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Greenberg JA, Roth EJ, Wuermser LA, Almagor O, Schnitzer TJ. Osteoporosis Treatment for Patients with Stroke. Top Stroke Rehabil 2014; 14:62-7. [PMID: 17517576 DOI: 10.1310/tsr1402-62] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE Little is known about the frequency of use of medications to maintain bone health for patients with stroke. This study was undertaken at an urban academic rehabilitation center to determine the prevalence of use of agents that could reduce bone loss in the stroke population. METHOD A clinical database was searched for all patients 18 years old and over with stroke. The sample included 1,219 inpatients and 2,776 outpatients. Demographic information (age, gender, and race) and medications were obtained for each patient. RESULTS Among inpatients with stroke, 7.1% were taking osteoporosis medications (bisphosphonates, calcitonin, parathyroid hormone, or hormone replacement therapy), 11.3% were taking calcium supplements, 5.9% were taking vitamin D supplements, and 45.1% were taking multivitamin supplements. Among outpatients with stroke, 5.7% were taking osteoporosis medication, 5.8% were taking calcium supplements, 2.2% were taking vitamin D supplements, and 16.0% were taking multivitamin supplements. Patients being treated with specific osteoporosis therapies tended to be older and female by calculated odds ratios. The use of multivitamins was not related to age, gender, or race. CONCLUSION Overall, relatively few stroke patients were taking osteoporosis medications or supplements. There is a need to increase the recognition, prevention, and treatment of bone loss in this high-risk population.
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Roth EJ, Lovell L. Community Skill Performance and Its Association with the Ability to Perform Everyday Tasks by Stroke Survivors One Year Following Rehabilitation Discharge. Top Stroke Rehabil 2014; 14:48-56. [PMID: 17311790 DOI: 10.1310/tsr1401-48] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Stroke survivors experience functional loss in basic activities of daily living (ADLs) and in everyday community activities or instrumental activities of daily living (IADLs). Historically there has been a greater focus by rehabilitation professionals on basic ADLs than on IADLs. PURPOSE The purpose of this study was to describe the relationship between the ability to perform ADLs and community activities in a large group of stroke patients measured 1 year following rehabilitation discharge. METHOD A structured survey was administered by telephone. Outcome measures were the Frenchay Activities Index (FAI), a measure of IADL, and the FIM, a measure of disability. RESULTS Visual inspection of the relationship between FAI scores and FIM scores revealed that the data largely followed a curvilinear pattern. Curve estimation regression models were used to determine the line of best fit. A cubic function was found to give a good fit with an R2 of 0.644. The three activities in which stroke patients most frequently engaged were social outings, walking outside for more than 15 minutes, and local shopping. The three activities in which stroke patients engaged the least were gainful work, gardening outside, and household/car maintenance. CONCLUSION A score of approximately 80 or greater on the FIM was associated with a substantially increased level of participation in home and community activities.
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Roth EJ, Lovell L, Harvey RL, Bode RK. Delay in Transfer to Inpatient Stroke Rehabilitation: The Role of Acute Hospital Medical Complications and Stroke Characteristics. Top Stroke Rehabil 2014; 14:57-64. [PMID: 17311791 DOI: 10.1310/tsr1401-57] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND An increased delay between stroke onset and transfer to rehabilitation has been associated with poorer outcomes after stroke rehabilitation. PURPOSE The purpose of this study was to examine the relationships between selected clinical factors and the interval from stroke onset to rehabilitation admission. METHOD A cohort of 2,457 patients consecutively admitted for inpatient stroke rehabilitation was studied. Patient demographic data, stroke characteristics, stroke onset to rehabilitation admission interval (ORAI), and medical complications that occurred during the acute post-stroke hospitalization were documented. Univariate and multiple regression analyses were used to determine relationships between patient demographic data, stroke characteristics, and acute medical complications with ORAI. RESULTS The average ORAI was 17.2 days, with a median of 12 days. Stroke characteristics and acute medical complications were the two groups of factors that were most strongly associated with longer ORAIs. These two groups each explained approximately 15.5% and 17.3% of the variance in the model, respectively. The most significant individual factors included the presence of an enteral feeding tube, a hemorrhagic stroke, a cortical stroke, pneumonia, urinary tract infection, and younger age at stroke onset. CONCLUSION Although some medical problems associated with longer ORAI are functions of the severity of the stroke and patient characteristics, attention to preventable medical complications may be associated with a more rapid transition to the inpatient rehabilitation setting.
