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Forkert ND, Verleger T, Cheng B, Thomalla G, Hilgetag CC, Fiehler J. Multiclass Support Vector Machine-Based Lesion Mapping Predicts Functional Outcome in Ischemic Stroke Patients. PLoS One 2015; 10:e0129569. [PMID: 26098418 PMCID: PMC4476759 DOI: 10.1371/journal.pone.0129569] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 05/11/2015] [Indexed: 11/18/2022] Open
Abstract
PURPOSE The aim of this study was to investigate if ischemic stroke final infarction volume and location can be used to predict the associated functional outcome using a multi-class support vector machine (SVM). MATERIAL AND METHODS Sixty-eight follow-up MR FLAIR datasets of ischemic stroke patients with known modified Rankin Scale (mRS) functional outcome after 30 days were used. The infarct regions were segmented and used to calculate the percentage of lesioned voxels in the predefined MNI, Harvard-Oxford cortical and subcortical atlas regions as well as using four problem-specific VOIs, which were identified from the database using voxel-based lesion symptom mapping. An overall of 12 SVM classification models for predicting the corresponding mRS score were generated using the lesion overlap values from the different brain region definitions, stroke laterality information, and the optional parameters infarct volume, admission NIHSS, and patient age. RESULTS Leave-one-out cross validations revealed that including information about the stroke location in terms of lesion overlap measurements led to improved mRS prediction results compared to classification models not utilizing the stroke location information. Furthermore, integration of the optional features led to improved mRS prediction results in all cases tested. The problem-specific brain regions and additional integration of the optional features led to the best mRS predictions with a precise multi-value mRS prediction accuracy of 56%, sliding window multi-value mRS prediction accuracy (mRS±1) of 82%, and binary mRS (0-2 vs. 3-5) prediction accuracy of 85%. CONCLUSION Therefore, a graded SVM-based functional stroke outcome prediction using the problem-specific brain regions for lesion overlap quantification leads to promising results but needs to be further validated using an independent database to rule out a potential methodical bias and overfitting effects. The prediction of the graded mRS functional outcome could be a valuable tool if combined with voxel-wise tissue outcome predictions based on multi-parametric datasets acquired at the acute phase.
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Affiliation(s)
- Nils Daniel Forkert
- Department of Radiology and Hotchkiss Brain Institute, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
- * E-mail:
| | - Tobias Verleger
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Bastian Cheng
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Claus C. Hilgetag
- Department of Computational Neuroscience, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
- Department of Health Sciences, Boston University, 635 Commonwealth Ave, Boston, MA, 02215, United States of America
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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Hung MC, Lu WS, Chen SS, Hou WH, Hsieh CL, Wang JD. Validation of the EQ-5D in Patients with Traumatic Limb Injury. JOURNAL OF OCCUPATIONAL REHABILITATION 2015; 25:387-393. [PMID: 25261389 DOI: 10.1007/s10926-014-9547-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE The measurement properties of the EQ-5D have not been explored for patients with traumatic limb injuries. The purpose of this study was to examine the construct validity, predictive validity, and responsiveness of the EQ-5D in patients with traumatic limb injuries. METHODS A consecutive cohort of 1,167 patients was assessed with the EQ-5D and the World Health Organization Quality of Life instrument (WHOQOL-BREF) at baseline while the patients were hospitalized because of the injury, and the patients were followed up at 3 months (1,003 patients), 6 months (1,010 patients), and 12 months (987 patients) after injury via telephone interview. RESULTS The utility and visual analogue scale (VAS) scores of the EQ-5D had moderate to high association with the physical and psychological domains and the two general questions (overall QOL and overall health) of the WHOQOL-BREF at all time points except baseline (Pearson's correlation coefficient >0.3), but the EQ-5D profiles were weakly associated with the social and environment domains of the WHOQOL-BREF (absolute value of Spearman's correlation coefficient <0.3). These results indicate that the EQ-5D has satisfactory construct validity. The utility and VAS scores of the EQ-5D at 3 and 6 months after injury can predict (with moderate to large relationships) the four domains and two general questions of the WHOQOL-BREF administered at 12 months after injury. The responsiveness of the utility and VAS of the EQ-5D were high (effect sizes >0.9) at 0-3, 0-6, and 0-12 months after injury. CONCLUSIONS The EQ-5D has sufficient construct validity, predictive validity, and responsiveness, and also provides evidence for using the utility of the EQ-5D for cost-utility analyses of patients with traumatic limb injuries in the future.
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Affiliation(s)
- Mei-Chuan Hung
- Department of Public Health, National Cheng Kung University College of Medicine, Tainan, Taiwan
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Byl N, Zhang W, Coo S, Tomizuka M. Clinical impact of gait training enhanced with visual kinematic biofeedback: Patients with Parkinson's disease and patients stable post stroke. Neuropsychologia 2015; 79:332-43. [PMID: 25912760 DOI: 10.1016/j.neuropsychologia.2015.04.020] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 03/28/2015] [Accepted: 04/20/2015] [Indexed: 10/23/2022]
Abstract
As the world's population ages, falls, physical inactivity, decreased attention and impairments in balance and gait arise as a consequence of decreased sensation, weakness, trauma and degenerative disease. Progressive balance and gait training can facilitate postural righting, safe ambulation and community participation. This small randomized clinical trial evaluated if visual and kinematic feedback provided during supervised gait training would interfere or enhance mobility, endurance, balance, strength and flexibility in older individuals greater than one year post stroke (Gobbi et al., 2009) or Parkinson's disease (PD) (Gobbi et al., 2009). Twenty-four individuals consented to participate. The participants were stratified by diagnosis and randomly assigned to a control (usual gait training (Gobbi et al., 2009)) or an experimental group (usual gait training plus kinematic feedback (Gobbi et al., 2009)). At baseline and 6 weeks post training (18 h), subjects completed standardized tests (mobility, balance, strength, range of motion). Gains were described across all subjects, by treatment group and by diagnosis. Then they were compared for significance using nonparametric statistics. Twenty-three subjects completed the study with no adverse events. Across all subjects, by diagnosis (stroke and PD) and by training group (control and experimental), there were significant gains in mobility (gait speed, step length, endurance, and quality), balance (Berg Balance), range of motion and strength. There were no significant differences in the gain scores between the control and experimental groups. Subjects chronic post stroke made greater strength gains on the affected side than subjects with PD but otherwise there were no significant differences. In summary, during supervised gait training, dynamic visual kinematic feedback from wireless pressure and motion sensors had similar, positive effects as verbal, therapist feedback. A wireless kinematic feedback system could be used at home, to provide feedback and motivation for self correction of gait while simultaneously providing data to the therapist (at a distance).
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Affiliation(s)
- Nancy Byl
- Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of California, San Francisco, CA 94158 USA.
| | - Wenlong Zhang
- Department of Mechanical Engineering, University of California, Berkeley, CA 94720 USA.
| | - Sophia Coo
- Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of California, San Francisco, CA 94158 USA.
| | - Masayoshi Tomizuka
- Department of Mechanical Engineering, University of California, Berkeley, CA 94720 USA.
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Afzal MR, Byun HY, Oh MK, Yoon J. Effects of kinesthetic haptic feedback on standing stability of young healthy subjects and stroke patients. J Neuroeng Rehabil 2015; 12:27. [PMID: 25889581 PMCID: PMC4367920 DOI: 10.1186/s12984-015-0020-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 02/24/2015] [Indexed: 11/29/2022] Open
Abstract
Background Haptic control is a useful therapeutic option in rehabilitation featuring virtual reality interaction. As with visual and vibrotactile biofeedback, kinesthetic haptic feedback may assist in postural control, and can achieve balance control. Kinesthetic haptic feedback in terms of body sway can be delivered via a commercially available haptic device and can enhance the balance stability of both young healthy subjects and stroke patients. Method Our system features a waist-attached smartphone, software running on a computer (PC), and a dedicated Phantom Omni® device. Young healthy participants performed balance tasks after assumption of each of four distinct postures for 30 s (one foot on the ground; the Tandem Romberg stance; one foot on foam; and the Tandem Romberg stance on foam) with eyes closed. Patient eyes were not closed and assumption of the Romberg stance (only) was tested during a balance task 25 s in duration. An Android application running continuously on the smartphone sent mediolateral (ML) and anteroposterior (AP) tilt angles to a PC, which generated kinesthetic haptic feedback via Phantom Omni®. A total of 16 subjects, 8 of whom were young healthy and 8 of whom had suffered stroke, participated in the study. Results Post-experiment data analysis was performed using MATLAB®. Mean Velocity Displacement (MVD), Planar Deviation (PD), Mediolateral Trajectory (MLT) and Anteroposterior Trajectory (APT) parameters were analyzed to measure reduction in body sway. Our kinesthetic haptic feedback system was effective to reduce postural sway in young healthy subjects regardless of posture and the condition of the substrate (the ground) and to improve MVD and PD in stroke patients who assumed the Romberg stance. Analysis of Variance (ANOVA) revealed that kinesthetic haptic feedback significantly reduced body sway in both categories of subjects. Conclusion Kinesthetic haptic feedback can be implemented using a commercial haptic device and a smartphone. Intuitive balance cues were created using the handle of a haptic device, rendering the approach very simple yet efficient in practice. This novel form of biofeedback will be a useful rehabilitation tool improving the balance of stroke patients.
