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Kawanabe E, Suzuki M, Tanaka S, Sasaki S, Hamaguchi T. Impairment in toileting behavior after a stroke. Geriatr Gerontol Int 2018; 18:1166-1172. [PMID: 29770543 DOI: 10.1111/ggi.13435] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 03/13/2018] [Accepted: 04/04/2018] [Indexed: 02/06/2023]
Abstract
AIM Dependence for toileting is the most problematic aspect for patients after a stroke. However, the relative difficulty of each component of toileting and the predictors for independent performance of these activities are unknown. We investigated these issues in stroke patients using Boltzmann sigmoid and generalized linear modeling. METHODS We carried out a cross-sectional correlation study, including 107 adult inpatients, hospitalized for a stroke. We assessed the activity components of toileting, as well as evaluated physical impairment using the Fugl-Meyer Assessment, impairments in balance using the Berg Balance Scale, cognitive impairments using the Mini-Mental State Examination and the presence or absence of unilateral spatial neglect or aphasia. RESULTS Boltzmann sigmoid modeling showed that the total scores required to obtain a response at 50% of the maximal value for the required components of toileting ranged between 2.691 and 34.962 points, for the components of "wearing pants" and "cutting the toilet paper," respectively. A generalized linear model showed that the Berg Balance Scale score was a significant predictor for independent performance on most component activities of toileting. CONCLUSIONS The component of toileting that was easiest to carry out was cutting the toilet paper, and the most difficult was wearing pants. Balance impairment was an independent predictor of independent toileting after stroke. This detailed toileting assessment enabled us to document the most difficult components of toileting, and to assess the motor and process skills required for independent toileting. Geriatr Gerontol Int 2018; 18: 1166-1172.
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Affiliation(s)
- Eri Kawanabe
- Department of Rehabilitation, Hamareha Home-visit Rehabilitation Station, Kanagawa, Japan
| | - Makoto Suzuki
- Faculty of Health Sciences, Tokyo Kasei University, Saitama, Japan
| | - Satoshi Tanaka
- Laboratory of Psychology, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Shotaro Sasaki
- Department of Rehabilitation, St. Marianna University, Yokohama City Seibu Hospital, Kanagawa, Japan
| | - Toyohiro Hamaguchi
- School of Health Sciences, Saitama Prefectural University, Saitama, Japan
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Coppens MJM, Roelofs JMB, Donkers NAJ, Nonnekes J, Geurts ACH, Weerdesteyn V. A startling acoustic stimulus facilitates voluntary lower extremity movements and automatic postural responses in people with chronic stroke. J Neurol 2018; 265:1625-1635. [PMID: 29761295 PMCID: PMC6022528 DOI: 10.1007/s00415-018-8889-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 04/25/2018] [Accepted: 04/30/2018] [Indexed: 12/27/2022]
Abstract
A startling acoustic stimulus (SAS) involuntary releases prepared movements at accelerated latencies, known as the StartReact effect. Previous work has demonstrated intact StartReact in paretic upper extremity movements in people after stroke, suggesting preserved motor preparation. The question remains whether motor preparation of lower extremity movements is also unaffected after stroke. Here, we investigated StartReact effects on ballistic lower extremity movements and on automatic postural responses (APRs) following perturbations to standing balance. These APRs are particularly interesting as they are critical to prevent a fall following balance perturbations, but show substantial delays and poor muscle coordination after stroke. Twelve chronic stroke patients and 12 healthy controls performed voluntary ankle dorsiflexion movements in response to a visual stimulus, and responded to backward balance perturbations evoking APRs. Twenty-five percent of all trials contained a SAS (120 dB) simultaneously with the visual stimulus or balance perturbation. As expected, in the absence of a SAS muscle and movement onset latencies at the paretic side were delayed compared to the non-paretic leg and to controls. The SAS accelerated ankle dorsiflexion onsets in both the legs of the stroke subjects and in controls. Following perturbations, the SAS accelerated bilateral APR onsets not only in controls, but for the first time, we also demonstrated this effect in people after stroke. Moreover, APR inter- and intra-limb muscle coordination was rather weak in our stroke subjects, but substantially improved when the SAS was applied. These findings show preserved movement preparation, suggesting that there is residual (subcortical) capacity for motor recovery.
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Affiliation(s)
- Milou J M Coppens
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Jolanda M B Roelofs
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Nicole A J Donkers
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Jorik Nonnekes
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Alexander C H Geurts
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Vivian Weerdesteyn
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
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Uchiyama Y, Koyama T, Wada Y, Katsutani M, Kodama N, Domen K. Botulinum Toxin Type A Treatment Combined with Intensive Rehabilitation for Gait Poststroke: A Preliminary Study. J Stroke Cerebrovasc Dis 2018; 27:1975-1986. [PMID: 29610039 DOI: 10.1016/j.jstrokecerebrovasdis.2018.02.054] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 02/12/2018] [Accepted: 02/23/2018] [Indexed: 12/13/2022] Open
Abstract
GOAL To examine the effects of botulinum toxin type A (BoNT-A) treatment combined with intensive rehabilitation for gait compared with intensive rehabilitation alone in patients with chronic stroke. MATERIALS AND METHODS A comparative case series design was used. Subjects were 19 patients with chronic stroke and spastic hemiplegia. In 9 patients (group I), BoNT-A was injected into spastic muscles of the affected lower limbs, followed by a 4-week inpatient intensive rehabilitation program. In the other 10 patients (group II), a 4-week inpatient intensive rehabilitation program alone was first provided (control period) followed by the same treatment protocol in group I. The Modified Ashworth Scale (MAS) scores, range of motion (ROM), gait speed in the 10-Meter Walking Test, 6-Minute Walking Distance Test (6MD) scores, Timed Up and Go Test (TUG) scores, and Berg Balance Scale scores were evaluated every 4 weeks following baseline assessments. RESULTS All results except for the MAS score of knee flexor and the ROM of knee flexion improved in group I and the gait speed, 6MD, and TUG scores improved in group II. Intergroup comparisons at week 4 showed significantly greater improvements in the MAS score of ankle plantar flexor, ROM of ankle dorsiflexion, and 6MD in group I than in group II (P = .016, .011, and .009, respectively). CONCLUSIONS BoNT-A treatment for lower-limb spasticity, combined with intensive rehabilitation, was effective in improving spasticity and the 6MD compared with intensive rehabilitation alone in patients with chronic stroke.
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Affiliation(s)
- Yuki Uchiyama
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
| | - Tetsuo Koyama
- Department of Rehabilitation Medicine, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Hyogo, Japan
| | - Yosuke Wada
- Department of Rehabilitation Medicine, Sasayama Medical Center Hyogo College of Medicine, Sasayama, Hyogo, Japan
| | - Masashi Katsutani
- Department of Rehabilitation Medicine, Nishinomiya Kyoritsu Rehabilitation Hospital, Nishinomiya, Hyogo, Japan
| | - Norihiko Kodama
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Kazuhisa Domen
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
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Liu TW, Ng GYF, Ng SSM. Effectiveness of a combination of cognitive behavioral therapy and task-oriented balance training in reducing the fear of falling in patients with chronic stroke: study protocol for a randomized controlled trial. Trials 2018; 19:168. [PMID: 29514677 PMCID: PMC5842580 DOI: 10.1186/s13063-018-2549-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 02/15/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The consequences of falls are devastating for patients with stroke. Balance problems and fear of falling are two major challenges, and recent systematic reviews have revealed that habitual physical exercise training alone cannot reduce the occurrence of falls in stroke survivors. However, recent trials with community-dwelling healthy older adults yielded the promising result that interventions with a cognitive behavioral therapy (CBT) component can simultaneously promote balance and reduce the fear of falling. Therefore, the aim of the proposed clinical trial is to evaluate the effectiveness of a combination of CBT and task-oriented balance training (TOBT) in promoting subjective balance confidence, and thereby reducing fear-avoidance behavior, improving balance ability, reducing fall risk, and promoting independent living, community reintegration, and health-related quality of life of patients with stroke. METHODS The study will constitute a placebo-controlled single-blind parallel-group randomized controlled trial in which patients are assessed immediately, at 3 months, and at 12 months. The selected participants will be randomly allocated into one of two parallel groups (the experimental group and the control group) with a 1:1 ratio. Both groups will receive 45 min of TOBT twice per week for 8 weeks. In addition, the experimental group will receive a 45-min CBT-based group intervention, and the control group will receive 45 min of general health education (GHE) twice per week for 8 weeks. The primary outcome measure is subjective balance confidence. The secondary outcome measures are fear-avoidance behavior, balance ability, fall risk, level of activities of daily living, community reintegration, and health-related quality of life. DISCUSSION The proposed clinical trial will compare the effectiveness of CBT combined with TOBT and GHE combined with TOBT in promoting subjective balance confidence among chronic stroke patients. We hope our results will provide evidence of a safe, cost-effective, and readily transferrable therapeutic approach to clinical practice that reduces fear-avoidance behavior, improves balance ability, reduces fall risk, promotes independence and community reintegration, and enhances health-related quality of life. TRIAL REGISTRATION ClinicalTrials.gov, NCT02937532 . Registered on 17 October 2016.
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Affiliation(s)
- Tai-Wa Liu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, Special Administrative Region of China
- Division of Nursing and Health Studies, The Open University of Hong Kong, Ho Man Tin, Hong Kong, Special Administrative Region of China
| | - Gabriel Y. F. Ng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, Special Administrative Region of China
| | - Shamay S. M. Ng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, Special Administrative Region of China
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Gaffney BMM, Christiansen CL, Murray AM, Davidson BS. Trunk movement compensations and corresponding core muscle demand during step ambulation in people with unilateral transtibial amputation. J Electromyogr Kinesiol 2018; 39:16-25. [PMID: 29413449 DOI: 10.1016/j.jelekin.2018.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 11/28/2017] [Accepted: 01/09/2018] [Indexed: 01/13/2023] Open
Abstract
The objective of this investigation was to identify demands from core muscles that corresponded with trunk movement compensations during bilateral step ambulation in people with unilateral transtibial amputation (TTA). Trunk rotational angular momentum (RAM) was measured using motion capture and bilateral surface EMG was measured from four bilateral core muscles during step ascent and descent tasks in people with TTA and healthy controls. During step ascent, the TTA group generated larger mediolateral (P = 0.01) and axial (P = 0.01) trunk RAM toward the leading limb when stepping onto the intact limb than the control group, which corresponded with high demand from the bilateral erector spinae and oblique muscles. During step descent, the TTA group generated larger trunk RAM in the sagittal (P < 0.01), frontal (P < 0.01), and transverse planes (P = 0.01) than the control group, which was an effect of falling onto the intact limb. To maintain balance and arrest trunk RAM, core muscle demand was larger throughout the loading period of step descent in the TTA group. However, asymmetric trunk movement compensations did not correspond to asymmetric core muscle demand during either task, indicating a difference in motor control compensations dependent on the leading limb.
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Affiliation(s)
- Brecca M M Gaffney
- University of Denver, Human Dynamics Laboratory, Denver, CO, United States
| | - Cory L Christiansen
- University of Colorado Denver, Dept. of Physical Medicine & Rehabilitation, Aurora, CO, United States; VA Eastern Colorado Health Care System, Geriatric Research Education and Clinical Center, Aurora, CO, United States
| | - Amanda M Murray
- University of Colorado Denver, Dept. of Physical Medicine & Rehabilitation, Aurora, CO, United States; VA Eastern Colorado Health Care System, Geriatric Research Education and Clinical Center, Aurora, CO, United States
| | - Bradley S Davidson
- University of Denver, Human Dynamics Laboratory, Denver, CO, United States.
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Abstract
Stroke, or cerebrovascular accident, involves injury to the central nervous system as a result of a vascular cause, and is a leading cause of disability worldwide. People with stroke often experience sensory, cognitive, and motor sequelae that can lead to difficulty walking, controlling balance in standing and voluntary tasks, and reacting to prevent a fall following an unexpected postural perturbation. This chapter discusses the interrelationships between stroke-related impairments, problems with control of balance and gait, fall risk, fear of falling, and participation in daily physical activity. Rehabilitation can improve balance and walking function, and consequently independence and quality of life, for those with stroke. This chapter also describes effective interventions for improving balance and walking function poststroke, and identifies some areas for further research in poststroke rehabilitation.
