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Batool S, Zafar H, Gilani SA, Ahmad A, Hanif A. Intrarater and interrater reliability of the dynamic gait index in post stroke patients with eye movement disorders. J Bodyw Mov Ther 2023; 35:38-42. [PMID: 37330797 DOI: 10.1016/j.jbmt.2023.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 09/05/2022] [Accepted: 04/11/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND The Dynamic Gait Index (DGI) is a useful tool that has been evaluated for its reliability in patients with vestibular disorders, elderly people and, in chronic stroke population. Present study was aimed to evaluate the intrarater and interrater reliability of the DGI to measure dynamic balance and gait performance in stroke patients with eye movement disorders. METHODS A sample of 30 stroke patients suffering from eye movement disorders were recruited. Two Physical therapists assessed the intrarater and interrater reliability of the DGI in two testing sessions three days apart. In the later session, two raters assessed the patients' performance simultaneously on the DGI. The reliability was calculated using the intra-class correlation coefficient (ICC2, 1). Standard error of measurement (SEM) and minimal detectable change (MDC95) at 95% confidence interval were also calculated. A significance level was set at p-value <0.05. RESULTS The (ICC2, 1) for intrarater and interrater reliability of total DGI scores was 0.86 and 0.91 respectively. While (ICC2, 1) for intrarater and interrater reliability of individual items ranged from 0.73 to 0.91 to 0.73-0.93, respectively. The (SEM) and (MDC95) for intrarater reliability of total DGI scores were 0.76 and 2.10, respectively. Corresponding values for interrater reliability were 0.62 and 1.71, respectively. CONCLUSIONS The DGI is a reliable tool for evaluating the dynamic balance and gait performance in stroke patients with eye movement disorders. This tool showed good to excellent intrarater and interrater reliability of total DGI scores and moderate to good intrarater and interrater reliability of individual items of the DGI.
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Affiliation(s)
- Sana Batool
- University Institute of Physical Therapy, Faculty of Allied Health Sciences, The University of Lahore, Lahore, Pakistan.
| | - Hamayun Zafar
- University Institute of Physical Therapy, Faculty of Allied Health Sciences, The University of Lahore, Lahore, Pakistan; Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia; Rehabilitation Research Chair, King Saud University, Riyadh, Saudi Arabia; Department of Odontology, Clinical Oral Physiology, Faculty of Medicine, Umea University, Umea, Sweden.
| | - Syed Amir Gilani
- Faculty of Allied Health Sciences, Director; Directorate of International Linkages, University of Lahore, Lahore, Pakistan.
| | - Ashfaq Ahmad
- Faculty of Allied Health Sciences, Head of Department University Institute of Physical Therapy, The University of Lahore, Lahore, Pakistan.
| | - Asif Hanif
- University Institute of Physical Therapy, Faculty of Allied Health Sciences, The University of Lahore, Lahore, Pakistan.
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Gervasoni E, Beghi E, Corrini C, Parelli R, Bianchi E, Mestanza Mattos FG, Jonsdottir J, Montesano A, Cattaneo D. Validity of 2 Fall Prevention Strategy Scales for People With Stroke, Parkinson's Disease, and Multiple Sclerosis. J Geriatr Phys Ther 2023; 46:36-45. [PMID: 34392263 DOI: 10.1519/jpt.0000000000000325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND PURPOSE Falls are a common and persistent concern among people with neurological disorders (PwND), as they frequently result in mobility deficits and may lead to loss of functional independence. This study investigated the ceiling and floor effects, internal consistency, and convergent validity of 2 patient-reported fall prevention strategy scales in PwND. METHODS This is a prospective cohort study. Two-hundred and ninety-nine PwND (111 people with multiple sclerosis, 94 people with Parkinson's disease, and 94 people with stroke) were seen for rehabilitation and assessed. The number of retrospective and prospective falls, use of walking assistive devices, scores on the Fall Prevention Strategy Survey (FPSS), Falls Behavioural Scale (FaB), and balance and mobility scales (Berg Balance Scale, Dynamic Gait Index, Timed Up and Go, 10-m walking test, and Activities-specific Balance Confidence) were analyzed. RESULTS Total score distributions showed negligible ceiling and floor effects for both the FPSS (ceiling: 0.3%, floor: 0.3%) and the FaB (ceiling: 0%, floor: 0%). The Cronbach α (CI) was of 0.87 (0.85-0.89) for the FPSS and 0.86 (0.84-0.88) for the FaB. In terms of convergent validity, the FPSS and FaB were moderately correlated (Spearman correlation coefficient = 0.65). Moreover, the correlations between the FPSS and FaB and balance and mobility scales ranged from 0.25 to 0.49 ( P < .01). Both scales are slightly better able to distinguish between retrospective fallers/nonfallers [area under the curve, AUC (95% CI): FPSS: 0.61 (0.5-0.7); FaB: 0.60 (0.5-0.6)] compared with prospective fallers/nonfallers [AUC (95% CI): FPSS: 0.56 (0.4-0.6); FaB: 0.57 (0.4-0.6)]. Both scales accurately identified individuals who typically required the use of a walking assistive device for daily ambulation [AUC (95% CI): FPSS: 0.74 (0.7-0.8); FaB: 0.69 (0.6-0.7)]. Multiple regression analysis showed that previous falls, use of an assistive device, and balance confidence significantly predicted participants' prevention strategies (FPSS: R2 = 0.31, F(8,159) = 10.5, P < .01; FaB: R2 = 0.31, F(8,164) = 10.89, P < .01). CONCLUSION The FPSS and the FaB appear to be valid tools to assess fall prevention strategies in people with neurological disorders. Both scales provide unique and added value in providing information on individual behavior for fall prevention.
