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Aphiphaksakul P, Siriphorn A. Home-based exercise using balance disc and smartphone inclinometer application improves balance and activity of daily living in individuals with stroke: A randomized controlled trial. PLoS One 2022; 17:e0277870. [PMID: 36409753 PMCID: PMC9678269 DOI: 10.1371/journal.pone.0277870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 11/02/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Sitting ability is critical for daily activities in individuals who have experienced a stroke. A combination of seated balance training on an unstable surface and real-time visual feedback via a simple mobile inclinometer application may improve trunk control in stroke survivors. OBJECTIVE This randomized controlled trial aimed to determine the effects of home-based exercise utilizing a balance disc with input from a smartphone inclinometer application on sitting balance and activities of daily living in stroke survivors. METHODS This trial enrolled 32 stroke survivors aged 30 to 75 years. Participants were randomly assigned to one of two groups: intervention or control. Both groups underwent four weeks of traditional therapy. Additionally, the intervention group received four weeks of multidirectional lean training utilizing a balance disc and a smartphone application with an inclinometer. The Postural Assessment Scale for Stroke (PASS), the Function in Sitting Test (FIST), and the Barthel Index (BI) were used to assess the results. To compare between group effects, an ANCOVA analysis was performed using a baseline as a covariate. RESULTS The PASS changing posture and BI were considerably greater in the intervention group compared to the control group. Other metrics revealed no statistically significant differences between the groups. CONCLUSION Home-based training with balance discs and input from a smartphone inclinometer application may improve postural control and daily activity in stroke patients. TRIAL REGISTRATION Clinical trials registry number: TCTR20210617004.
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Affiliation(s)
- Pantawit Aphiphaksakul
- Department of Physical Therapy, Human Movement Performance Enhancement Research Unit, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Akkradate Siriphorn
- Department of Physical Therapy, Human Movement Performance Enhancement Research Unit, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand
- * E-mail:
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Liang HW, Tai TL, Li YH, Chen YC. Application of a virtual reality tracker-based system to measure seated postural stability in stroke patients. J Neuroeng Rehabil 2022; 19:71. [PMID: 35831835 PMCID: PMC9281022 DOI: 10.1186/s12984-022-01052-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 07/06/2022] [Indexed: 11/23/2022] Open
Abstract
Background Postural stability while sitting is an important indicator of balance and an early predictor for future functional improvement in neurorehabilitation, but the evaluation is usually dependent on clinical balance function measures. Meanwhile, instrumental posturography has been used widely to obtain quantitative data and characterize balance abilities and underlying control mechanisms, but not as often for sitting balance. Moreover, traditional kinetic methods using a force platform to test sitting stability often require modification and are costly. We proposed a tracker-based posturography with a commercial virtual reality system, the VIVE Pro system (HTC, Inc. Taiwan), to record the trunk displacement (TD) path with a lumbar tracker for evaluation of sitting stability. The goals were to test the reliability and validity of the TD parameters among stroke patients. Methods Twenty-one stroke individuals and 21 healthy adults had their postural sway measured with this system under four sitting conditions, i.e., sitting on a solid surface or a soft surface, with eyes open or closed. The test–retest reliability of the TD parameters was evaluated with intraclass correlation coefficients in 22 participants. We also tested the discriminative validity of these parameters to discriminate between stroke and healthy controls, and among four sitting conditions. Furthermore, the TD parameters were correlated with the three balance function tests: the Berg Balance Scale (BBS), the Postural Assessment Scale for Stroke Patients (PASS) and the Function in Sitting Test (FIST). Results The results indicated that the TD parameters obtained by tracker-based posturography had mostly moderate to good reliability across the four conditions, with a few exceptions in the solid surface and eyes open tasks. The TD parameters could discriminate the postural stability between sitting on solid and soft surfaces. The stroke group had more seated postural sway than the control group, especially while sitting on a soft surface. In addition, velocity measures in the sagittal and frontal planes had moderate to high correlations with the PASS and BBS scores. Conclusions This tracker-based system is a cost-effective option for the clinical assessment of body stability for stroke patients in a seated position and shows acceptable reliability and validity.