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Affiliation(s)
- Avril Mansfield
- Toronto Rehabilitation Institute, University Health Network and Department of Physical Therapy, University of Toronto, Toronto, ON, Canada.
| | - Elizabeth L Inness
- Toronto Rehabilitation Institute, University Health Network and Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - William E Mcilroy
- Department of Kinesiology, University of Waterloo and Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Waterloo, ON, Canada
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Xu T, O'Loughlin K, Clemson L, Lannin NA, Dean C, Koh G. Developing a falls prevention program for community-dwelling stroke survivors in Singapore: client and caregiver perspectives. Disabil Rehabil 2017; 41:1044-1054. [PMID: 29277114 DOI: 10.1080/09638288.2017.1419293] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Drawing on the perspectives of stroke survivors, family members and domestic helpers, this study explores participants' experiences of self-perceived fall risk factors after stroke, common fall prevention strategies used, and challenges to community participation after a fall. METHODS Semi-structured interviews were conducted in Singapore with community-dwelling stroke survivors with a previous fall (n = 9), family caregivers (n = 4), and domestic helpers (n = 4) who have cared for a stroke survivor with a previous fall. Purposive sampling was used for recruitment; all interviews were audio-recorded with permission and transcribed. Thematic analysis was conducted using NVivo (v10) software. RESULTS All participants shared their self-perceived intrinsic and extrinsic fall risk factors and main challenges after a fall. For stroke participants and family caregivers, motivational factors in developing safety strategies after a previous fall(s) include social connectedness, independent living and community participation. For family caregivers and domestic helpers, the stroke survivor's safety is their top priority, however this can also lead to over-protective behavior outside of the rehabilitation process. CONCLUSIONS Reducing the risk of falls in community-dwelling stroke survivors seems to be more important than promoting community participation among caregivers. The study findings highlight that a structured and client-centered fall prevention program targeting stroke survivors and caregivers is needed in Singapore. Implications for rehabilitation Falls after stroke can lead to functional decline in gait and mobility and restricted self-care activities. Community-dwelling stroke survivors develop adaptive safety strategies after a fall and want to be socially connected. However, caregivers see the safety of the stroke survivors as their top priority and demonstrate over-protective behaviors. Fall prevention programs for community-dwelling stroke survivors should target both stroke survivors and their caregivers. A structured and client-centered fall prevention program targeting at multiple risk factors post-stroke is needed for community-living stroke survivors.
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Affiliation(s)
- Tianma Xu
- a Ageing Work and Health Research Group, Faculty of Health Sciences , University of Sydney , Sydney , Australia.,b Health & Social Sciences Cluster , Singapore Institute of Technology , Singapore
| | - Kate O'Loughlin
- a Ageing Work and Health Research Group, Faculty of Health Sciences , University of Sydney , Sydney , Australia
| | - Lindy Clemson
- a Ageing Work and Health Research Group, Faculty of Health Sciences , University of Sydney , Sydney , Australia
| | - Natasha A Lannin
- c Department of Community and Clinical Allied Health , La Trobe Clinical School La Trobe University , Melbourne , Australia
| | - Catherine Dean
- d Department of Health Professions, Faculty of Medicine and Health Sciences , Macquarie University , Sydney , Australia
| | - Gerald Koh
- e Saw Swee Hock School of Public Health , National University of Singapore , Singapore
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Gerards MH, McCrum C, Mansfield A, Meijer K. Perturbation-based balance training for falls reduction among older adults: Current evidence and implications for clinical practice. Geriatr Gerontol Int 2017; 17:2294-2303. [PMID: 28621015 PMCID: PMC5763315 DOI: 10.1111/ggi.13082] [Citation(s) in RCA: 142] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 03/02/2017] [Accepted: 03/28/2017] [Indexed: 01/16/2023]
Abstract
Falls are a leading cause of injury, hospitalization and even death among older adults. Although various strength and balance exercise interventions have shown moderate reductions in falls incidence among healthy older adults, no significant falls incidence improvements have been consistently seen in frail older adults or in patient groups with an increased falls risk (e.g. people with Parkinson's disease and stroke). This might be due to a lack of task specificity of previous exercise interventions to the recovery actions required to prevent a fall. Perturbation-based balance training (PBT) is an emerging task-specific intervention that aims to improve reactive balance control after destabilizing perturbations in a safe and controlled environment. Although early studies were carried out predominantly in research laboratory settings, work in clinical settings with various patient groups has been proliferating. A systematic search of recent PBT studies showed a significant reduction of falls incidence among healthy older adults and certain patient groups (e.g. people with Parkinson's disease and stroke), with clinically relevant reductions in frail older adults. The most practical methods in clinical settings might be treadmill-based systems and therapist-applied perturbations, and PBT that incorporates multiple perturbation types and directions might be of most benefit. Although more controlled studies with long-term follow-up periods are required to better elucidate the effects of PBT on falls incidence, PBT appears to be a feasible and effective approach to falls reduction among older adults in clinical settings. Geriatr Gerontol Int 2017; 17: 2294-2303..
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Affiliation(s)
- Marissa H.G. Gerards
- Department of Human Movement ScienceNUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+Maastrichtthe Netherlands
- azM Herstelzorg Center for Geriatric Rehabilitation and CareMaastrichtthe Netherlands
| | - Christopher McCrum
- Department of Human Movement ScienceNUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+Maastrichtthe Netherlands
- Institute of Movement and Sport GerontologyGerman Sport University CologneCologneGermany
| | - Avril Mansfield
- Toronto Rehabilitation InstituteUniversity Health NetworkTorontoOntarioCanada
- Rehabilitation Sciences InstituteUniversity of TorontoTorontoOntarioCanada
- Department of Physical TherapyUniversity of TorontoTorontoOntarioCanada
- Evaluative Clinical Sciences, Hurvitz Brain Sciences Research ProgramSunnybrook Research InstituteTorontoOntarioCanada
| | - Kenneth Meijer
- Department of Human Movement ScienceNUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+Maastrichtthe Netherlands
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Abstract
BACKGROUND Whole-body vibration training (WBVT) confers a continuous vibration stimuli to the body. Although some reports have discussed the effects of whole-body vibration (WBV) on bone mineral density and muscle strength, study of WBV effects on lean mass have not been determined. The purpose of the present meta-analysis was to evaluate published, randomized controlled trials (RCTs) that investigated the effects of WBVT on lean mass. METHODS We identified only RCTs by searching databases, including Web of Science, PubMed, Scopus, Embase, and the Cochrane Library from inception to March 2017. Data extraction, quality assessment, and meta-analysis were performed. RESULTS Ten RCTs with 5 RCTs concentrating on older people, 3 on young adults, and 2 on children and adolescents were included. We additionally explored the effect of WBVT on postmenopausal women (6 trials from the 10 trials). Significant improvements in lean mass with WBVT were merely found in young adults (P = .02) but not in other populations compared to control group. CONCLUSION The effect of WBVT found in the present meta-analysis may be used in counteracting the loss of muscle mass in younger adults. Moreover, optimal WBVT protocols for greater muscle hypertrophy are expected to be investigated.
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Affiliation(s)
| | - Jianxiong Ma
- Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin, People's Republic of China
| | - Bin Lu
- Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin, People's Republic of China
| | - Xin-long Ma
- Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin, People's Republic of China
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Park MH, Won JI. The effects of task-oriented training with altered sensory input on balance in patients with chronic stroke. J Phys Ther Sci 2017; 29:1208-1211. [PMID: 28744049 PMCID: PMC5509593 DOI: 10.1589/jpts.29.1208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 04/23/2017] [Indexed: 12/02/2022] Open
Abstract
[Purpose] The purpose of this study was to identify the effects of task-oriented training
with altered somatosensory input on the balance ability of chronic stroke patients.
[Subjects and Methods] Twenty-six subjects with chronic stroke were divided into an
experimental group (n=14) and a control group (n=12). Both groups attended physical
therapy sessions five times a week for four weeks. The experimental group performed
additional, task-oriented training with altered sensory input three times a week for four
weeks. Limit-of-stability tests were conducted before and after the intervention. In
addition, all subjects were evaluated using the Berg Balance Scale (BBS) and Korean
Activities-Specific Balance Confidence Scale before and after the intervention. [Results]
There was a significant interaction between time and group on BBS scores, on the total
surface area of the limit of stability, and on the surface area of the limit of stability
of the affected side. However, an analysis of covariance in which the baseline values of
each variable served as the covariates showed that only the post-intervention BBS score of
the experimental group was significantly higher than that of the control group.
[Conclusion] Task-oriented training with altered somatosensory input can improve
functional balance in patients with chronic stroke.
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Affiliation(s)
- Min-Hee Park
- Department of Physical Therapy, Design Hospital, Republic of Korea
| | - Jong-Im Won
- Department of Physical Therapy, College of Medical Sciences, Jeonju University, Republic of Korea
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de Kam D, Roelofs JMB, Bruijnes AKBD, Geurts ACH, Weerdesteyn V. The Next Step in Understanding Impaired Reactive Balance Control in People With Stroke: The Role of Defective Early Automatic Postural Responses. Neurorehabil Neural Repair 2017; 31:708-716. [PMID: 28691582 PMCID: PMC5714159 DOI: 10.1177/1545968317718267] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background and objective. Postural muscle responses are often impaired after stroke. We aimed to identify the contribution of deficits in very early postural responses to poorer reactive balance capacity, with a particular focus on reactive stepping as a key strategy for avoiding falls. Methods. A total of 34 chronic stroke survivors and 17 controls were subjected to translational balance perturbations in 4 directions. We identified the highest perturbation intensity that could be recovered without stepping (single stepping threshold [SST]) and with maximally 1 step (multiple stepping threshold [MST]). We determined onset latencies and response amplitudes of 7 leg muscles bilaterally and identified associations with balance capacity. Results. People with stroke had a lower MST than controls in all directions. Side steps resulted in a higher lateral MST than crossover steps but were less common toward the paretic side. Postural responses were delayed and smaller in amplitude on the paretic side only. We observed the strongest associations between gluteus medius (GLUT) onset and amplitude and MST toward the paretic side (R2 = 0.33). Electromyographic variables were rather weakly associated with forward and backward MSTs (R2 = 0.10-0.22) and with SSTs (R2 = 0.08-0.15). Conclusions. Delayed and reduced paretic postural responses are associated with impaired reactive stepping after stroke. Particularly, fast and vigorous activity of the GLUT is imperative for overcoming large sideways perturbations, presumably because it facilitates the effective use of side steps. Because people with stroke often fall toward the paretic side, this finding indicates an important target for training.
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Affiliation(s)
- Digna de Kam
- 1 Radboud University Medical Center, Nijmegen, Netherlands
| | | | | | - Alexander C H Geurts
- 1 Radboud University Medical Center, Nijmegen, Netherlands.,2 Sint Maartenskliniek Research, Nijmegen, Netherlands
| | - Vivian Weerdesteyn
- 1 Radboud University Medical Center, Nijmegen, Netherlands.,2 Sint Maartenskliniek Research, Nijmegen, Netherlands
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Verma S, Kumar D, Kumawat A, Dutta A, Lahiri U. A Low-Cost Adaptive Balance Training Platform for Stroke Patients: A Usability Study. IEEE Trans Neural Syst Rehabil Eng 2017; 25:935-944. [DOI: 10.1109/tnsre.2017.2667406] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abdolrahmani A, Sakita H, Yonetsu R, Iwata A. Immediate effects of quick trunk movement exercise on sit-to-stand movement in children with spastic cerebral palsy: a pilot study. J Phys Ther Sci 2017; 29:905-909. [PMID: 28603369 PMCID: PMC5462696 DOI: 10.1589/jpts.29.905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 02/16/2017] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This pilot study examined the immediate effects of quick-seated trunk exercise
on sit-to-stand movement in children with cerebral palsy. [Subjects and Methods] Five
children with spastic cerebral palsy (hemiplegia, 3; diplegia, 2; age 6–17 years)
performed five sessions of natural-seated trunk exercise at a self-selected speed
(control). Following a 50-min rest period, five sessions of the quick-seated trunk
exercise were conducted (experimental intervention) for each child. Each seated trunk
exercise included 10 repetitions in the anterior-posterior and lateral directions.
Sit-to-stand was assessed before and after each intervention using a motion analysis
system. The total sit-to-stand task duration and sagittal, angular movements of the trunk,
hip, knee, and ankle were calculated. [Results] There was a significant difference in the
total duration of the sit-to-stand movement before and after natural-seated trunk exercise
(2.40 ± 0.67 s vs. 2.24 ± 0.44 s) as well as quick seated trunk exercise (2.41 ± 0.54 s
vs. 2.06 ± 0.45 s). However, the sit-to-stand duration increased after natural-seated
trunk exercise in one participant while that after quick-seated trunk exercise decreased
in all participants. [Conclusion] Performing a trunk exercise in a seated position
resulted in immediate improvement of the temporal sit-to-stand parameters in children with
spastic cerebral palsy.