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Affiliation(s)
| | - Ettore Beghi
- IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | | | | | - Elisa Bianchi
- IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | | | | | | | - Davide Cattaneo
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
- Department of Physiopathology and Transplants, University of Milan, Milan, Italy
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Aguilar Acevedo F, Pacheco Bautista D, Acevedo Gómez M, Toledo Toledo G, Nieva García OS. User-Centered Virtual Environment for Post-Stroke Motor Rehabilitation. J Med Device 2022. [DOI: 10.1115/1.4053605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Abstract
The use of Virtual Reality in the rehabilitation of lost or diminished functions after a stroke has been shown to be an innovative means in motor recovery. However, there are still several design challenges to increment the efficiency of these systems. This paper presents the development and evaluation of a non-immersive 3D virtual environment for post-stroke rehabilitation of elbow flexion-extension movements, which considers the therapist as a direct user and the patient as a secondary user. The development of virtual environment was supported by the criteria of a team of specialists in physical and occupational therapy, following the philosophy of User-Centered Design through three iterations, and incorporating tasks based on the Activities of Daily Living of the Barthel scale. Tests were carried out with healthy users and a patient with a diagnosis of stroke, using the SUS test and a flow status questionnaire respectively. Average satisfaction of user group without diagnosis was 79.6 out of 100 points. On the other hand, according to mean values observed with the patient, dimensions of control sense (6.33) and positive emotional experience (6.66) reflect an "optimal" experience, which indicates an enjoyment of virtual tasks de-spite the effort made to fulfill them.
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Affiliation(s)
- Francisco Aguilar Acevedo
- Department of Computer Engineering, Universidad del Istmo, Cd. Universitaria S/N, Barrio Santa Cruz, 4a. Sección, Sto. Domingo Tehuantepec, Oaxaca 70760, México
| | - Daniel Pacheco Bautista
- Department of Computer Engineering, Universidad del Istmo, Cd. Universitaria S/N, Barrio Santa Cruz, 4a. Sección, Sto. Domingo Tehuantepec, Oaxaca 70760, México
| | - Marleydy Acevedo Gómez
- Department of Computer Engineering, Universidad del Istmo, Cd. Universitaria S/N, Barrio Santa Cruz, 4a. Sección, Sto. Domingo Tehuantepec, Oaxaca 70760, México
| | - Guadalupe Toledo Toledo
- Department of Computer Engineering, Universidad del Istmo, Cd. Universitaria S/N, Barrio Santa Cruz, 4a. Sección, Sto. Domingo Tehuantepec, Oaxaca 70760, México
| | - Omar Santiago Nieva García
- Department of Computer Engineering, Universidad del Istmo, Barrio Santa Cruz, Sto. Domingo Tehuantepec, Oaxaca 70760, México
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Morris L, Cramp M, Turton A. User perspectives on the future of mobility assistive devices: Understanding users’ assistive device experiences and needs. J Rehabil Assist Technol Eng 2022; 9:20556683221114790. [PMID: 35983071 PMCID: PMC9380214 DOI: 10.1177/20556683221114790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 07/05/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction Current assistive devices are inadequate in addressing the needs of some people living with impaired mobility. This study explored the experiences of living with impaired mobility in relation to how wearable assistive adaptive and rehabilitative technologies may improve their quality of life. Methods A cross-case study approach was adopted; the case being defined as the experience of impaired mobility. Semi-structured interviews were utilised. The sample ( n = 8) was purposefully selected to have impaired mobility due to stroke, age-related frailty, or lower limb amputation. From the interview transcripts, in-depth case illustrations were written to provide personal stories and thematic analysis was carried out to provide a cross-case analysis. Results There were two overarching themes: lifestyle changes; and wishes and desires for assistive devices. There were shared experiences across participant groups, such as falls and fear of falling. All participants identified a wish for increased speed of walking. However, the reasons for their difficulties differed depending on personal factors and their condition. Participants wanted devices to be adjustable to their perceived ability on a day-to-day basis. Conclusions Although common concerns and impacts of living with impaired mobility were apparent, individuals have unique requirements that should inform the design of assistive technology devices.
