction or coronary bypass surgery. Related Articles

Use of cardiac rehabilitation by Medicare beneficiaries after myocardial infarction or coronary bypass surgery.

Circulation. 2007 Oct 9;116(15):1653-62

Stroke rehabilitation research :- Authors: Suaya JA, Shepard DS, Normand SL, Ades PA, Prottas J, Stason WB

BACKGROUND: Cardiac rehabilitation (CR) is effective in prolonging survival and reducing disability in patients with coronary heart disease. However, national use patterns and predictors of CR use have not been evaluated thoroughly. METHODS AND RESULTS: Using Medicare claims, we analyzed outpatient (phase II) CR use after hospitalizations for acute myocardial infarctions or coronary artery bypass graft surgery in 267,427 fee-for-service beneficiaries aged > or = 65 years who survived for at least 30 days after hospital discharge. We used multivariable analyses to identify predictors of CR use and to quantify geographic variations in its use. We obtained unadjusted, adjusted-smoothed, and standardized rates of CR use by state. Overall, CR was used in 13.9% of patients hospitalized for acute myocardial infarction and 31.0% of patients who underwent coronary artery bypass graft surgery. Older individuals, women, nonwhites, and patients with comorbidities (including congestive heart failure, previous stroke, diabetes mellitus, or cancer) were significantly less likely to receive CR. Coronary artery bypass graft surgery during the index hospitalization, higher median household income, higher level of education, and shorter distance to the nearest CR facility were important predictors of higher CR use. Adjusted CR use varied 9-fold among states, ranging from 6.6% in Idaho to 53.5% in Nebraska. The highest CR use rates were clustered in the north central states of the United States. CONCLUSIONS: CR use is relatively low among Medicare beneficiaries despite convincing evidence of its benefits and recommendations for its use by professional organizations. Use is higher after coronary artery bypass graft surgery than with acute myocardial infarctions not treated with revascularization procedures and varies dramatically by state and region of the United States.

Stroke rehabilitation research PMID: 17893274 [PubMed - indexed for MEDLINE]Stroke-related knowledge and health behaviors among poststroke patients in inpatient rehabilitation. Related Articles

Stroke-related knowledge and health behaviors among poststroke patients in inpatient rehabilitation.

Arch Phys Med Rehabil. 2007 Sep;88(9):1214-6

Stroke rehabilitation research :- Authors: Koenig KL, Whyte EM, Munin MC, O'Donnell L, Skidmore ER, Penrod LE, Lenze EJ

OBJECTIVE: To measure stroke knowledge and prestroke personal health behaviors of stroke patients undergoing inpatient rehabilitation and their caregivers. DESIGN: Prospective cohort. SETTING: Academic rehabilitation hospital. PARTICIPANTS: A total of 130 stroke patients and 85 caregivers interviewed after ischemic stroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The Stroke Education Assessment measured stroke knowledge and prestroke personal health behaviors. RESULTS: Large deficiencies in patient and caregiver stroke knowledge were found. Fifty-two percent of patients could not name any stroke risk factors, 52% were unable to name a stroke warning sign, and 35% were unable to identify appropriate actions to take in a stroke emergency. Older patients were less knowledgeable than younger patients. Caregivers were more knowledgeable than patients. Regarding prestroke personal health behaviors, 28% of patients reported medication nonadherence, 26% did not see their primary care physician in the preceding year, and less than 40% of patients with diabetes or hypertension reported diets consistent with these diagnoses. CONCLUSIONS: Stroke patients participating in inpatient rehabilitation and their caregivers have large gaps in stroke knowledge and have suboptimal personal health behaviors, thereby putting patients at high risk for recurrent stroke. Our finding highlights the need to develop stroke-education programs for rehabilitating patients that are effective in closing these gaps in knowledge and personal health behaviors.

Stroke rehabilitation research PMID: 17826471 [PubMed - indexed for MEDLINE]The impact of previous strokes on the rehabilitation of elderly patients sustaining a hip fracture. Related Articles

The impact of previous strokes on the rehabilitation of elderly patients sustaining a hip fracture.

Arch Phys Med Rehabil. 2007 Sep;88(9):1136-9

Stroke rehabilitation research :- Authors: Mizrahi EH, Fleissig Y, Arad M, Adunsky A

OBJECTIVE: To evaluate whether a previous stroke may affect the functional outcome gain of elderly patients undergoing rehabilitation for a hip fracture. DESIGN: A retrospective cohort study. SETTING: The division of geriatric medicine with rehabilitation wards at a university-affiliated referral hospital. PARTICIPANTS: Patients with hip fractures (N=460) undergoing a standard rehabilitation course. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The functional outcome of previous stroke- and nonprevious stroke (NPS)-affected patients assessed by the FIM instrument at admission and discharge from the rehabilitation facility. Data were analyzed by t tests, Pearson correlation, chi-square tests, and linear regression analysis. RESULTS: Both admission and discharge total FIM scores were significantly higher in NPS compared with previous stroke patients (63.53+/-19.89 vs 52.19+/-19.37, P<.001) and (84.23+/-24.93 vs 71.37+/-25.03, P=.001), respectively. However, changes in total FIM (20.70+/-11.68 vs 19.17+/-13.32, P=.38) and in motor FIM (19.84+/-10.63 vs 17.96+/-11.21, P=.23) at discharge were not statistically significant between the 2 groups. A linear regression analysis showed that a previous stroke was not predictive of a worse total FIM gain at discharge (P=.58). CONCLUSIONS: NPS hip fracture elderly patients show higher admission and discharge FIM scores compared with previous stroke patients. Nevertheless, both groups achieve similar FIM gains during rehabilitation period. A previous stroke should not be considered as adversely affecting the rehabilitation of such patients.

Stroke rehabilitation research PMID: 17826458 [PubMed - indexed for MEDLINE]The stroke upper-limb activity monitor: its sensitivity to measure hemiplegic upper-limb activity during daily life. Related Articles

The stroke upper-limb activity monitor: its sensitivity to measure hemiplegic upper-limb activity during daily life.

Arch Phys Med Rehabil. 2007 Sep;88(9):1121-6

Stroke rehabilitation research :- Authors: de Niet M, Bussmann JB, Ribbers GM, Stam HJ

OBJECTIVE: To test the Stroke Upper-Limb Activity Monitor (Stroke-ULAM), which uses electrogoniometry and accelerometry to measure the amount of upper-limb usage in stroke patients in daily life conditions, for its sensitivity to discriminate between moderately recovered and well-recovered stroke patients and control subjects. DESIGN: Cross-sectional study. SETTING: At home or a rehabilitation center. PARTICIPANTS: Seventeen patients with stroke and 5 control subjects. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Level of usage of upper limb and the percentage of affected upper-limb activity compared with unaffected upper-limb activity (proportion). RESULTS: The level of usage of the affected upper limb of stroke patients was lower than that of the nondominant upper limb of control subjects (electrogoniometry, 97.8 degrees+/-92.3 degrees/min vs 286.2 degrees+/-46.5 degrees/min, P<.01; accelerometry 1.0+/-0.5 g/min vs 2.4+/-0.8 g/min, P<.01). Stroke patients had lower proportions than control subjects in both electrogoniometry (22.6%+/-18.0% vs 84.6%+/-9.8%, P<.01) and accelerometry (39.2%+/-21.4% vs 93.3%+/-5.0%, P<.01). Well-recovered stroke patients had significantly higher proportions compared with moderately recovered patients on both electrogoniometry and accelerometry. CONCLUSIONS: The Stroke-ULAM sensitively measures actual performance, and therefore can be a valuable addition to the mostly capacity-oriented tools currently used to evaluate upper-limb function. Proportion is preferred to the level of usage.

Stroke rehabilitation research PMID: 17826456 [PubMed - indexed for MEDLINE]Sensory retraining of the lower limb after acute stroke: a randomized controlled pilot trial. Related Articles

Sensory retraining of the lower limb after acute stroke: a randomized controlled pilot trial.

Arch Phys Med Rehabil. 2007 Sep;88(9):1101-7

Stroke rehabilitation research :- Authors: Lynch EA, Hillier SL, Stiller K, Campanella RR, Fisher PH

OBJECTIVE: To determine the effects of a sensory retraining protocol on sensation, postural control, and gait in acute stroke subjects. DESIGN: Randomized controlled pilot trial. SETTING: Inpatient rehabilitation hospital. PARTICIPANTS: Twenty-one subjects with sensory deficits in the feet, undergoing rehabilitation for stroke. INTERVENTION: Sensory retraining of the more affected lower limb versus relaxation (sham intervention). MAIN OUTCOME MEASURES: Light touch at the sole of the foot (Semmes-Weinstein monofilaments), proprioception (Distal Proprioception Test), postural control (Berg Balance Scale), and gait (timed, Iowa Level of Assistance Scale). RESULTS: Significant improvements (P<.05) over time were found in light touch at 3 points of the feet and in postural control, timed gait, and walking aid. No significant time effects were observed in proprioception or amount of assistance required to walk. No significant differences were detected between groups in any of the outcome variables, apart from light touch at the first metatarsal. The study had poor power (13%) to detect group effects due to the small sample size. CONCLUSIONS: Results of this pilot study are unable to support or refute the routine use of sensory retraining of the lower limb for people during inpatient rehabilitation after stroke. Further research with a larger sample size is required.