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Affiliation(s)
- Muhammad Raheel Afzal
- School of Mechanical & Aerospace Engineering & ReCAPT, Gyeongsang National University, Jinju, Republic of Korea.
| | - Ha-Young Byun
- Department of Rehabilitation Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea.
| | - Min-Kyun Oh
- Department of Rehabilitation Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea.
| | - Jungwon Yoon
- School of Mechanical & Aerospace Engineering & ReCAPT, Gyeongsang National University, Jinju, Republic of Korea.
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105
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Kim TJ, Seo KM, Kim DK, Kang SH. The relationship between initial trunk performances and functional prognosis in patients with stroke. Ann Rehabil Med 2015; 39:66-73. [PMID: 25750874 PMCID: PMC4351497 DOI: 10.5535/arm.2015.39.1.66] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 09/04/2014] [Indexed: 11/15/2022] Open
Abstract
Objective To confirm the relationship between initial trunk performance and functional outcomes according to gait ability, and whether initial trunk performance is of predictive value in terms of functional prognosis in patients with stroke. Methods We reviewed 135 patients who suffered from stroke. Trunk performance of the patients was evaluated using the Trunk Impairment Scale (TIS). The patients were divided into 2 groups according to gait ability at initial stage of stroke. Correlation analyses were performed to assess relationship between initial TIS and functional outcomes. We also evaluated the relationship between initial TIS and the Korean version of Modified Barthel Index (K-MBI) subitems. Finally, stepwise multiple regression analyses were performed to examine the predictive validity of initial TIS and its subscales with functional outcomes. Results For both groups, initial TIS was correlated with K-MBI and Functional Ambulation Categories at 4 weeks after stroke; however, the relationship did not remain stable at 6 months in ambulatory patients. All K-MBI subitems, which were associated with trunk movement, as well as others about basic skills was correlated with initial TIS. Finally, when of subscales TIS, dynamic sitting balance (TIS-D) was included in by stepwise multiple regression analyses, high proportion of the explained variance was represented. Conclusion The strong relationship between trunk performance and functional outcomes in patients with stroke emphasizes the importance of trunk rehabilitation. Indeed, an evaluation of a patient's initial TIS after stroke, especially TIS-D, could be helpful in predicting patient's functional prognosis.
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Affiliation(s)
- Tha Joo Kim
- Department of Physical Medicine and Rehabilitation, Chung-Ang University College of Medicine, Seoul, Korea
| | - Kyung Mook Seo
- Department of Physical Medicine and Rehabilitation, Chung-Ang University College of Medicine, Seoul, Korea
| | - Don-Kyu Kim
- Department of Physical Medicine and Rehabilitation, Chung-Ang University College of Medicine, Seoul, Korea
| | - Si Hyun Kang
- Department of Physical Medicine and Rehabilitation, Chung-Ang University College of Medicine, Seoul, Korea
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106
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Brown AW, Therneau TM, Schultz BA, Niewczyk PM, Granger CV. Measure of functional independence dominates discharge outcome prediction after inpatient rehabilitation for stroke. Stroke 2015; 46:1038-44. [PMID: 25712941 DOI: 10.1161/strokeaha.114.007392] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Identifying clinical data acquired at inpatient rehabilitation admission for stroke that accurately predict key outcomes at discharge could inform the development of customized plans of care to achieve favorable outcomes. The purpose of this analysis was to use a large comprehensive national data set to consider a wide range of clinical elements known at admission to identify those that predict key outcomes at rehabilitation discharge. METHODS Sample data were obtained from the Uniform Data System for Medical Rehabilitation data set with the diagnosis of stroke for the years 2005 through 2007. This data set includes demographic, administrative, and medical variables collected at admission and discharge and uses the FIM (functional independence measure) instrument to assess functional independence. Primary outcomes of interest were functional independence measure gain, length of stay, and discharge to home. RESULTS The sample included 148,367 people (75% white; mean age, 70.6±13.1 years; 97% with ischemic stroke) admitted to inpatient rehabilitation a mean of 8.2±12 days after symptom onset. The total functional independence measure score, the functional independence measure motor subscore, and the case-mix group were equally the strongest predictors for any of the primary outcomes. The most clinically relevant 3-variable model used the functional independence measure motor subscore, age, and walking distance at admission (r(2)=0.107). No important additional effect for any other variable was detected when added to this model. CONCLUSIONS This analysis shows that a measure of functional independence in motor performance and age at rehabilitation hospital admission for stroke are predominant predictors of outcome at discharge in a uniquely large US national data set.
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Affiliation(s)
- Allen W Brown
- From the Department of Physical Medicine and Rehabilitation (A.W.B., B.A.S.) and Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN (T.M.T.); Uniform Data System for Medical Rehabilitation, Buffalo, NY (P.M.N., C.V.G.); Department of Health Care Studies, Daemen College, Amherst, NY (P.M.N.); and the Department of Neurology, University at Buffalo, Buffalo, NY (C.V.G.).
| | - Terry M Therneau
- From the Department of Physical Medicine and Rehabilitation (A.W.B., B.A.S.) and Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN (T.M.T.); Uniform Data System for Medical Rehabilitation, Buffalo, NY (P.M.N., C.V.G.); Department of Health Care Studies, Daemen College, Amherst, NY (P.M.N.); and the Department of Neurology, University at Buffalo, Buffalo, NY (C.V.G.)
| | - Billie A Schultz
- From the Department of Physical Medicine and Rehabilitation (A.W.B., B.A.S.) and Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN (T.M.T.); Uniform Data System for Medical Rehabilitation, Buffalo, NY (P.M.N., C.V.G.); Department of Health Care Studies, Daemen College, Amherst, NY (P.M.N.); and the Department of Neurology, University at Buffalo, Buffalo, NY (C.V.G.)
| | - Paulette M Niewczyk
- From the Department of Physical Medicine and Rehabilitation (A.W.B., B.A.S.) and Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN (T.M.T.); Uniform Data System for Medical Rehabilitation, Buffalo, NY (P.M.N., C.V.G.); Department of Health Care Studies, Daemen College, Amherst, NY (P.M.N.); and the Department of Neurology, University at Buffalo, Buffalo, NY (C.V.G.)
| | - Carl V Granger
- From the Department of Physical Medicine and Rehabilitation (A.W.B., B.A.S.) and Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN (T.M.T.); Uniform Data System for Medical Rehabilitation, Buffalo, NY (P.M.N., C.V.G.); Department of Health Care Studies, Daemen College, Amherst, NY (P.M.N.); and the Department of Neurology, University at Buffalo, Buffalo, NY (C.V.G.)
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107
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Larson EB, Kirschner K, Bode RK, Heinemann AW, Clorfene J, Goodman R. Brief Cognitive Assessment and Prediction of Functional Outcome in Stroke. Top Stroke Rehabil 2015; 9:10-21. [PMID: 14523696 DOI: 10.1310/84yn-y640-8ueq-pdnv] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
To evaluate the ability to predict outcome with a brief measure of cognitive ability, we tested consecutive admissions who received inpatient rehabilitation for stroke with the Repeatable Battery for Assessment of Neuropsychological Symptoms (RBANS). Six months later, 34 discharged patients were contacted by telephone and were interviewed using a battery of functional outcome and quality of life measures. Multiple regression analysis showed that inpatient RBANS indexes predicted cognitive disability 6 months later. The present findings support the use of cognitive evaluations of patients with acute stroke to assist with prediction of outcome to be used in treatment planning.
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Affiliation(s)
- Eric B Larson
- Rehabilitation Institute of Chicago, and Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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108
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Bode RK, Rychlik K, Heinemann AW, Lovell L, Modla L. Reconceptualizing Poststroke Activity Level Using the Frenchay Activities Index. Top Stroke Rehabil 2015; 9:82-91. [PMID: 14523702 DOI: 10.1310/rcwl-75jj-jrew-fvqt] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Modifications of the Frenchay Activities Index were implemented in a study of postacute stroke rehabilitation outcomes. These modifications incorporated the prestroke activity levels and postrehabilitation goals and assessments of activity importance of 136 persons with stroke who received services in either a single modality or comprehensive outpatient rehabilitation setting. Prestroke activity levels were assessed retrospectively at admission to postacute rehabilitation, and current activity levels were assessed at discharge and 3 months post discharge. Prestroke activity levels were used to determine postrehabilitation goal attainment. Results showed that activities for which goals were less likely to be attained were more strenuous in nature, and activities for which goals were more likely to be attained were more sedentary in nature. The importance persons placed on specific activities was used to tailor the estimates of overall activity levels to reflect their importance to each person. Results showed that adjusting for importance decreased the estimate of prestroke activity level but had little effect on poststroke activity level. Incorporation of these modifications represents a reconceptualization of poststroke activity levels that clinicians can use to guide their selection of postacute rehabilitation therapy goals.