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Affiliation(s)
- Leah Morris
- School of Health and Wellbeing, UWE Bristol - Glenside Campus, Bristol, UK
| | - Mary Cramp
- School of Health and Wellbeing, UWE Bristol - Glenside Campus, Bristol, UK
| | - Ailie Turton
- School of Health and Wellbeing, UWE Bristol - Glenside Campus, Bristol, UK
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Huang WY, Tuan SH, Li MH, Hsu PT. Efficacy of a novel walking assist device with auxiliary laser illuminator in stroke Patients~ a randomized control trial. J Formos Med Assoc 2021; 121:592-603. [PMID: 34247893 DOI: 10.1016/j.jfma.2021.06.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 05/18/2021] [Accepted: 06/21/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND/PURPOSE Task-oriented functional walking is important in stroke patients. We aimed to investigate effects of a quad-cane with auxiliary laser illuminator (laser-cane) among stroke patients. METHODS This was a randomized-prospective study. Patients in the experimental group (EG) received 15-min of walking training with laser-cane and 15-min of traditional physical therapy. Patients in the control group (CG) received the same rehabilitation without laser-cane. The rehabilitation lasted for 4 weeks, twice per week. Primary outcome were gait parameters. Secondary outcomes were Berg Balance Scale (BBS), Timed Up and Go Test (TUG), and Barthel index (BI). Outcomes were measured at baseline, at the end of the rehabilitation (visit-1), and 4 weeks later (visit-2). RESULTS Both the groups (both n = 15) showed improvement of cadence, relative stance and swing phase duration of non-paretic side, BBS, and TUG at both visits. In the intragroup comparison, the EG additionally improved at stride length, relative stance and swing phase duration of paretic side, and gait speed at both visits; temporal swing symmetry, and toe-off angle of non-paretic side at the visit-2. Intergroup comparing for changing of outcomes with the CG, stride length and gait speed increased, relative stance phase duration of the non-paretic site decreased, and the temporal swing symmetry improved at the visit-1; relative stance phase duration of the paretic side decreased and the temporal stance symmetry improved at the visit-2 in the EG. CONCLUSION Rehabilitation with laser-cane improved the balance, activity of daily living, gait symmetry and gait parameters of stroke patients.
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Affiliation(s)
- Wan-Yun Huang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Institute of Allied Health Sciences, National Cheng Kung University, Tainan, Taiwan
| | - Sheng-Hui Tuan
- Department of Rehabilitation Medicine, Cishan Hospital, Ministry of Health and Welfare, Kaohsiung, Taiwan; Department of Physical Therapy, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan
| | - Min-Hui Li
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
| | - Pei-Te Hsu
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
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Ahmad Ainuddin H, Romli MH, Hamid TA, SF Salim M, Mackenzie L. An Exploratory Qualitative Study With Older Malaysian Stroke Survivors, Caregivers, and Healthcare Practitioners About Falls and Rehabilitation for Falls After Stroke. Front Public Health 2021; 9:611814. [PMID: 33987161 PMCID: PMC8110702 DOI: 10.3389/fpubh.2021.611814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 03/23/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Studies on rehabilitation for falls after a stroke remain limited despite its impact being profound. This scenario justifies a deeper understanding of why falls in stroke rehabilitation received less attention. Current investigations on the perception of falls and stroke also proved inadequate. Therefore, this study aims to explore the perceptions and experiences of older Malaysian stroke survivors, spousal caregivers, and healthcare practitioners on falls in stroke rehabilitation. Method: A qualitative study of three focus groups with 18 individuals from one community-based stroke rehabilitation center was conducted. The discussions were audio-recorded, video-recorded, transcribed, summarized, and analyzed using thematic analysis. Results: Three themes emerged from the analysis: (i) perceived factors and consequences of falls after stroke, (ii) physical-based interventions predominate in rehabilitation for falls after stroke, and (iii) the role of home hazards in fall prevention is taken for granted. Although, awareness of falls is high, they are regarded as a peripheral issue in stroke. Rehabilitation interventions such as improved functionality are believed to be adequate and can indirectly prevent falls. Other interventions for fall prevention such as home hazards management are relatively less known. Conclusion: There is a need for more attention regarding home environment risk assessment and intervention among healthcare professionals, and more education for clients and caregivers is required. Although, other stroke interventions may also benefit stroke survivors, falls prevention should be a central component in stroke rehabilitation. As this study focused on a specific population, the findings should be validated with larger populations, and in diverse settings.