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Eum RS, Seel RT, Goldstein R, Brown AW, Watanabe TK, Zasler ND, Roth EJ, Zafonte RD, Glenn MB. Predicting institutionalization after traumatic brain injury inpatient rehabilitation. J Neurotrauma 2014; 32:280-6. [PMID: 25203001 DOI: 10.1089/neu.2014.3351] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Risk factors contributing to institutionalization after inpatient rehabilitation for people with traumatic brain injury (TBI) have not been well studied and need to be better understood to guide clinicians during rehabilitation. We aimed to develop a prognostic model that could be used at admission to inpatient rehabilitation facilities to predict discharge disposition. The model could be used to provide the interdisciplinary team with information regarding aspects of patients' functioning and/or their living situation that need particular attention during inpatient rehabilitation if institutionalization is to be avoided. The study population included 7219 patients with moderate-severe TBI in the Traumatic Brain Injury Model Systems (TBIMS) National Database enrolled from 2002-2012 who had not been institutionalized prior to injury. Based on institutionalization predictors in other populations, we hypothesized that among people who had lived at a private residence prior to injury, greater dependence in locomotion, bed-chair-wheelchair transfers, bladder and bowel continence, feeding, and comprehension at admission to inpatient rehabilitation programs would predict institutionalization at discharge. Logistic regression was used, with adjustment for demographic factors, proxy measures for TBI severity, and acute-care length-of-stay. C-statistic and predictiveness curves validated a five-variable model. Higher levels of independence in bladder management (adjusted odds ratio [OR], 0.88; 95% CI 0.83, 0.93), bed-chair-wheelchair transfers (OR, 0.81 [95% CI, 0.83-0.93]), and comprehension (OR, 0.78 [95% CI, 0.68, 0.89]) at admission were associated with lower risks of institutionalization on discharge. For every 10-year increment in age was associated with a 1.38 times higher risk for institutionalization (95% CI, 1.29, 1.48) and living alone was associated with a 2.34 times higher risk (95% CI, 1.86, 2.94). The c-statistic was 0.780. We conclude that this simple model can predict risk of institutionalization after inpatient rehabilitation for patients with TBI.
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Billinger SA, Arena R, Bernhardt J, Eng JJ, Franklin BA, Johnson CM, MacKay-Lyons M, Macko RF, Mead GE, Roth EJ, Shaughnessy M, Tang A. Physical Activity and Exercise Recommendations for Stroke Survivors. Stroke 2014; 45:2532-53. [PMID: 24846875 DOI: 10.1161/str.0000000000000022] [Citation(s) in RCA: 825] [Impact Index Per Article: 82.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Waldman G, Yang CY, Ren Y, Liu L, Guo X, Harvey RL, Roth EJ, Zhang LQ. Effects of robot-guided passive stretching and active movement training of ankle and mobility impairments in stroke. NeuroRehabilitation 2013; 32:625-34. [PMID: 23648617 DOI: 10.3233/nre-130885] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To investigate the effects of controlled passive stretching and active movement training using a portable rehabilitation robot on stroke survivors with ankle and mobility impairment. METHODS Twenty-four patients at least 3 months post stroke were assigned to receive 6 week training using the portable robot in a research laboratory (robot group) or an instructed exercise program at home (control group). All patients underwent clinical and biomechanical evaluations in the laboratory at pre-evaluation, post-evaluation, and 6-week follow-up. RESULTS Subjects in the robot group improved significantly more than that in the control group in reduction in spasticity measured by modified Ashworth scale, mobility by Stroke Rehabilitation Assessment of Movement (STREAM), the balance by Berg balance score, dorsiflexion passive range of motion, dorsiflexion strength, and load bearing on the affected limb during gait after 6-week training. Both groups improved in the STREAM, dorsiflexion active range of motion and dorsiflexor strength after the training, which were retained in the follow-up evaluation. CONCLUSION Robot-assisted passive stretching and active movement training is effective in improving motor function and mobility post stroke.