Stroke rehabilitation research PMID: 17826453 [PubMed - indexed for MEDLINE]Nano neurology and the four P's of central nervous system regeneration: preserve, permit, promote, plasticity. Related Articles

Nano neurology and the four P's of central nervous system regeneration: preserve, permit, promote, plasticity.

Med Clin North Am. 2007 Sep;91(5):937-62

Stroke rehabilitation research :- Authors: Ellis-Behnke R

True nanomaterials are delivered as a specific structure, or combination of structures, designed to deliver the therapeutic intact, directly to the site, requiring a much lower dose. These materials use very specific and deliberate molecular structures that can interact with neurons or protein structures inside the cells. Until recently, functional recovery of the central nervous system (CNS) was an unattainable goal and nanotechnology was an invisible science. A well-planned treatment spaced over time will produce functional return in the CNS. The four P's of CNS regeneration is a new framework for approaching CNS injury and evidence shows that nanotechnology is currently being used for stroke rehabilitation and, in several clinical trials, the treatment of scar formation blockade in the spinal cord. The four components are preserve, permit, promote, and plasticity.

Stroke rehabilitation research PMID: 17826112 [PubMed - indexed for MEDLINE]The impact of diabetes mellitus on stroke acute rehabilitation outcomes. Related Articles

The impact of diabetes mellitus on stroke acute rehabilitation outcomes.

Am J Phys Med Rehabil. 2007 Sep;86(9):754-61

Stroke rehabilitation research :- Authors: Ripley DL, Seel RT, Macciocchi SN, Schara SL, Raziano K, Ericksen JJ

OBJECTIVE: To examine the impact of diabetes mellitus (DM) on functional outcomes after acute rehabilitation for cerebrovascular accident (CVA). DESIGN: A retrospective research design was used to analyze outcomes in patients with a primary diagnosis of unilateral stroke (n = 367) admitted to an urban, acute rehabilitation center in the Southeastern United States. RESULTS: Multivariable hierarchical regression revealed that DM did not contribute statistically significant variance to stroke acute rehabilitation prediction models. Rehabilitation admission functioning scores, rehabilitation length of stay, age, and stroke type were significant predictors of poststroke rehabilitation motor outcomes (r2 = 0.603) and cognitive outcomes (r2 = 0.712). Diabetes also had no significant impact on acute stroke rehabilitation lengths of stay or rehabilitation discharge setting. CONCLUSIONS: Diabetes does not seem to significantly impact short-term acute rehabilitation outcomes after stroke. Persons with diabetes who suffer a stroke seem to benefit and improve during their acute rehabilitation stay at levels equivalent to peers who are not diagnosed with diabetes. Future research should examine the impact of diabetes subtypes and undiagnosed diabetes on short- and long-term outcomes.

Stroke rehabilitation research PMID: 17710000 [PubMed - indexed for MEDLINE]Urinary tract infection and bacteriurua in stroke patients: frequencies, pathogen microorganisms, and risk factors. Related Articles

Urinary tract infection and bacteriurua in stroke patients: frequencies, pathogen microorganisms, and risk factors.

Am J Phys Med Rehabil. 2007 Sep;86(9):734-41

Stroke rehabilitation research :- Authors: Ersoz M, Ulusoy H, Oktar MA, Akyuz M

OBJECTIVE: To investigate the frequencies, pathogen microorganisms involved, and possible risk factors of urinary tract infections, asymptomatic bacteriuria, and significant bacteriuria in subacute and chronic stroke patients. DESIGN: The frequencies were determined and compared for subgroups with respect to age, gender, level of education, type of lesion, side of lesion, bladder-emptying method, postvoid residual urine, ambulation-level class, and Brunnstrom recovery stage class of upper and lower extremities in 110 consecutive stroke patients. RESULTS: Frequencies were 27.3, 11.8, and 39.1% for urinary tract infections, asymptomatic bacteriuria, and significant bacteriuria, respectively. Bladder-emptying method (P < 0.05), presence of postvoid residual urine >50 ml (P < 0.04), and Brunnstrom recovery stage class of upper extremity (P < 0.02) were significant factors for the frequency of urinary tract infections. Bladder-emptying method, ambulation-level class, Brunnstrom recovery stage class of upper and lower extremities (P < 0.01), presence of postvoid residual urine >50 ml (P < 0.02), gender, and level of education (P < 0.05) were significant factors for the frequency of significant bacteriuria. CONCLUSIONS: Early treatment of urinary dysfunction for elimination of indwelling catheter use and high postvoid residue, early physical rehabilitation for better ambulation and hand function, patient education about prevention, and close monitoring of patients with unmodifiable risk factors may decrease the frequency of urinary tract infections and significant bacteriuria in stroke patients.

Stroke rehabilitation research PMID: 17709997 [PubMed - indexed for MEDLINE]Variation of muscle coactivation patterns in chronic stroke during robot-assisted elbow training. Related Articles

Variation of muscle coactivation patterns in chronic stroke during robot-assisted elbow training.

Arch Phys Med Rehabil. 2007 Aug;88(8):1022-9

Stroke rehabilitation research :- Authors: Hu X, Tong KY, Song R, Tsang VS, Leung PO, Li L

OBJECTIVE: To investigate the variation of muscle coactivation patterns during the course of robot-assisted rehabilitation on elbow flexion and extension for chronic stroke. DESIGN: A detailed electromyographic analysis was conducted on muscle activation levels and muscle coactivation patterns, represented by a cocontraction index of a muscle pair, for the muscles of biceps brachii, triceps brachii, anterior deltoid, and posterior deltoid, during training of elbow extension and flexion, actively assisted by a robot, from 0 degrees to 90 degrees by tracking a target moving at a speed of 10 degrees /s on the screen. SETTING: Rehabilitation center research laboratory. PARTICIPANTS: Seven hemiplegic chronic stroke patients received elbow training. INTERVENTIONS: Each subject received 20 sessions (1.5 hours/session) of the elbow training on his/her paretic side at an intensity of 3 to 5 times a week for a training period of 7 consecutive weeks. MAIN OUTCOME MEASURES: Muscle cocontraction index, muscle activation level, and Modified Ashworth Scale (MAS), Fugl-Meyer Assessment (FMA), and Motor Status Scale (MSS) scores. RESULTS: The electromyographic activation levels of the biceps brachii, triceps brachii, and anterior deltoid of each subject decreased during the training. The overall electromyographic activation levels of the biceps and triceps, which, summarizing the performance of all subjects, decreased significantly in the middle sessions (from the 8th to 12th sessions) of the training (P<.05), associated with the significant decrease (P<.05) in the MAS score. The overall electromyographic activation level of the anterior deltoid also decreased significantly from the 8th to 20th sessions (P<.05). Significant decreases in the cocontractions of all muscle pairs were observed in all subjects and also in the overall cocontraction index (P<.05). The cocontraction between the biceps and triceps significantly decreased when the overall electromyographic levels of the 2 muscles were stable from the 10th to 20th sessions (P<.05). Significant improvements (P<.05) on the FMA and MSS score were also found by the pre- and postassessments. CONCLUSIONS: In the 20-session robot-assisted training, the excessive muscle activations reduced mainly in the first half of the training course, which could be related to the learning process of the tracking skill and also to the reduction in muscle spasticity. The muscle coordination for achieving elbow tracking improved significantly in the latter sessions of the training, represented as decreased cocontraction indexes between the muscle pairs.

Stroke rehabilitation research PMID: 17678665 [PubMed - indexed for MEDLINE]Changes in postural control in hemiplegic patients after stroke performing a dual task. Related Articles

Changes in postural control in hemiplegic patients after stroke performing a dual task.

Arch Phys Med Rehabil. 2007 Aug;88(8):1009-15

Stroke rehabilitation research :- Authors: Bensoussan L, Viton JM, Schieppati M, Collado H, Milhe de Bovis V, Mesure S, Delarque A

OBJECTIVE: To determine the effects of an attentional task on hemiplegic patients' postural control performances. DESIGN: Retrospective study. SETTING: Department of physical and rehabilitation medicine at a university hospital. PARTICIPANTS: Twenty-three hemiplegic patients and 23 healthy age- and sex-matched control subjects. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Sway area and sway path of the center of pressure were measured during 30 seconds in standing subjects and patients under 3 conditions: eyes open (EO), EO while performing a simple arithmetic task (EO-AT), and eyes closed (EC). RESULTS: In the hemiplegic patients, the body sway area increased significantly with EC (P<.001) and during the EO-AT task (P<.017) in comparison with EO. Sway area with EO-AT remained, however, significantly smaller than with EC (P<.014). In the healthy subjects, the body sway did not differ significantly between the EO-AT and EO tasks (P<.42). The increase observed in the sway area and path in the hemiplegic population during the EO-AT task correlated significantly with age. CONCLUSIONS: The postural performances of hemiplegic patients decreased during both the arithmetic task and the EC task. The cognitive task had no effect on healthy subjects' postural performances. This study is the first to show the combined effects of age and dual task on the postural performances of hemiplegic subjects.