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Affiliation(s)
- Husna Ahmad Ainuddin
- Department of Rehabilitation Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
- Centre of Occupational Therapy Studies, Faculty of Health Sciences, Universiti Teknologi MARA, Selangor, Malaysia
| | - Muhammad Hibatullah Romli
- Department of Rehabilitation Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Selangor, Malaysia
| | - Tengku Aizan Hamid
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Selangor, Malaysia
| | - Mazatulfazura SF Salim
- Department of Rehabilitation Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Lynette Mackenzie
- Discipline of Occupational Therapy, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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Miller A, Wright T, Wright H, Thompson E, Pohlig RT, Reisman DS. Readiness to Change is Related to Real-World Walking and Depressive Symptoms in Chronic Stroke. J Neurol Phys Ther 2021; 45:28-35. [PMID: 33315834 PMCID: PMC7739270 DOI: 10.1097/npt.0000000000000345] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE The transtheoretical model is a health behavior model used to understand an individual's readiness to change their behavior. This study aims to apply the transtheoretical model in understanding a person with stroke's readiness to change their activity level, as it relates to physical capacity, physical health, depressive symptoms, self-efficacy, and daily stepping activity. METHODS This was a cross-sectional analysis of baseline data from a clinical trial. Participants' readiness to change their activity levels was measured via self-report and daily stepping activity was measured using a step activity monitor. Robust regression (M-estimation with robust standard errors) was used to test the relationship between readiness to change and measures of physical capacity (6-minute walk test, self-selected walking speed), physical health (body mass index, age-adjusted Charlson Comorbidity Index), depressive symptoms (Patient Health Questionnaire-9), self-efficacy (Activities-Specific Balance Confidence Scale), and daily stepping (steps per day). RESULTS A total of 274 individuals were included in the analysis. Adjusted for age, readiness to change was positively related to daily stepping (β = 0.29, P < 0.001) and negatively related to depressive symptoms (β = -0.13, P = 0.01). Readiness to change was not significantly associated with measures of physical capacity, physical health, or self-efficacy. DISCUSSION These results suggest that individuals with stroke in the later stages of change may demonstrate greater daily stepping activity and lower depressive symptoms compared with those in earlier stages. CONCLUSIONS Understanding the relationship between readiness to change, daily stepping, and depressive symptoms will help clinicians implement appropriate stage-specific intervention strategies and facilitate greater improvement in activity levels.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A333).
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Affiliation(s)
- Allison Miller
- Department of Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware 19713
| | - Tamara Wright
- Department of Physical Therapy, University of Delaware, Newark, Delaware 19713
| | - Henry Wright
- Department of Physical Therapy, University of Delaware, Newark, Delaware 19713
| | - Elizabeth Thompson
- Department of Physical Therapy, University of Delaware, Newark, Delaware 19713
| | - Ryan T. Pohlig
- Department of Biostatistics Core Facility, University of Delaware, Newark, Delaware 19716
| | - Darcy S. Reisman
- Department of Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware 19713
- Department of Physical Therapy, University of Delaware, Newark, Delaware 19713
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Ebaditabar M, Babaei N, Davarzani S, Imani H, Soares MJ, Shab-Bidar S. Lack of a relationship between vitamin D status and resting metabolic rate in Iranian adults. Am J Hum Biol 2020; 33:e23543. [PMID: 33274831 DOI: 10.1002/ajhb.23543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/19/2020] [Accepted: 11/19/2020] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES Studies suggest a positive relationship between 25-hydroxy vitamin D (25(OH)D)) and resting metabolic rate (RMR). We aimed to determine whether this relationship was also true of populations with very low vitamin D status. METHODS Fat mass (FM) and fat free mass (FFM) were determined from multifrequency bioimpedance analysis (InBody 720, Korea). RMR was based on indirect calorimetry (Cortex Metalyser 3B, Germany). Fasting blood measurements of 25(OH)D concentration, glucose and triglycerides were measured. Data were analyzed separately on men and women by tertile of vitamin D status and multiple linear regression analysis. RESULTS Two hundred and sixty-three subjects (115 males; 148 females) with a mean age of 37 years and mean %body fat of 30.5% were studied. In women but not men, age, body weight, waist circumference, FM, and FFM increased significantly across tertiles of 25(OH)D. However, there was no difference in unadjusted or adjusted RMR across tertiles of 25OHD in both women and men. Stepwise forward regression analysis showed that age and FFM in men, age and FM in women but not by 25(OH)D, were determinants of RMR. In addition, RMR adjusted for age, sex, FM, FFM and triglyceride-glucose index did not relate to 25(OH)D when linear (r = 0, P = .98), quadratic (r = 0.008, P = .34), or cubic (r = 0.010, P = .43) relationships were tested. CONCLUSIONS Residual variation in RMR did not relate to vitamin D status in a group of Iranian adults with very low vitamin D status. Future studies could examine whether such a relationship holds true, after the normalization of vitamin D status.