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Pellicane AJ, Millis SR, Barker KD, Temme KE, Sayyad A, Oswald MC, Roth EJ. The effect of protein and calorie intake on prealbumin, complications, length of stay, and function in the acute rehabilitation inpatient with stroke. NeuroRehabilitation 2013; 33:367-76. [DOI: 10.3233/nre-130966] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Pellicane AJ, Millis SR, Zimmerman SE, Roth EJ. Calorie and protein intake in acute rehabilitation inpatients with traumatic spinal cord injury versus other diagnoses. Top Spinal Cord Inj Rehabil 2013; 19:229-35. [PMID: 23960707 DOI: 10.1310/sci1903-229] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Obesity and its consequences affect patients with spinal cord injury (SCI). There is a paucity of data with regard to the dietary intake patterns of patients with SCI in the acute inpatient rehabilitation setting. Our hypothesis is that acute rehabilitation inpatients with SCI consume significantly more calories and protein than other inpatient rehabilitation diagnoses. OBJECTIVE To compare calorie and protein intake in patients with new SCI versus other diagnoses (new traumatic brain injury [TBI], new stroke, and Parkinson's disease [PD]) in the acute inpatient rehabilitation setting. METHODS The intake of 78 acute rehabilitation inpatients was recorded by registered dieticians utilizing once-weekly calorie and protein intake calculations. RESULTS Mean ± SD calorie intake (kcal) for the SCI, TBI, stroke, and PD groups was 1,967.9 ± 611.6, 1,546.8 ± 352.3, 1,459.7 ± 443.2, and 1,459.4 ± 434.6, respectively. ANOVA revealed a significant overall group difference, F(3, 74) = 4.74, P = .004. Mean ± SD protein intake (g) for the SCI, TBI, stroke, and PD groups was 71.5 ± 25.0, 61.1 ± 12.8, 57.6 ± 16.6, and 55.1 ± 19.1, respectively. ANOVA did not reveal an overall group difference, F(3, 74) = 2.50, P = .066. CONCLUSIONS Given the diet-related comorbidities and energy balance abnormalities associated with SCI, combined with the intake levels demonstrated in this study, education with regard to appropriate calorie intake in patients with SCI should be given in the acute inpatient rehabilitation setting.
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Major MJ, Fatone S, Roth EJ. Validity and reliability of the Berg Balance Scale for community-dwelling persons with lower-limb amputation. Arch Phys Med Rehabil 2013; 94:2194-202. [PMID: 23856150 DOI: 10.1016/j.apmr.2013.07.002] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 07/02/2013] [Accepted: 07/03/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the validity and reliability of the Berg Balance Scale (BBS) for use in people with lower-limb amputation. DESIGN Cross-sectional study. SETTING Research laboratory. PARTICIPANTS Individuals (N=30; age, 54±12y; 20 men) with unilateral transtibial (n=13), unilateral transfemoral (n=14), or bilateral (n=3) lower-limb amputation of dysvascular (n=7), traumatic (n=14), infectious (n=6), or congenital (n=3) origin. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES BBS, 2-minute walk test, L test, Prosthesis Evaluation Questionnaire-Mobility Subscale, Activities-specific Balance Confidence Scale, and Frenchay Activities Index; self-reported descriptors were also collected, including frequency of prosthesis use, number of falls in 12 months before the visit, fear of falling, and daily mobility aid use. RESULTS The BBS had high interrater reliability (intraclass correlation coefficient =.945) and internal consistency (α=.827). Relations between the BBS scores and those of other outcome measures were all statistically significant (P≤.001). Significant group differences in BBS scores were observed for fear of falling (P=.008) and mobility aid use (P<.001), but not for multiple (≥2) falls in the previous 12 months (P=.381). BBS items involving reaching forward, turning 360°, tandem standing, and standing on 1 leg had relatively greater frequencies of lower scores across participants. CONCLUSIONS The BBS appears to be a valid and reliable clinical instrument for assessing balance in individuals with lower-limb amputation, but it may not be able to discriminate between individuals with greater or lesser fall risk. Limitations in prosthetic motion and control may be responsible for the challenges experienced on items of lower performance. Future studies would be useful to assess the responsiveness of the BBS to interventions aimed at improving balance in individuals with lower-limb amputation.