Stroke rehabilitation research PMID: 17678663 [PubMed - indexed for MEDLINE]Kinematic and clinical analyses of upper-extremity movements after constraint-induced movement therapy in patients with stroke: a randomized controlled trial. Related Articles

Kinematic and clinical analyses of upper-extremity movements after constraint-induced movement therapy in patients with stroke: a randomized controlled trial.

Arch Phys Med Rehabil. 2007 Aug;88(8):964-70

Stroke rehabilitation research :- Authors: Wu CY, Chen CL, Tang SF, Lin KC, Huang YY

OBJECTIVE: To study the effects of constraint-induced movement therapy (CIMT) relative to traditional intervention on motor-control strategies for upper-arm reaching and motor performance at the impairment and functional levels in stroke patients. DESIGN: Two-group randomized controlled trial (RCT); pretreatment and posttreatment measures. SETTING: Rehabilitation clinics. PARTICIPANTS: Forty-seven stroke patients (mean age, 55y) 3 weeks to 37 months postonset of a first-ever cerebrovascular accident. INTERVENTIONS: Forty-seven patients received either CIMT (restraint of the less affected hand combined with intensive training of the more affected upper extremity) or traditional intervention (control treatment) during the study. The treatment intensity was matched between the 2 groups (2h/d, 5d/wk for 3wk). MAIN OUTCOME MEASURES: Outcomes were evaluated using (1) kinematic variables of reaching movement used to describe the control strategies for reaching, (2) the Fugl-Meyer Assessment (FMA) of motor-impairment severity, and (3) the Motor Activity Log (MAL) evaluating the functional ability of the upper extremity. RESULTS: After treatment, the CIMT group showed better strategies of reaching control than the control group (P<.03). The CIMT group also showed less motor impairment on the FMA (P=.019) and higher functional ability on the MAL (P<.001). CONCLUSIONS: This study is the first RCT to show differences in motor-control strategies as measured by kinematic variables after CIMT versus traditional intervention. In addition to improving motor performance at the impairment and functional levels, CIMT conferred therapeutic benefits on control strategies determined by kinematic analysis.

Stroke rehabilitation research PMID: 17678656 [PubMed - indexed for MEDLINE]Circuit class therapy versus individual physiotherapy sessions during inpatient stroke rehabilitation: a controlled trial. Related Articles

Circuit class therapy versus individual physiotherapy sessions during inpatient stroke rehabilitation: a controlled trial.

Arch Phys Med Rehabil. 2007 Aug;88(8):955-63

Stroke rehabilitation research :- Authors: English CK, Hillier SL, Stiller KR, Warden-Flood A

OBJECTIVE: To compare the effectiveness of circuit class therapy and individual physiotherapy (PT) sessions in improving walking ability and functional balance for people recovering from stroke. DESIGN: Nonrandomized, single-blind controlled trial. SETTING: Medical rehabilitation ward of a rehabilitation hospital. PARTICIPANTS: Sixty-eight persons receiving inpatient rehabilitation after a stroke. INTERVENTIONS: Subjects received group circuit class therapy or individual treatment sessions as the sole method of PT service delivery for the duration of their inpatient stay. MAIN OUTCOME MEASURES: Five-meter walk test (5MWT), two-minute walk test (2MWT), and the Berg Balance Scale (BBS) measured 4 weeks after admission. Secondary outcome measures included the Iowa Level of Assistance Scale, Motor Assessment Scale upper-limb items, and patient satisfaction. Measures were taken on admission and 4 weeks later. RESULTS: Subjects in both groups showed significant improvements between admission and week 4 in all primary outcome measures. There were no significant between group differences in the primary outcome measures at week 4 (5MWT mean difference, .07m/s; 2MWT mean difference, 1.8m; BBS mean difference, 3.9 points). A significantly higher proportion of subjects in the circuit class therapy group were able to walk independently at discharge (P=.01) and were satisfied with the amount of therapy received (P=.007). CONCLUSIONS: Circuit class therapy appeared as effective as individual PT sessions for this sample of subjects receiving inpatient rehabilitation poststroke. Favorable results for circuit classes in terms of increased walking independence and patient satisfaction suggest this model of service delivery warrants further investigation.

Stroke rehabilitation research PMID: 17678655 [PubMed - indexed for MEDLINE]Impact of patient's weight on stroke rehabilitation results. Related Articles

Impact of patient's weight on stroke rehabilitation results.

Am J Phys Med Rehabil. 2007 Aug;86(8):650-5

Stroke rehabilitation research :- Authors: Kalichman L, Rodrigues B, Gurvich D, Israelov Z, Spivak E

OBJECTIVE: To evaluate the influence of patient's weight on rehabilitation results after first stroke. DESIGN: Retrospective, comparative study. The sample comprised 84 males and females, first-time stroke patients, who had been hospitalized in the department of rehabilitation at the Hartzfeld Geriatric Hospital, Gedera, Israel for a full 3 mos and who, on admission, had scored between 40 and 60 on the total Functional Improvement Measure (FIM) test. We evaluated the difference in total FIM improvement between normal-weight, overweight, and obese patients. RESULTS: The relative improvement of FIM score was significantly higher in normal-weight patients than in overweight patients, and improvement in overweight patients was significantly higher than in obese ones. We also found a statistically significant negative correlation (r = -0.27, P = 0.014) between relative improvement of FIM score and body mass index (BMI) in the total sample. CONCLUSIONS: Our study revealed that during the first 12 wks, rehabilitation is statistically significantly less effective in overweight and, particularly, in obese patients (evaluated by BMI). We also found a statistically significant negative association between the individual's BMI and relative improvement of the FIM score, representing the functional status of the stroke patient.

Stroke rehabilitation research PMID: 17667195 [PubMed - indexed for MEDLINE]Amantadine for adynamic speech: possible benefit for aphasia? Related Articles

Amantadine for adynamic speech: possible benefit for aphasia?

Am J Phys Med Rehabil. 2007 Aug;86(8):605-12

Stroke rehabilitation research :- Authors: Barrett AM, Eslinger PJ

OBJECTIVE: Dopaminergic agents may stimulate behavior and verbal expression after frontal lobe dysfunction. Although amantadine is used in neurorehabilitation of motivational disorders and head injury, it is not commonly prescribed to improve aphasia. This pilot study examined verbal fluency on and off amantadine for nonfluent speech. DESIGN: Four participants undergoing inpatient rehabilitation, meeting criteria for transcortical motor aphasia had stroke (2), stroke postaneurysm surgery (1), or brain tumor resection (1). We administered 100 mg of amantadine twice a day in an open-label, on-off protocol, with multiple assessments per on-off period. RESULTS: Off medication, subjects generated a mean 12.62 of words (abnormally few) on the Controlled Oral Word Association test. On medication, word generation significantly improved to 17.71 words (P = 0.04), although scores remained psychometrically in the abnormal range. CONCLUSIONS: Further research on amantadine, specifically for nonfluent speech and nonfluent aphasia, including effects on functional communication and control conditions, may be warranted.

Stroke rehabilitation research PMID: 17667190 [PubMed - indexed for MEDLINE]Proximal paresis of the upper extremity in patients with stroke. Related Articles

Proximal paresis of the upper extremity in patients with stroke.

Neurology. 2007 Jul 24;69(4):348-55

Stroke rehabilitation research :- Authors: Hatakenaka M, Miyai I, Sakoda S, Yanagihara T

OBJECTIVE: To characterize the physiologic and neuroanatomical features and functional outcome of proximal dominant paresis of the upper extremity (UE) in poststroke patients. METHODS: The Stroke rehabilitation research :- Authors studied 34 hemiparetic patients after the first subcortical stroke (mean age 65 years; males/females = 21/13; mean 45 days after stroke; right/left hemiparesis = 20/14). They were divided into proximal and distal paresis groups according to the distribution of UE paresis. Transcranial magnetic stimulation (TMS) was used to assess residual function of the descending pathways to the UE muscles. The location and size of lesions were assessed by MRI. RESULTS: The lesion density maps revealed damages in the posterior putamen, posterior limb of the internal capsule, and posterior half of the corona radiata in the distal group (n = 19), whereas lesions in the proximal group (n = 15) uniformly encompassed the middle part of the corona radiata, usually sparing the posterior half of the posterior limb of the internal capsule. TMS indicated that the descending pathways to proximal muscles were disrupted in patients with proximal UE paresis, whereas innervation to distal muscles was spared. Functional outcome of the affected UE after inpatient rehabilitation was better in the proximal group. It depended on the initial severity of UE paresis, but not on TMS findings, age, or the size of the lesions. CONCLUSION: Although the distribution of upper extremity (UE) paresis was associated with distinct MRI and transcranial magnetic stimulation (TMS) findings, the clinical examination of UE paresis was more sensitive than MRI or TMS findings in predicting functional outcome of the paretic UE.

Stroke rehabilitation research PMID: 17646626 [PubMed - indexed for MEDLINE]Gait training combining partial body-weight support, a treadmill, and functional electrical stimulation: effects on poststroke gait. Related Articles

Gait training combining partial body-weight support, a treadmill, and functional electrical stimulation: effects on poststroke gait.