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Affiliation(s)
- Mojdeh Ebaditabar
- Community Nutrition Department, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Nadia Babaei
- Community Nutrition Department, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Samira Davarzani
- Community Nutrition Department, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Hossein Imani
- Clinical Nutrition Department, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Mario J Soares
- Nutrition & Dietetics, School of Public Health, Curtin Health Innovation Research Institute-Metabolic Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Sakineh Shab-Bidar
- Community Nutrition Department, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
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Maguire CC, Sieben JM, Lutz N, van der Wijden G, Scheidhauer H, de Bie R. Replacing canes with an elasticated orthotic-garment in chronic stroke patients - The influence on gait and balance. A series of N-of-1 trials. J Bodyw Mov Ther 2020; 24:203-214. [PMID: 33218513 DOI: 10.1016/j.jbmt.2020.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 03/02/2020] [Accepted: 06/07/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To investigate the effect of replacing canes with an elasticated orthotic-garment on balance and gait-function in chronic stroke survivors. DESIGN Experimental, N-of-1 series with a replicated, ABC design with randomised phase duration in a home setting. PARTICIPANTS Four cane using chronic stroke survivors (P1-4). INTERVENTIONS Phase A (9-12 weeks) cane-walking "as usual" to establish baseline values; Phase B (9-16 weeks) intervention: orthotic-garment worn throughout the day with maximal cane-use reduction; Phase C (9-10 weeks) participant-determined follow-up: either no walking-aid, orthotic-garment or cane. OUTCOME MEASURES Primary: Functional-Gait-Assessment (FGA), Secondary: Trunk-sway during walking measured as Total-Angle-Area (TAA°2) in frontal and sagittal-planes, both measured weekly. RESULTS Visual and statistical analysis of results showed significant improvements in FGA from phase A to B in all participants. Improvement continued in phase C in P2, stabilized in P1 and P4 and deteriorated in P3. A Minimal-Clinical-Important-Difference of 6 points-change was achieved in P2 & P4. Trunk-sway reduced during walking, indicating increased stability, in two participants from phase A to B and in three participants from A to C but no TAA changes were statistically significant. In phase C participant-selected walking-aids were: P1 cane-usage reduced by 25%, P2 independent-walking with no assistive-device, S3 usual cane-usage, P4 orthotic-garment with reduced cane-usage 2-3 days-a-week, usual cane-usage 4-5 days. CONCLUSIONS Although walking ability is multifactorial these results indicate that the choice of walking-aids can have a specific and clinically relevant impact on gait following stroke. "Hands-free" assistive-devices may be more effective than canes in improving gait-function in some patients. CLINICALTRIALS. GOV ID NCT03642444.
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Affiliation(s)
- Clare C Maguire
- Department of Physiotherapy, Bildungszentrum Gesundheit Basel-Stadt, 4142, Muenchenstein, Switzerland; Caphri School for Public Health and Primary Care Research, Maastricht University, 6200, MD, Maastricht, the Netherlands; Department of Physiotherapy, REHAB, Clinic for Neurorehabilitation and Paraplegiology, Basel, Switzerland; Department of Health, Bern University of Applied Science, Schwarztorstrasse 48, 3007, Bern, Switzerland.
| | - Judith M Sieben
- Caphri School for Public Health and Primary Care Research, Maastricht University, 6200, MD, Maastricht, the Netherlands; Department of Anatomy and Embryology, Maastricht University, 6200, MD, Maastricht, the Netherlands
| | - Nathanael Lutz
- Department of Physiotherapy, Bildungszentrum Gesundheit Basel-Stadt, 4142, Muenchenstein, Switzerland
| | - Gisela van der Wijden
- Department of Physiotherapy, REHAB, Clinic for Neurorehabilitation and Paraplegiology, Basel, Switzerland
| | - Heike Scheidhauer
- Department of Physiotherapy, Bildungszentrum Gesundheit Basel-Stadt, 4142, Muenchenstein, Switzerland
| | - RobertA de Bie
- Caphri School for Public Health and Primary Care Research, Maastricht University, 6200, MD, Maastricht, the Netherlands; Department of Epidemiology, Maastricht University, 6200, MD, Maastricht, the Netherlands
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10
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Huang WY, Tuan SH, Li MH, Liu XY, Hsu PT. Immediate effects of a novel walking assist device with auxiliary illuminator on patients after acute strokes. Hong Kong Physiother J 2019; 39:115-124. [PMID: 31889762 PMCID: PMC6900335 DOI: 10.1142/s1013702519500100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 04/02/2019] [Accepted: 04/08/2019] [Indexed: 11/18/2022] Open
Abstract
Background: Many patients after acute stage of stroke are present with abnormal gait pattern due to weakness or hypertonicity of the affected limbs. Facilitation of normal gait is a primary goal of rehabilitation on these patients. Objective: We aimed to investigate whether walking assist device with auxiliary illuminator (quad-cane with laser) providing visual feedback during ambulation could improve parameters of gait cycle immediately among patients with subacute and chronic stroke. Methods: This was a cross-sectional study and 30 participants (male 23, female 7, group 1) with mean age 60.20±11.12 years were recruited. Among them, 22 used ankle-foot orthosis [(AFO), group 2] and 8 did not use AFO (group 3) at usual walking. All the participants walked along a strait corridor with even surface for 20 m without and with using a quad-cane with laser, respectively. A gait analyzer (Reha-Watch1 system) was used to measure the changes of the parameters of gait cycle, including stride length, cadence, gait speed, stance phase, swing phase, duration of single support and double support, the angle between toes and the ground at the time of toe-off (the toe-off angle) and the angle between calcaneus and the ground at the time of heel-strike (the heel-strike angle), before and with the use of a quad-cane with laser. Results: The increase in the heel-strike angle reached a significant difference in groups 1 2, and 3 (p=0.02,<0.01, and =0.05, respectively). However, the stride length, the gait speed, the cadence, percentage of the stance phase, swing phase, single-support phase, and double-support phase in a gait cycle, and the toe-off angle showed no significant change with the use of quad-cane with laser. Conclusion: Patients after acute stroke had an immediate and significant increase in the heel-stroke angle by using a quad-cane with laser during ambulation, which might help the patients to reduce knee hyperextension moment and lessen the pressure of heel at loading phase.