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Affiliation(s)
- Abbas Abdolrahmani
- Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University, Japan
| | - Hiroyuki Sakita
- Osaka Medical Center and Research Institute for Maternal and Child Health, Japan
| | - Ryo Yonetsu
- Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University, Japan
| | - Akira Iwata
- Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University, Japan
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Abstract
BACKGROUND Circuit class therapy (CCT) offers a supervised group forum for people after stroke to practise tasks, enabling increased practice time without increasing staffing. This is an update of the original review published in 2010. OBJECTIVES To examine the effectiveness and safety of CCT on mobility in adults with stroke. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (last searched January 2017), CENTRAL (the Cochrane Library, Issue 12, 2016), MEDLINE (1950 to January 2017), Embase (1980 to January 2017), CINAHL (1982 to January 2017), and 14 other electronic databases (to January 2017). We also searched proceedings from relevant conferences, reference lists, and unpublished theses; contacted authors of published trials and other experts in the field; and searched relevant clinical trials and research registers. SELECTION CRITERIA Randomised controlled trials (RCTs) including people over 18 years old, diagnosed with stroke of any severity, at any stage, or in any setting, receiving CCT. DATA COLLECTION AND ANALYSIS Review authors independently selected trials for inclusion, assessed risk of bias in all included studies, and extracted data. MAIN RESULTS We included 17 RCTs involving 1297 participants. Participants were stroke survivors living in the community or receiving inpatient rehabilitation. Most could walk 10 metres without assistance. Ten studies (835 participants) measured walking capacity (measuring how far the participant could walk in six minutes) demonstrating that CCT was superior to the comparison intervention (Six-Minute Walk Test: mean difference (MD), fixed-effect, 60.86 m, 95% confidence interval (CI) 44.55 to 77.17, GRADE: moderate). Eight studies (744 participants) measured gait speed, again finding in favour of CCT compared with other interventions (MD 0.15 m/s, 95% CI 0.10 to 0.19, GRADE: moderate). Both of these effects are considered clinically meaningful. We were able to pool other measures to demonstrate the superior effects of CCT for aspects of walking and balance (Timed Up and Go: five studies, 488 participants, MD -3.62 seconds, 95% CI -6.09 to -1.16; Activities of Balance Confidence scale: two studies, 103 participants, MD 7.76, 95% CI 0.66 to 14.87). Two other pooled balance measures failed to demonstrate superior effects (Berg Blance Scale and Step Test). Independent mobility, as measured by the Stroke Impact Scale, Functional Ambulation Classification and the Rivermead Mobility Index, also improved more in CCT interventions compared with others. Length of stay showed a non-significant effect in favour of CCT (two trials, 217 participants, MD -16.35, 95% CI -37.69 to 4.99). Eight trials (815 participants) measured adverse events (falls during therapy): there was a non-significant effect of greater risk of falls in the CCT groups (RD 0.03, 95% CI -0.02 to 0.08, GRADE: very low). Time after stroke did not make a difference to the positive outcomes, nor did the quality or size of the trials. Heterogeneity was generally low; risk of bias was variable across the studies with poor reporting of study conduct in several of the trials. AUTHORS' CONCLUSIONS There is moderate evidence that CCT is effective in improving mobility for people after stroke - they may be able to walk further, faster, with more independence and confidence in their balance. The effects may be greater later after the stroke, and are of clinical significance. Further high-quality research is required, investigating quality of life, participation and cost-benefits, that compares CCT with standard care and that also investigates the influence of factors such as stroke severity and age. The potential risk of increased falls during CCT needs to be monitored.
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Affiliation(s)
- Coralie English
- University of NewcastleSchool of Health Sciences and Priority Research Centre for Stroke and Brain InjuryUniversity DrCallaghanNSWAustralia2308
- NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Florey Institute of Neuroscience and Mental Health & Hunter Medical Research InstituteMelbourne and NewcastleAustralia
| | - Susan L Hillier
- University of South Australia (City East)Sansom Institute for Health ResearchNorth TerraceAdelaideSAAustralia5000
| | - Elizabeth A Lynch
- NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Florey Institute of Neuroscience and Mental Health & Hunter Medical Research InstituteMelbourne and NewcastleAustralia
- The University of AdelaideAdelaide Nursing SchoolAdelaideSouth AustraliaAustralia
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O’Brien J, Ottoboni G, Tessari A, Setti A. One bout of open skill exercise improves cross-modal perception and immediate memory in healthy older adults who habitually exercise. PLoS One 2017; 12:e0178739. [PMID: 28570704 PMCID: PMC5453579 DOI: 10.1371/journal.pone.0178739] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 05/18/2017] [Indexed: 11/27/2022] Open
Abstract
One single bout of exercise can be associated with positive effects on cognition, due to physiological changes associated with muscular activity, increased arousal, and training of cognitive skills during exercise. While the positive effects of life-long physical activity on cognitive ageing are well demonstrated, it is not well established whether one bout of exercise is sufficient to register such benefits in older adults. The aim of this study was to test the effect of one bout of exercise on two cognitive processes essential to daily life and known to decline with ageing: audio-visual perception and immediate memory. Fifty-eight older adults took part in a quasi-experimental design study and were divided into three groups based on their habitual activity (open skill exercise (mean age = 69.65, SD = 5.64), closed skill exercise, N = 18, 94% female; sedentary activity-control group, N = 21, 62% female). They were then tested before and after their activity (duration between 60 and 80 minutes). Results showed improvement in sensitivity in audio-visual perception in the open skill group and improvements in one of the measures of immediate memory in both exercise groups, after controlling for baseline differences including global cognition and health. These findings indicate that immediate benefits for cross-modal perception and memory can be obtained after open skill exercise. However, improvements after closed skill exercise may be limited to memory benefits. Perceptual benefits are likely to be associated with arousal, while memory benefits may be due to the training effects provided by task requirements during exercise. The respective role of qualitative and quantitative differences between these activities in terms of immediate cognitive benefits should be further investigated. Importantly, the present results present the first evidence for a modulation of cross-modal perception by exercise, providing a plausible avenue for rehabilitation of cross-modal perception deficits, which are emerging as a significant contributor to functional decline in ageing.
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Affiliation(s)
- Jessica O’Brien
- School of Applied Psychology, University College Cork, Cork, Ireland
| | | | - Alessia Tessari
- Department of Psychology, Bologna University, Bologna, Italy
| | - Annalisa Setti
- School of Applied Psychology, University College Cork, Cork, Ireland
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Balance, Body Motion, and Muscle Activity After High-Volume Short-Term Dance-Based Rehabilitation in Persons With Parkinson Disease: A Pilot Study. J Neurol Phys Ther 2017; 40:257-68. [PMID: 27576092 DOI: 10.1097/npt.0000000000000150] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND PURPOSE The objectives of this pilot study were to (1) evaluate the feasibility and investigate the efficacy of a 3-week, high-volume (450 minutes per week) Adapted Tango intervention for community-dwelling individuals with mild-moderate Parkinson disease (PD) and (2) investigate the potential efficacy of Adapted Tango in modifying electromyographic (EMG) activity and center of body mass (CoM) displacement during automatic postural responses to support surface perturbations. METHODS Individuals with PD (n = 26) were recruited for high-volume Adapted Tango (15 lessons, 1.5 hour each over 3 weeks). Twenty participants were assessed with clinical balance and gait measures before and after the intervention. Nine participants were also assessed with support-surface translation perturbations. RESULTS Overall adherence to the intervention was 77%. At posttest, peak forward CoM displacement was reduced (4.0 ± 0.9 cm, pretest, vs 3.7 ± 1.1 cm, posttest; P = 0.03; Cohen's d = 0.30) and correlated to improvements on Berg Balance Scale (ρ = -0.68; P = 0.04) and Dynamic Gait Index (ρ = -0.75; P = 0.03). Overall antagonist onset time was delayed (27 ms; P = 0.02; d = 0.90) and duration was reduced (56 ms, ≈39%, P = 0.02; d = 0.45). Reductions in EMG magnitude were also observed (P < 0.05). DISCUSSION AND CONCLUSIONS Following participation in Adapted Tango, changes in kinematic and some EMG measures of perturbation responses were observed in addition to improvements in clinical measures. We conclude that 3-week, high-volume Adapted Tango is feasible and represents a viable alternative to longer duration adapted dance programs.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A143).
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Huang HK, Lin SM, Yang CSH, Liang CC, Cheng HY. Post-ischemic stroke rehabilitation is associated with a higher risk of fractures in older women: A population-based cohort study. PLoS One 2017; 12:e0175825. [PMID: 28414796 PMCID: PMC5393872 DOI: 10.1371/journal.pone.0175825] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 03/22/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Rehabilitation can improve physical activity after stroke. However, patients may be more prone to falls and fractures because of balance and gait deficits. Few reports have studied the relationship between rehabilitation and subsequent fractures after ischemic stroke. OBJECTIVE To investigate whether post-stroke rehabilitation affects fracture risk. METHODS We conducted a population-based retrospective cohort study based on the Taiwan National Health Insurance Research Database. Patients with a newly diagnosed ischemic stroke between 2000 and 2012 were included. After propensity score matching, a total of 8,384 patients were enrolled. Half of the patients (4,192) received post-stroke rehabilitation within 1 month; the other half did not receive any post-stroke rehabilitation. Cox proportional hazards regression model was used to calculate hazard ratios (HRs) for fractures among patients with and without rehabilitation within 1 year after ischemic stroke. Patients were further stratified by sex and age (20-64 and ≥65 years). RESULTS Patients receiving post-stroke rehabilitation had a higher incidence of fracture (6.2 per 100 person-years) than those who did not (4.1 per 100 person-years) after adjustment for sociodemographic and coexisting medical conditions [HR = 1.53, 95% confidence interval (CI) = 1.25-1.87, p < 0.001]. The analyses performed after stratifying for sex and age showed that only older women undergoing rehabilitation had a significantly higher risk of fracture (HR = 1.62, 95% CI = 1.21-2.17, p = 0.001). CONCLUSION Rehabilitation after ischemic stroke is associated with an increased fracture risk in older women.
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Affiliation(s)
- Huei Kai Huang
- Department of Family Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Shu Man Lin
- Department of Physical Medicine and Rehabilitation, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Clement Shih Hsien Yang
- Department of Physical Medicine and Rehabilitation, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Chung Chao Liang
- Department of Physical Medicine and Rehabilitation, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Hung Yu Cheng
- Department of Physical Medicine and Rehabilitation, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
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Lien WC, Cheng YH, Kuan TS, Zheng YL, Hsieh CH, Wang WF. Comparison of gait symmetry between poststroke fallers and nonfallers during level walking using triaxial accelerometry: A STROBE-compliant cross-sectional study. Medicine (Baltimore) 2017; 96:e5990. [PMID: 28248856 PMCID: PMC5340429 DOI: 10.1097/md.0000000000005990] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To compare the degree of gait symmetry of chronic poststroke fallers with that of nonfallers during level walking using triaxial accelerometry.In this cross-sectional study, a total of 14 patients with chronic stroke were recruited from a community hospital from February 2015 to July 2016. Patient characteristics, including the number of falls in the previous 12 months, were obtained from medical records. The Berg Balance Scale (BBS) and timed up and go (TUG) test were used at the onset of the study. Triaxial accelerometers were attached to the back and bilateral lower extremities of each subject with sampling rates of 120 Hz. The cross-correlation between the acceleration signals of the affected and unaffected feet was measured to assess the degree of gait symmetry. The triaxial acceleration signals of the 5 consecutive and bilateral strides from the middle of each trial were processed to measure the cross-correlation and time delay (Ts) between the magnitude of the acceleration vector of the affected and unaffected foot.After controlling for possible confounding factors, the mixed-effect models showed that cross-correlation was significantly higher among nonfallers than fallers (β = -0.093; standard error [SE] = 0.029; P-value = 0.002), and that the Ts was significantly longer among fallers than nonfallers (β = -1.900; SE = 0.719; P-value = 0.011).Cross-correlation and Ts between the affected and unaffected lower extremities may be useful indicators to distinguish poststroke fallers from nonfallers.
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Affiliation(s)
- Wei-Chih Lien
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Yung-Heng Cheng
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, Dou-Liou Branch, College of Medicine, National Cheng Kung University, Yunlin
| | - Ta-Shen Kuan
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Cheng Kung University, Tainan
| | - Yu-Lun Zheng
- Department of Computer Science and Information Engineering, National Yunlin University of Science and Technology, Yunlin, Taiwan
| | - Chao-Hsien Hsieh
- College of Mechanical and Electronic Engineering, Wenzhou University, Zhejiang, China
| | - Wen-Fong Wang
- Department of Computer Science and Information Engineering, National Yunlin University of Science and Technology, Yunlin, Taiwan
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Sharafi B, Hoffmann G, Tan AQ, Y Dhaher Y. Evidence of impaired neuromuscular responses in the support leg to a destabilizing swing phase perturbation in hemiparetic gait. Exp Brain Res 2016; 234:3497-3508. [PMID: 27491683 PMCID: PMC5097098 DOI: 10.1007/s00221-016-4743-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 07/26/2016] [Indexed: 01/07/2023]
Abstract
The neuromuscular mechanisms that underlie post-stroke impairment in reactive balance control during gait are not fully understood. Previous research has described altered muscle activations in the paretic leg in response to postural perturbations from static positions. Additionally, attenuation of interlimb reflexes after stroke has been reported. Our goal was to characterize post-stroke changes to neuromuscular responses in the stance leg following a swing phase perturbation during gait. We hypothesized that, following a trip, altered timing, sequence, and magnitudes of perturbation-induced activations would emerge in the paretic and nonparetic support legs of stroke survivors compared to healthy control subjects. The swing foot was interrupted, while subjects walked on a treadmill. In healthy subjects, a sequence of perturbation-induced activations emerged in the contralateral stance leg with mean onset latencies of 87-147 ms. The earliest latencies occurred in the hamstrings and hip abductor and adductors. The hamstrings, the adductor magnus, and the gastrocnemius dominated the relative balance of perturbation-induced activations. The sequence and balance of activations were largely preserved after stroke. However, onset latencies were significantly delayed across most muscles in both paretic and nonparetic stance legs. The shortest latencies observed suggest the involvement of interlimb reflexes with supraspinal pathways. The preservation of the sequence and balance of activations may point to a centrally programmed postural response that is preserved after stroke, while post-stroke delays may suggest longer transmission times for interlimb reflexes.
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Affiliation(s)
- Bahar Sharafi
- Liberty Mutual Research Institute for Safety, 71 Frankland Road, Hopkinton, MA, 01748, USA.
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA.