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Affiliation(s)
- Huey-Wen Liang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan, ROC.
| | - Tzu-Ling Tai
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Yue-Hua Li
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Ying-Chun Chen
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan, ROC
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Inoue M, Amimoto K, Shida K, Sekine D, Hasegawa D, Fukata K, Fujino Y, Makita S, Takahashi H. Effects of Dynamic Sitting Exercise with Delayed Visual Feedback in the Early Post-Stroke Phase: A Pilot Double-Blinded Randomized Controlled Trial. Brain Sci 2022; 12:brainsci12050670. [PMID: 35625055 PMCID: PMC9139189 DOI: 10.3390/brainsci12050670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/09/2022] [Accepted: 05/18/2022] [Indexed: 11/16/2022] Open
Abstract
Sitting ability in the early post-stroke phase affects functional balance ability and other prognoses. We investigated whether dynamic sitting exercise with delayed visual feedback in the mediolateral and anteroposterior directions affected postural control in the early post-stroke phase. In this pilot randomized controlled trial, 27 hemiparetic stroke patients were randomized to experimental (n = 13) and control (n = 14) groups. Dynamic sitting exercise (30 times/day, 5 days/week) in the mediolateral and anteroposterior directions, with 500-ms-delayed (experimental group) or real-time (control group) visual feedback on a computer, was added to usual physical therapy. We evaluated the postural assessment scale for stroke (PASS), static and dynamic sitting balance tasks, the five-times sit-to-stand test, trunk impairment scale, functional ambulation category, and functional independence measure−motor items. In intention-to-treat analysis, the experimental group demonstrated a significant intervention effect on the PASS score (p < 0.05). The mean percentage of body weight on the moving side in the lateral sitting task and the number of successes in the five-times sit-to-stand test were significantly higher in the experimental group than those in the control group (p < 0.05). Thus, the proposed exercise improves postural control, dynamic sitting balance, and sit-to-stand ability in early post-stroke patients.
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Affiliation(s)
- Masahide Inoue
- Department of Rehabilitation, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan; (M.I.); (K.S.); (D.S.); (D.H.); (K.F.); (S.M.); (H.T.)
- Department of Physical Therapy, Tokyo Metropolitan University, 7-2-10 Higashiogu, Arakawa-ku, Tokyo 116-8551, Japan
| | - Kazu Amimoto
- Department of Physical Therapy, Tokyo Metropolitan University, 7-2-10 Higashiogu, Arakawa-ku, Tokyo 116-8551, Japan
- Correspondence: ; Tel.: +81-3-3819-1211
| | - Kohei Shida
- Department of Rehabilitation, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan; (M.I.); (K.S.); (D.S.); (D.H.); (K.F.); (S.M.); (H.T.)
- Department of Physical Therapy, Tokyo Metropolitan University, 7-2-10 Higashiogu, Arakawa-ku, Tokyo 116-8551, Japan
| | - Daisuke Sekine
- Department of Rehabilitation, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan; (M.I.); (K.S.); (D.S.); (D.H.); (K.F.); (S.M.); (H.T.)
| | - Daichi Hasegawa
- Department of Rehabilitation, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan; (M.I.); (K.S.); (D.S.); (D.H.); (K.F.); (S.M.); (H.T.)
| | - Kazuhiro Fukata
- Department of Rehabilitation, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan; (M.I.); (K.S.); (D.S.); (D.H.); (K.F.); (S.M.); (H.T.)
| | - Yuji Fujino
- Department of Physical Therapy, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan;
| | - Shigeru Makita
- Department of Rehabilitation, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan; (M.I.); (K.S.); (D.S.); (D.H.); (K.F.); (S.M.); (H.T.)
| | - Hidetoshi Takahashi
- Department of Rehabilitation, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan; (M.I.); (K.S.); (D.S.); (D.H.); (K.F.); (S.M.); (H.T.)