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Affiliation(s)
- Rita K Bode
- Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, and Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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109
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Opal Cox E, Dooley A, Liston M, Miller M. Coping with Stroke: Perceptions of Elderly Who Have Experienced Stroke and Rehabilitation Interventions. Top Stroke Rehabil 2015. [DOI: 10.1310/bx0j-2n96-vdva-ue28] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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110
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Use of the Berg Balance Scale to Predict Independent Gait After Stroke: A Study of an Inpatient Population in Japan. PM R 2015; 7:392-9. [PMID: 25633633 DOI: 10.1016/j.pmrj.2015.01.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 01/13/2015] [Accepted: 01/17/2015] [Indexed: 11/23/2022]
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111
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112
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Howells A, Morris R, Darwin C. A Questionnaire to Assess Carers’ Experience of Stroke Rehabilitation. Top Stroke Rehabil 2015; 19:256-67. [DOI: 10.1310/tsr1903-256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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113
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Kemper C, Koller D, Glaeske G, van den Bussche H. Mortality and Nursing Care Dependency One Year After First Ischemic Stroke: An Analysis of German Statutory Health Insurance Data. Top Stroke Rehabil 2015; 18:172-8. [DOI: 10.1310/tsr1802-172] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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114
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Skidmore ER, Rogers JC, Chandler LS, Jovin TG, Holm MB. A Precise Method for Linking Neuroanatomy to Function After Stroke: A Pilot Study. Top Stroke Rehabil 2014; 14:12-7. [PMID: 17901011 DOI: 10.1310/tsr1405-12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE We examined the hypotheses that a comprehensive method for categorizing specific brain regions impaired by stroke is feasible and that this method may be used to explore associations between specific impaired brain regions and functional outcomes. METHOD Impaired brain regions were identified with neuroanatomical diagrams. Body function outcomes (motor, somatosensory, and cognition) were measured with the National Institutes of Health Stroke Scale and activity outcomes (functional mobility, self-care, and instrumental activities of daily living) were measured with the Performance Assessment of Self-care Skills. Decision analyses identified brain regions associated with functional outcomes and the influence of ischemia on outcome scores. RESULTS Motor control and somatosensation brain regions were linked with motor and somatosensory outcomes; those associated with decision making and motor planning were linked with cognition and functional mobility outcomes. Data were insufficiently powered to examine brain regions associated with self-care and instrumental activities of daily living outcomes. CONCLUSION The findings support the feasibility of study methods. Further investigation with larger, well-defined samples is warranted using study methods.
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Affiliation(s)
- Elizabeth R Skidmore
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, Pennsylavania, USA
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115
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Dhiman NR, Shah GL, Joshi D, Gyanpuri V. Relationship between side of hemiparesis and functional independence using activities of daily living index. J ANAT SOC INDIA 2014. [DOI: 10.1016/j.jasi.2014.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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116
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Lee YC, Chen SS, Koh CL, Hsueh IP, Yao KP, Hsieh CL. Development of two Barthel Index-based Supplementary Scales for patients with stroke. PLoS One 2014; 9:e110494. [PMID: 25329051 PMCID: PMC4203801 DOI: 10.1371/journal.pone.0110494] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 09/16/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The Barthel Index (BI) assesses actual performance of activities of daily living (ADL). However, comprehensive assessment of ADL functions should include two other constructs: self-perceived difficulty and ability. OBJECTIVE The aims of this study were to develop two BI-based Supplementary Scales (BI-SS), namely, the Self-perceived Difficulty Scale and the Ability Scale, and to examine the construct validity of the BI-SS in patients with stroke. METHOD The BI-SS was first developed by consultation with experts and then tested on patients to confirm the clarity and feasibility of administration. A total of 306 participants participated in the construct validity study. Construct validity was investigated using Mokken scale analysis and analyzing associations between scales. The agreement between each pair of the scales' scores was further examined. RESULTS The Self-perceived Difficulty Scale consisted of 10 items, and the Ability Scale included 8 items (excluding both bladder and bowel control items). Items in each individual scale were unidimensional (H ≥ 0.5). The scores of the Self-perceived Difficulty and Ability Scales were highly correlated with those of the BI (rho = 0.78 and 0.90, respectively). The scores of the two BI-SS scales and BI were significantly different from each other (p<.001). These results indicate that both BI-SS scales assessed unique constructs. CONCLUSIONS The BI-SS had overall good construct validity in patients with stroke. The BI-SS can be used as supplementary scales for the BI to comprehensively assess patients' ADL functions in order to identify patients' difficulties in performing ADL tasks, plan intervention strategies, and assess outcomes.
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Affiliation(s)
- Ya-Chen Lee
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Sheng-Shiung Chen
- Department of Physical Medicine and Rehabilitation, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan
| | - Chia-Lin Koh
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - I-Ping Hsueh
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Zhongzheng District, Taipei, Taiwan
- * E-mail:
| | - Kai-Ping Yao
- Department of Psychology, College of Science, National Taiwan University, Taipei, Taiwan
| | - Ching-Lin Hsieh
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Zhongzheng District, Taipei, Taiwan
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117
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Admission to and Continuation of Inpatient Stroke Rehabilitation in Queensland, Australia: A Survey of Factors that Contribute to the Consultant's Decision. BRAIN IMPAIR 2014. [DOI: 10.1017/brimp.2014.12] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Aim: To evaluate factors that may contribute to the decision of the consultant medical officer (CMO) to: (1) admit a person with stroke to inpatient rehabilitation from acute hospitalisation; and (2) continue or cease inpatient rehabilitation.Methods: A web-based survey of CMOs practising in Queensland Australia, who were members of the Australian and New Zealand Society of Geriatric Medicine (n ~ 90) or the Queensland Stroke Clinical Network (n ~ 30) was completed. The survey contained two sections to explore factors that could: (1) favour or disfavour admission to inpatient rehabilitation from acute hospitalisation; and (2) favour continuation or cessation of inpatient rehabilitation. Open and closed questions were used.Results: Twenty-one CMOs (13–20% response rate, 43% geriatrician) completed the survey. Factors related to physical function, along with the presence of social supports favoured admission, while the presence of behavioural and cognitive impairments and a lack of staff capacity disfavoured admission. Improvements in function favoured continuation of inpatient rehabilitation, while a lack of improvement favoured cessation.Conclusion: Factors related to the patient, their social support network and the organisation were found to influence the decision of the CMO to admit a person with stroke to inpatient rehabilitation from acute hospitalisation. Once in rehabilitation, demonstration of benefit was consistently reported to indicate continued service need.
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118
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Chern JS, Chen MH, Lee YC, Chen SS, Lin LF, Hou WH, Hsieh CL. Validation of a Chinese version of the Frenchay Activities Index in patients with traumatic limb injury. JOURNAL OF OCCUPATIONAL REHABILITATION 2014; 24:439-445. [PMID: 24077894 DOI: 10.1007/s10926-013-9477-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE The Frenchay Activities Index (FAI) is a frequently used measure that assesses instrumental activities of daily living (IADL). However, the measurement properties of the FAI are largely unknown for patients with traumatic limb injuries. The purpose of this study was to examine the measurement properties of a Chinese version of the FAI, including score distribution, internal consistency, construct validity, predictive validity, and responsiveness in patients with traumatic limb injuries. METHODS We performed a secondary data analysis, primarily using non-parametric item response theory, on a data set. The FAI and the World Health Organization Quality of Life Assessment (WHOQOL-BREF) were administered via telephone interview to a cohort of patients at 3, 6, and 12 months after injury. Totals of 342 patients' data (at 3 months after injury), 1,010 patients' data (6 months), and 987 patients' data (12 months) were available for analysis. RESULTS After the deletion of 5 items (i.e., travel outings, gardening, household/car maintenance, reading books, and gainful work), the 10-item revised FAI (R-FAI) formed a unidimensional construct. The R-FAI exhibited a unidimensional construct at each of the 3 time points. The R-FAI had sufficient score distribution, internal consistency, predictive validity, and responsiveness in patients with limb injuries. CONCLUSIONS Our results support the conclusion that the R-FAI has satisfactory measurement properties. The R-FAI is useful for assessing IADL in patients with limb injuries.
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Lee SW, Landers KA, Park HS. Development of a biomimetic hand exotendon device (BiomHED) for restoration of functional hand movement post-stroke. IEEE Trans Neural Syst Rehabil Eng 2014; 22:886-98. [PMID: 24760924 PMCID: PMC4096326 DOI: 10.1109/tnsre.2014.2298362] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Significant functional impairment of the hand is common among stroke survivors and restoration of hand function should be prioritized during post-stroke rehabilitation. The goal of this study was to develop a novel biomimetic device to assist patients in producing complex hand movements with a limited number of actuators. The Biomimetic Hand Exoskeleton Device (BiomHED) is actuated by exotendons that mimic the geometry of the major tendons of the hand. Ten unimpaired subjects and four chronic stroke survivors participated in experiments that tested the efficacy of the system. The exotendons reproduced distinct spatial joint coordination patterns similar to their target muscle-tendon units for both subject groups. In stroke survivors, the exotendon-produced joint angular displacements were smaller, but not significantly different, than those of unimpaired subjects [Formula: see text]. Even with limited use of the BiomHED, the kinematic workspace of the index finger increased by 63%-1014% in stroke survivors. The device improved the kinematics of the tip-pinch task in stroke survivors and resulted in a significant reduction in the fingertip-thumb tip distance ( 17.9 ±15.3 mm). This device is expected to enable effective "task-oriented" training of the hand post-stroke.