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, IL, USA.
| | - Gilles Hoffmann
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, IL, USA
| | - Andrew Q Tan
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, IL, USA
- Northwestern University Interdepartmental Neuroscience, Northwestern University, Chicago, IL, USA
| | - Yasin Y Dhaher
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, IL, USA
- Northwestern University Interdepartmental Neuroscience, Northwestern University, Chicago, IL, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
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Luo X, Zhang J, Zhang C, He C, Wang P. The effect of whole-body vibration therapy on bone metabolism, motor function, and anthropometric parameters in women with postmenopausal osteoporosis. Disabil Rehabil 2016; 39:2315-2323. [PMID: 27718643 DOI: 10.1080/09638288.2016.1226417] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Xiaotian Luo
- Rehabilitation Medicine Center, Sichuan University, West China Hospital, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan, Chengdu, Sichuan, PR China
| | - Jifeng Zhang
- Department of General surgery Medicine, Datong Second People's Hospital, Datong, Shanxi, PR China
| | - Chi Zhang
- Rehabilitation Medicine Center, Sichuan University, West China Hospital, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan, Chengdu, Sichuan, PR China
| | - Chengqi He
- Rehabilitation Medicine Center, Sichuan University, West China Hospital, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan, Chengdu, Sichuan, PR China
| | - Pu Wang
- Rehabilitation Medicine Center, Sichuan University, West China Hospital, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan, Chengdu, Sichuan, PR China
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van Duijnhoven HJR, Heeren A, Peters MAM, Veerbeek JM, Kwakkel G, Geurts ACH, Weerdesteyn V. Effects of Exercise Therapy on Balance Capacity in Chronic Stroke: Systematic Review and Meta-Analysis. Stroke 2016; 47:2603-10. [PMID: 27633021 DOI: 10.1161/strokeaha.116.013839] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 08/01/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this systematic review and meta-analysis was to investigate the effects of exercise training on balance capacity in people in the chronic phase after stroke. Furthermore, we aimed to identify which training regimen was most effective. METHODS Electronic databases were searched for randomized controlled trials evaluating the effects of exercise therapy on balance capacity in the chronic phase after stroke. Studies were included if they were of moderate or high methodological quality (PEDro score ≥4). Data were pooled if a specific outcome measure was reported in at least 3 randomized controlled trials. A sensitivity analysis and consequent subgroup analyses were performed for the different types of experimental training (balance and/or weight-shifting training, gait training, multisensory training, high-intensity aerobic exercise training, and other training programs). RESULTS Forty-three randomized controlled trials out of 369 unique hits were included. A meta-analysis could be conducted for the Berg Balance Scale (28 studies, n=985), Functional Reach Test (5 studies, n=153), Sensory Organization Test (4 studies, n=173), and mean postural sway velocity (3 studies, n=89). A significant overall difference in favor of the intervention group was found for the Berg Balance Scale (mean difference 2.22 points (+3.9%); 95% confidence interval [CI], 1.26-3.17; P<0.01; I(2)=52%), Functional Reach Test (mean difference=3.12 cm; 95% CI, 0.90-5.35; P<0.01; I(2)=74%), and Sensory Organization Test (mean difference=6.77 (+7%) points; 95% CI, 0.83-12.7; P=0.03; I(2)=0%). Subgroup analyses of the studies that included Berg Balance Scale outcomes demonstrated a significant improvement after balance and/or weight-shifting training of 3.75 points (+6.7%; 95% CI, 1.71-5.78; P<0.01; I(2)=52%) and after gait training of 2.26 points (+4.0%; 95% CI, 0.94-3.58; P<0.01; I(2)=21, whereas no significant effects were found for other training regimens. CONCLUSIONS This systematic review and meta-analysis showed that balance capacities can be improved by well-targeted exercise therapy programs in the chronic phase after stroke. Specifically, balance and/or weight-shifting and gait training were identified as successful training regimens.
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Affiliation(s)
- Hanneke J R van Duijnhoven
- From the Donders Centre for Neuroscience, Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands (H.J.R.v.D., A.C.H.G., V.W.); Rehabilitation Medical Centre Groot Klimmendaal, Arnhem, The Netherlands (A.H.); Hogeschool van Arnhem en Nijmegen (HAN), School of Occupational Therapy, University of Applied Sciences, Nijmegen, The Netherlands (M.A.M.P.); Department of Rehabilitation Medicine, MOVE Research Institute, VU University Medical Centre, Amsterdam, The Netherlands (J.M.V., G.K.); Neuroscience Campus Amsterdam, VU University, Amsterdam, The Netherlands (G.K.); Department of Neurorehabilitatioan, Reade Centre of Rehabilitation and Rheumatology, Amsterdam, The Netherlands (G.K.); Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL (G.K.); and Sint Maartenskliniek, Research, Nijmegen, The Netherlands (A.C.H.G., V.W.).
| | - Anita Heeren
- From the Donders Centre for Neuroscience, Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands (H.J.R.v.D., A.C.H.G., V.W.); Rehabilitation Medical Centre Groot Klimmendaal, Arnhem, The Netherlands (A.H.); Hogeschool van Arnhem en Nijmegen (HAN), School of Occupational Therapy, University of Applied Sciences, Nijmegen, The Netherlands (M.A.M.P.); Department of Rehabilitation Medicine, MOVE Research Institute, VU University Medical Centre, Amsterdam, The Netherlands (J.M.V., G.K.); Neuroscience Campus Amsterdam, VU University, Amsterdam, The Netherlands (G.K.); Department of Neurorehabilitatioan, Reade Centre of Rehabilitation and Rheumatology, Amsterdam, The Netherlands (G.K.); Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL (G.K.); and Sint Maartenskliniek, Research, Nijmegen, The Netherlands (A.C.H.G., V.W.)
| | - Marlijn A M Peters
- From the Donders Centre for Neuroscience, Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands (H.J.R.v.D., A.C.H.G., V.W.); Rehabilitation Medical Centre Groot Klimmendaal, Arnhem, The Netherlands (A.H.); Hogeschool van Arnhem en Nijmegen (HAN), School of Occupational Therapy, University of Applied Sciences, Nijmegen, The Netherlands (M.A.M.P.); Department of Rehabilitation Medicine, MOVE Research Institute, VU University Medical Centre, Amsterdam, The Netherlands (J.M.V., G.K.); Neuroscience Campus Amsterdam, VU University, Amsterdam, The Netherlands (G.K.); Department of Neurorehabilitatioan, Reade Centre of Rehabilitation and Rheumatology, Amsterdam, The Netherlands (G.K.); Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL (G.K.); and Sint Maartenskliniek, Research, Nijmegen, The Netherlands (A.C.H.G., V.W.)
| | - Janne M Veerbeek
- From the Donders Centre for Neuroscience, Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands (H.J.R.v.D., A.C.H.G., V.W.); Rehabilitation Medical Centre Groot Klimmendaal, Arnhem, The Netherlands (A.H.); Hogeschool van Arnhem en Nijmegen (HAN), School of Occupational Therapy, University of Applied Sciences, Nijmegen, The Netherlands (M.A.M.P.); Department of Rehabilitation Medicine, MOVE Research Institute, VU University Medical Centre, Amsterdam, The Netherlands (J.M.V., G.K.); Neuroscience Campus Amsterdam, VU University, Amsterdam, The Netherlands (G.K.); Department of Neurorehabilitatioan, Reade Centre of Rehabilitation and Rheumatology, Amsterdam, The Netherlands (G.K.); Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL (G.K.); and Sint Maartenskliniek, Research, Nijmegen, The Netherlands (A.C.H.G., V.W.)
| | - Gert Kwakkel
- From the Donders Centre for Neuroscience, Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands (H.J.R.v.D., A.C.H.G., V.W.); Rehabilitation Medical Centre Groot Klimmendaal, Arnhem, The Netherlands (A.H.); Hogeschool van Arnhem en Nijmegen (HAN), School of Occupational Therapy, University of Applied Sciences, Nijmegen, The Netherlands (M.A.M.P.); Department of Rehabilitation Medicine, MOVE Research Institute, VU University Medical Centre, Amsterdam, The Netherlands (J.M.V., G.K.); Neuroscience Campus Amsterdam, VU University, Amsterdam, The Netherlands (G.K.); Department of Neurorehabilitatioan, Reade Centre of Rehabilitation and Rheumatology, Amsterdam, The Netherlands (G.K.); Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL (G.K.); and Sint Maartenskliniek, Research, Nijmegen, The Netherlands (A.C.H.G., V.W.)
| | - Alexander C H Geurts
- From the Donders Centre for Neuroscience, Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands (H.J.R.v.D., A.C.H.G., V.W.); Rehabilitation Medical Centre Groot Klimmendaal, Arnhem, The Netherlands (A.H.); Hogeschool van Arnhem en Nijmegen (HAN), School of Occupational Therapy, University of Applied Sciences, Nijmegen, The Netherlands (M.A.M.P.); Department of Rehabilitation Medicine, MOVE Research Institute, VU University Medical Centre, Amsterdam, The Netherlands (J.M.V., G.K.); Neuroscience Campus Amsterdam, VU University, Amsterdam, The Netherlands (G.K.); Department of Neurorehabilitatioan, Reade Centre of Rehabilitation and Rheumatology, Amsterdam, The Netherlands (G.K.); Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL (G.K.); and Sint Maartenskliniek, Research, Nijmegen, The Netherlands (A.C.H.G., V.W.)
| | - Vivian Weerdesteyn
- From the Donders Centre for Neuroscience, Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands (H.J.R.v.D., A.C.H.G., V.W.); Rehabilitation Medical Centre Groot Klimmendaal, Arnhem, The Netherlands (A.H.); Hogeschool van Arnhem en Nijmegen (HAN), School of Occupational Therapy, University of Applied Sciences, Nijmegen, The Netherlands (M.A.M.P.); Department of Rehabilitation Medicine, MOVE Research Institute, VU University Medical Centre, Amsterdam, The Netherlands (J.M.V., G.K.); Neuroscience Campus Amsterdam, VU University, Amsterdam, The Netherlands (G.K.); Department of Neurorehabilitatioan, Reade Centre of Rehabilitation and Rheumatology, Amsterdam, The Netherlands (G.K.); Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL (G.K.); and Sint Maartenskliniek, Research, Nijmegen, The Netherlands (A.C.H.G., V.W.)
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Kumar D, Das A, Lahiri U, Dutta A. A Human-machine-interface Integrating Low-cost Sensors with a Neuromuscular Electrical Stimulation System for Post-stroke Balance Rehabilitation. J Vis Exp 2016. [PMID: 27166666 DOI: 10.3791/52394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
A stroke is caused when an artery carrying blood from heart to an area in the brain bursts or a clot obstructs the blood flow to brain thereby preventing delivery of oxygen and nutrients. About half of the stroke survivors are left with some degree of disability. Innovative methodologies for restorative neurorehabilitation are urgently required to reduce long-term disability. The ability of the nervous system to reorganize its structure, function and connections as a response to intrinsic or extrinsic stimuli is called neuroplasticity. Neuroplasticity is involved in post-stroke functional disturbances, but also in rehabilitation. Beneficial neuroplastic changes may be facilitated with non-invasive electrotherapy, such as neuromuscular electrical stimulation (NMES) and sensory electrical stimulation (SES). NMES involves coordinated electrical stimulation of motor nerves and muscles to activate them with continuous short pulses of electrical current while SES involves stimulation of sensory nerves with electrical current resulting in sensations that vary from barely perceivable to highly unpleasant. Here, active cortical participation in rehabilitation procedures may be facilitated by driving the non-invasive electrotherapy with biosignals (electromyogram (EMG), electroencephalogram (EEG), electrooculogram (EOG)) that represent simultaneous active perception and volitional effort. To achieve this in a resource-poor setting, e.g., in low- and middle-income countries, we present a low-cost human-machine-interface (HMI) by leveraging recent advances in off-the-shelf video game sensor technology. In this paper, we discuss the open-source software interface that integrates low-cost off-the-shelf sensors for visual-auditory biofeedback with non-invasive electrotherapy to assist postural control during balance rehabilitation. We demonstrate the proof-of-concept on healthy volunteers.
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Affiliation(s)
| | | | | | - Anirban Dutta
- Institut national de recherche en informatique et en automatique (INRIA); Leibniz Research Centre for Working Environment and Human Factors (IfADo);
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Facilitating Community-Based Exercise for People With Stroke: Cross-Sectional e-Survey of Physical Therapist Practice and Perceived Needs. Phys Ther 2016; 96:469-78. [PMID: 26294684 PMCID: PMC4817209 DOI: 10.2522/ptj.20150117] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 08/09/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Educating people with stroke about community-based exercise programs (CBEPs) is a recommended practice that physical therapists are well positioned to implement. OBJECTIVE The aim of this study was to evaluate the provision of education about CBEPs to people with stroke, barriers to providing education, and preferences for resources to facilitate education among physical therapists in neurological practice. DESIGN A cross-sectional e-survey of physical therapists treating adults with stroke in Ontario, Canada, was conducted. METHODS A link to the questionnaire was emailed to physical therapists in a provincial stroke network, a provincial physical therapy association, and on hospital and previous research lists. RESULTS Responses from 186 physical therapists were analyzed. The percentage of respondents who reported providing CBEP education was 84.4%. Only 36.6% reported typically providing education to ≥7 out of 10 patients with stroke. Physical (90.5%) and preventative (84.6%) health benefits of exercise were most frequently discussed. Therapists reported most commonly delivering education at discharge (73.7%). Most frequently cited barriers to educating patients were a perceived lack of suitable programs (53.2%) and a lack of awareness of local CBEPs (23.8%). Lists of CBEPs (94.1%) or brochures (94.1%) were considered to be facilitators. The percentage of physical therapists providing CBEP education varied across acute, rehabilitation, and public outpatient settings. LIMITATIONS The percentage of physical therapists providing education may have been overestimated if respondents who deliver CBEP education were more likely to participate and if participants answered in a socially desirable way. CONCLUSIONS Even though a high proportion of physical therapists provide CBEP education, education is not consistently delivered to the majority of patients poststroke. Although a CBEP list or brochure would facilitate education regarding existing CBEPs, efforts to implement CBEPs are needed to help overcome the lack of suitable programs.