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Zhao J, Chau JPC, Zang Y, Choi KC, He R, Zhao Y, Xiang X, Li Q, Thompson DR. Psychometric properties of the Chinese version of the Trunk Impairment Scale in people with a stroke. Health Qual Life Outcomes 2021; 19:85. [PMID: 33691738 PMCID: PMC7948338 DOI: 10.1186/s12955-021-01730-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 03/04/2021] [Indexed: 11/22/2022] Open
Abstract
Background The Trunk Impairment Scale (TIS) has been translated into Chinese, but the psychometric properties of the Chinese version of the TIS (TIS-C) have not yet been established. We aimed to examine the reliability and validity of the TIS-C for assessing sitting balance among Chinese people with a stroke. Methods A descriptive, cross-sectional design was used. We recruited a convenience sample of 170 subacute stroke patients aged 18 years or over from the neurology departments of four traditional Chinese medicine hospitals in China. Patients completed the TIS-C, the Berg Balance Scale and the Modified Barthel Index. The psychometric properties of the TIS-C were examined to establish test–retest reliability, internal consistency, equivalence, and content, criterion, and construct validity. Results Intraclass correlation coefficients for inter-rater and intra-rater reliability ranged from 0.75 to 0.89 and from 0.90 to 0.97, respectively. The TIS-C Cronbach α was 0.86. The strong correlation between the total score of the TIS-C and the Berg Balance Scale (rs = 0.81, p < 0.001) or Modified Barthel Index (rs = 0.84, p < 0.001) suggested good concurrent and convergent validity, respectively. Known-group validity was supported by the significant difference (p < 0.001) in TIS-C scores between participants with mild and moderate stroke. Conclusions The TIS-C is a valid and reliable tool for assessing static and dynamic sitting balance as well as coordination of trunk movement among stroke survivors with mild and moderate stroke.
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Affiliation(s)
- Jie Zhao
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Room 825,8/F, Esther Lee Building, Shatin, New Territories, Hong Kong.,School of Nursing, Yunnan University of Traditional Chinese Medicine, Kunming, Yunnan, China
| | - Janita Pak Chun Chau
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Room 825,8/F, Esther Lee Building, Shatin, New Territories, Hong Kong.
| | - Yuli Zang
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Room 825,8/F, Esther Lee Building, Shatin, New Territories, Hong Kong
| | - Kai Chow Choi
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Room 825,8/F, Esther Lee Building, Shatin, New Territories, Hong Kong
| | - Rong He
- Yunnan Provincial Hospital of Traditional Chinese Medicine, Kunming, Yunnan, China
| | - Yali Zhao
- Kunming Municipal Hospital of Traditional Chinese Medicine, Kunming, Yunnan, China
| | - Xiaoqi Xiang
- Yunnan Provincial Hospital of Traditional Chinese Medicine, Kunming, Yunnan, China
| | - Qin Li
- Kunming Municipal Hospital of Traditional Chinese Medicine, Kunming, Yunnan, China
| | - David R Thompson
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
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Hasegawa S, Matsui T, Kishi M, Kouchi H, Watanabe M, Yanagisawa T, Usuda S. Sensitivity to change and responsiveness of the Balance Evaluation Systems Test (BESTest), Mini-BESTest, and Brief-BESTest in patients with subacute cerebral infarction. J Phys Ther Sci 2021; 33:69-74. [PMID: 33519078 PMCID: PMC7829567 DOI: 10.1589/jpts.33.69] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 10/25/2020] [Indexed: 11/24/2022] Open
Abstract
[Purpose] To compare the sensitivity to change and responsiveness of the Balance
Evaluation Systems Test, Mini-Balance Evaluation Systems Test, and Brief-Balance
Evaluation Systems Test in patients with subacute cerebral infarction. [Participants and
Methods] Thirty patients with subacute cerebral infarction participated in this study. The
Balance Evaluation Systems Test, Mini-Balance Evaluation Systems Test, Brief-Balance
Evaluation Systems Test, Berg Balance Scale, and ambulatory ability were assessed on
admission and discharge. Sensitivity to change was calculated using the effect size,
standardized response mean, and relative efficiency. Responsiveness was analyzed by
comparing the ability of the difference between the scores of the balance assessments at
admission and discharge in classifying the participants’ ambulatory independence.