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Zhang LQ, Chung SG, Ren Y, Liu L, Roth EJ, Rymer WZ. Simultaneous characterizations of reflex and nonreflex dynamic and static changes in spastic hemiparesis. J Neurophysiol 2013; 110:418-30. [PMID: 23636726 PMCID: PMC3727067 DOI: 10.1152/jn.00573.2012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 04/30/2013] [Indexed: 11/22/2022] Open
Abstract
This study characterizes tonic and phasic stretch reflex and stiffness and viscosity changes associated with spastic hemiparesis. Perturbations were applied to the ankle of 27 hemiparetic and 36 healthy subjects under relaxed or active contracting conditions. A nonlinear delay differential equation model characterized phasic and tonic stretch reflex gains, elastic stiffness, and viscous damping. Tendon reflex was characterized with reflex gain and threshold. Reflexively, tonic reflex gain was increased in spastic ankles at rest (P < 0.038) and was not regulated with muscle contraction, indicating impaired tonic stretch reflex. Phasic-reflex gain in spastic plantar flexors was higher and increased faster with plantar flexor contraction (P < 0.012) than controls (P < 0.023) and higher in dorsi-flexors at lower torques (P < 0.038), primarily because of its increase at rest (P = 0.045), indicating exaggerated phasic stretch reflex especially in more spastic plantar flexors, which showed higher phasic stretch reflex gain than dorsi-flexors (P < 0.032). Spasticity was associated with increased tendon reflex gain (P = 0.002) and decreased threshold (P < 0.001). Mechanically, stiffness in spastic ankles was higher than that in controls across plantar flexion/dorsi-flexion torque levels (P < 0.032), and the more spastic plantar flexors were stiffer than dorsi-flexors at comparable torques (P < 0.031). Increased stiffness in spastic ankles was mainly due to passive stiffness increase (P < 0.001), indicating increased connective tissues/shortened fascicles. Viscous damping in spastic ankles was increased across the plantar flexion torque levels and at lower dorsi-flexion torques, reflecting increased passive viscous damping (P = 0.033). The more spastic plantar flexors showed higher viscous damping than dorsi-flexors at comparable torque levels (P < 0.047). Simultaneous characterizations of reflex and nonreflex changes in spastic hemiparesis may help to evaluate and treat them more effectively.
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Roth EJ, Bruce J, Ghovanloo M, Holbrook JS, Huo X, Kim J, Laumann AE, Minocha J, Nardone B, Pucci D, Rowles D, Sutton E, Veledar E, West DP. The Tongue Drive System: Testing Novel Assistive Technology that Uses Magnetic Signals Derived from Tongue Movements. PM R 2012. [DOI: 10.1016/j.pmrj.2012.09.616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Roth EJ, Rowles D, Bruce J, Holbrook J. Article 4 Tongue Drive System: Evaluation of Novel Technology and Comparison to Existing Assistive Technology Control Methods. Arch Phys Med Rehabil 2012. [DOI: 10.1016/j.apmr.2012.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gao F, Ren Y, Roth EJ, Harvey R, Zhang LQ. Effects of repeated ankle stretching on calf muscle-tendon and ankle biomechanical properties in stroke survivors. Clin Biomech (Bristol, Avon) 2011; 26:516-22. [PMID: 21211873 PMCID: PMC3085098 DOI: 10.1016/j.clinbiomech.2010.12.003] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Revised: 12/03/2010] [Accepted: 12/07/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND The objective of this study was to investigate changes in active and passive biomechanical properties of the calf muscle-tendon unit induced by controlled ankle stretching in stroke survivors. METHODS Ten stroke survivors with ankle spasticity/contracture and ten healthy control subjects received intervention of 60-min ankle stretching. Joint biomechanical properties including resistance torque, stiffness and index of hysteresis were evaluated pre- and post-intervention. Achilles tendon length was measured using ultrasonography. The force output of the triceps surae muscles was characterized via the torque-angle relationship, by stimulating the calf muscles at a controlled intensity across different ankle positions. FINDINGS Compared to healthy controls, the ankle position corresponding to the peak torque of the stroke survivors was shifted towards plantar flexion (P<0.001). Stroke survivors showed significantly higher resistance torques and joint stiffness (P<0.05), and these higher resistances were reduced significantly after the stretching intervention, especially in dorsiflexion (P=0.013). Stretching significantly improved the force output of the impaired calf muscles in stroke survivors under matched stimulations (P<0.05). Ankle range of motion was also increased by stretching (P<0.001). INTERPRETATION At the joint level, repeated stretching loosened the ankle joint with increased passive joint range of motion and decreased joint stiffness. At the muscle-tendon level, repeated stretching improved calf muscle force output, which might be associated with decreased muscle fascicle stiffness, increased fascicle length and shortening of the Achilles tendon. The study provided evidence of improvement in muscle tendon properties through stretching intervention.