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Saunders DH, Sanderson M, Hayes S, Kilrane M, Greig CA, Brazzelli M, Mead GE. Physical fitness training for stroke patients. Cochrane Database Syst Rev 2016; 3:CD003316. [PMID: 27010219 PMCID: PMC6464717 DOI: 10.1002/14651858.cd003316.pub6] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Levels of physical fitness are low after stroke. It is unknown whether improving physical fitness after stroke reduces disability. OBJECTIVES To determine whether fitness training after stroke reduces death, dependence, and disability and to assess the effects of training with regard to adverse events, risk factors, physical fitness, mobility, physical function, quality of life, mood, and cognitive function. Interventions to improve cognitive function have attracted increased attention after being identified as the highest rated research priority for life after stroke. Therefore we have added this class of outcomes to this updated review. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (last searched February 2015), the Cochrane Central Register of Controlled Trials (CENTRAL 2015, Issue 1: searched February 2015), MEDLINE (1966 to February 2015), EMBASE (1980 to February 2015), CINAHL (1982 to February 2015), SPORTDiscus (1949 to February 2015), and five additional databases (February 2015). We also searched ongoing trials registers, handsearched relevant journals and conference proceedings, screened reference lists, and contacted experts in the field. SELECTION CRITERIA Randomised trials comparing either cardiorespiratory training or resistance training, or both (mixed training), with usual care, no intervention, or a non-exercise intervention in stroke survivors. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials, assessed quality and risk of bias, and extracted data. We analysed data using random-effects meta-analyses. Diverse outcome measures limited the intended analyses. MAIN RESULTS We included 58 trials, involving 2797 participants, which comprised cardiorespiratory interventions (28 trials, 1408 participants), resistance interventions (13 trials, 432 participants), and mixed training interventions (17 trials, 957 participants). Thirteen deaths occurred before the end of the intervention and a further nine before the end of follow-up. No dependence data were reported. Diverse outcome measures restricted pooling of data. Global indices of disability show moderate improvement after cardiorespiratory training (standardised mean difference (SMD) 0.52, 95% confidence interval (CI) 0.19 to 0.84; P value = 0.002) and by a small amount after mixed training (SMD 0.26, 95% CI 0.04 to 0.49; P value = 0.02); benefits at follow-up (i.e. after training had stopped) were unclear. There were too few data to assess the effects of resistance training.Cardiorespiratory training involving walking improved maximum walking speed (mean difference (MD) 6.71 metres per minute, 95% CI 2.73 to 10.69), preferred gait speed (MD 4.28 metres per minute, 95% CI 1.71 to 6.84), and walking capacity (MD 30.29 metres in six minutes, 95% CI 16.19 to 44.39) at the end of the intervention. Mixed training, involving walking, increased preferred walking speed (MD 4.54 metres per minute, 95% CI 0.95 to 8.14), and walking capacity (MD 41.60 metres per six minutes, 95% CI 25.25 to 57.95). Balance scores improved slightly after mixed training (SMD 0.27, 95% CI 0.07 to 0.47). Some mobility benefits also persisted at the end of follow-up. The variability, quality of the included trials, and lack of data prevents conclusions about other outcomes and limits generalisability of the observed results. AUTHORS' CONCLUSIONS Cardiorespiratory training and, to a lesser extent, mixed training reduce disability during or after usual stroke care; this could be mediated by improved mobility and balance. There is sufficient evidence to incorporate cardiorespiratory and mixed training, involving walking, within post-stroke rehabilitation programmes to improve the speed and tolerance of walking; some improvement in balance could also occur. There is insufficient evidence to support the use of resistance training. The effects of training on death and dependence after stroke are still unclear but these outcomes are rarely observed in physical fitness training trials. Cognitive function is under-investigated despite being a key outcome of interest for patients. Further well-designed randomised trials are needed to determine the optimal exercise prescription and identify long-term benefits.
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Affiliation(s)
- David H Saunders
- Institute for Sport, Physical Education and Health Sciences (SPEHS), University of EdinburghMoray House School of EducationSt Leonards LandHolyrood RoadEdinburghUKEH8 2AZ
| | - Mark Sanderson
- University of the West of ScotlandInstitute of Clinical Exercise and Health ScienceRoom A071A, Almada BuildingHamiltonUKML3 0JB
| | - Sara Hayes
- University of LimerickDepartment of Clinical TherapiesLimerickIreland
| | - Maeve Kilrane
- Royal Infirmary of EdinburghDepartment of Stroke MedicineWard 201 ‐ Stroke UnitLittle FranceEdinburghUKEH16 4SA
| | - Carolyn A Greig
- University of BirminghamSchool of Sport, Exercise and Rehabilitation Sciences, MRC‐ARUK Centre for Musculoskeletal Ageing ResearchEdgbastonBirminghamUKB15 2TT
| | - Miriam Brazzelli
- University of AberdeenHealth Services Research UnitHealth Sciences BuildingForesterhillAberdeenUKAB25 2ZD
| | - Gillian E Mead
- University of EdinburghCentre for Clinical Brain SciencesRoom S1642, Royal InfirmaryLittle France CrescentEdinburghUKEH16 4SA
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Molina-Rueda F, Molero-Sánchez A, Alguacil-Diego IM, Carratalá-Tejada M, Cuesta-Gómez A, Miangolarra-Page JC. Weight Symmetry and Latency Scores for Unexpected Surface Perturbations in Subjects With Traumatic and Vascular Unilateral Transtibial Amputation. PM R 2016; 8:235-40. [DOI: 10.1016/j.pmrj.2015.05.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 05/28/2015] [Accepted: 05/31/2015] [Indexed: 10/23/2022]
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Vadas D, Kalichman L. Post-stroke hip fracture in older people: A narrative review. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2016. [DOI: 10.12968/ijtr.2016.23.2.58] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims: A hip fracture is a serious and common complication after stroke. Individuals often experience particular gait problems post-stroke and may have difficulty with everyday activities such as walking. Therefore, the interventions for falls prevention in older patients should be re-examined when applied to the post-stroke population. This study reviews the risk factors for falls and hip fractures that are specific to the post-stroke population and the measures that may be taken to prevent hip fractures and/or falls in this patient group. Method: A narrative review of articles written in English in the scientific literature on the risk factors, natural history and prevention of hip fractures in post-stroke patients. Results: The interventions that were reviewed showed some benefit to post-stroke patients. These included interventions designed to increase physical activity, water-based exercise, general falls prevention programmes, and the use of force platforms and body weight supported treadmills. More solid evidence was found to support strategies such as the symmetrical use of limbs, which provides appropriate support and an environment where an individual can regain more normal movement patterns. This can be achieved by training in a low-gravity environment using water-based exercises or a body-weight supported treadmill. To perform more symmetrical movements, biofeedback (visual feedback) or a force platform can be used in addition to symmetrical exercises. Conclusions: In a post-stroke population, it is better to pay special attention to the prevention of falls and hip fracture than to rehabilitate after a fracture has occurred. Evaluation and management of the risk factors that contribute to falls should be a priority in post-stroke rehabilitation, focusing on as many risk factors as possible in hip fracture prevention programmes. A variety of techniques should be used to facilitate functional recovery, emphasising symmetry and optimal movement patterns.
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Affiliation(s)
- Dor Vadas
- Israeli Center for Rehabilitation of Stroke and Traumatic Brain Injury Patients, Rehovot, Israel
| | - Leonid Kalichman
- Senior lecturer, Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
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Tang A, Tao A, Soh M, Tam C, Tan H, Thompson J, Eng JJ. The effect of interventions on balance self-efficacy in the stroke population: a systematic review and meta-analysis. Clin Rehabil 2015; 29:1168-77. [PMID: 25681409 PMCID: PMC4596690 DOI: 10.1177/0269215515570380] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 12/27/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To conduct a systematic review of clinical trials that examined the effectiveness of interventions on balance self-efficacy among individuals with stroke. DESIGN Systematic review. SUMMARY OF REVIEW Searches of the following databases were completed in December 2014: MEDLINE (1948-present), CINAHL (1982-present), EMBASE (1980-present) and PsycINFO (1987-present) for controlled clinical trials that measured balance self-efficacy in adults with stroke. Reference lists of selected articles were hand-searched to identify further relevant studies. REVIEW METHODS Two independent reviewers performed data extraction and assessed the methodological quality of the studies using the Physical Therapy Evidence Database Scale. Standardized mean differences (SMD) were calculated. RESULTS A total of 19 trials involving 729 participants used balance self-efficacy as a secondary outcome. Study quality ranged from poor (n = 3) to good (n = 8). In the meta-analysis of 15 trials that used intensive physical activity interventions, a moderate beneficial effect on balance self-efficacy was observed immediately following the programs (SMD 0.44, 95% CI 0.11-0.77, P = 0.009). In the studies that included follow-up assessments, there was no difference between groups across retention periods (eight studies, SMD 0.32, 95% CI -0.17-0.80, P = 0.20). In the four studies that used motor imagery interventions, there was no between-group difference in change in balance self-efficacy (fixed effects SMD 0.68, 95% CI -0.33-1.69, P = 0.18). CONCLUSIONS Physical activity interventions appear to be effective in improving balance self-efficacy after stroke.
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Affiliation(s)
- Ada Tang
- McMaster University School of Rehabilitation Science Population Health Research Institute, Hamilton, Canada Canadian Partnership for Stroke Recovery, Ottawa, Canada
| | - Amy Tao
- Department of Physical Therapy, University of British Columbia, Faculty of Medicine, Vancouver, Canada
| | - Michelle Soh
- Department of Physical Therapy, University of British Columbia, Faculty of Medicine, Vancouver, Canada
| | - Carolyn Tam
- Department of Physical Therapy, University of British Columbia, Faculty of Medicine, Vancouver, Canada
| | - Hannah Tan
- Department of Physical Therapy, University of British Columbia, Faculty of Medicine, Vancouver, Canada
| | - Jessica Thompson
- Department of Physical Therapy, University of British Columbia, Faculty of Medicine, Vancouver, Canada
| | - Janice J Eng
- Canadian Partnership for Stroke Recovery, Ottawa, Canada Department of Physical Therapy, University of British Columbia, Faculty of Medicine, Vancouver, Canada Vancouver Coastal Health, Vancouver, Canada International Collaboration on Repair Discoveries, Vancouver, Canada
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78
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Biomechanical response to ladder slipping events: Effects of hand placement. J Biomech 2015; 48:3810-5. [DOI: 10.1016/j.jbiomech.2015.09.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 08/07/2015] [Accepted: 09/05/2015] [Indexed: 11/18/2022]
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79
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Young HJ, Erickson ML, Johnson KB, Johnson MA, McCully KK. A wellness program for individuals with disabilities: Using a student wellness coach approach. Disabil Health J 2015; 8:345-52. [DOI: 10.1016/j.dhjo.2014.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 12/04/2014] [Accepted: 12/13/2014] [Indexed: 10/24/2022]
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80
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Hammarén E, Lindberg C, Kjellby-Wendt G. Effects of a balance exercise programme in myotonic dystrophy type 1: A pilot study. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2015. [DOI: 10.3109/21679169.2015.1049204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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81
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Lawal IU, Hillier SL, Hamzat TK, Rhoda A. Effectiveness of a structured circuit class therapy model in stroke rehabilitation: a protocol for a randomised controlled trial. BMC Neurol 2015; 15:88. [PMID: 26055635 PMCID: PMC4460628 DOI: 10.1186/s12883-015-0348-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 05/29/2015] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Currently, the key advocacy in neuroscientific studies for stroke rehabilitation is that therapy should be directed towards task specificity performed with multiple repetitions. Circuit Class Therapy (CCT) is well suited to accomplish multiple task-specific activities. However, while repetitive task practice is achievable with circuit class therapy, in stroke survivors repetitive activities may be affected by poor neurologic inputs to motor units, resulting in decreases in discharging rates which consequently may reduce the efficiency of muscular contraction. To accomplish multiple repetitions, stroke survivors may require augmented duration of practice. To date, no study has examined the effect of augmented duration of CCT in stroke rehabilitation, and specifically what duration of CCT is more effective in influencing functional capacity among stroke survivors. METHODS/DESIGN Using a randomised controlled trial with blinded outcome assessment, this study is aimed at determining the effectiveness of structured augmented CCT in stroke rehabilitation. Sixty-eight stroke survivors (to be recruited from a tertiary health institution in Kano, Northwest, Nigeria) will be randomised into one of four groups: three intervention groups of differing CCT durations namely: 60 min, 90 min, and 120 minuntes respectively, and a control group. Participants will take part in an 8-week structured intensive CCT intervention. Participants will be assessed at baseline, post-intervention, and six-month follow-up for the effectiveness of the varied durations of therapy, using standardised tools. Based on the WHO-ICF model, the outcomes are body structure/function, activity limitation, and participation restriction measures. DISCUSSION It is expected that the outcome of this study will clarify whether increasing CCT duration leads to better recovery of motor function in stroke survivors. TRIAL REGISTRATION Pan African Clinical Trial Registry (PACTR): PACTR201311000701191.