Phys Ther. 2007 Sep;87(9):1144-54

Stroke rehabilitation research :- Authors: Lindquist AR, Prado CL, Barros RM, Mattioli R, da Costa PH, Salvini TF

BACKGROUND AND PURPOSE: Treadmill training with harness support is a promising, task-oriented approach to restoring locomotor function in people with poststroke hemiparesis. Although the combined use of functional electrical stimulation (FES) and treadmill training with body-weight support (BWS) has been studied before, this combined intervention was compared with the Bobath approach as opposed to BWS alone. The purpose of this study was to evaluate the effects of the combined use of FES and treadmill training with BWS on walking functions and voluntary limb control in people with chronic hemiparesis. SUBJECTS: Eight people who were ambulatory after chronic stroke were evaluated. METHODS: An A(1)-B-A(2) single-case study design was applied. Phases A(1) and A(2) included 3 weeks of gait training on a treadmill with BWS, and phase B included 3 weeks of treadmill training plus FES applied to the peroneal nerve. The Stroke Rehabilitation Assessment of Movement was used to assess motor recovery, and a videography analysis was used to assess gait parameters. RESULTS: An improvement (from 54.9% to 71.0%) in motor function was found during phase B. The spatial and temporal variables cycle duration, stance duration, and cadence as well as cycle length symmetry showed improvements when phase B was compared with phases A(1) and A(2). DISCUSSION AND CONCLUSION: The combined use of FES and treadmill training with BWS led to an improvement in motor recovery and seemed to improve the gait pattern of subjects with hemiparesis, indicating the utility of this combination method during gait rehabilitation. In addition, this single-case series showed that this alternative method of gait training--treadmill training with BWS and FES--may decrease the number of people required to carry out the training.

Stroke rehabilitation research PMID: 17609334 [PubMed - indexed for MEDLINE]Factors affecting short-term rehabilitation outcomes of disabled elderly patients with proximal hip fracture. Related Articles

Factors affecting short-term rehabilitation outcomes of disabled elderly patients with proximal hip fracture.

Arch Phys Med Rehabil. 2007 Jul;88(7):916-21

Stroke rehabilitation research :- Authors: Hershkovitz A, Kalandariov Z, Hermush V, Weiss R, Brill S

OBJECTIVE: To identify factors associated with postacute rehabilitation outcome of disabled elderly patients with proximal hip fracture. SETTING: Geriatric rehabilitation center. PARTICIPANTS: One hundred thirty-three older patients. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: FIM instrument, motor FIM score, absolute functional gain on the FIM and motor FIM scores, relative functional gain on the FIM and motor FIM scores, rate of improvement on the FIM and motor FIM scores, proportion of patients discharged to home, and length of stay (LOS). RESULTS: Mean FIM score improved by 14 points (22%) with a functional gain rate of .56 point per day. No significant differences (P>.05) were found between weight-bearing and non-weight-bearing patients regarding the above outcome measures. Functionally independent and cognitively intact patients achieved significantly better score changes and rates of improvement and showed a higher ability to extract their rehabilitation potential than dependent and cognitively impaired patients. Their LOSs were significantly shorter. Patients with latency time (time delay from fracture to operation) of more than 5 days and patients with a history of stroke had significantly longer LOSs. Mini-Mental State Examination score, albumin levels on admission, and prefracture functional status were the most important parameters associated with FIM discharge scores (r=.756) and relative functional gain on the FIM (r=.583). Depression was the most important factor associated with LOS in patients with weight-bearing instructions on admission. The presence of a caregiver was the significant predictive value variable for returning home. CONCLUSIONS: Cognitive function, nutritional status, preinjury functional level, and depression were the most important prognostic factors associated with rehabilitation success of older patients with proximal hip fracture. Of these, depression and nutritional status are correctable, and early intervention may improve rehabilitation outcome.

Stroke rehabilitation research PMID: 17601474 [PubMed - indexed for MEDLINE]The Hopkins Rehabilitation Engagement Rating Scale: development and psychometric properties. Related Articles

The Hopkins Rehabilitation Engagement Rating Scale: development and psychometric properties.

Arch Phys Med Rehabil. 2007 Jul;88(7):877-84

Stroke rehabilitation research :- Authors: Kortte KB, Falk LD, Castillo RC, Johnson-Greene D, Wegener ST

OBJECTIVE: To conduct an initial investigation of the psychometric properties of the Hopkins Rehabilitation Engagement Rating Scale (HRERS), a 5-item, clinician-rated measure developed to quantify engagement in acute rehabilitation services. DESIGN: We used a cross-sectional design to conduct correlational and multivariate analyses to establish the measure's internal consistency, interrater reliability, construct validity, and criterion validity. SETTING: Acute inpatient rehabilitation in 3 metropolitan hospitals. PARTICIPANTS: A total of 206 subjects with spinal cord injury, ischemic or hemorrhagic stroke, amputation, or hip or knee replacement. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The HRERS, Positive and Negative Affect Schedule, Brief Symptom Inventory, Levine's Denial of Illness Scale, Craig Handicap Assessment and Reporting Technique, and FIM instrument. RESULTS: The HRERS has good internal consistency (alpha=.91) and interrater reliability (intraclass correlation coefficient, .73) and represents a unidimensional construct. It correlated negatively with symptoms of depression (r=-.24, P<.01), higher ratings of denial of illness (r=-.30, P<.001), and self-rated negative affect (r=-.23, P<.01), and correlated positively with self-rated positive affect (r=.36, P<.001) and level of functioning 3 months postdischarge (r=.22, P<.01). CONCLUSIONS: The HRERS is a valid and reliable measure of rehabilitation engagement that relates to intermediate-term functional outcomes.

Stroke rehabilitation research PMID: 17601468 [PubMed - indexed for MEDLINE]Upper-extremity functional electric stimulation-assisted exercises on a workstation in the subacute phase of stroke recovery. Related Articles

Upper-extremity functional electric stimulation-assisted exercises on a workstation in the subacute phase of stroke recovery.

Arch Phys Med Rehabil. 2007 Jul;88(7):833-9

Stroke rehabilitation research :- Authors: Kowalczewski J, Gritsenko V, Ashworth N, Ellaway P, Prochazka A

OBJECTIVE: To test the efficacy of functional electric stimulation (FES)-assisted exercise therapy (FES-ET) on a workstation in the subacute phase of recovery from a stroke. DESIGN: Single-blind, randomly controlled comparison of high- and low-intensity treatment. SETTING: Laboratory in a rehabilitation hospital. PARTICIPANTS: Nineteen stroke survivors (10 men, 9 women; mean age +/- standard deviation, 60.6+/-5.8y), with upper-extremity hemiplegia (mean poststroke time, 48+/-17d). The main inclusion criteria were: stroke occurred within 3 months of onset of trial and resulted in severe upper-limb dysfunction, and FES produced adequate hand opening. INTERVENTION: An FES stimulator and an exercise workstation with instrumented objects were used by 2 groups to perform specific motor tasks with their affected upper extremity. Ten subjects in the high-intensity FES-ET group received FES-ET for 1 hour a day on 15 to 20 consecutive workdays. Nine subjects in the low-intensity FES-ET group received 15 minutes of sensory electric stimulation 4 days a week and on the fifth day they received 1 hour of FES-ET. MAIN OUTCOME MEASURES: Primary outcome measure included the Wolf Motor Function Test (WMFT). Secondary outcome measures included the Motor Activity Log (MAL), the upper-extremity portion of the Fugl-Meyer Assessment (FMA), and the combined kinematic score (CKS) derived from workstation measurements. The WMFT, MAL, and FMA were used to assess function in the absence of FES whereas CKS was used to evaluate function assisted by FES. RESULTS: Improvements in the WMFT and CKS were significantly greater in the high-intensity group (post-treatment effect size, .95) than the low-intensity group (post-treatment effect size, 1.3). The differences in MAL and FMA were not statistically significant. CONCLUSIONS: Subjects performing high-intensity FES-ET showed significantly greater improvements on the WMFT than those performing low-intensity FES-ET. However, this was not reflected in subjects' self-assessments (MAL) or in their FMA scores, so the clinical significance of the result is open to debate. The CKS data suggest that high-intensity FES-ET may be advantageous in neuroprosthetic applications.

Stroke rehabilitation research PMID: 17601461 [PubMed - indexed for MEDLINE]The effect of the introduction of a case-mix-based funding model of rehabilitation for severe stroke: an Australian experience. Related Articles

The effect of the introduction of a case-mix-based funding model of rehabilitation for severe stroke: an Australian experience.