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Affiliation(s)
- Wan-Yun Huang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,National Cheng Kung University, Institute of Allied Health Sciences, Tainan, Taiwan
| | - Sheng-Hui Tuan
- Department of Rehabilitation Medicine, Cishan Hospital, Ministry of Health and Welfare, Kaohsiung, Taiwan
| | - Min-Hui Li
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Graduate Institute of Aerospace and Undersea Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Xin-Yu Liu
- Department of Kinesiology, Health, and Leisure Studies, National University of Kaohsiung, Kaohsiung, Taiwan
| | - Pei-Te Hsu
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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Chen JL, Wang RY, Lee CS, Chen YJ, Yang YR. Immediate effect of hip taping on balance and walking ability in cane-dependent ambulators with chronic stroke: a randomized controlled trial. Eur J Phys Rehabil Med 2018; 55:156-161. [PMID: 30160436 DOI: 10.23736/s1973-9087.18.05300-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Previous studies showed that cane-dependent post-stroke ambulators have poor balance and gait performance. Adhesive taping on the hip may be used as a therapeutic modality for improving range of motion and muscle activity in individuals with stroke. AIM The objective of this study was to investigate the immediate effect of the hip extensor and abductor taping on balance and walking ability in cane-dependent ambulators with chronic stroke. DESIGN This study was a single-blinded, randomized controlled trial. SETTING Outpatients from a hospital rehabilitation department. POPULATION Twenty-eight cane-dependent ambulators with chronic stroke were recruited. METHODS Participants were randomized into either the control group with sham tape (N.=14) or experimental group with non-elastic tape (N.=14). The Berg Balance Scale, gait speed, 6-minute walk test, and Fall Efficacy Scale were measured with and without taping. RESULTS After taping, participants in the experimental group showed significant improvement in the Berg Balance Scale, gait speed, and 6-minute walk test. Furthermore, experimental group showed significant improvement in the Berg Balance Scale and 6-minute walk test compared with sham taping control group. CONCLUSIONS Non-elastic tape could immediately improve balance, gait speed, and endurance in cane-dependent ambulators with chronic stroke. CLINICAL REHABILITATION IMPACT Non-elastic tape may be a useful adjunct to current rehabilitation strategies for individuals with chronic stroke.