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Affiliation(s)
- Isa U Lawal
- Department of Physiotherapy, Faculty Community and Health Sciences, University of the Western Cape, Private Bag X17, Bellville, 7535, South Africa.
- Department of Physiotherapy, Faculty of Allied Health Sciences, College of Health Sciences, Bayero University, Kano, Private Mail Bag 3011, Nigeria.
| | - Susan L Hillier
- International Centre for Allied Health Evidence, School of Health Sciences, University of South Australia (City East), Adelaide, 5000, Australia.
| | - Talhatu K Hamzat
- Department of Physiotherapy, Faculty of Clinical Sciences, College of Medicine University of Ibadan, Queen Elizabeth Road, Private Mail Bag 5017, GPO Dugbe, Ibadan, Nigeria.
| | - Anthea Rhoda
- Department of Physiotherapy, Faculty Community and Health Sciences, University of the Western Cape, Private Bag X17, Bellville, 7535, South Africa.
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82
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Mansfield A, Aqui A, Centen A, Danells CJ, DePaul VG, Knorr S, Schinkel-Ivy A, Brooks D, Inness EL, McIlroy WE, Mochizuki G. Perturbation training to promote safe independent mobility post-stroke: study protocol for a randomized controlled trial. BMC Neurol 2015; 15:87. [PMID: 26048054 PMCID: PMC4456796 DOI: 10.1186/s12883-015-0347-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 05/29/2015] [Indexed: 11/10/2022] Open
Abstract
Background Falls are one of the most common medical complications post-stroke. Physical exercise, particularly exercise that challenges balance, reduces the risk of falls among healthy and frail older adults. However, exercise has not proven effective for preventing falls post-stroke. Falls ultimately occur when an individual fails to recover from a loss of balance. Thus, training to specifically improve reactive balance control could prevent falls. Perturbation training aims to improve reactive balance control by repeatedly exposing participants to postural perturbations. There is emerging evidence that perturbation training reduces fall rates among individuals with neurological conditions, such as Parkinson disease. The primary aim of this work is to determine if perturbation-based balance training can reduce occurrence of falls in daily life among individuals with chronic stroke. Secondary objectives are to determine the effect of perturbation training on balance confidence and activity restriction, and functional balance and mobility. Methods/design Individuals with chronic stroke will be recruited. Participants will be randomly assigned to one of two groups: 1) perturbation training, or 2) ‘traditional’ balance training. Perturbation training will involve both manual perturbations (e.g., a push or pull from a physiotherapist), and rapid voluntary movements to cause a loss of balance. Training will occur twice per week for 6 weeks. Participants will record falls and activity for 12 months following completion of the training program. Standardized clinical tools will be used to assess functional balance and mobility, and balance confidence before and after training. Discussion Falls are a significant problem for those with stroke. Despite the large body of work demonstrating effective interventions, such as exercise, for preventing falls in other populations, there is little evidence for interventions that prevent falls post-stroke. The proposed study will investigate a novel and promising intervention: perturbation training. If effective, this training has the potential to not only prevent falls, but to also improve safe independent mobility and engagement in daily activities for those with stroke. Trial registration Current Controlled Trials: ISRCTN05434601.
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Affiliation(s)
- Avril Mansfield
- Toronto Rehabilitation Institute, University Health Network, Room 11-117, 550 University Avenue, Toronto, ON, M5G 2A2, Canada. .,Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Ottawa, ON, Canada. .,Department of Physical Therapy and Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada. .,Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada.
| | - Anthony Aqui
- Toronto Rehabilitation Institute, University Health Network, Room 11-117, 550 University Avenue, Toronto, ON, M5G 2A2, Canada.
| | - Andrew Centen
- Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada.
| | - Cynthia J Danells
- Toronto Rehabilitation Institute, University Health Network, Room 11-117, 550 University Avenue, Toronto, ON, M5G 2A2, Canada. .,Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada.
| | - Vincent G DePaul
- Toronto Rehabilitation Institute, University Health Network, Room 11-117, 550 University Avenue, Toronto, ON, M5G 2A2, Canada. .,Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Ottawa, ON, Canada. .,Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada. .,St Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
| | - Svetlana Knorr
- Toronto Rehabilitation Institute, University Health Network, Room 11-117, 550 University Avenue, Toronto, ON, M5G 2A2, Canada.
| | - Alison Schinkel-Ivy
- Toronto Rehabilitation Institute, University Health Network, Room 11-117, 550 University Avenue, Toronto, ON, M5G 2A2, Canada.
| | - Dina Brooks
- Toronto Rehabilitation Institute, University Health Network, Room 11-117, 550 University Avenue, Toronto, ON, M5G 2A2, Canada. .,Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Ottawa, ON, Canada. .,Department of Physical Therapy and Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.
| | - Elizabeth L Inness
- Toronto Rehabilitation Institute, University Health Network, Room 11-117, 550 University Avenue, Toronto, ON, M5G 2A2, Canada. .,Department of Physical Therapy and Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.
| | - William E McIlroy
- Toronto Rehabilitation Institute, University Health Network, Room 11-117, 550 University Avenue, Toronto, ON, M5G 2A2, Canada. .,Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Ottawa, ON, Canada. .,Department of Physical Therapy and Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada. .,Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada. .,Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada.
| | - George Mochizuki
- Toronto Rehabilitation Institute, University Health Network, Room 11-117, 550 University Avenue, Toronto, ON, M5G 2A2, Canada. .,Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Ottawa, ON, Canada. .,Department of Physical Therapy and Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada. .,Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada.
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Pak P, Jawed H, Tirone C, Lamb B, Cott C, Brunton K, Mansfield A, Inness EL. Incorporating research technology into the clinical assessment of balance and mobility: perspectives of physiotherapists and people with stroke. Physiother Can 2015; 67:1-8. [PMID: 25931648 DOI: 10.3138/ptc.2013-63] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To describe the perspectives of people with stroke and their physiotherapists on the use of biomechanics technology to assess balance and mobility. METHODS This qualitative study used semi-structured interviews with patients with stroke and a focus group with their physiotherapists. Coding of interview and focus-group data used a line-by-line inductive approach, with qualitative software to develop codes into themes. RESULTS The quantitative data from the assessment were seen as beneficial to providing patients with insight into balance and mobility problems. Physiotherapists found that the assessment confirmed clinical reasoning and aided in precise evaluation of progress but expressed mixed opinions as to whether treatment choice was influenced. Patients would have liked more communication regarding the purpose of the assessment. Patients also stated that trust in their physiotherapists helped them overcome anxieties and that confidence was gained through exposure to more challenging balance assessments. Physiotherapists advocated for the use of a harness system to safely incorporate reactive balance control assessment and training into practice. CONCLUSION Both patients and therapists saw value in the quantitative data provided by the assessment. Regardless of the technology used, patients value a strong physiotherapist-patient relationship. Ongoing collaboration between clinicians and researchers should guide the evolution of technology into clinically useful tools.
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Affiliation(s)
| | | | | | | | - Cheryl Cott
- Department of Physical Therapy ; Graduate Department of Rehabilitation Sciences, University of Toronto ; Toronto Rehabilitation Institute ; Toronto Western Research Institute, University Health Network
| | - Karen Brunton
- Department of Physical Therapy ; Toronto Rehabilitation Institute
| | - Avril Mansfield
- Department of Physical Therapy ; Graduate Department of Rehabilitation Sciences, University of Toronto ; Toronto Rehabilitation Institute ; Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Health Sciences Centre, Toronto
| | - Elizabeth L Inness
- Department of Physical Therapy ; Graduate Department of Rehabilitation Sciences, University of Toronto ; Toronto Rehabilitation Institute
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84
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Does perturbation-based balance training prevent falls? Systematic review and meta-analysis of preliminary randomized controlled trials. Phys Ther 2015; 95:700-9. [PMID: 25524873 DOI: 10.2522/ptj.20140090] [Citation(s) in RCA: 151] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 11/26/2014] [Indexed: 02/09/2023]
Abstract
BACKGROUND Older adults and individuals with neurological conditions are at an increased risk for falls. Although physical exercise can prevent falls, certain types of exercise may be more effective. Perturbation-based balance training is a novel intervention involving repeated postural perturbations aiming to improve control of rapid balance reactions. PURPOSE The purpose of this study was to estimate the effect of perturbation-based balance training on falls in daily life. DATA SOURCES MEDLINE (1946-July 2014), EMBASE (1974-July 2014), PEDro (all dates), CENTRAL (1991-July 2014), and Google Scholar (all dates) were the data sources used in this study. STUDY SELECTION Randomized controlled trials written in English were included if they focused on perturbation-based balance training among older adults or individuals with neurological conditions and collected falls data posttraining. DATA EXTRACTION Two investigators extracted data independently. Study authors were contacted to obtain missing information. A PEDro score was obtained for each study. Primary outcomes were proportion of participants who reported one or more falls (ie, number of "fallers") and the total number of falls. The risk ratio (proportion of fallers) and rate ratio (number of falls) were entered into the analysis. DATA SYNTHESIS Eight studies involving 404 participants were included. Participants who completed perturbation-based balance training were less likely to report a fall (overall risk ratio=0.71; 95% confidence interval=0.52, 0.96; P=.02) and reported fewer falls than those in the control groups (overall rate ratio=0.54; 95% confidence interval=0.34, 0.85; P=.007). LIMITATIONS Study authors do not always identify that they have included perturbation training in their intervention; therefore, it is possible that some appropriate studies were not included. Study designs were heterogeneous, preventing subanalyses. CONCLUSIONS Perturbation-based balance training appears to reduce fall risk among older adults and individuals with Parkinson disease.
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Guan Q, Jin L, Li Y, Han H, Zheng Y, Nie Z. Multifactor analysis for risk factors involved in the fear of falling in patients with chronic stroke from mainland China. Top Stroke Rehabil 2015; 22:368-73. [DOI: 10.1179/1074935714z.0000000048] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Khadilkar A, Phillips K, Jean N, Lamothe C, Milne S, Sarnecka J. Ottawa Panel Evidence-Based Clinical Practice Guidelines for Post-Stroke Rehabilitation. Top Stroke Rehabil 2015; 13:1-269. [PMID: 16939981 DOI: 10.1310/3tkx-7xec-2dtg-xqkh] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this project was to create guidelines for 13 types of physical rehabilitation interventions used in the management of adult patients (>18 years of age) presenting with hemiplegia or hemiparesis following a single clinically identifiable ischemic or hemorrhagic cerebrovascular accident (CVA). METHOD Using Cochrane Collaboration methods, the Ottawa Methods Group identified and synthesized evidence from comparative controlled trials. The group then formed an expert panel, which developed a set of criteria for grading the strength of the evidence and the recommendation. Patient-important outcomes were determined through consensus, provided that these outcomes were assessed with a validated and reliable scale. RESULTS The Ottawa Panel developed 147 positive recommendations of clinical benefit concerning the use of different types of physical rehabilitation interventions involved in post-stroke rehabilitation. DISCUSSION AND CONCLUSION The Ottawa Panel recommends the use of therapeutic exercise, task-oriented training, biofeedback, gait training, balance training, constraint-induced movement therapy, treatment of shoulder subluxation, electrical stimulation, transcutaneous electrical nerve stimulation, therapeutic ultrasound, acupuncture, and intensity and organization of rehabilitation in the management of post stroke.
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Bonan I, Raillon A, Yelnik AP. Rieducazione dopo accidente vascolare cerebrale. Neurologia 2015. [DOI: 10.1016/s1634-7072(14)69824-x] [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] Open
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Takao T, Tanaka N, Iizuka N, Saitou H, Tamaoka A, Yanagi H. Improvement of gait ability with a short-term intensive gait rehabilitation program using body weight support treadmill training in community dwelling chronic poststroke survivors. J Phys Ther Sci 2015; 27:159-63. [PMID: 25642063 PMCID: PMC4305551 DOI: 10.1589/jpts.27.159] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 08/03/2014] [Indexed: 12/03/2022] Open
Abstract
[Purpose] Most previous studies have shown that body weight support treadmill training
(BWSTT) can improve gait speed poststroke patients. The purpose of this study was to
evaluate effectiveness of a short-term intensive program using BWSTT among community
dwelling poststroke survivors. [Subjects] Eighteen subjects participated in this study.
The treatment group was composed of 10 subjects (2 women; 8 men; mean age, 59.1 ±
12.5 years; time since stroke onset, 35.3 ± 33.2 months), whereas the control group was
made up of 8 subjects (3 women; 5 men; mean age, 59.8 ± 6.3 years; time since stroke
onset, 39.3 ± 27.3 months). [Methods] The treatment group received BWSTT 3 times a week
for 4 weeks (a total of 12 times), with each session lasting 20 minutes. The main outcome
measures were maximum gait speed on a flat floor, cadence, and step length. [Results] No
differences were observed in the baseline clinical data between the 2 groups. The gait
speed in the treatment group was significantly improved compared with that in the control
by 2-way ANOVA, while the other parameters showed no significant interaction. [Conclusion]
These results suggested that short-term intensive gait rehabilitation using BWSTT was
useful for improving gait ability among community dwelling poststroke subjects.