Arch Phys Med Rehabil. 2007 Jul;88(7):827-32

Stroke rehabilitation research :- Authors: Brock KA, Vale SJ, Cotton SM

OBJECTIVE: To compare resource use of, and outcomes for, rehabilitation for severe stroke before and after the implementation of the Casemix and Rehabilitation Funding Tree case-mix-based funding model. DESIGN: Prospective, observational cohort study. SETTING: Eight inpatient rehabilitation centers in Australia. PARTICIPANTS: Consecutive sample of 609 patients with severe stroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Rehabilitation length of stay (LOS), discharge destination, and FIM instrument motor score at discharge. RESULTS: The average rehabilitation LOS changed significantly between the preimplementation year and the implementation year (Mann-Whitney U, P=.001). There were no significant differences in discharge destination. FIM motor score at discharge showed significant reduction in improvement (Mann-Whitney U, P=.001) between the preimplementation year and the implementation year. There were no significant correlations between LOS in rehabilitation and gain in function for either the preimplementation year (Spearman rho, P=.07) or the implementation year (P=.15). CONCLUSIONS: The change in funding model was associated with a decrease in inpatient costs and with an associated increase in disability at discharge. Our results suggest that the rate of improvement in severe stroke is variable; also, they support the use of funding models for stroke rehabilitation that allow flexibility in resource allocation.

Stroke rehabilitation research PMID: 17601460 [PubMed - indexed for MEDLINE]Social determinants of discharge destination for patients after stroke with low admission FIM instrument scores. Related Articles

Social determinants of discharge destination for patients after stroke with low admission FIM instrument scores.

Arch Phys Med Rehabil. 2007 Jun;88(6):740-4

Stroke rehabilitation research :- Authors: Nguyen TA, Page A, Aggarwal A, Henke P

OBJECTIVE: To investigate the effects of immigrant status (via country of birth), marital status, and area-based socioeconomic status (SES) on discharge destination after stroke for those with low admission scores on the FIM instrument. DESIGN: Cross-sectional study. SETTING: Inpatient rehabilitation ward at an urban community hospital in Australia. PARTICIPANTS: A total of 326 inpatients admitted for rehabilitation poststroke. INTERVENTION: Multidisciplinary rehabilitation. MAIN OUTCOME MEASURE: Discharge home versus nursing home. RESULTS: A total admission FIM score of 75 or lower was associated with a higher probability of nursing home discharge. Married patients with a total FIM admission score of 75 or lower were significantly more likely to be discharged home, after adjusting for immigrant status, type and side of stroke, sex, and age (odds ratio, 6.07; 95% confidence interval, 1.65-22.40; P<.01). This effect was also observed for low motor and cognition components of FIM admission score. The effect of immigrant status did not remain significant after adjusting for marital status. Area-based SES and stroke characteristics did not substantially attenuate the relationship between immigrant status, marital status, and discharge location. CONCLUSIONS: Marital status is a significant determinant of discharge destination. Immigrant status and area-based SES were not significant predictors of discharge disposition.

Stroke rehabilitation research PMID: 17532895 [PubMed - indexed for MEDLINE]Effect of sensory-amplitude electric stimulation on motor recovery and gait kinematics after stroke: a randomized controlled study. Related Articles

Effect of sensory-amplitude electric stimulation on motor recovery and gait kinematics after stroke: a randomized controlled study.

Arch Phys Med Rehabil. 2007 Jun;88(6):710-4

Stroke rehabilitation research :- Authors: Yavuzer G, Oken O, Atay MB, Stam HJ

OBJECTIVE: To evaluate the effects of sensory-amplitude electric stimulation (SES) of the paretic leg on motor recovery and gait kinematics of patients with stroke. DESIGN: Randomized, controlled, double-blind study. SETTING: Rehabilitation ward and gait laboratory of a university hospital. PARTICIPANTS: A total of 30 consecutive inpatients with stroke (mean age, 63.2 y), all within 6 months poststroke and without volitional ankle dorsiflexion were studied. INTERVENTION: Both the SES group (n=15) and the placebo group (n=15) participated in a conventional stroke rehabilitation program 5 days a week for 4 weeks. The SES group also received 30 minutes of SES to the paretic leg without muscle contraction 5 days a week for 4 weeks. MAIN OUTCOME MEASURES: Brunnstrom stages of motor recovery and time-distance and kinematic characteristics of gait. RESULTS: Brunnstrom stages improved significantly in both groups (P<.05). In total, 58% of the SES group and 56% of the placebo group gained voluntary ankle dorsiflexion. The between-group difference of percentage change was not significant (P>.05). Gait kinematics was improved in both groups, but the between-group difference was not significant. CONCLUSIONS: In our patients with stroke, SES of the paretic leg was not superior to placebo in terms of lower-extremity motor recovery and gait kinematics.

Stroke rehabilitation research PMID: 17532891 [PubMed - indexed for MEDLINE]Pharmacological, surgical, and neurovascular interventions to augment acute aphasia recovery. Related Articles

Pharmacological, surgical, and neurovascular interventions to augment acute aphasia recovery.

Am J Phys Med Rehabil. 2007 Jun;86(6):426-34

Stroke rehabilitation research :- Authors: Hillis AE

Aphasia recovery has often been attributed to a combination of "spontaneous recovery" and rehabilitation. However, a variety of new pharmacological, surgical, and interventional neuroradiology procedures have been developed that can complement rehabilitation in the first days to weeks after stroke by restoring blood flow to dysfunctional but salvageable brain tissue. This paper will review the medical and surgical interventions to improve regional cerebral blood flow that recently have been shown to (1) augment aphasia recovery by improving tissue function, and (2) prevent expansion of the stroke that would otherwise impede recovery. Success with such treatments facilitates aphasia rehabilitation by improving the baseline language performance that must be improved further with language therapy.

Stroke rehabilitation research PMID: 17515681 [PubMed - indexed for MEDLINE]Treatment innovation in rehabilitation of cognitive and motor deficits after stroke and brain injury: physiological adjunctive treatments. Related Articles

Treatment innovation in rehabilitation of cognitive and motor deficits after stroke and brain injury: physiological adjunctive treatments.

Am J Phys Med Rehabil. 2007 Jun;86(6):423-5

Stroke rehabilitation research :- Authors: Barrett AM, Levy CE, Gonzalez Rothi LJ

Stroke rehabilitation research PMID: 17515680 [PubMed - indexed for MEDLINE]Mirror therapy enhances lower-extremity motor recovery and motor functioning after stroke: a randomized controlled trial. Related Articles

Mirror therapy enhances lower-extremity motor recovery and motor functioning after stroke: a randomized controlled trial.

Arch Phys Med Rehabil. 2007 May;88(5):555-9

Stroke rehabilitation research :- Authors: Sütbeyaz S, Yavuzer G, Sezer N, Koseoglu BF

OBJECTIVE: To evaluate the effects of mirror therapy, using motor imagery training, on lower-extremity motor recovery and motor functioning of patients with subacute stroke. DESIGN: Randomized, controlled, assessor-blinded, 4-week trial, with follow-up at 6 months. SETTING: Rehabilitation education and research hospital. PARTICIPANTS: A total of 40 inpatients with stroke (mean age, 63.5 y), all within 12 months poststroke and without volitional ankle dorsiflexion. INTERVENTIONS: Thirty minutes per day of the mirror therapy program, consisting of nonparetic ankle dorsiflexion movements or sham therapy, in addition to a conventional stroke rehabilitation program, 5 days a week, 2 to 5 hours a day, for 4 weeks. MAIN OUTCOME MEASURES: The Brunnstrom stages of motor recovery, spasticity assessed by the Modified Ashworth Scale (MAS), walking ability (Functional Ambulation Categories [FAC]), and motor functioning (motor items of the FIM instrument). RESULTS: The mean change score and 95% confidence interval (CI) of the Brunnstrom stages (mean, 1.7; 95% CI, 1.2-2.1; vs mean, 0.8; 95% CI, 0.5-1.2; P=.002), as well as the FIM motor score (mean, 21.4; 95% CI, 18.2-24.7; vs mean, 12.5; 95% CI, 9.6-14.8; P=.001) showed significantly more improvement at follow-up in the mirror group compared with the control group. Neither MAS (mean, 0.8; 95% CI, 0.4-1.2; vs mean, 0.3; 95% CI, 0.1-0.7; P=.102) nor FAC (mean, 1.7; 95% CI, 1.2-2.1; vs mean, 1.5; 95% CI, 1.1-1.9; P=.610) showed a significant difference between the groups. CONCLUSIONS: Mirror therapy combined with a conventional stroke rehabilitation program enhances lower-extremity motor recovery and motor functioning in subacute stroke patients.

Stroke rehabilitation research PMID: 17466722 [PubMed - indexed for MEDLINE]The impact of the inpatient rehabilitation facility prospective payment system on stroke program outcomes. Related Articles

The impact of the inpatient rehabilitation facility prospective payment system on stroke program outcomes.

Am J Phys Med Rehabil. 2007 May;86(5):356-63

Stroke rehabilitation research :- Authors: Gillen R, Tennen H, McKee T

OBJECTIVE: To examine the impact of the Medicare inpatient rehabilitation facility (IRF) prospective payment system (PPS) on outcomes in a stroke rehabilitation program. DESIGN: An analysis was performed on a database including 945 stroke patients admitted to an inpatient stroke rehabilitation program 5 yrs before implementation of the IRF PPS and 3.5 yrs after implementation. Patients were classified with regard to stroke location (left vs. right), level of cognitive impairment, presence/absence of unilateral neglect, and level of depressive symptomatology. Functional status was evaluated at time of admission and discharge by functional independence measure (FIM). Other outcome measures included length of stay (LOS) and discharge destination. The impact of IRF PPS on LOS, progress in rehabilitation, and discharge destination was examined via univariate analyses of covariance and logistic regression. RESULTS: Patients admitted after implementation of the IRF PPS had shorter LOS but made less progress, had lower functional levels at discharge, and had higher rates of institutional discharge. CONCLUSIONS: Although associated with decreased LOS, implementation of the IRF PPS was associated with decreased functional gains, lower discharge FIM levels, and higher rates of institutional discharge. Cost savings associated with the PPS must be considered in light of these untoward outcomes.