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Roth EJ. Hooked Up and Linked In: How the Integration of Rehabilitation Research and Patient Care Will Affect PM&R Practice in the Future. PM R 2011; 3:405-7. [DOI: 10.1016/j.pmrj.2011.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Accepted: 03/29/2011] [Indexed: 11/26/2022]
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Roth EJ. Man as the Intermediate Host of the Taenia Solium. BRITISH MEDICAL JOURNAL 2011; 2:470-1. [PMID: 20772764 DOI: 10.1136/bmj.2.3427.470] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Do KD, Oswald M, Pellicane AJ, Roth EJ. Poster 438: Hypoprealbuminemia in the Acute Inpatient Rehabilitation Stroke Patient and Its Effect on Function and Complications. PM R 2010. [DOI: 10.1016/j.pmrj.2010.07.469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Bode RK, Heinemann AW, Butt Z, Stallings J, Taylor C, Rowe M, Roth EJ. Development and validation of participation and positive psychologic function measures for stroke survivors. Arch Phys Med Rehabil 2010; 91:1347-56. [PMID: 20801251 PMCID: PMC3815554 DOI: 10.1016/j.apmr.2010.06.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Revised: 05/21/2010] [Accepted: 06/18/2010] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the reliability and validity of Neurologic Quality of Life (NeuroQOL) item banks that assess quality-of-life (QOL) domains not typically included in poststroke measures. DESIGN Secondary analysis of item responses to selected NeuroQOL domains. SETTING Community. PARTICIPANTS Community-dwelling stroke survivors (n=111) who were at least 12 months poststroke. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Five measures developed for 3 NeuroQoL domains: ability to participate in social activities, satisfaction with participation in social activities, and positive psychologic function. RESULTS A single bank was developed for the positive psychologic function domain, but 2 banks each were developed for the ability-to-participate and satisfaction-with-participation domains. The resulting item banks showed good psychometric properties and external construct validity with correlations with the legacy instruments, ranging from .53 to .71. Using these measures, stroke survivors in this sample reported an overall high level of QOL. CONCLUSIONS The NeuroQoL-derived measures are promising and valid methods for assessing aspects of QOL not typically measured in this population.
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Moore JL, Roth EJ, Killian C, Hornby TG. Locomotor Training Improves Daily Stepping Activity and Gait Efficiency in Individuals Poststroke Who Have Reached a “Plateau” in Recovery. Stroke 2010; 41:129-35. [DOI: 10.1161/strokeaha.109.563247] [Citation(s) in RCA: 164] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Individuals with chronic stroke often demonstrate a “plateau,” or deceleration of motor recovery, which may lead to discharge from physical therapy (PT). However, numerous studies report improvements in motor function when individuals are provided intensive practice of motor tasks. We suggest that reduced task-specific walking practice during clinical PT contributes to limited gains in ambulatory function in those with a perceived plateau poststroke, and suggest that further gains can be realized if intensive stepping, or locomotor training (LT) is provided after discharge.
Methods—
Twenty subjects with chronic stroke completed a repeated baseline measures, randomized crossover trial in which walking performance was assessed during the last 4 weeks of clinical PT before discharge secondary to reaching a plateau, followed by 4 weeks of intensive LT and 4 weeks of no intervention. Outcome measures included clinical and physiological (metabolic) measures of walking overground and on a treadmill, and measures of daily stepping activity in the home and community, including during clinical PT and subsequent LT sessions.