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Affiliation(s)
- Sang Wook Lee
- Department of Biomedical Engineering, Catholic University of America, Washington, DC, USA
- Center for Applied Biomechanics and Rehabilitation Research, Medstar National Rehabilitation Hospital, Washington, DC, USA
| | - Katlin A. Landers
- Department of Biomedical Engineering, Catholic University of America, Washington, DC, USA
- Center for Applied Biomechanics and Rehabilitation Research, Medstar National Rehabilitation Hospital, Washington, DC, USA
| | - Hyung-Soon Park
- Mechanical Engineering Department, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
- Rehabilitation Medicine Department, National Institute of Health, Bethesda, MD, USA
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Robotic upper limb rehabilitation after acute stroke by NeReBot: evaluation of treatment costs. BIOMED RESEARCH INTERNATIONAL 2014; 2014:265634. [PMID: 24967345 PMCID: PMC4017845 DOI: 10.1155/2014/265634] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 03/18/2014] [Indexed: 11/18/2022]
Abstract
Stroke is the first cause of disability. Several robotic devices have been developed for stroke rehabilitation. Robot therapy by NeReBot is demonstrated to be an effective tool for the treatment of poststroke paretic upper limbs, able to improve the activities of daily living of stroke survivors when used both as additional treatment and in partial substitution of conventional rehabilitation therapy in the acute and subacute phases poststroke. This study presents the evaluation of the costs related to delivering such therapy, in comparison with conventional rehabilitation treatment. By comparing several NeReBot treatment protocols, made of different combinations of robotic and nonrobotic exercises, we show that robotic technology can be a valuable and economically sustainable aid in the management of poststroke patient rehabilitation.
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Haselbach D, Renggli A, Carda S, Croquelois A. Determinants of neurological functional recovery potential after stroke in young adults. Cerebrovasc Dis Extra 2014; 4:77-83. [PMID: 24847344 PMCID: PMC4024500 DOI: 10.1159/000360218] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 02/01/2014] [Indexed: 11/26/2022] Open
Abstract
Background/Objectives Despite recent progress in stroke prevention and acute treatment, neurorehabilitation remains one of the main methods of treatment in the management of stroke patients. The aim of this study is to point out some important predicting factors of in-hospital neurorehabilitation outcomes. Methods A rehabilitation registry including all patients who had undergone a standardized program of neurorehabilitation at the neurorehabilitation unit of the Lausanne University Hospital, Lausanne, Switzerland, was created. Patients aged <65 years and having experienced a first ever nontraumatic stroke from 2005 to 2010 were admitted. Using logistical regression models, predicting factors for each patient were compared to the exit Functional Independence Measure (FIM) score. Results Age >55 years, gender, aphasia, hemilateral spatial neglect, spasticity, complications, length of stay >70 days, entry FIM >100 and relative possible FIM gain/week of >10% were considered to be significant and independent predicting factors of the neurorehabilitation outcome. Discussion/Conclusion Some factors of the in-hospital rehabilitation period have been identified before (spasticity, complications, length of stay, relative possible FIM gain/week) and should be considered for a better management of the neurorehabilitation therapy. In addition, a personalized rehabilitation strategy based on the patient's individual needs should be aimed at. The question of resource allocation can also be addressed with regard to the present findings.
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Affiliation(s)
- Daniel Haselbach
- Neurorehabilitation Unit, Department of Clinical Neurosciences, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Anastasia Renggli
- Neurorehabilitation Unit, Department of Clinical Neurosciences, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Stefano Carda
- Neurorehabilitation Unit, Department of Clinical Neurosciences, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Alexandre Croquelois
- Neurorehabilitation Unit, Department of Clinical Neurosciences, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
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Thompson DD, Murray GD, Dennis M, Sudlow CLM, Whiteley WN. Formal and informal prediction of recurrent stroke and myocardial infarction after stroke: a systematic review and evaluation of clinical prediction models in a new cohort. BMC Med 2014; 12:58. [PMID: 24708686 PMCID: PMC4022243 DOI: 10.1186/1741-7015-12-58] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 02/28/2014] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The objective of this study was to: (1) systematically review the reporting and methods used in the development of clinical prediction models for recurrent stroke or myocardial infarction (MI) after ischemic stroke; (2) to meta-analyze their external performance; and (3) to compare clinical prediction models to informal clinicians' prediction in the Edinburgh Stroke Study (ESS). METHODS We searched Medline, EMBASE, reference lists and forward citations of relevant articles from 1980 to 19 April 2013. We included articles which developed multivariable clinical prediction models for the prediction of recurrent stroke and/or MI following ischemic stroke. We extracted information to assess aspects of model development as well as metrics of performance to determine predictive ability. Model quality was assessed against a pre-defined set of criteria. We used random-effects meta-analysis to pool performance metrics. RESULTS We identified twelve model development studies and eleven evaluation studies. Investigators often did not report effective sample size, regression coefficients, handling of missing data; typically categorized continuous predictors; and used data dependent methods to build models. A meta-analysis of the area under the receiver operating characteristic curve (AUROCC) was possible for the Essen Stroke Risk Score (ESRS) and for the Stroke Prognosis Instrument II (SPI-II); the pooled AUROCCs were 0.60 (95% CI 0.59 to 0.62) and 0.62 (95% CI 0.60 to 0.64), respectively. An evaluation among minor stroke patients in the ESS demonstrated that clinicians discriminated poorly between those with and those without recurrent events and that this was similar to clinical prediction models. CONCLUSIONS The available models for recurrent stroke discriminate poorly between patients with and without a recurrent stroke or MI after stroke. Models had a similar discrimination to informal clinicians' predictions. Formal prediction may be improved by addressing commonly encountered methodological problems.
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Affiliation(s)
- Douglas D Thompson
- Edinburgh MRC Hub for Trials Methodology Research, Centre for Population Health Sciences, University of Edinburgh Medical School, Teviot Place, Edinburgh EH8 9AG, UK.
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Skidmore ER, Dawson DR, Whyte EM, Butters MA, Dew MA, Grattan ES, Becker JT, Holm MB. Developing complex interventions: lessons learned from a pilot study examining strategy training in acute stroke rehabilitation. Clin Rehabil 2014; 28:378-87. [PMID: 24113727 PMCID: PMC3949124 DOI: 10.1177/0269215513502799] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To examine the feasibility of a strategy training clinical trial in a small group of adults with stroke-related cognitive impairments in inpatient rehabilitation, and to explore the impact of strategy training on disability. DESIGN Non-randomized two-group intervention pilot study. SETTING Two inpatient rehabilitation units within an academic health centre. PARTICIPANTS Individuals with a primary diagnosis of acute stroke, who were admitted to inpatient rehabilitation and demonstrated cognitive impairments were included. Individuals with severe aphasia; dementia; major depressive disorder, bipolar, or psychotic disorder; recent drug or alcohol abuse; and anticipated length of stay less than five days were excluded. INTERVENTION Participants received strategy training or an attention control session in addition to usual rehabilitation care. Sessions in both groups were 30-40 minutes daily, five days per week, for the duration of inpatient rehabilitation. MAIN OUTCOME MEASURES We assessed feasibility through participants' recruitment and retention; research intervention session number and duration; participants' comprehension and engagement; intervention fidelity; and participants' satisfaction. We assessed disability at study admission, inpatient rehabilitation discharge, 3 and 6 months using the Functional Independence Measure. RESULTS Participants in both groups (5 per group) received the assigned intervention (>92% planned sessions; >94% fidelity) and completed follow-up testing. Strategy training participants in this small sample demonstrated significantly less disability at six months (M (SE) = 117 (3)) than attention control participants (M(SE) = 96 (14); t 8 = 7.87, P = 0.02). CONCLUSIONS It is feasible and acceptable to administer both intervention protocols as an adjunct to acute inpatient rehabilitation, and strategy training shows promise for reducing disability.