[Results] All assessments showed significant improvement from admission to discharge. The
effect size of the three versions of the Balance Evaluation Systems Test ranged from 0.41
to 0.69. The standardized response mean ranged from 0.75 to 1.28. The cutoff score was
16.7% for the Balance Evaluation Systems Test, 5.5 points for the Mini-Balance Evaluation
Systems Test, 1.5 points for the Brief-Balance Evaluation Systems Test, and 3.5 points for
the Berg Balance Scale. [Conclusion] The sensitivity to change of the three versions of
the Balance Evaluation Systems Test was high or moderate. However, the Mini-Balance
Evaluation Systems Test had the highest responsiveness, as determined with the extent of
ambulatory independence.
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Affiliation(s)
- Satoshi Hasegawa
- Public Nanokaichi Hospital: 643 Nanokaichi, Tomioka-shi, Gunma 370-2343, Japan.,Gunma University Graduate School of Health Sciences, Japan
| | - Tomoko Matsui
- Public Nanokaichi Hospital: 643 Nanokaichi, Tomioka-shi, Gunma 370-2343, Japan
| | | | - Hirokuni Kouchi
- Public Nanokaichi Hospital: 643 Nanokaichi, Tomioka-shi, Gunma 370-2343, Japan
| | - Masaki Watanabe
- Public Nanokaichi Hospital: 643 Nanokaichi, Tomioka-shi, Gunma 370-2343, Japan
| | - Tadashi Yanagisawa
- Public Nanokaichi Hospital: 643 Nanokaichi, Tomioka-shi, Gunma 370-2343, Japan
| | - Shigeru Usuda
- Gunma University Graduate School of Health Sciences, Japan
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Erol BN, Aydoğan Arslan S, Yaşar E, Keskin ED, Demirci CS. Reliability and validity of the Turkish version of Function in Sitting Test (FIST-T) in stroke. Top Stroke Rehabil 2021; 29:49-57. [PMID: 33438519 DOI: 10.1080/10749357.2020.1871284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: Trunk control in sitting position after stroke is one of the most important determinants of independence in daily living activities and there is no gold standard assessment used to measure sitting postural control.Objectives: The aim of this study is to determine the reliability and validity of the Turkish version of Function in Sitting Test (FIST-T).Methods: After translation was conducted, Function in Sitting Test, Berg Balance Scale, Functional Independent Measure and Trunk Impairment Scale were applied to 72 stroke patients (mean age was 59.26 ± 16.38 years; post-stroke time was 95.93 ± 59.64 days). For reliability and validity analysis the spearman correlation analysis was used.Results: A positive, high correlation was found between the first application and repetition of Function in Sitting Test-T (ICC = 0.97, r = 0.95, p = .001). The internal consistency was high (Cronbach Alpha = 0.97), interrater correlation was high (Cronbach Alpha = 0.98) and a positive, high correlation was found with the scores obtained from the Berg Balance Scale (r = 0.82, p = .001), Functional Independent Measure (r = 0.84, p = .001) and Trunk Impairment Scale (r = 0.80, p = .001).Conclusions: It is concluded that the Turkish version of Function in Sitting Test is a valid and reliable scale for use in stroke patients, in clinical and scientific researches.