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Affiliation(s)
- Toshifumi Takao
- Department of Physical Therapy, Faculty of Health, Tsukuba International University, Japan ; Department of Neurology, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Japan
| | - Naoki Tanaka
- Department of Rehabilitation, Tsukuba Memorial Hospital, Japan
| | - Noboru Iizuka
- Department of Rehabilitation, Tsukuba Memorial Hospital, Japan ; Department of Medical Science and Welfare, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Japan
| | - Hideyuki Saitou
- Department of Rehabilitation, Tsukuba Memorial Hospital, Japan
| | - Akira Tamaoka
- Department of Neurology, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Japan
| | - Hisako Yanagi
- Department of Medical Science and Welfare, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Japan
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89
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Dutta A, Lahiri U, Das A, Nitsche MA, Guiraud D. Post-stroke balance rehabilitation under multi-level electrotherapy: a conceptual review. Front Neurosci 2015; 8:403. [PMID: 25565937 PMCID: PMC4266025 DOI: 10.3389/fnins.2014.00403] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 11/19/2014] [Indexed: 11/23/2022] Open
Abstract
Stroke is caused when an artery carrying blood from heart to an area in the brain bursts or a clot obstructs the blood flow thereby preventing delivery of oxygen and nutrients. About half of the stroke survivors are left with some degree of disability. Innovative methodologies for restorative neurorehabilitation are urgently required to reduce long-term disability. The ability of the nervous system to respond to intrinsic or extrinsic stimuli by reorganizing its structure, function, and connections is called neuroplasticity. Neuroplasticity is involved in post-stroke functional disturbances, but also in rehabilitation. It has been shown that active cortical participation in a closed-loop brain machine interface (BMI) can induce neuroplasticity in cortical networks where the brain acts as a controller, e.g., during a visuomotor task. Here, the motor task can be assisted with neuromuscular electrical stimulation (NMES) where the BMI will act as a real-time decoder. However, the cortical control and induction of neuroplasticity in a closed-loop BMI is also dependent on the state of brain, e.g., visuospatial attention during visuomotor task performance. In fact, spatial neglect is a hidden disability that is a common complication of stroke and is associated with prolonged hospital stays, accidents, falls, safety problems, and chronic functional disability. This hypothesis and theory article presents a multi-level electrotherapy paradigm toward motor rehabilitation in virtual reality that postulates that while the brain acts as a controller in a closed-loop BMI to drive NMES, the state of brain can be can be altered toward improvement of visuomotor task performance with non-invasive brain stimulation (NIBS). This leads to a multi-level electrotherapy paradigm where a virtual reality-based adaptive response technology is proposed for post-stroke balance rehabilitation. In this article, we present a conceptual review of the related experimental findings.
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Affiliation(s)
- Anirban Dutta
- DEMAR (INRIA Sophia Antipolis), INRIA, CNRS: UMR5506, Université Montpellier II - Sciences et Techniques, Université Montpellier I Montpellier, France ; Laboratoire d'Informatique de Robotique et de Microélectronique de Montpellier, CNRS: UMR5506, Université Montpellier II - Sciences et Techniques Montpellier, France
| | - Uttama Lahiri
- Electrical Engineering, Indian Institute of Technology Gandhinagar, India
| | - Abhijit Das
- Department of Neurorehabilitation, Institute of Neurosciences Kolkata, India
| | - Michael A Nitsche
- Department of Clinical Neurophysiology, Göttingen University Medical School Göttingen, Germany
| | - David Guiraud
- DEMAR (INRIA Sophia Antipolis), INRIA, CNRS: UMR5506, Université Montpellier II - Sciences et Techniques, Université Montpellier I Montpellier, France ; Laboratoire d'Informatique de Robotique et de Microélectronique de Montpellier, CNRS: UMR5506, Université Montpellier II - Sciences et Techniques Montpellier, France
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90
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Moore SA, Hallsworth K, Jakovljevic DG, Blamire AM, He J, Ford GA, Rochester L, Trenell MI. Effects of Community Exercise Therapy on Metabolic, Brain, Physical, and Cognitive Function Following Stroke. Neurorehabil Neural Repair 2014; 29:623-35. [DOI: 10.1177/1545968314562116] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background. Exercise therapy could potentially modify metabolic risk factors and brain physiology alongside improving function post stroke. Objective. To explore the short-term metabolic, brain, cognitive, and functional effects of exercise following stroke. Methods. A total of 40 participants (>50 years, >6 months post stroke, independently mobile) were recruited to a single-blind, parallel, randomized controlled trial of community-based exercise (19 weeks, 3 times/wk, “exercise” group) or stretching (“control” group). Primary outcome measures were glucose control and cerebral blood flow. Secondary outcome measures were cardiorespiratory fitness, blood pressure, lipid profile, body composition, cerebral tissue atrophy and regional brain metabolism, and physical and cognitive function. Results. Exercise did not change glucose control (homeostasis model assessment 1·5 ± 0·8 to 1·5 ± 0·7 vs 1·6 ± 0·8 to 1·7 ± 0·7, P = .97; CI = −0·5 to 0·49). Medial temporal lobe tissue blood flow increased with exercise (38 ± 8 to 42 ± 10 mL/100 g/min; P < .05; CI = 9.0 to 0.1) without any change in gray matter tissue volume. There was no change in medial temporal lobe tissue blood flow in the control group (41 ± 8 to 40 ± 7 mL/100 g/min; P = .13; CI = −3.6 to 6.7) but significant gray matter atrophy. Cardiorespiratory fitness, diastolic blood pressure, high-density lipoprotein cholesterol, physical function, and cognition also improved with exercise. Conclusion. Exercise therapy improves short-term metabolic, brain, physical, and cognitive function, without changes in glucose control following stroke. The long-term impact of exercise on stroke recurrence, cardiovascular health, and disability should now be explored.
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Affiliation(s)
- Sarah A. Moore
- Institute for Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
- Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
| | - Kate Hallsworth
- Institute for Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
- Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
| | - Djordje G. Jakovljevic
- Institute for Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
- Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
| | - Andrew M. Blamire
- Institute for Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Jiabao He
- Institute for Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Gary A. Ford
- Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
| | - Lynn Rochester
- Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
| | - Michael I. Trenell
- Institute for Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
- Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
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91
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Kopitar N, Goljar N, Mlinarič Lešnik V. Aktivnosti za preprečevanje padcev v rehabilitaciji pacientov po možganski kapi in njihov učinek na incidenco padcev. OBZORNIK ZDRAVSTVENE NEGE 2014. [DOI: 10.14528/snr.2014.48.3.26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Uvod: Preprečevanje padcev je pomemben del rehabilitacijske obravnave. S timsko obravnavo in sistematičnim izvajanjem aktivnosti pri za padec visoko ogroženih pacientih se število padcev lahko zmanjša.
Metode: V raziskavo je bilo vključenih 1.634 pacientov na rehabilitaciji po možganski kapi v Univerzitetnem rehabilitacijskem inštitutu Republike Slovenije – Soča (URI – Soča) od 1. 1. 2007 do 31. 12. 2012. Za ugotavljanje učinkovitosti aktivnosti za preprečevanje padcev pacientov je bila izvedena retrospektivna opazovalna raziskava z elementi akcijskega raziskovanja. Uspešnost izvedenih aktivnosti za preprečevanje padcev se je ugotavljala na podlagi incidence padcev.
Rezultati: V primerjavi z obdobjem 2007 do 2010, ko so se izvajale splošne aktivnosti za preprečevanje padcev in je incidenca padcev npr. leta 2007 znašala 4,5/1000 bolnišničnooskrbnih dni, se je le-ta v letih 2011 in 2012 po uvedbi lestvice za oceno tveganja za padec ter sistematičnega delovanja celotnega rehabilitacijskega tima pomembno zmanjšala, tako da je leta 2012 znašala 2,8/1000 bolnišničnooskrbnih dni. Učinkovitost sistematičnega delovanja pri preprečevanju padcev se kaže v manjšem številu pacientov, ki so padli enkrat (p = 0,025).
Diskusija in zaključek: S sistematičnim delovanjem multidisciplinarnega rehabilitacijskega tima lahko učinkovito zmanjšamo število padcev pacientov po možganski kapi na rehabilitacijskem oddelku. Vpliv teh aktivnosti na preprečevanje padcev pacientov v domačem okolju po zaključeni rehabilitaciji odpira tudi možnosti za nadaljnje raziskovalno delo.
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92
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Akbari A, Sarmadi A, Zafardanesh P. The effect of ankle taping and balance exercises on postural stability indices in healthy women. J Phys Ther Sci 2014; 26:763-9. [PMID: 24926148 PMCID: PMC4047248 DOI: 10.1589/jpts.26.763] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 12/16/2013] [Indexed: 01/01/2023] Open
Abstract
[Purpose] The purpose of this study was to compare the effect of ankle taping and
balance exercises on postural stability indices in healthy women. [Subjects and Methods]
Thirty healthy female students were randomly assigned into two equal groups: ankle taping
and balance exercise. The balance exercise group performed balance exercises for 6 weeks,
with 3 sessions per week and each session lasting 40 minutes. Ankle joint taping was
performed for 6 weeks and was renewed three times a week. Before and after the
interventions, overall, anteroposterior, and mediolateral stability indices were measured
with a Biodex Balance System in bilateral and unilateral stance positions with the eyes
open and closed. [Results] In the taping group during bilateral standing with the eyes
closed, the overall stability index changed from 6±1.4 to 4.8±1.3, anteroposterior
stability index changed from 4.2±1.27 to 3.4±0.97, and mediolateral stability index
changed from 3.2±0.75 to 2.7± 0.7. In the balance exercise group during bilateral standing
with the eyes closed, the overall stability index changed from 5.7±1.69 to 4.5±1.94,
anteroposterior stability index changed from 4.1±1.61 to 3±1.21, and mediolateral
stability index changed from 3.5±1.4 to 2.2± 1.3. No significant difference was seen
between the two groups regarding any study variables. [Conclusion] The results showed that
compared with the taping technique, balance training increases postural stability in the
majority of the studied balance situations.
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Affiliation(s)
- Asghar Akbari
- Health Promotion Research Center, Zahedan University of Medical Sciences, Iran
| | - Alireza Sarmadi
- Department of Physiotherapy, Faculty of Medicine, Tarbiat Modares University, Iran
| | - Parisa Zafardanesh
- Department of Physiotherapy, Zahedan University of Medical Sciences, Iran
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93
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Zhang S, Holmes M, Li L. Reliability of nerve function assessments for people with peripheral neuropathy. Int J Neurosci 2014; 125:201-7. [PMID: 24802152 DOI: 10.3109/00207454.2014.920332] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Examining degenerative sensory and reflexive activity among people with peripheral neuropathy (PN) is important for clinical examinations and understanding relevant neural impairments. However, other than the test of presynaptic inhibition, the reliability of other related tests is largely unknown. The purpose of this project was to examine the test-retest reliability of lower extremity sensory and reflexive measures in people with PN. Twelve participants (8 women, 4 men, age = 72.5 ± 9.2 years) diagnosed with PN were assessed on two occasions at least 7 d apart. Plantar sensitivity, H-reflex and active and passive ankle proprioception (AAP and PAP) were tested. Paired student's t-test and Intraclass correlation coefficients (ICC) were used for statistical analysis. Significant difference was observed in AAP at 0º position (p = 0.04). No other significant differences were observed. Moderate to high reliability was observed at measures of Plantar sensitivity (0.92), peak to peak H (0.71) and M (0.84) waves, latency between H and M (0.78), H-Index (0.85), AAP (0.62) and PAP index (0.60). Low reliability was observed of other parameters. The measures of Hmax, Mmax, latency, H-Index, plantar sensitivity and AAP & PAP indices of proprioception tests can be measured reliably for further study in this population.
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Affiliation(s)
- Shuqi Zhang
- 1Louisiana State University, Baton Rouge, LA, USA
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94
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Taricco M, Dallolio L, Calugi S, Rucci P, Fugazzaro S, Stuart M, Pillastrini P, Fantini MP, Taricco M, Bassi E, Bernucci C, Gaudenzi N, Kopliku B, Manigrasso V, Morara M, Dallolio L, Calugi S, Fantini MP, Pillastrini P, Rucci P, Fugazzaro S, Gandini M, Piccinelli B, Zanichelli FS, Tedeschi C, Testoni S. Impact of Adapted Physical Activity and Therapeutic Patient Education on Functioning and Quality of Life in Patients With Postacute Strokes. Neurorehabil Neural Repair 2014; 28:719-28. [DOI: 10.1177/1545968314523837] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective. The aim of this study was to assess whether the combination of Adapted Physical Activity (APA) and Therapeutic Patient Education (TPE) improves function and quality of life in survivors of strokes. Methods. This nonrandomized controlled study enrolled patients with mild to moderate hemiparesis referred to 2 physical medicine and rehabilitation units in Emilia-Romagna, Italy, 3 to 18 months after a single unilateral mild to moderate stroke. The experimental group (n = 126) received 16 APA sessions and 3 sessions of TPE, and the control group (n = 103) received usual care; 86.9% completed treatment. The main outcome measure was a 4-month change in gait endurance (that corresponds to 2 months after intervention in the experimental group), and secondary outcomes included the Short Physical Performance Battery, Berg Balance Scale, Barthel Index, Geriatric Depression Scale, 12-item Short-Form Health Survey, and Caregiver Strain Index. Changes in scores at 4 months were compared between groups using analysis of variance and controlling for group imbalance by means of the propensity score. Results. Gait endurance, physical performance, balance, and the physical component of the quality of life score increased significantly at 4 months in the APA group and remained stable in the control group. The propensity-adjusted between-group change was significant for these scores at P < .01. Conclusions. Our results confirm that it is feasible and potentially effective to implement APA programs for elderly patients with complex clinical conditions as early as 3 months after a stroke and suggest that, when combined with TPE, the effects of a postrehabilitation APA program are relatively enduring.