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Affiliation(s)
- Elizabeth R. Skidmore
- Department of Occupational Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences
- Rehabilitation Institute, University of Pittsburgh Medical Center
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh School of Medicine
| | - Deirdre R. Dawson
- Rotman Research Institute at Baycrest
- Department of Occupational Science & Occupational Therapy and Graduate Department of Rehabilitation Sciences, University of Toronto
| | - Ellen M. Whyte
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh School of Medicine
- Department of Psychiatry, University of Pittsburgh School of Medicine
- Advanced Center for Intervention and Services Research for Late Life Mood Disorders, Western Psychiatric Institute & Clinic
| | - Meryl A. Butters
- Department of Psychiatry, University of Pittsburgh School of Medicine
- Advanced Center for Intervention and Services Research for Late Life Mood Disorders, Western Psychiatric Institute & Clinic
| | - Mary Amanda Dew
- Department of Psychiatry, University of Pittsburgh School of Medicine
- Advanced Center for Intervention and Services Research for Late Life Mood Disorders, Western Psychiatric Institute & Clinic
| | - Emily S. Grattan
- Department of Occupational Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences
- Rehabilitation Institute, University of Pittsburgh Medical Center
| | - James T. Becker
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Margo B. Holm
- Department of Occupational Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences
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Masiero S, Armani M, Ferlini G, Rosati G, Rossi A. Randomized trial of a robotic assistive device for the upper extremity during early inpatient stroke rehabilitation. Neurorehabil Neural Repair 2013; 28:377-86. [PMID: 24316679 DOI: 10.1177/1545968313513073] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND A recent Cochrane Review showed that early robotic training of the upper limb in stroke survivors can be more effective than other interventions when improving activities of daily living involving the arm function is the aim of therapy. OBJECTIVE We tested for efficacy of the study a protocol which involved the use of the NeReBot therapy in partial substitution of standard upper limb rehabilitation in post-acute stroke patients. METHODS In this dose-matched, randomized controlled clinical trial, 34 hemiparetic participants with movement against gravity in shoulder, elbow, and wrist muscle groups were enrolled within 15 days of the onset of stroke. All participants received a total daily rehabilitation treatment for 120 minutes, 5 days per week for 5 weeks. The control group received standard therapy for the upper limb. The experimental group received standard therapy (65% of exercise time) associated with robotic training (35% of exercise time). Muscle tone (Modified Ashworth Scale), strength (Medical Research Council), and synergism (Fugl-Meyer motor scores) were measured at impairment level, whereas dexterity (Box and Block Test and Frenchay Arm Test) and activities of daily living (Functional Independence Measure) were measured at activity level. All assessments were performed at baseline, at the end of therapy (time T1), at 3 months (time T2), and at 7 months (time T3) after entry. All between-group analyses were tested using nonparametric test with Bonferroni's adjustments for multiple testing. RESULTS No significant between-group differences were found with respect to demographic characteristics, motor, dexterity, and ADLs at baseline, postintervention (T1) and at follow-up (T2 and T3). CONCLUSIONS The robot therapy by NeReBot did not lead to better outcomes compared with conventional inpatient rehabilitation.
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Klein AM, Howell K, Straube A, Pfefferkorn T, Bender A. Rehabilitation outcome of patients with severe and prolonged disorders of consciousness after aneurysmal subarachnoid hemorrhage (aSAH). Clin Neurol Neurosurg 2013; 115:2136-41. [DOI: 10.1016/j.clineuro.2013.08.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 07/23/2013] [Accepted: 08/04/2013] [Indexed: 12/21/2022]
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Choi YE, Kim JH, Yun YD. Relationship of Physical Impairment, function and Insulin Resistance in stroke patients. INTERNATIONAL JOURNAL OF CONTENTS 2013. [DOI: 10.5392/ijoc.2013.9.3.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Joseph C, Rhoda A. Activity limitations and factors influencing functional outcome of patients with stroke following rehabilitation at a specialised facility in the Western Cape. Afr Health Sci 2013; 13:646-54. [PMID: 24250302 DOI: 10.4314/ahs.v13i3.18] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Determining the functional abilities and factors influencing outcome of patients with stroke following rehabilitation are essential for the planning of future interventions and services in order to optimise recovery. OBJECTIVES To determine the activity limitations and factors influencing functional outcome of patients with stroke managed at a specialised rehabilitation centre. METHODOLOGY A longitudinal study design was used to determine the functional outcomes of patients admitted to the centre on admission and discharge. A data gathering sheet was developed to collect information pertaining to the demographicand medical profile and process of rehabilitation, whereas the Barthel Index was used to collect data relating to functional abilities. For analysis, descriptive statistics as well as inferential statistics (Student t test) were utilised to determine the paired differences. Six prognostic factors influencing functional outcome were selected and tested using linear (bivariate) regression. RESULTS The mean Barthel Index scores on admission and at discharge were 58.85 and 81.59 respectively. A significant improvement was noted in the execution of functional task of patients with stroke (p< 0.01) between the data collection points. Despite the significant overall improvement, results show a high prevalence of dependence with walking and stair climbing at discharge. Only functional ability on admission (r=0.49) predicted a favourable functional outcome at discharge. CONCLUSION This study highlights the limitations of younger stroke survivors and the need for continued rehabilitation following in-patient care. It further underscores the administration of a functional rating scale on admission in order to aggressively manage activity limitations.
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Affiliation(s)
- C Joseph
- Department of Physiotherapy, University of the Western Cape, Cape Town, South Africa
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128
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Guo Y, Zhao G, Liu Q, Mei Z, Ivanov K, Wang L. Balance and knee extensibility evaluation of hemiplegic gait using an inertial body sensor network. Biomed Eng Online 2013; 12:83. [PMID: 23988116 PMCID: PMC3766026 DOI: 10.1186/1475-925x-12-83] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 08/24/2013] [Indexed: 11/29/2022] Open
Abstract
Background Most hemiplegic patients have difficulties in their balance and posture control while walking because of the asymmetrical posture and the abnormal body balance. The assessment of rehabilitation of hemiplegic gait is usually made by doctors using clinical scale, but it is difficult and could not be used frequently. It is therefore needed to quantitatively analyze the characteristics of hemiplegic gait. Thus the assessment would be simple, and real-time evaluation of rehabilitation could be carried out. Methods Twenty subjects (ten hemiplegic patients, ten normal subjects) were recruited. The subjects walked straight for five meters at their self-selected comfortable speed towards a target line on the floor. Xsens MTx motion trackers were used for acquiring gestures of body segments to estimate knee joint angles and identify gait cycles. A practical method for data acquisition that does not need to obtain accurate distances between a knee joint and its corresponding sensors is presented. Results The results showed that there were significant differences between the two groups in the three nominated angle amplitudes. The mean values of balance level of each parameter in hemiplegic gait and normal gait were: 0.21 versus 0.01, 0.18 versus 0.03, and 0.92 versus 0.03, respectively. The mean values of added angles of each parameter in hemiplegic gait and normal gait were: 74.64 versus 91.31, -76.48 versus −132.4, and 6.77 versus 35.74. Conclusions It was concluded that the wearable bio-motion acquisition platform provided a practical approach that was effective in discriminating gait symptoms between hemiplegic and asymptomatic subjects. The extensibility of hemiplegic patients’ lower limbs was significantly lower than that of normal subjects, and the hemiplegic gait had worse balance level compared with normal gait. The effect of rehabilitation training of hemiplegic gait could be quantitatively analyzed.
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Affiliation(s)
- Yanwei Guo
- Shenzhen Institutes of Advanced Technology, The Shenzhen Key Laboratory for Low-cost Healthcare, Shenzhen University Town, 1068 Xueyuan Avenue, Shenzhen 518055, PR China.
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Responsiveness and predictive validity of the hierarchical balance short forms in people with stroke. Phys Ther 2013; 93:798-808. [PMID: 23392186 DOI: 10.2522/ptj.20120259] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND The lack of knowledge about the responsiveness and predictive validity of a set of Hierarchical Balance Short Forms (the HBSF) in people with stroke limits the utility of the HBSF in both clinical and research settings. OBJECTIVE The purpose of this study was to investigate the responsiveness and predictive validity of the HBSF in people receiving inpatient rehabilitation after stroke. DESIGN A prospective cohort study was conducted. METHODS Sixty-six participants completed both the 6-item HBSF and the 12-item Postural Assessment Scale for Stroke (PASS) after admission to the rehabilitation ward and before hospital discharge. The standardized effect size (ES) and the standardized response mean (SRM) were used to investigate the internal responsiveness of the HBSF and the PASS. Changes in the Barthel Index and the mobility subscale of the Stroke Rehabilitation Assessment of Movement were used as the external criteria for examining external responsiveness. Moreover, the admission scores on the HBSF and the PASS and the discharge scores on the Barthel Index and mobility subscale of the Stroke Rehabilitation Assessment of Movement were analyzed to investigate the predictive validity of the 2 balance measures. RESULTS The internal responsiveness of the HBSF was high (ES>0.9, SRM>1.6). The SRM of the HBSF was significantly larger than that of the PASS, whereas the ES of the HBSF was not significantly larger than that of the PASS. The external responsiveness and predictive validity of the HBSF were sufficient and similar to those of the PASS (external responsiveness: r≥.35; predictive validity: r≥.67). LIMITATIONS The convenience sampling of people receiving inpatient rehabilitation after stroke may limit the generalization of the results. CONCLUSIONS The HBSF has sufficient responsiveness and predictive validity in people receiving inpatient rehabilitation after stroke and is thus recommended for both clinicians and researchers.