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Affiliation(s)
- Jyue-Liang Chen
- Department of Rehabilitation Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Ray-Yau Wang
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan
| | - Chun-Shou Lee
- Section of Physical Therapy, Department of Rehabilitation Medicine, Renai Branch of Taipei City Hospital, Taipei, Taiwan
| | - Yun-Ju Chen
- Section of Physical Therapy, Department of Rehabilitation Medicine, Zhongxing Branch of Taipei City Hospital, Taipei, Taiwan
| | - Yea-Ru Yang
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan - .,Preventive Medicine Research Center, National Yang-Ming University, Taipei, Taiwan
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Disturbances of spatial reference frame and postural asymmetry after a chronic stroke. Exp Brain Res 2018; 236:2377-2385. [DOI: 10.1007/s00221-018-5308-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 06/05/2018] [Indexed: 01/24/2023]
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Persson CU, Kjellberg S, Lernfelt B, Westerlind E, Cruce M, Hansson PO. Risk of falling in a stroke unit after acute stroke: The Fall Study of Gothenburg (FallsGOT). Clin Rehabil 2017; 32:398-409. [DOI: 10.1177/0269215517728325] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Carina U Persson
- Rehabilitation Medicine, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Sigvar Kjellberg
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Bodil Lernfelt
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ellen Westerlind
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Malin Cruce
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Per-Olof Hansson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Orellano-Colón EM, Rivero-Méndez M, Lizama M, Jutai JW. Assistive technology unmet needs of independent living older Hispanics with functional limitations. Disabil Rehabil Assist Technol 2017; 13:194-200. [PMID: 28326905 DOI: 10.1080/17483107.2017.1300693] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To identify: (1) the most frequently used assistive technology (AT) by a sample of community-living older Hispanics; (2) their AT needs; (3) the AT that would not be used by the simple; and (4) the factors associated with the willingness to use AT. MATERIALS AND METHODS We used a cross-sectional descriptive study design with a purposive sample of 60 individuals 70 years and older living in Puerto Rico. Data collection tools included a socio-demographic questionnaire and the Assistive Technology Card Assessment. We used descriptive statistics to identify the sample AT use and needs, χ2 to determine the frequency distribution of the socio-demographic variables and the Spearman's rank correlation coefficient (rho) to describe the strength of the association between these variables and the willingness to use AT devices. RESULTS The sample had unmet needs for AT devices for cooking, home tasks and home safety. A higher number of health conditions as well as having low educational levels were associated with willingness to use AT devices. CONCLUSIONS Policy implications are discussed supporting the role of rehabilitation professionals, state government and community-based programmes, including the Area Agencies on Aging, in providing culturally relevant AT education and accessibility to assistive devices. Implications for rehabilitations Hispanic older adults with functional limitations living independently in Puerto Rico have unmet needs for AT devices to compensate for physical limitations and increase safety performance, predominantly in instrumental activities of daily living. New policies need to be developed to advocate for increased healthcare coverage of low tech AT devices that could be highly beneficial to older people with functional limitations. Community-based programs administered by the state government, the Area Agencies of Aging, or operated through Medicare need to be developed to provide education, training, loans, purchasing, and delivery of low AT devices that can compensate for older people functional limitations.
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Affiliation(s)
- Elsa M Orellano-Colón
- a Occupational Therapy Program, School of Health Professions , Medical Sciences Campus, University of Puerto Rico , San Juan , Puerto Rico.,b Puerto Rico Assistive Technology Program, Research and Technology Vice-Presidency , San Juan , Puerto Rico
| | - Marta Rivero-Méndez
- c School of Nursing, Medical Sciences Campus, University of Puerto Rico , San Juan , Puerto Rico
| | - Mauricio Lizama
- b Puerto Rico Assistive Technology Program, Research and Technology Vice-Presidency , San Juan , Puerto Rico
| | - Jeffrey W Jutai
- d Faculty of Health Sciences , University of Ottawa , Ottawa , ON , Canada
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Boland P, Levack W, Perry M, Graham F. Equipment provision after stroke: A scoping review of the use of personal care and mobility aids in rehabilitation. Br J Occup Ther 2016. [DOI: 10.1177/0308022616664910] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction The aim of this scoping review was to examine and synthesise literature on adaptive equipment use for personal care and mobility after stroke. Method We searched databases including Medline, EMBASE, AMED, CINAHL and Scopus to February 2016. Two authors independently screened 789 titles, identifying 28 studies for inclusion in the review. Results Findings were grouped into four themes: (1) stroke-specific impairments and consequences for equipment use and training; (2) meaning of equipment for people with stroke; (3) cost of equipment after stroke; and (4) conflicts between equipment provision and models of stroke rehabilitation. Conclusion The wide range of impairments after stroke increases complexity of how people use equipment. Nonetheless, training needs and the relationship between social context, identity and equipment use are increasingly better understood,. The findings highlight a tension between practice that seeks to re-train function by ‘normal’ movement without equipment and restoration of function by using compensation strategies involving use of equipment. However, there is no evidence that compensation strategies impede recovery of physical abilities. High-quality evidence about costs of equipment after stroke, which could inform policy decisions, is urgently needed.