Stroke rehabilitation research PMID: 17449980 [PubMed - indexed for MEDLINE]The meaning of rehabilitation in the home environment after acute stroke from the perspective of a multiprofessional team. Related Articles

The meaning of rehabilitation in the home environment after acute stroke from the perspective of a multiprofessional team.

Phys Ther. 2007 Jun;87(6):778-88; discussion 788-91

Stroke rehabilitation research :- Authors: Wottrich AW, von Koch L, Tham K

BACKGROUND AND PURPOSE: Intervention programs for home-based rehabilitation are not fully described in the literature, and rehabilitation team members' experiences and tacit understanding of working with patients after stroke in the home environment need to be further understood. The aim of this study was to identify the meaning of rehabilitation in the home environment after stroke from the perspective of members of a multiprofessional team. SUBJECTS: Thirteen members of a multiprofessional outreach team (physical therapists, occupational therapists, speech and language therapists, and a social worker) working at a geriatric hospital in Stockholm, Sweden, participated in the study. METHODS: A qualitative method (the Empirical Phenomenological Psychological method) was used, with data being obtained from retrospective interviews of the team members after completing home-based rehabilitation of patients after acute stroke. RESULTS: One main theme ("supporting continuity") and 4 subthemes ("making a journey together from hospital to home," "enabling experiences of functioning," "refraining from interventions-encouraging patient problem-solving skills," and "looking for a new phase-uncertain endings") were revealed. DISCUSSION AND CONCLUSION: The findings suggest that contextual factors, both environmental and personal, were considered to be of great importance by the members of the multiprofessional team and were accounted for when they were working in the home environment in the rehabilitation of patients after stroke. Contextual factors detected in the home environment gave valuable information to the team members, who used the information in their strategies to assist the patients in finding continuity in their daily life and to link the past to the present and the "new body" to the "old body."

Stroke rehabilitation research PMID: 17442837 [PubMed - indexed for MEDLINE]Locomotor adaptation on a split-belt treadmill can improve walking symmetry post-stroke. Related Articles

Locomotor adaptation on a split-belt treadmill can improve walking symmetry post-stroke.

Brain. 2007 Jul;130(Pt 7):1861-72

Stroke rehabilitation research :- Authors: Reisman DS, Wityk R, Silver K, Bastian AJ

Human locomotion must be flexible in order to meet varied environmental demands. Alterations to the gait pattern occur on different time scales, ranging from fast, reactive adjustments to slower, more persistent adaptations. A recent study in humans demonstrated that the cerebellum plays a key role in slower walking adaptations in interlimb coordination during split-belt treadmill walking, but not fast reactive changes. It is not known whether cerebral structures are also important in these processes, though some studies of cats have suggested that they are not. We used a split-belt treadmill walking task to test whether cerebral damage from stroke impairs either type of flexibility. Thirteen individuals who had sustained a single stroke more than 6 months prior to the study (four females) and 13 age- and gender-matched healthy control subjects were recruited to participate in the study. Results showed that stroke involving cerebral structures did not impair either reactive or adaptive abilities and did not disrupt storage of new interlimb relationships (i.e. after-effects). This suggests that cerebellar interactions with brainstem, rather than cerebral structures, comprise the critical circuit for this type of interlimb control. Furthermore, the after-effects from a 15-min adaptation session could temporarily induce symmetry in subjects who demonstrated baseline asymmetry of spatiotemporal gait parameters. In order to re-establish symmetric walking, the choice of which leg is on the fast belt during split-belt walking must be based on the subject's initial asymmetry. These findings demonstrate that cerebral stroke survivors are indeed able to adapt interlimb coordination. This raises the possibility that asymmetric walking patterns post-stroke could be remediated utilizing the split-belt treadmill as a long-term rehabilitation strategy.

Stroke rehabilitation research PMID: 17405765 [PubMed - indexed for MEDLINE]Priorities for stroke rehabilitation and research: results of a 2003 Canadian Stroke Network consensus conference. Related Articles

Priorities for stroke rehabilitation and research: results of a 2003 Canadian Stroke Network consensus conference.

Arch Phys Med Rehabil. 2007 Apr;88(4):526-8

Stroke rehabilitation research :- Authors: Bayley MT, Hurdowar A, Teasell R, Wood-Dauphinee S, Korner-Bitensky N, Richards CL, Harrison M, Jutai JW

The Canadian Stroke Network Consensus Conference panel met in 2003 in Toronto, Canada, to address areas of stroke rehabilitation that require additional research as well as increased efforts to knowledge translation. The results of an extensive literature review, of a study of factors related to poststroke quality of life, and a survey of clinicians were presented to the panel. From this review, the panel compiled a consensus list of 5 priority areas in stroke rehabilitation research that warrant further investigation. The priorities are: (1) multimodal programs for reintegration into the community; (2) rehabilitation of patients with severe strokes; (3) the ideal timing and intensity of aphasia therapy; (4) cognitive rehabilitation; and (5) and the timing and intensity of rehabilitation after mild-to-moderate stroke. The panel recommended that agencies that fund research create special competitions to support large, multicenter randomized controlled studies to investigate these areas of research. In addition, the panel identified 3 priority areas for knowledge translation where research was convincing: (1) lower-extremity (leg) interventions; (2) upper-extremity (arm) interventions; and (3) detection of clients who are at risk of complications, specifically depression, dysphagia, or cognitive impairment, as well as those at risk for falls and pressure ulcers.

Stroke rehabilitation research PMID: 17398256 [PubMed - indexed for MEDLINE]Improving hand function in stroke survivors: a pilot study of contralaterally controlled functional electric stimulation in chronic hemiplegia. Related Articles

Improving hand function in stroke survivors: a pilot study of contralaterally controlled functional electric stimulation in chronic hemiplegia.

Arch Phys Med Rehabil. 2007 Apr;88(4):513-20

Stroke rehabilitation research :- Authors: Knutson JS, Harley MY, Hisel TZ, Chae J

OBJECTIVE: To assess the feasibility of a new stroke rehabilitation therapy for the hemiparetic hand. DESIGN: Case series. Pre- and postintervention assessment with 1- and 3-month follow-ups. SETTING: Clinical research laboratory of a large public hospital. PARTICIPANTS: Three subjects with chronic (>6mo postcerebrovascular accident) upper-extremity hemiplegia. INTERVENTION: Subjects used an electric stimulator to cause the paretic hand extensor muscles to contract and thereby open the hand. Subjects controlled the intensity of the stimulation, and thus the degree of hand opening, by volitionally opening the unimpaired contralateral hand, which was detected by an instrumented glove. For 6 weeks, subjects used the stimulator to perform active repetitive hand-opening exercises 2 hours daily at home and functional tasks 1.5 hours twice a week in the laboratory. MAIN OUTCOME MEASURES: Maximum voluntary finger extension, maximum voluntary isometric finger-extension moment, finger-movement control, and box and block test (BBT) score at pre- and posttreatment and at 1 month and 3 months posttreatment. RESULTS: Maximum voluntary finger extension increased from baseline to end of treatment and from the end of treatment to 1-month follow-up in 2 subjects. Maximum voluntary isometric finger-extension moment, finger-movement control, and BBT score increased from baseline to the end of treatment and from the end of treatment to 1-month follow-up in all 3 subjects. The improvements generally declined at 3 months. CONCLUSIONS: The results suggest a positive effect on motor impairment, meriting further investigation of the intervention.

Stroke rehabilitation research PMID: 17398254 [PubMed - indexed for MEDLINE]Satisfaction with quality of life poststroke: effect of sex differences in pain response. Related Articles

Satisfaction with quality of life poststroke: effect of sex differences in pain response.

Arch Phys Med Rehabil. 2007 Apr;88(4):413-7

Stroke rehabilitation research :- Authors: Bergés IM, Ottenbacher KJ, Kuo YF, Smith PM, Smith D, Ostir GV

OBJECTIVE: To study the relationship between sex differences among men and women in the response to pain and the effect on satisfaction with quality of life (QOL) in poststroke patients approximately 90 days after discharge from inpatient medical rehabilitation. DESIGN: Cross-sectional design. SETTING: Community based. PARTICIPANTS: The sample included 1724 patients (877 men, 847 women) aged 40 years and older with a history of stroke, according to information obtained from the IT HealthTrack database. The average age was 68.7 years; 79.3% were non-Hispanic white. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Satisfaction with QOL. RESULTS: Pain ratings for both the men and the women were significant and inversely associated with satisfaction with QOL after adjustments for possible confounding factors. However, among men with stroke, each 1-point increase in pain rating was associated with an 18% decreased odds of being satisfied with QOL (odds ratio [OR], .81; 95% confidence interval [CI], .77-.86). Conversely, among women with stroke, each 1-point increase in pain rating was associated with an 11% decreased odds of being satisfied with QOL (OR=.89; 95% CI, .84-.95). CONCLUSIONS: Our data indicate that pain after stroke is significantly associated with reduced satisfaction with QOL, particularly among men. Increased awareness and treatment of pain may improve satisfaction with QOL. Our findings suggest that sex differences and pain response are clinically important factors in examining satisfaction with QOL in the poststroke population.