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130
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Oh HM, Im S, Ko YA, Ko SB, Park GY. The sitting-unsupported balance score as an early predictor of functional prognosis in stroke patients: a pilot study. Ann Rehabil Med 2013; 37:241-6. [PMID: 23705120 PMCID: PMC3660486 DOI: 10.5535/arm.2013.37.2.241] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2012] [Accepted: 09/03/2012] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate the impact of initial "sitting-unsupported" Berg Balance Scale (SUB), the specific trunk control parameter, on patients' functional outcome, Korean version of Modified Barthel Index (K-MBI) at 6 months. METHODS The charts of 30 patients retrospectively reviewed reviewed. The initial Korean version of Berg Balance Scale (K-BBS) including SUB along with patients' Korean version of Mini-Mental State Examination (K-MMSE), Glasgow Coma Scale (GCS), and other functional parameters that affect functional outcome were recorded. Cases were divided into low (group I) and high (group II) initial SUB score groups. Correlation and regression analysis were performed to assess the relationship between the initial SUB on the K-MBI at 6 months. RESULTS The mean±standard deviation score of initial SUB/K-MBI at 6 months of groups I and II were 0.056±0.236/26.89±32.48, 3.58±0.515/80.25±18.78, respectively, and showed statistical significant differences to each other (p<0.05). K-MBI at 6 months was highly correlated with initial GCS, SUB, K-BBS, K-MMSE, and initial K-MBI (p<0.05). In multiple linear regression analysis, initial SUB and GCS scores remained significantly associated with K-MBI at 6 months. A logistic regression model revealed that initial SUB (p=0.004, odds ratio=16), initial K-MBI, GCS, and K-MMSE were all significant predictors of K-MBI scores at 6 months. CONCLUSION Initial SUB scores could be helpful in predicting patient's potential functional recovery at 6 months. Further studies with concurrent controls and a larger sample group are required to fully establish this tool.
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Affiliation(s)
- Hyun-Mi Oh
- Department of Rehabilitation Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Bucheon, Korea
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Lucioni C, Mazzi S, Micieli G, Sacchetti ML, Toni D. Valutazione economica del trattamento con alteplase di pazienti con ictus ischemico in fase acuta, con riferimento all’Italia. ACTA ACUST UNITED AC 2013. [DOI: 10.1007/bf03320667] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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132
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van Laerhoven H, de Haan TR, Offringa M, Post B, van der Lee JH. Prognostic tests in term neonates with hypoxic-ischemic encephalopathy: a systematic review. Pediatrics 2013; 131:88-98. [PMID: 23248219 DOI: 10.1542/peds.2012-1297] [Citation(s) in RCA: 141] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Hypoxic-ischemic encephalopathy (HIE) after perinatal asphyxia in term neonates causes long-term neurologic sequelae or death. A reliable evidence-based prognosis is essential. The study goal was to investigate the prognostic value of currently used clinical tests in neonatal patients with perinatal asphyxia and HIE. METHODS Searches were made on MEDLINE, Embase, Central, and CINAHL for studies occurring between January 1980 and November 2011. Studies were included if they (1) evaluated outcome in term infants with perinatal asphyxia and HIE, (2) evaluated prognostic tests, and (3) reported outcome at a minimal follow-up age of 18 months. Study selection, assessment of methodologic quality, and data extraction were performed by 3 independent reviewers. Pooled sensitivities and specificities of investigated tests were calculated when possible. RESULTS Of the 259 relevant studies, 29 were included describing 13 prognostic tests conducted 1631 times in 1306 term neonates. A considerable heterogeneity was noted in test performance, cut-off values, and outcome measures. The most promising tests were amplitude-integrated electroencephalography (sensitivity 0.93, [95% confidence interval 0.78-0.98]; specificity 0.90 [0.60-0.98]), EEG (sensitivity 0.92 [0.66-0.99]; specificity 0.83 [0.64-0.93]), and visual evoked potentials (sensitivity 0.90 [0.74-0.97]; specificity 0.92 [0.68-0.98]). In imaging, diffusion weighted MRI performed best on specificity (0.89 [0.62-0.98]) and T1/T2-weighted MRI performed best on sensitivity (0.98 [0.80-1.00]). Magnetic resonance spectroscopy demonstrated a sensitivity of 0.75 (0.26-0.96) with poor specificity (0.58 [0.23-0.87]). CONCLUSIONS This evidence suggests an important role for amplitude-integrated electroencephalography, EEG, visual evoked potentials, and diffusion weighted and conventional MRI. Given the heterogeneity in the tests' performance and outcomes studied, well-designed large prospective studies are needed.
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Affiliation(s)
- Henriette van Laerhoven
- Department of aNeonatology, Emma Children’s Hospital, Academic Medical Center Amsterdam, Netherlands
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Ali M, English C, Bernhardt J, Sunnerhagen KS, Brady M. More Outcomes than Trials: A Call for Consistent Data Collection across Stroke Rehabilitation Trials. Int J Stroke 2012; 8:18-24. [DOI: 10.1111/j.1747-4949.2012.00973.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Stroke survivors experience complex combinations of impairments, activity limitations, and participation restrictions. The essential components of stroke rehabilitation remain elusive. Determining efficacy in randomized controlled trials (RCTs) is challenging; there is no commonly agreed primary outcome measure for rehabilitation trials. Clinical guidelines depend on proof of efficacy in RCTs and meta-analyses. However, diverse trial aims, differing methods, inconsistent data collection, and use of multiple assessment tools hinder comparability across trials. Consistent data collection in acute stroke trials has facilitated meta-analyses to inform trial design and clinical practice. With few exceptions, inconsistent data collection has hindered similar progress in stroke rehabilitation research. There is an urgent need for the routine collection of a core dataset of common variables in rehabilitation trials. The European Stroke Organisation Outcomes Working Group, the National Institutes of Neurological Disorders and Stroke Common Data Elements project, and the Collaborative Stroke Audit and Research project have called for consistency in data collection in stroke trials. Standardizing data collection can decrease study start up times, facilitate data sharing, and inform clinical guidelines. Although achieving consensus on which outcome measures to use in stroke rehabilitation trials is a considerable task, perhaps a feasible starting point is to achieve consistency in the collection of data on demography, stroke severity, and stroke onset to inclusion times. Longer term goals could include the development of a consensus process to establish the core dataset. This should be endorsed by researchers, funders, and journal editors in order to facilitate sustainable change.
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Affiliation(s)
- M. Ali
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - C. English
- Stroke Division, Florey Neuroscience Institutes, Austin Health, Melbourne, Vic., Australia
- International Centre for Allied Health Evidence, University of South Australia, Adelaide, SA, Australia
| | - J. Bernhardt
- Stroke Division, Florey Neuroscience Institutes, Austin Health, Melbourne, Vic., Australia
| | - K. S. Sunnerhagen
- Section for Clinical Neuroscience and Rehabilitation, University of Gothenburg, Gothenburg, Sweden
| | - M. Brady
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
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Tormene P, Bartolo M, De Nunzio AM, Fecchio F, Quaglini S, Tassorelli C, Sandrini G. Estimation of human trunk movements by wearable strain sensors and improvement of sensor's placement on intelligent biomedical clothes. Biomed Eng Online 2012; 11:95. [PMID: 23237732 PMCID: PMC3528414 DOI: 10.1186/1475-925x-11-95] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 11/12/2012] [Indexed: 11/25/2022] Open
Abstract
Background The aim of this study was to evaluate the concept of a wearable device and, specifically: 1) to design and implement analysis procedures to extract clinically relevant information from data recorded using the wearable system; 2) to evaluate the design and placement of the strain sensors. Methods Different kinds of trunk movements performed by a healthy subject were acquired as a comprehensive data set of 639 multivariate time series and off-line analyzed. The space of multivariate signals recorded by the strain sensors was reduced by means of Principal Components Analysis, and compared with the univariate angles contemporaneously measured by an inertial sensor. Results Very high correlation between the two kinds of signals showed the usefulness of the garment for the quantification of the movements’ range of motion that caused at least one strain sensor to lengthen or shorten accordingly. The repeatability of signals was also studied. The layout of a next garment prototype was designed, with additional strain sensors placed across the front and hips, able to monitor a wider set of trunk motor tasks. Conclusions The proposed technologies and methods would offer a low-cost and unobtrusive approach to trunk motor rehabilitation.
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Affiliation(s)
- Paolo Tormene
- Department of Computer Engineering and Systems Science, University of Pavia, Pavia, Italy
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135
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Couple and Family Therapy with Five Physical Rehabilitation Populations: A Scoping Review. THE AUSTRALIAN JOURNAL OF REHABILITATION COUNSELLING 2012. [DOI: 10.1017/jrc.2012.13] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This article provides a scoping review with a focus on the substantive and methodological issues of the research pertaining to couple and family therapy (CFT) with five physical medical rehabilitation populations. We searched for literature concerned with five populations: spinal cord injury, stroke, multiple sclerosis, traumatic brain injury and amputations. A detailed review of CINAHL, PubMed, and PsycINFO databases identified 14 publications that researched couple/family therapy interventions with these populations. We synthesised the data by outlining and charting the substantive and methodological issues with this research. Findings suggest that individuals who have sustained an injury or are diagnosed with an illness requiring extensive rehabilitation experience increased relationship distress and decreased family functioning. While the literature clearly points to the impact on spouses and families, CFT was primarily used to engage families in efforts to assist health care workers improve physical functioning.