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Affiliation(s)
- Pauline Boland
- Lecturer, MSc Occupational Therapy Programme, Clinical Therapies, University of Limerick, Republic of Ireland
- Senior Lecturer, Rehabilitation, Teaching and Research Unit, University of Otago, New Zealand
| | - William Levack
- Senior Lecturer, Rehabilitation, Teaching and Research Unit, University of Otago, New Zealand
| | - Meredith Perry
- Lecturer, Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Wellington, New Zealand
| | - Fiona Graham
- Senior Lecturer, Rehabilitation, Teaching and Research Unit, University of Otago, New Zealand
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Falls and Fear of Falling After Stroke: A Case-Control Study. PM R 2016; 8:1173-1180. [PMID: 27268565 DOI: 10.1016/j.pmrj.2016.05.012] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 05/13/2016] [Accepted: 05/19/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Falls are common after stroke, with potentially serious consequences. Few investigations have included age-matched control participants to directly compare fall characteristics between older adults with and without stroke. Further, fear of falling, a significant psychological consequence of falls, has only been examined to a limited degree as a risk factor for future falls in a stroke population. OBJECTIVE To compare the fall history between older adults with and without a previous stroke and to identify the determinants of falls and fear of falling in older stroke survivors. DESIGN Case-control observational study. SETTING Primary teaching hospital. PARTICIPANTS Seventy-five patients with stroke (mean age ± standard deviation, 66 ± 7 years) and 50 age-matched control participants with no previous stroke were tested. METHODS Fall history, fear of falling, and physical, cognitive, and psychological function were assessed. A χ2 test was performed to compare characteristics between groups, and logistic regression was performed to determine the risk factors for falls and fear of falling. MAIN OUTCOME MEASURES Fall events in the past 12 months, Fall Efficacy Scale-International, Berg Balance Scale, Functional Ambulation Category, Fatigue Severity Scale, Montreal Cognitive Assessment, and Patient Healthy Questionnaire-9 were measured for all participants. Fugl-Meyer Motor Assessment was used to quantify severity of stroke motor impairments. RESULTS Twenty-three patients and 13 control participants reported at least one fall in the past 12 months (P = .58). Nine participants with stroke had recurrent falls (≥2 falls) compared with none of the control participants (P < .01). Participants with stroke reported greater concern for falling than did nonstroke control participants (P < .01). Female gender was associated with falls in the nonstroke group, whereas falls in the stroke group were not significantly associated with any measured outcomes. Fear of falling in the stroke group was associated with functional ambulation level and balance. Functional ambulation level alone explained 22% of variance in fear of falling in the stroke group. CONCLUSIONS Compared with persons without a stroke, patients with stroke were significantly more likely to experience recurrent falls and fear of falling. Falls in patients with stroke were not explained by any of the outcome measures used, whereas fear of falling was predicted by functional ambulation level. This study has identified potentially modifiable risk factors with which to devise future prevention strategies for falls in patients with stroke. LEVEL OF EVIDENCE III.
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Park Y, Chang M. Effects of the Otago exercise program on fall efficacy, activities of daily living and quality of life in elderly stroke patients. J Phys Ther Sci 2016; 28:190-3. [PMID: 26957755 PMCID: PMC4756001 DOI: 10.1589/jpts.28.190] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 10/14/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to determine the effects of the Otago exercise
program on fall efficacy, activities of daily living, and quality of life in elderly
stroke patients. [Subjects and Methods] Eight subjects performed the Otago exercise
program three times per week, for 8 weeks. The outcome measures were the Fall Efficacy
Scale score for fall efficacy, modified Barthel index for activities of daily living, and
EQ-5D for quality of life. [Results] In our comparison of the results before and after the
intervention, we found that the Otago exercise program improved fall efficacy
significantly as well as the score for activities of daily living and quality of life,
though not significantly. [Conclusion] We consider that the Otago exercise program is an
effective method for improving fall efficacy in elderly stroke patients.
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Affiliation(s)
- Youngju Park
- Department of Rehabilitation Science, Graduate School of Inje University, Republic of Korea
| | - Moonyoung Chang
- Department of Occupational Therapy, College of Biomedical Science and Engineering, Inje University, Republic of Korea
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Abstract
OBJECTIVE Resting metabolic rate (RMR) is the component of energy expenditure that explains the largest proportion of total daily energy requirements. Since RMR is determined largely by fat-free mass and a low RMR predicts weight gain in healthy adults, identifying the role of muscle atrophy following stroke on RMR may help identify ways to mitigate the development of obesity post-stroke. METHODS Thirty-nine stroke survivors with chronic hemiparesis (mean ± SEM: age: 61 ± 1 years, latency from stroke: 107 ± 40 months, BMI: 31 ± 3 kg/m2) underwent DXA scans for measurement of body composition, including total, paretic, and non-paretic leg lean mass and fasted, 30-min indirect calorimetry for measurement of RMR. RESULT Predicted RMR was calculated by the Mifflin-St Jeor equation, which considers weight, height, and age for both men and women. RMR was 14% lower than predicted (1438 ± 45 vs. 1669 ± 38 kcals/24 hrs; P<0.01). Total (r=0.73, P<0.01), paretic (r=0.72, P<0.01) and non-paretic (r=0.67, P<0.01) leg lean mass predicted RMR. CONCLUSION These data indicate that muscle atrophy post stroke may lead to a reduced RMR. This substantiates the need to attenuate the loss of lean mass after a stroke to prevent declines in RMR and possible weight gain common post-stroke.
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Affiliation(s)
- Monica C Serra
- Department of Veterans Affairs, Baltimore VAMC, Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, USA
| | - Charlene E Hafer-Macko
- Department of Veterans Affairs, Baltimore VAMC, Department of Neurology, University of Maryland School of Medicine, Baltimore, USA
| | - Alice S Ryan
- Department of Veterans Affairs, Baltimore VAMC, Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, USA
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