Stroke rehabilitation research PMID: 17398240 [PubMed - indexed for MEDLINE]A comparison of psychometric properties of the smart balance master system and the postural assessment scale for stroke in people who have had mild stroke. Related Articles

A comparison of psychometric properties of the smart balance master system and the postural assessment scale for stroke in people who have had mild stroke.

Arch Phys Med Rehabil. 2007 Mar;88(3):374-80

Stroke rehabilitation research :- Authors: Chien CW, Hu MH, Tang PF, Sheu CF, Hsieh CL

OBJECTIVE: To compare the psychometric properties (including the test-retest reliability, responsiveness, and predictive validity) of the Smart Balance Master (SBM) system and the Postural Assessment Scale for Stroke patients (PASS) in patients with mild stroke. DESIGN: One repeated-measures design (at a 2-wk interval) was used to examine the test-retest reliability of the SBM and PASS, and another similar design was applied to investigate their responsiveness. Patients who participated in the responsiveness study were followed up approximately 1 year later, and the predictive validity of the SBM system and PASS were examined by assessing the patients' comprehensive activities of daily living (ADL) function. SETTING: Three rehabilitation units in Taiwan. PARTICIPANTS: Twenty patients with chronic stroke in the reliability study; 40 and 32 patients who had recently had a stroke in the responsiveness and predictive validity studies, respectively. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Three computerized tests of the SBM (the equilibrium score of the Sensory Organization Test, scores in rhythmic weight-shifting tests, and scores in the limits of stability test) and the PASS were used. The combination of the Barthel Index and Frenchay Activities Index was used to represent the comprehensive ADL function. RESULTS: For the SBM, all but the weight-shifting tests of the SBM had moderate to high reliability (intraclass correlation coefficient [ICC] range, .78-.91). The responsiveness of the equilibrium score and the limits of stability test were moderate (effect size [d], .63) and small (d range, .27-.33), respectively, whereas the responsiveness of the weight-shifting tests was limited (d range, .04-.29). All but the weight-shifting tests of the SBM in the second evaluation had acceptable predictive validity for comprehensive ADL function (r2 range, .15-.17). The PASS showed high reliability (ICC=.84) and small responsiveness (d=.41), and the PASS in the second evaluation had acceptable predictive validity (r2=.24). CONCLUSIONS: The PASS and the equilibrium score and limits of stability scores of the SBM had acceptable test-retest reliability, responsiveness, and predictive validity in patients with mild stroke, but the psychometric properties of the weight-shifting tests of the SBM should be further examined before consideration of their usage in patients with stroke.

Stroke rehabilitation research PMID: 17321832 [PubMed - indexed for MEDLINE]Clinimetric properties of the Duruoz hand index in patients with stroke. Related Articles

Clinimetric properties of the Duruoz hand index in patients with stroke.

Arch Phys Med Rehabil. 2007 Mar;88(3):309-14

Stroke rehabilitation research :- Authors: Sezer N, Yavuzer G, Sivrioglu K, Basaran P, Koseoglu BF

OBJECTIVE: To investigate the reliability, validity, and responsiveness of the Duruoz Hand Index (DHI) in assessing activity limitation related to hand function in patients with stroke. DESIGN: Prospective validation study. A consecutive sample of stroke patients was evaluated on 3 occasions: 2 baseline measurements with a 24-hour interval in between, and again 1 month later immediately after a 4-week inpatient rehabilitation program. SETTING: Three different inpatient rehabilitation centers. PARTICIPANTS: A consecutive sample of 56 patients with stroke (33 men, 23 women) with a mean age 62 years and a mean time since stroke 84 days. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Brunnstrom stages, Modified Ashworth Scale, sensory status, FIM instrument, and DHI. Test-retest reliability was tested using the intraclass correlation coefficient (ICC) and internal consistency was tested using the Cronbach alpha coefficient. Indexes of measurement error were calculated by standard error of measurement and minimal detectable change (MDC). Construct validity was assessed by association with the FIM instrument (Spearman rho correlation coefficient). Responsiveness was assessed by calculation of the effect size and paired t test. RESULTS: The test-retest reliability and internal consistency of the DHI were excellent, with an ICC of .99 (95% confidence interval, .93-.99) and alpha of .97. The MDC was 1.4 DHI points. The correlation between the DHI and the FIM self-care items was high (rho=-.73). The DHI significantly discriminated the patients with dominant side paresis versus nondominant side paresis (P<.01). The DHI score improved significantly after a 4-week inpatient rehabilitation program (P<.05). CONCLUSIONS: The DHI is a time and labor efficient, practical instrument that can be used to assess the hand-related activity level for clinical and research purposes in patients with stroke.

Stroke rehabilitation research PMID: 17321822 [PubMed - indexed for MEDLINE]Poststroke shoulder pain: its relationship to motor impairment, activity limitation, and quality of life. Related Articles

Poststroke shoulder pain: its relationship to motor impairment, activity limitation, and quality of life.

Arch Phys Med Rehabil. 2007 Mar;88(3):298-301

Stroke rehabilitation research :- Authors: Chae J, Mascarenhas D, Yu DT, Kirsteins A, Elovic EP, Flanagan SR, Harvey RL, Zorowitz RD, Fang ZP

OBJECTIVE: To assess the relationship between poststroke shoulder pain, upper-limb motor impairment, activity limitation, and pain-related quality of life (QOL). DESIGN: Cross-sectional, secondary analysis of baseline data from a multisite clinical trial. SETTING: Outpatient rehabilitation clinics of 7 academic medical centers. PARTICIPANTS: Volunteer sample of 61 chronic stroke survivors with poststroke shoulder pain and glenohumeral subluxation. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: We measured poststroke shoulder pain with the Brief Pain Inventory question 12 (BPI 12), a self-reported 11-point numeric rating scale (NRS) that assesses "worst pain" in the last 7 days. Motor impairment was measured with the Fugl-Meyer Assessment (FMA). Activity limitation was measured with the Arm Motor Ability Test (AMAT) and the FIM instrument. Pain-related QOL was measured with BPI question 23, a self-reported 11-point NRS that assesses pain interference with general activity, mood, walking ability, normal work, interpersonal relationships, sleep, and enjoyment of life. RESULTS: Stepwise regression analyses indicated that poststroke shoulder pain is associated with the BPI 23, but not with the FMA, FIM, or AMAT scores. CONCLUSIONS: Poststroke shoulder pain is associated with reduced QOL, but not with motor impairment or activity limitation.

Stroke rehabilitation research PMID: 17321820 [PubMed - indexed for MEDLINE]A randomized controlled trial of modified constraint-induced movement therapy for elderly stroke survivors: changes in motor impairment, daily functioning, and quality of life. Related Articles

A randomized controlled trial of modified constraint-induced movement therapy for elderly stroke survivors: changes in motor impairment, daily functioning, and quality of life.

Arch Phys Med Rehabil. 2007 Mar;88(3):273-8

Stroke rehabilitation research :- Authors: Wu CY, Chen CL, Tsai WC, Lin KC, Chou SH

OBJECTIVE: To examine the benefits of modified constraint-induced movement therapy (mCIMT) on motor function, daily function, and health-related quality of life (HRQOL) in elderly stroke survivors. DESIGN: Two-group randomized controlled trial, with pretreatment and posttreatment measures. SETTING: Rehabilitation clinics. PARTICIPANTS: Twenty-six elderly stroke patients (mean age, 72 y) with 0.5 to 31 months postonset of a first-ever cerebrovascular accident. INTERVENTIONS: Twenty-six patients received either mCIMT (restraint of the unaffected limb combined with intensive training of the affected limb) or traditional rehabilitation for a period of 3 weeks. MAIN OUTCOME MEASURES: Outcome measures included the Fugl-Meyer Assessment (FMA), FIM instrument, Motor Activity Log (MAL), and Stroke Impact Scale (SIS). The FMA evaluated the severity of motor impairment; the FIM instrument and MAL reported daily function; and the SIS detected HRQOL. RESULTS: The mCIMT group exhibited significantly greater improvements in motor function, daily function, and the physical domain of HRQOL than the traditional rehabilitation group. Patients in the mCIMT group perceived significantly greater percent of recovery after treatment than patients in the traditional rehabilitation group. CONCLUSIONS: These findings suggest mCIMT is a promising intervention for improving motor function, daily function, and physical aspects of HRQOL in elderly patients with stroke. The mCIMT was well tolerated by the elderly patients even though it is a rigorous training program.

Stroke rehabilitation research PMID: 17321816 [PubMed - indexed for MEDLINE]Deficits in surface force production during seated reaching in people after stroke. Related Articles

Deficits in surface force production during seated reaching in people after stroke.