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136
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Einbezug von Familienangehörigen chronisch Kranker in die Arzt-Patient-Kommunikation. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2012; 55:1125-31. [DOI: 10.1007/s00103-012-1532-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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137
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Jones L, Morris R. Experiences of adult stroke survivors and their parent carers: a qualitative study. Clin Rehabil 2012; 27:272-80. [PMID: 22850756 DOI: 10.1177/0269215512455532] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To explore the experiences of adult stroke survivors and their parent carers. DESIGN Qualitative methodology: interpretative phenomenological analysis. SETTING Six residential areas across England and south Wales. PARTICIPANTS Six adult stroke survivors (aged 27-46), six mothers (aged 59-76) and five fathers (aged 55-76). METHOD Semi-structured interviews to explore the relationship and interactions between parent and survivor prior to and after a stroke, with opportunities to explore both positive and negative changes. All interviews were transcribed and analysed by a six step interpretative phenomenological analysis process. Survivors, mothers and fathers were analysed as three separate groups and the results were synthesised. RESULTS Identical and interconnected themes emerged from the three groups, permitting synthesis into a single organising framework with four superordinate themes capturing the key issues for all three groups. The four superordinate themes were: 'emotional turmoil'; 'significance of parents'; 'negotiating independence versus dependence' and 'changed relationships'. CONCLUSIONS Parents reported adjusting to caring with relative ease. Survivors did not adjust to being cared for with such ease and felt positioned in a child role. Balancing independence and dependence was a challenge for survivors and parents and is considered within a systemic theory framework. Implications for service developments and guidelines are considered.
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Affiliation(s)
- Lisa Jones
- Rookwood Hospital, Fairwater Road, Llandaff, Cardiff, UK
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138
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Demain S, Metcalf CD, Merrett GV, Zheng D, Cunningham S. A narrative review on haptic devices: relating the physiology and psychophysical properties of the hand to devices for rehabilitation in central nervous system disorders. Disabil Rehabil Assist Technol 2012; 8:181-9. [PMID: 22794937 DOI: 10.3109/17483107.2012.697532] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE This article provides rehabilitation professionals and engineers with a theoretical and pragmatic rationale for the inclusion of haptic feedback in the rehabilitation of central nervous system disorders affecting the hand. METHOD A narrative review of haptic devices used in sensorimotor hand rehabilitation was undertaken. Presented papers were selected to outline and clarify the underlying somatosensory mechanisms underpinning these technologies and provide exemplars of the evidence to date. RESULTS Haptic devices provide kinaesthetic and/or tactile stimulation. Kinaesthetic haptics are beginning to be incorporated in central nervous system rehabilitation; however, there has been limited development of tactile haptics. Clinical research in haptic rehabilitation of the hand is embryonic but initial findings indicate potential clinical benefit. CONCLUSIONS Haptic rehabilitation offers the potential to advance sensorimotor hand rehabilitation but both scientific and pragmatic developments are needed to ensure that its potential is realized.
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Affiliation(s)
- Sara Demain
- Faculty of Health Sciences, University of Southampton, Highfield Campus, Southampton, UK.
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139
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Changes in oro-facial function and hand-grip strength during a 2-year observation period after stroke. Clin Oral Investig 2012; 17:867-76. [DOI: 10.1007/s00784-012-0769-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Accepted: 06/07/2012] [Indexed: 10/28/2022]
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140
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Sommerfeld DK, Johansson H, Jönsson AL, Murray V, Wessari T, Holmqvist LW, von Arbin M. Rivermead mobility index can be used to predict length of stay for elderly persons, 5 days after stroke onset. J Geriatr Phys Ther 2012; 34:64-71. [PMID: 21937895 DOI: 10.1519/jpt.0b013e3181ffb70d] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Recovery after acute stroke is expected to continue for a long time but is most rapid during the first few days after onset. Because the cost of hospital care is rising constantly, there is increasing pressure from various administrative bodies to reduce the duration of hospital stay. To select the optimal level of care for elderly patients with stroke-related disability, it is important to be aware of adequate discharge destinations and to have reliable predictors for the length of institutional stay (LOS) (ie in hospital or nursing home). PURPOSE The purpose of the study was to find feasible prognostic indicators for the LOS, to be used 5 days after acute stroke, in persons 65 years and older. METHODS One hundred fifteen consecutive persons, 65 years and older, were assessed 5 days poststroke for the following: consciousness (Glasgow Coma Scale), language (aphasia/no aphasia), perceptual (Cancellation Tasks and Block Test), emotional (lability/no lability), energy and drive (Montgomery-Åsberg Depression Scale), mental (Mini-Mental State Examination), somatosensory (normal/impaired), and urinary (continent/incontinent) functions; mobility (Rivermead mobility index [RMI]); activities of daily living (Barthel Index); and side of hemiplegia or hemiparesis. In addition, previous living arrangements (alone vs with another person), stroke characteristics, and demographic information were documented. Length of institutional stay was recorded 5 days to 3 months poststroke onset. RESULTS Multiple regression survival analyses showed that the factors with the greatest positive impact on short LOS, 5 days poststroke, were the following: no previous stroke; Glasgow Coma Scale ≥ 13 (mild brain injury); and RMI ≥ 4 points, corresponding to the ability to rise from a chair in less than 15 seconds and stand there for 15 seconds with or without an aid. CONCLUSIONS In addition to medical appraisal, the RMI ≥ 4 points, a quickly performed test, can be used to predict short LOS for persons with stroke as early as 5 days after stroke onset.
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Affiliation(s)
- Disa Kathryn Sommerfeld
- Department of Neurobiology Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Sweden.
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Effect of duration, participation rate, and supervision during community rehabilitation on functional outcomes in the first poststroke year in Singapore. Arch Phys Med Rehabil 2012; 93:279-86. [PMID: 22289238 DOI: 10.1016/j.apmr.2011.08.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2010] [Revised: 08/09/2011] [Accepted: 08/15/2011] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To examine the effect of duration, participation rate, and supervision during community rehabilitation on functional outcome during the first poststroke year. DESIGN Prospective longitudinal study with interviews at admission, discharge, 1 month, 6 months, and 1 year after discharge. SETTING Two subacute inpatient rehabilitation units and the community after discharge in Singapore. PARTICIPANTS Subacute nonaphasic stroke patients (N=215). INTERVENTION Participation rate in supervised therapy (at an outpatient rehabilitation center) and unsupervised therapy (at home) as defined as proportion of time performing therapy as prescribed by the subacute hospital's multidisciplinary rehabilitation team at discharge. MAIN OUTCOME MEASURE Performance of activities of daily living as measured by Barthel Index (BI) score at 1 year and improvement in BI scores between adjacent timepoints. RESULTS At 1 month after discharge, 33.3% were performing supervised therapy more than 25% of the recommended time, and 66.3% of subjects were performing unsupervised therapy more than 75% of the recommended time. On a mixed-model analysis, the independent predictors of lower BI scores were older age, hypertension, greater cognitive impairment, greater depressive symptoms, and greater neurologic impairment. Adjusting for these independent factors, performance of supervised therapy at 1 (β=8.8; 95% confidence interval [CI], 0.5-17.0; P=.039) and 6 (β=20.1; 95% CI, 11.0-29.2; P<.001) months postdischarge, but not unsupervised therapy, predicted better BI score at 1 year. Those who performed supervised therapy more than 25% of the recommended time achieved their maximal functional recovery faster than those who performed supervised therapy 25% or less of the recommended time (1 mo vs 6 mo). CONCLUSIONS Supervised stroke rehabilitation in the community at 1 and 6 months was associated with better functional status at 1 year than unsupervised therapy, and a higher participation rate in supervised therapy was associated with greater and faster functional recovery.
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142
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Prediction of discharge walking ability from initial assessment in a stroke inpatient rehabilitation facility population. Arch Phys Med Rehabil 2012; 93:1441-7. [PMID: 22446516 DOI: 10.1016/j.apmr.2012.02.029] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Revised: 02/28/2012] [Accepted: 02/29/2012] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To (1) determine which clinical assessments at admission to an inpatient rehabilitation facility (IRF) most simply predict discharge walking ability, and (2) identify a clinical decision rule to differentiate household versus community ambulators at discharge from an IRF. DESIGN Retrospective cohort study. SETTING IRF. PARTICIPANTS Two samples of participants (n=110 and 159) admitted with stroke. INTERVENTIONS A multiple regression determined which variables obtained at admission (age, time from stroke to assessment, Motricity Index, somatosensation, Modified Ashworth Scale, FIM, Berg Balance Scale, 10-m walk speed) could most simply predict discharge walking ability (10-m walk speed). A logistic regression determined the likelihood of a participant achieving household (<0.4m/s) versus community (≥0.4-0.8m/s; >0.8m/s) ambulation at the time of discharge. Validity of the results was evaluated on a second sample of participants. MAIN OUTCOME MEASURE Discharge 10-m walk speed. RESULTS Admission Berg Balance Scale and FIM walk item scores explained most of the variance in discharge walk speed. The odds ratio of achieving only household ambulation at discharge was 20 (95% confidence interval [CI], 6-63) for sample 1 and 32 (95% CI, 10-96) for sample 2 when the combination of having a Berg Balance Scale score of ≤20 and a FIM walk item score of 1 or 2 was present. CONCLUSIONS A Berg Balance Scale score of ≤20 and a FIM walk item score of 1 or 2 at admission indicates that a person with stroke is highly likely to only achieve household ambulation speeds at discharge from an IRF.