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Affiliation(s)
| | - Laura Dallolio
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum–University of Bologna, Bologna, Italy
| | - Simona Calugi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum–University of Bologna, Bologna, Italy
| | - Paola Rucci
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum–University of Bologna, Bologna, Italy
| | - Stefania Fugazzaro
- Istituto di Ricerca e Cura a Carattere Scientifico - Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Mary Stuart
- Health Administration and Policy Program, Baltimore County, Maryland, USA
| | - Paolo Pillastrini
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum–University of Bologna, Bologna, Italy
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum–University of Bologna, Bologna, Italy
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Baek IH, Lee T, Song M, Goo BO. Effect of Circuit Class Training for Eight Weeks on Changes in Ratios of F-Trp/BCAAs and Depression in People with Poststroke Depression. J Phys Ther Sci 2014; 26:243-6. [PMID: 24648640 PMCID: PMC3944297 DOI: 10.1589/jpts.26.243] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 09/05/2013] [Indexed: 11/25/2022] Open
Abstract
[Purpose] The purpose of the present study was to investigate the potential effects of
circuit class training (CCT) on poststroke depression through changes in branched-chain
amino acids (BCAAs) (isoleucine, leucine, and valine) and free-tryptophan (f-Trp).
[Subjects] The study subjects were 40 stroke patients with major depressive disorder. The
subjects were group-matched into an experimental and a control group according to sex,
age, height, and weight. [Methods] The experimental CCT group performed gradual
task-oriented CCT (80 min per session). The control group performed stretching exercises
and weight bearing exercises (80 min per session). Both groups performed the exercises
three times per week for eight weeks (24 sessions). Blood samples were collected
immediately before the exercise (9:10 a.m.) and after the exercise (10:30 a.m.), every two
weeks for eight weeks. [Results] The f-Trp/BCAAs ratio in the CCT group showed a
significant increase compared to the control group over time. [Conclusion] The results
show that the CCT may help to improve depression in people with poststroke depression
(PSD).
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Affiliation(s)
- Il-Hun Baek
- Department of Physical Therapy, Dong-Eui Institute of Technology, Republic of Korea
| | - Taesik Lee
- Department of Physical Therapy, Dong-Eui Institute of Technology, Republic of Korea
| | - Minyoung Song
- Department of Physical Therapy, Dong-Eui Institute of Technology, Republic of Korea
| | - Bong-Oh Goo
- Department of Physical Therapy, College of Health Sciences, Catholic University of Pusan, Republic of Korea
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Veerbeek JM, van Wegen E, van Peppen R, van der Wees PJ, Hendriks E, Rietberg M, Kwakkel G. What is the evidence for physical therapy poststroke? A systematic review and meta-analysis. PLoS One 2014; 9:e87987. [PMID: 24505342 PMCID: PMC3913786 DOI: 10.1371/journal.pone.0087987] [Citation(s) in RCA: 684] [Impact Index Per Article: 68.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 12/30/2013] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Physical therapy (PT) is one of the key disciplines in interdisciplinary stroke rehabilitation. The aim of this systematic review was to provide an update of the evidence for stroke rehabilitation interventions in the domain of PT. METHODS AND FINDINGS Randomized controlled trials (RCTs) regarding PT in stroke rehabilitation were retrieved through a systematic search. Outcomes were classified according to the ICF. RCTs with a low risk of bias were quantitatively analyzed. Differences between phases poststroke were explored in subgroup analyses. A best evidence synthesis was performed for neurological treatment approaches. The search yielded 467 RCTs (N = 25373; median PEDro score 6 [IQR 5-7]), identifying 53 interventions. No adverse events were reported. Strong evidence was found for significant positive effects of 13 interventions related to gait, 11 interventions related to arm-hand activities, 1 intervention for ADL, and 3 interventions for physical fitness. Summary Effect Sizes (SESs) ranged from 0.17 (95%CI 0.03-0.70; I(2) = 0%) for therapeutic positioning of the paretic arm to 2.47 (95%CI 0.84-4.11; I(2) = 77%) for training of sitting balance. There is strong evidence that a higher dose of practice is better, with SESs ranging from 0.21 (95%CI 0.02-0.39; I(2) = 6%) for motor function of the paretic arm to 0.61 (95%CI 0.41-0.82; I(2) = 41%) for muscle strength of the paretic leg. Subgroup analyses yielded significant differences with respect to timing poststroke for 10 interventions. Neurological treatment approaches to training of body functions and activities showed equal or unfavorable effects when compared to other training interventions. Main limitations of the present review are not using individual patient data for meta-analyses and absence of correction for multiple testing. CONCLUSIONS There is strong evidence for PT interventions favoring intensive high repetitive task-oriented and task-specific training in all phases poststroke. Effects are mostly restricted to the actually trained functions and activities. Suggestions for prioritizing PT stroke research are given.
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Affiliation(s)
- Janne Marieke Veerbeek
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Erwin van Wegen
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Roland van Peppen
- Department of Physiotherapy, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Philip Jan van der Wees
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Erik Hendriks
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
| | - Marc Rietberg
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Gert Kwakkel
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
- Department of Neurorehabilitation, Reade Center for Rehabilitation and Rheumatology, Amsterdam, The Netherlands
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Abstract
BACKGROUND Levels of physical fitness are low after stroke. It is unknown whether improving physical fitness after stroke reduces disability. OBJECTIVES To determine whether fitness training after stroke reduces death, dependence, and disability. The secondary aims were to determine the effects of training on physical fitness, mobility, physical function, quality of life, mood, and incidence of adverse events. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (last searched January 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 12: searched January 2013), MEDLINE (1966 to January 2013), EMBASE (1980 to January 2013), CINAHL (1982 to January 2013), SPORTDiscus (1949 to January 2013), and five additional databases (January 2013). We also searched ongoing trials registers, handsearched relevant journals and conference proceedings, screened reference lists, and contacted experts in the field. SELECTION CRITERIA Randomised trials comparing either cardiorespiratory training or resistance training, or both, with no intervention, a non-exercise intervention, or usual care in stroke survivors. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials, assessed quality, and extracted data. We analysed data using random-effects meta-analyses. Diverse outcome measures limited the intended analyses. MAIN RESULTS We included 45 trials, involving 2188 participants, which comprised cardiorespiratory (22 trials, 995 participants), resistance (eight trials, 275 participants), and mixed training interventions (15 trials, 918 participants). Nine deaths occurred before the end of the intervention and a further seven at the end of follow-up. No dependence data were reported. Diverse outcome measures made data pooling difficult. Global indices of disability show a tendency to improve after cardiorespiratory training (standardised mean difference (SMD) 0.37, 95% confidence interval (CI) 0.10 to 0.64; P = 0.007); benefits at follow-up and after mixed training were unclear. There were insufficient data to assess the effects of resistance training.Cardiorespiratory training involving walking improved maximum walking speed (mean difference (MD) 7.37 metres per minute, 95% CI 3.70 to 11.03), preferred gait speed (MD 4.63 metres per minute, 95% CI 1.84 to 7.43), walking capacity (MD 26.99 metres per six minutes, 95% CI 9.13 to 44.84), and Berg Balance scores (MD 3.14, 95% CI 0.56 to 5.73) at the end of the intervention. Mixed training, involving walking, increased preferred walking speed (MD 4.54 metres per minute, 95% CI 0.95 to 8.14), walking capacity (MD 41.60 metres per six minutes, 95% CI 25.25 to 57.95), and also pooled balance scores but the evidence is weaker (SMD 0.26 95% CI 0.04 to, 0.49). Some mobility benefits also persisted at the end of follow-up. The variability and trial quality hampered the assessment of the reliability and generalisability of the observed results. AUTHORS' CONCLUSIONS The effects of training on death and dependence after stroke are unclear. Cardiorespiratory training reduces disability after stroke and this may be mediated by improved mobility and balance. There is sufficient evidence to incorporate cardiorespiratory and mixed training, involving walking, within post-stroke rehabilitation programs to improve the speed and tolerance of walking; improvement in balance may also occur. There is insufficient evidence to support the use of resistance training. Further well-designed trials are needed to determine the optimal content of the exercise prescription and identify long-term benefits.
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Affiliation(s)
- David H Saunders
- Moray House School of Education, Institute for Sport, Physical Education and Health Sciences (SPEHS), University of Edinburgh, St Leonards Land, Holyrood Road, Edinburgh, Midlothian, UK, EH8 2AZ
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98
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Schmid AA, Van Puymbroeck M, Altenburger PA, Miller KK, Combs SA, Page SJ. Balance is associated with quality of life in chronic stroke. Top Stroke Rehabil 2013; 20:340-6. [PMID: 23893833 DOI: 10.1310/tsr2004-340] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate the association between balance and quality of life (QOL) in chronic stroke survivors by (1) examining the associations between balance and QOL scores; (2) identifying the frequency of balance impairment and poststroke falls; and (3) determining the differences in QOL scores between persons with and those without balance impairment. METHODS This is a secondary analysis of a cross-sectional study. People who had a stroke more than 6 months earlier from 3 Midwest states were included in the study if they met the following criteria: were referred to occupational or physical therapy for poststroke physical deficits; had self-reported stroke-related physical deficits; completed all stroke-related rehabilitation; had residual functional disability; had a score of ≥4 out of 6 on the short 6-item Mini-Mental State Examination; and were between 50 and 85 years old (n = 59). The main outcome measures included the Berg Balance Scale (BBS) to assess balance and the Stroke Specific Quality of Life Scale (SS-QOL) to assess QOL. Number of falls since stroke was self-reported. RESULTS Mean BBS score was 44 ± 8 and mean SS-QOL score was 46 ± 8; these scores were significantly correlated (r = .394, P = .002). Seventy-six percent of the sample reported a fall since stroke. Persons with balance impairment (BBS score ≤46; n = 29; 49%) had an average BBS score of 39 ± 7 and significantly worse SS-QOL scores than those without balance impairment (42 ± 8 vs 49 ± 7; P = .001). CONCLUSION In the chronic stroke population, balance impairment and fall risk are associated with lower QOL scores. If balance can be improved and maintained into the chronic phases of stroke, it is likely that individuals will benefit with improved QOL.
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Affiliation(s)
- Arlene A Schmid
- Roudebush Veterans Administration (VA) Medical Center, Health Services Research and Development (HSR&D) Center on Implementing Evidence-Based Practice, Indianapolis, IN, USA
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Homnick DN, Henning KM, Swain CV, Homnick TD. Effect of Therapeutic Horseback Riding on Balance in Community-Dwelling Older Adults with Balance Deficits. J Altern Complement Med 2013; 19:622-6. [DOI: 10.1089/acm.2012.0642] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Miklitsch C, Krewer C, Freivogel S, Steube D. Effects of a predefined mini-trampoline training programme on balance, mobility and activities of daily living after stroke: a randomized controlled pilot study. Clin Rehabil 2013; 27:939-47. [PMID: 23818410 DOI: 10.1177/0269215513485591] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate the effects of a predefined mini-trampoline therapy programme for increasing postural control, mobility and the ability to perform activities of daily living after stroke. DESIGN Randomized non-blinded controlled pilot study. SETTING Neurological rehabilitation hospital. SUBJECTS First-time stroke; age 18-80 years; independent standing ability for a minimum of 2 minutes. INTERVENTION Patients were randomized into two groups: the mini-trampoline group (n = 20) received 10 sessions of balance training using the mini-trampoline over three weeks. The patients of the control group (n =20) participated 10 times in a group balance training also over three weeks. MAIN MEASURES Postural control (Berg Balance Scale, BBS), mobility and gait endurance (timed 'up and go' test, TUG; 6-minute walk test, 6MWT) and the ability to perform activities of daily living (Barthel Index, BI). Measurements were undertaken prior to and after the intervention period. RESULTS Both groups were comparable before the study. The mini-trampoline group improved significantly more in the BBS (P = 0.003) compared to the control group. Mean or median differences of both groups showed improvements in the TUG 10.12 seconds/7.23 seconds, the 6MWT 135 m/75 m and the BI 20 points/13 points for the mini-trampoline and control group, respectively. These outcome measurements did not differ significantly between the two groups. CONCLUSION A predefined mini-trampoline training programme resulted in significantly increased postural control in stroke patients compared to balance training in a group. Although not statistically significant, the mini-trampoline training group showed increased improvement in mobility and activities of daily living. These differences could have been statistically significant if we had investigated more patients (i.e. a total sample of 84 patients for the TUG, 98 patients for the 6MWT, and 186 patients for the BI).
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Affiliation(s)
- Claudia Miklitsch
- Neurologische Klinik Bad Neustadt/Saale, Rhoen Klinikum, Bad Neustadt/Saale, Germany.
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