Phys Ther. 2007 Mar;87(3):326-36

Stroke rehabilitation research :- Authors: Reisman DS, Scholz JP

BACKGROUND AND PURPOSE: In order to design effective treatment strategies for the rehabilitation of reaching after stroke, it is necessary to understand the underlying deficits. Although the kinematic aspects of reaching after stroke have been studied frequently, little attention has been paid to the surface force production underlying this behavior. The purpose of this study was to investigate surface force production and its coordination with arm movement during seated reaching in a group of people with hemiparesis. SUBJECTS: Seven people with mild right hemiparesis after stroke and 7 people who were neurologically healthy participated. METHODS: Subjects performed seated reaching at 160% their normal speed toward ipsilateral and contralateral targets placed 160% beyond arm reach. Surface forces beneath the seat and feet and 3-dimensional hand movement and joint motions of the upper extremity and trunk were recorded. RESULTS: A weight shift from seat to feet occurred earlier whereas the onset of medial-lateral seat force was delayed and smaller in magnitude in people with hemiparesis. DISCUSSION AND CONCLUSION: The results suggest that the normal magnitude and timing of surface force production during reaching beyond arm's length are altered in people with even mild hemiparesis after stroke, particularly during reaching toward the hemiparetic side.

Stroke rehabilitation research PMID: 17311889 [PubMed - indexed for MEDLINE]The effect of poststroke impairments on brachialis muscle architecture as measured by ultrasound. Related Articles

The effect of poststroke impairments on brachialis muscle architecture as measured by ultrasound.

Arch Phys Med Rehabil. 2007 Feb;88(2):243-50

Stroke rehabilitation research :- Authors: Li L, Tong KY, Hu X

OBJECTIVE: To evaluate the joint angle dependence of brachialis muscle architecture at rest and changes in brachialis muscle architecture during isometric voluntary contractions in people after stroke. DESIGN: The pennation angle and fascicle length of the brachialis muscle were measured in the affected and unaffected sides of people after stroke at 9 different elbow angles ranging from 10 degrees to 90 degrees at the rest condition. Measurements were also carried out at a fixed joint angle of 90 degrees while the subjects were performing isometric muscle contractions at 5 incremental levels of maximal voluntary contraction (MVC) from 20% to 100% of MVC. The data obtained from the affected and unaffected sides of the subjects were compared. SETTING: A research laboratory in a rehabilitation center. PARTICIPANTS: Seven hemiplegic adults after stroke with passive range of motion in the elbow from 10 degrees to 90 degrees and Modified Ashworth Scale score larger than 1 were recruited. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Ultrasonography was used to measure brachialis muscle pennation angle and fascicle length at the rest condition and during isometric contractions. RESULTS: The measured pennation angles and fascicle lengths were found to be joint-angle-dependent in both the affected and unaffected groups at the rest condition. Further comparisons found that the pennation angles of the affected brachialis muscle were significantly larger (P<.05) than the unaffected muscle in the most extended positions (<50 degrees ), whereas the affected fascicle lengths were significantly shorter (P<.05) than the unaffected muscle in most flexed positions (>20 degrees ). As the level of isometric voluntary contraction was increased incrementally from 20% to 100% of MVC, the results showed that pennation angle increased significantly (P<.05) while fascicle length decreased significantly (P<.01) in the unaffected muscle. However, the contraction level has a significant effect only on pennation angle (P<.05) but not on fascicle length in the affected side. In addition, the measured fascicle lengths in the unaffected group were significantly shorter than those in the affected group for isometric contractions above 40% MVC. CONCLUSIONS: Our findings suggest that the architectural parameters of the brachialis muscle in people after stroke are elbow-joint-angle-dependent at the rest condition. In the affected side, pennation angle changed the most when the muscle was in an extension position and fascicle length changed the most in a flexed position when compared with the unaffected side. Immobilization and contracture might cause a shortening of the fascicle and an increase in pennation angle in the affected side. Smaller pennation angle and fascicle length changes in the affected side during isometric contraction might be due to weakness in the muscle after the onset of stroke.

Stroke rehabilitation research PMID: 17270524 [PubMed - indexed for MEDLINE]Executive function deficits in acute stroke. Related Articles

Executive function deficits in acute stroke.

Arch Phys Med Rehabil. 2007 Feb;88(2):173-80

Stroke rehabilitation research :- Authors: Zinn S, Bosworth HB, Hoenig HM, Swartzwelder HS

OBJECTIVES: To establish the frequency of executive dysfunction during acute hospitalization for stroke and to examine the relationship of that dysfunction to stroke severity and premorbid characteristics. DESIGN: Inception cohort study. SETTING: Inpatient wards at a Veterans Affairs hospital. PARTICIPANTS: Consecutive sample of inpatients with radiologically or neurologically confirmed stroke. Final sample included 47 patients screened for aphasia and capable of neuropsychologic testing. Two nonstroke inpatient control samples (n=10 each) with either transient ischemic attack (TIA) or multiple stroke risk factors were administered the same research procedure and tests. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Composite cognitive impairment ratio (CIR), calculated from 8 scores indicative of executive function on 6 neuropsychologic tests by dividing number of tests completed into the number of scores falling below cutoff point, defined as 1.5 standard deviations below normative population mean. RESULTS: Stroke patients had a mean CIR of .61, compared with .48 for TIAs and .44 for stroke-risk-only. Analysis of variance revealed that CIRs of stroke-risk-only patients but not TIAs were lower than those of the stroke patients (P=.02). Impairment frequencies were at least 50% for stroke patients on most test scores. The Symbol Digit Modalities Test (75% impairment) and a design fluency measure distinguished stroke from nonstroke patients. CIR was not related to stroke severity in the stroke patient sample, but was related to estimated premorbid intelligence. CONCLUSIONS: Executive function deficits are common in stroke patients. The data suggest that limitations in information processing due to these deficits may require environmental and procedural accommodations to increase rehabilitation benefit.

Stroke rehabilitation research PMID: 17270514 [PubMed - indexed for MEDLINE]Robotic-assisted rehabilitation of the upper limb after acute stroke. Related Articles

Robotic-assisted rehabilitation of the upper limb after acute stroke.

Arch Phys Med Rehabil. 2007 Feb;88(2):142-9

Stroke rehabilitation research :- Authors: Masiero S, Celia A, Rosati G, Armani M

OBJECTIVE: To investigate whether early therapy with a novel robotic device can reduce motor impairment and enhance functional recovery of poststroke patients with hemiparetic and hemiplegic upper limb. DESIGN: A single-blind randomized controlled trial, with an 8-month follow-up. SETTING: Neurologic department and rehabilitation hospital. PARTICIPANTS: Thirty-five patients with acute (< or =1 wk of onset), unilateral, ischemic embolic, or thrombotic stroke. INTERVENTIONS: Patients of both groups received the same dose and length per day of standard poststroke multidisciplinary rehabilitation. Patients were randomly assigned to 2 groups. The experimental group (n=17) received additional early sensorimotor robotic training, 4 hours a week for 5 weeks; the control group (n=18) was exposed to the robotic device, 30 minutes a week, twice a week, but the exercises were performed with the unimpaired upper limb. Training by robot consisted of peripheral manipulation of the shoulder and elbow of the impaired limb, correlated with visual stimuli. MAIN OUTCOME MEASURES: The Fugl-Meyer Assessment (FMA) of upper-extremity function (shoulder/elbow and coordination and wrist/hand subsections) to measure each trained limb segment; the Medical Research Council (MRC) score to measure the strength of muscle force during 3 actions: shoulder abduction (MRC deltoid), elbow flexion (MRC biceps), and wrist flexion (MRC wrist flexors); the FIM instrument and its motor component; and the Trunk Control Test (TCT) and Modified Ashworth Scale (MAS). RESULTS: Compared with the patients in the control group, the experimental group showed significant gains in motor impairment and functional recovery of the upper limb after robot therapy, as measured by the MRC deltoid (P< or =.05) and biceps (P<.05) scores, the FMA for the proximal upper arm (P<.05), the FIM instrument (P<.05), and the FIM motor score (P<.01); these gains were also sustained at the 3- and 8-month follow-up. The FMA and MRC wrist flexor test findings did not differ statistically either at the end of training or at the follow-up sessions. We found no significant differences in MAS and TCT in either group in any of the evaluations. No adverse effects occurred and the robotic approach was very well accepted. CONCLUSIONS: Patients who received robotic therapy in addition to conventional therapy showed greater reductions in motor impairment and improvements in functional abilities. Robotic therapy may therefore effectively complement standard rehabilitation from the start, by providing therapeutic support for patients with poststroke plegic and paretic upper limb.

Stroke rehabilitation research PMID: 17270510 [PubMed - indexed for MEDLINE]Geratology rehabilitation units are not just for stroke. Related Articles

Geratology rehabilitation units are not just for stroke.

BMJ. 2007 Jan 27;334(7586):170

Stroke rehabilitation research :- Authors: Soni A, Walter K, Ward SM, Jones H

Stroke rehabilitation research PMID: 17255579 [PubMed - indexed for MEDLINE]Review of stroke rehabilitation.

Review of stroke rehabilitation.

BMJ. 2007 Jan 13;334(7584):86-90

Stroke rehabilitation research :- Authors: Young J, Forster A

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