Results—
Stepping practice was more than 4-fold higher during LT versus clinical PT sessions, with significant improvements in daily stepping and gait efficiency only after LT. Changes in daily stepping after clinical PT and intensive LT were correlated (
P
<0.001) with the amount of stepping practice received during these interventions.
Conclusions—
Intensive LT results in improved daily stepping in individuals poststroke who have been discharged from PT because of a perceived plateau in motor function. These improvements may be related to the amount and intensity of stepping practice.
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Saxon SH, Harvey RL, Streff LM, Roth EJ, Schnitzer T, Supanwanid P, Wang YC. Poster 389: Effects of Neurological Impairment and Functional Mobility on Bone Mineral Density Following Stroke: A Pilot Study. PM R 2009. [DOI: 10.1016/j.pmrj.2009.08.417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Roth EJ. Trends in stroke rehabilitation. Eur J Phys Rehabil Med 2009; 45:247-254. [PMID: 19532111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Certain shifts and trends in stroke rehabilitation practices are occurring in the US, deriving from scientific developments, regulatory requirements, and other sources. The prevalence of stroke is increasing in the US, duration of rehabilitation hospitalizations is decreasing, and the availability of alternative methods and locations of rehabilitation services is expanding. More awareness of measures to treat medical comorbidities and the associated disabilities of stroke can be expected to enhance outcomes. New and innovative techniques, including constraint induced movement therapy, pharmacological agents, complementary or alternative medicine techniques such as acupuncture, and community activities such as exercise classes, are more widespread practices now. Novel technological interventions such as robotics and cortical stimulation are being developed to facilitate improved outcomes. The essential focus of these practices on enhancing quality of life of stroke survivors remains unaltered.
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Chung SG, van Rey E, Bai Z, Rymer WZ, Roth EJ, Zhang LQ. Separate Quantification of Reflex and Nonreflex Components of Spastic Hypertonia in Chronic Hemiparesis. Arch Phys Med Rehabil 2008; 89:700-10. [DOI: 10.1016/j.apmr.2007.09.051] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2007] [Revised: 08/08/2007] [Accepted: 09/17/2007] [Indexed: 11/15/2022]
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Roth EJ, Lovell L. Design of products and environments for people with stroke. Foreword. Top Stroke Rehabil 2008; 15:vi. [PMID: 18494178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Frontera WR, Fuhrer MJ, Jette AM, Chan L, Cooper RA, Duncan PW, Kemp JD, Ottenbacher KJ, Peckham PH, Roth EJ, Tate DG. Rehabilitation Medicine Summit: Building Research Capacity: executive summary. Am J Occup Ther 2007; 60:165-76. [PMID: 16596920 DOI: 10.5014/ajot.60.2.165] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The general objective of the "Rehabilitation Medicine Summit: Building Research Capacity" was to advance and promote research in medical rehabilitation by making recommendations to expand research capacity. The five elements of research capacity that guided the discussions were: (1) researchers; (2) research culture, environment, and infrastructure; (3) funding; (4) partnerships; and (5) metrics. The 100 participants included representatives of professional organizations, consumer groups, academic departments, researchers, governmental funding agencies, and the private sector. The small group discussions and plenary sessions generated an array of problems, possible solutions, and recommended actions. A post-Summit, multi-organizational initiative is called to pursue the agendas outlined in this report.
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Frontera WR, Fuhrer MJ, Jette AM, Chan L, Cooper RA, Duncan PW, Kemp JD, Ottenbacher KJ, Peckham PH, Roth EJ, Tate DG. Rehabilitation Medicine Summit: Building Research Capacity—Executive Summary. Assist Technol 2006; 18:2-14. [PMID: 16796237 DOI: 10.1080/10400435.2006.10131902] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
The advancement of medical science depends on the production, availability, and utilization of new information generated by research. A successful research enterprise depends not only on a carefully designed agenda that responds to clinical and societal needs but also on the research capacity necessary to perform the work. Research that is likely to enhance clinical practice presupposes the existence of a critical mass of investigators working as teams in supportive environments. Unfortunately, far too little research capacity of that kind exists in rehabilitation medicine to ensure a robust future for the field. The "Rehabilitation Medicine Summit: Building Research Capacity" was conceptualized as a way of fashioning a long-term plan to foster the required developments.
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