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Affiliation(s)
- Büşra Nur Erol
- Vocational School of Haymana, Physiotherapy Programme, Ankara University, Ankara, Turkey
| | - Saniye Aydoğan Arslan
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Kırıkkale University, Kırıkkale, Turkey
| | - Evren Yaşar
- Gülhane Faculty of Medicine, Department of Physical Medicine and Rehabilitation, University of Health Sciences, Ankara, Turkey
| | - Esra Dilek Keskin
- Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Kırıkkale University, Kırıkkale, Turkey
| | - Cevher Savcun Demirci
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Balıkesir University, Balıkesir, Turkey
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Komagata J, Sugiura A, Takamura H, Ohta A, Kitama T. Effect of optokinetic stimulation on weight-bearing shift in standing and sitting positions in stroke patients. Eur J Phys Rehabil Med 2020; 57:13-23. [PMID: 32972091 DOI: 10.23736/s1973-9087.20.06184-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Patients with hemiplegia after stroke tend to bear weight on the non-paretic side and exhibit large postural sway during static standing and walking, which may increase their risk of falls. Improvement of the sitting posture balance in the early phase of rehabilitation by adjusting weight-bearing would minimize the risk of falls as early rehabilitation reportedly improves walking ability and prevents falls in later phases of rehabilitation or at discharge. AIM This study aimed to evaluate the effect of optokinetic stimulation (OKS) on shift of the weight-bearing (displacement of the center of pressure [CoP]) in patients with hemiplegia who are incapable of independent standing. DESIGN Quasi-experimental, cross-sectional study. SETTING Rehabilitation hospital. POPULATION Patients with hemiplegia in the subacute phase after stroke (N.=37). METHODS Standing and sitting balance tests were performed during OKS projected onto a screen. For OKS, a pattern of random dots was presented, which continuously moved in horizontal or torsional directions during both static standing and sitting conditions. Postural sway was assessed during standing and sitting by measuring the sway path, sway area, sway velocity, and mean displacement of CoP. The magnitude of the lateral change in CoP as an indicator of the weight-bearing shift was evaluated by subtraction of the mean CoP of the right-left axis component in the stationary condition from the mean CoP sway during OKS. RESULTS OKS induced a unilateral change of the mean CoP position in patients during both, sitting and static standing, indicating that OKS can shift the weight-bearing in patients after stroke, irrespective of the posture condition. Moreover, the same OKS approach evoked an analogous shift in patients with more severe symptoms, with impairment in independent standing. CONCLUSIONS OKS could induce a significant shift in weight balance in patients with hemiplegia after stroke who are incapable of independent standing, suggesting that the OKS approach can be applied to a broader spectrum of patients, including those with more severe symptoms. CLINICAL REHABILITATION IMPACT OKS approach would improve exercise training in the early phase of rehabilitation of patients with hemiplegia after stroke.
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Affiliation(s)
- Junya Komagata
- Center for Life Science Research, University of Yamanashi, Chuo, Yamanashi, Japan.,Department of Physical Therapy, Health Science University, Minamitsuru-gun, Yamanashi, Japan
| | - Atsushi Sugiura
- Center for Life Science Research, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Hiroshi Takamura
- Department of Physical Therapy, Health Science University, Minamitsuru-gun, Yamanashi, Japan
| | - Akio Ohta
- Department of Rehabilitation, Isawa-Kyoritsu Hospital, Fuefuki, Yamanashi, Japan
| | - Toshihiro Kitama
- Center for Life Science Research, University of Yamanashi, Chuo, Yamanashi, Japan -
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Kimura T. Interaction between locomotion and three subcategories for patients with stroke demonstrating fewer than 37 points on the total functional independence measure upon admission to the recovery ward. J Phys Ther Sci 2020; 32:516-523. [PMID: 32884173 PMCID: PMC7443547 DOI: 10.1589/jpts.32.516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 05/13/2020] [Indexed: 12/02/2022] Open
Abstract
[Purpose] To investigate the interaction between locomotion and improvements in
performing self-care. [Participants and Methods] We retrospectively analyzed 930 patients
with stroke who were registered in the Japanese Rehabilitation Database. We performed a
correlation analysis to evaluate the relationships among all the collected data. Then,
hierarchical multiple regression analysis was performed using the self-care motor score of
the Functional Independent Measure (FIM) as the dependent variable. “Model 1” used two
independent variables (National Institute of Health Stroke and Rankin Scale), “model 2”
used two independent variables (locomotion gain and gain of an item with the closest
coefficient correlation added to model 1), and “model 3” used a mean-centering value,
which was added to model 2. R2 values were calculated using a simple slope
analysis. [Results] Locomotion showed an interaction with three self-care activities. The
R2 changes in models 1 and 2 (ΔR2) were significant for dressing
upper body (ΔR2=0.001), bowel management (ΔR2=0.006), and toileting
(ΔR2=0.006). The results of the simple slope analysis were significant.
[Conclusion] Locomotion demonstrated an interaction with various activities for improving
self-care. There were varying degrees of improvement in self-care despite a uniform
improvement in the degree of locomotion. Therefore, locomotion interaction should be
considered for each intervention that targets activities of daily living.