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Malhotra C, Chan A, Malhotra R, Østbye T. Prevalence, correlates and perceived causes of limitations in activities of daily living among older Singaporeans. Aging Clin Exp Res 2012; 24:56-61. [PMID: 22643305 DOI: 10.1007/bf03325354] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
AIMS To describe the prevalence of limitations in Activities of Daily Living (ADL) among older Singaporeans, examine the association of ADL limitations with various self-reported health conditions, assess perceived causes of ADL limitations, and compare prevalence of health conditions among those who perceive only 'old age' vs those who perceive at least one specific health condition as the cause of their limitations. METHODS Data from a national survey of Singaporeans 60 years and over was used. The association between ADL limitations and health conditions was assessed through logistic regression. Those with ADL limitations were asked about the perceived cause/s of their limitation/ s. Any significant difference in the prevalence of health conditions between those attributing their ADL limitations only to old age and those attributing to at least one specific health condition was ascertained. RESULTS Overall prevalence of ADL limitations was 9.7%. Joint/nerve pain, stroke, pelvic/femoral fractures, heart diseases, diabetes, osteoporosis, chronic respiratory illness and renal/urinary tract illness were significantly associated with ADL limitations, and the most common perceived cause was 'old age' (33%). The prevalence of most health conditions was similar in older adults attributing their limitations to only 'old age' and to at least one specific health condition. CONCLUSION Clinical suspicion is called for if individuals with ADL limitations attribute them solely to 'old age'.
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144
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Teale EA, Forster A, Munyombwe T, Young JB. A systematic review of case-mix adjustment models for stroke. Clin Rehabil 2012; 26:771-86. [DOI: 10.1177/0269215511433068] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Objective: To identify any externally validated prognostic model for predicting outcome in unselected populations following acute stroke comprising variables feasible for collection in routine care. Data sources: Searches were run in MEDLINE, EMBASE, CINAHL, PsycInfo, AMED and ISI Web of Science with no limits on publication date or language. Review methods: Any study describing the development or external validation of a discernible prognostic model to predict any valid outcome following acute stroke was included. Papers were retained if they met pre-specified inclusion criteria identified from previous reviews and pertinent discussion papers. Data extraction focused on methodological quality of model development, generalizability and feasibility of variable collection. Model performance was examined through consideration of external validation studies. Results: Seventeen externally validated models were identified from 43 papers fulfilling inclusion criteria. Quality of studies describing model development was variable and model performance in external validation studies was generally poor. Models were generally constructed through secondary use of randomized trial or stroke database data. Prognostic variables broadly encompassed markers of stroke severity, pre-stroke function and comorbidities. One model that fulfilled the review criteria and had extensive external validation in a range of post-stroke populations was identified (the Six Simple Variables model). Conclusion: The Six Simple Variables model performed well in six external validation studies, although prediction of outcome in patients with milder strokes was less reliable. Other models identified in this review have been developed using robust methodology but comprise more complex clinical variables which may limit their utility in routine stroke care.
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Affiliation(s)
- Elizabeth A Teale
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, UK
| | - Anne Forster
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, UK
| | | | - John B Young
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, UK
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145
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Joynt KE, O’Connor CM. Prognostic Implications of Depression in Ischemic Syndromes. Coron Artery Dis 2012. [DOI: 10.1007/978-1-84628-712-1_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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146
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Hakkennes SJ, Brock K, Hill KD. Selection for Inpatient Rehabilitation After Acute Stroke: A Systematic Review of the Literature. Arch Phys Med Rehabil 2011; 92:2057-70. [DOI: 10.1016/j.apmr.2011.07.189] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Revised: 07/03/2011] [Accepted: 07/12/2011] [Indexed: 01/04/2023]
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147
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Preston E, Ada L, Dean CM, Stanton R, Waddington G. What is the Probability of Patients who are Nonambulatory after Stroke Regaining Independent Walking? a Systematic Review. Int J Stroke 2011; 6:531-40. [DOI: 10.1111/j.1747-4949.2011.00668.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Patients after stroke who are nonambulatory require resources, and independent walking becomes a major determinant of the ability to participate in activities of daily living. Our objective was to determine the probability of walking for patients who are nonambulatory in the first month after stroke. We performed a systematic review and meta-analysis of consecutive, prospective studies of nonambulatory patients within the first month after stroke in rehabilitation and acute units. The outcomes were the probability of achieving independent walking at three-, six- and 12 months after stroke. Twenty-six studies were included in the review. Seventeen studies comprising 2856 participants were entered into meta-analyses. For initially nonambulatory stroke patients managed in a rehabilitation unit, the probability of independent walking was 0·60 (95% CI 0·47–0·74, 1373 participants) at three-months, 0·65 (95% CI 0·53–0·77, 444 participants) at six-months and 0·91 (95% CI 0·81–1·00, 24 participants) at 12 months. For patients managed in an acute unit, the probability of independent walking was 0·39 (95% CI 0·27–0·52, 634 participants) at three-months, 0·69 (95% CI 0·46–0·92, 405 participants) at six-months and 0·74 (95% CI 0·59–0·88, 34 participants) at 12 months. 60% of patients managed in a rehabilitation unit who are nonambulatory in the first month after stroke will regain independent walking compared with 39% of those managed in an acute unit. This information can be used clinically to make decisions about allocation of rehabilitation resources, education of patients and carers, and for discharge planning.
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Affiliation(s)
- Elisabeth Preston
- Discipline of Physiotherapy, The University of Sydney, Sydney, NSW, Australia
| | - Louise Ada
- Discipline of Physiotherapy, The University of Sydney, Sydney, NSW, Australia
| | - Catherine M. Dean
- Discipline of Physiotherapy, The University of Sydney, Sydney, NSW, Australia
| | - Rosalyn Stanton
- Discipline of Physiotherapy, The University of Sydney, Sydney, NSW, Australia
| | - Gordon Waddington
- Discipline of Physiotherapy, The University of Canberra, Canberra, ACT, Australia
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Wagle J, Farner L, Flekkøy K, Bruun Wyller T, Sandvik L, Fure B, Stensrød B, Engedal K. Early post-stroke cognition in stroke rehabilitation patients predicts functional outcome at 13 months. Dement Geriatr Cogn Disord 2011; 31:379-87. [PMID: 21720162 DOI: 10.1159/000328970] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/22/2011] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To identify prognostic factors associated with functional outcome at 13 months in a sample of stroke rehabilitation patients. Specifically, we hypothesized that cognitive functioning early after stroke would predict long-term functional outcome independently of other factors. METHODS 163 stroke rehabilitation patients underwent a structured neuropsychological examination 2-3 weeks after hospital admittance, and their functional status was subsequently evaluated 13 months later with the modified Rankin Scale (mRS) as outcome measure. Three predictive models were built using linear regression analyses: a biological model (sociodemographics, apolipoprotein E genotype, prestroke vascular factors, lesion characteristics and neurological stroke-related impairment); a functional model (pre- and early post-stroke cognitive functioning, personal and instrumental activities of daily living, ADL, and depressive symptoms), and a combined model (including significant variables, with p value <0.05, from the biological and functional models). RESULTS A combined model of 4 variables best predicted long-term functional outcome with explained variance of 49%: neurological impairment (National Institute of Health Stroke Scale; β = 0.402, p < 0.001), age (β = 0.233, p = 0.001), post-stroke cognitive functioning (Repeatable Battery of Neuropsychological Status, RBANS; β = -0.248, p = 0.001) and prestroke personal ADL (Barthel Index; β = -0.217, p = 0.002). Further linear regression analyses of which RBANS indexes and subtests best predicted long-term functional outcome showed that Coding (β = -0.484, p < 0.001) and Figure Copy (β = -0.233, p = 0.002) raw scores at baseline explained 42% of the variance in mRS scores at follow-up. CONCLUSIONS Early post-stroke cognitive functioning as measured by the RBANS is a significant and independent predictor of long-term functional post-stroke outcome.
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Affiliation(s)
- Jørgen Wagle
- Centre for Ageing and Health, Norwegian Centre for Dementia Research, Oslo University Hospital, Ullevaal, Norway
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149
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Associations between psychological factors and quality of life ratings in persons with spinal cord injury: a systematic review. Spinal Cord 2011; 50:174-87. [DOI: 10.1038/sc.2011.120] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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150
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Cognitive Functioning in the Acute Phase Poststroke: A Predictor of Discharge Destination? J Stroke Cerebrovasc Dis 2011; 20:549-55. [DOI: 10.1016/j.jstrokecerebrovasdis.2010.03.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Revised: 03/08/2010] [Accepted: 03/30/2010] [Indexed: 11/22/2022] Open
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