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Affiliation(s)
- Takashi Kimura
- Department of Physical Therapy, ASO Rehabilitation College: 3-2-1 Higashi-Hie, Hakata-ku, Fukuoka-Shi, Fukuoka 812-0007, Japan.,Department of Rehabilitation Medicine, Saga University Hospital, Japan
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9
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Lee HH, Lee JW, Kim BR, Jung HJ, Choi DH, Lee J. Predicting independence of gait by assessing sitting balance through sitting posturography in patients with subacute hemiplegic stroke. Top Stroke Rehabil 2020; 28:258-267. [PMID: 32783510 DOI: 10.1080/10749357.2020.1806437] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Post-stroke sitting balance is a known predictor of independence of gait after stroke. However, previous studies used only qualitative scales or measured static or dynamic sitting balance alone. OBJECTIVES To investigate whether quantitative parameters of sitting posturography at post-stroke 1 month can predict independent gait. METHODS In this prospective cohort study, we enrolled patients with first-ever stroke who could hold a sitting posture at post-stroke 1 month. Sitting balance was assessed using posturography at post-stroke 1 month. Independence of gait was assessed using functional ambulation categories at post-stroke 2 months. We predicted mobility independence at post-stroke 2 months according to sitting balance at post-stroke 1 month. We also assessed the correlation between sitting posturography parameters and clinical scales. RESULTS We enrolled 27 patients. The limit of stability deviation predicted independent gait at post stroke 2 months (cutoff, 78.4%). Further, there was a high degree of correlation between sitting posturography parameters (weight-bearing distribution deviation and limit of stability deviation) and Berg Balance Scale (ρ = 0.763, ρ = 0.777; p < .001, respectively), Scale for Assessment and Rating of Ataxia (ρ = -0.853, ρ = -0.929; p < .001, respectively), and Fugl-Meyer Assessment scale (upper extremities: ρ = 0.520, ρ = 0.480 [p = .005, p = .011, respectively]; lower extremities: ρ = 0.744, ρ = 0.564 [p < .001, p = .002, respectively]) scores. CONCLUSIONS Sitting posturography parameters is clinically useful because they can quantitatively assess post-stroke balance and neurological impairment and predict post-stroke independence of gait even when patients cannot reach their arms forward or stand upright.
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Affiliation(s)
- Hyun Haeng Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, Korea
| | - Jong Won Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, Korea
| | - Bo-Ram Kim
- Department of Rehabilitation Medicine, Gyeongin Rehabilitation Center Hospital, Incheon, Korea
| | - Ho Joong Jung
- Department of Rehabilitation Medicine, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, Korea
| | - Dong-Hee Choi
- Center for Neuroscience Research, Institute of Biomedical Science & Technology, Konkuk University, Seoul, Korea
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, Korea.,Center for Neuroscience Research, Institute of Biomedical Science & Technology, Konkuk University, Seoul, Korea.,Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea
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10
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Effect of Diagonal Pattern Training on Trunk Function, Balance, and Gait in Stroke Patients. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10134635] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: Trunk control disability commonly occurs after stroke. This study investigated the effect of diagonal pattern training in the sitting position to improve trunk control ability and gait performance. Method: 46 stroke patients were enrolled in this study. We used single plane training and diagonal pattern training. Additionally, the subjects were randomly assigned to the experiment group (diagonal pattern training) and the control group (single plane training). Diagonal pattern training was modified with proprioceptive neuromuscular facilitation technique’s chopping and lifting pattern to create 10 movements. Results: the trunk impairment scale score, Berg balance scale score, 10 m walking test result, and gait significantly increased in the experiment group compared to the control group. Conclusions: diagonal pattern training can be regarded as a promising method to improve postural control and increase balance and gait in stroke patients
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11
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Alzyoud J, Medley A, Thompson M, Csiza L. Responsiveness, minimal detectable change, and minimal clinically important difference of the sitting balance scale and function in sitting test in people with stroke. Physiother Theory Pract 2020; 38:327-336. [PMID: 32401095 DOI: 10.1080/09593985.2020.1756016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background: Limited studies have examined the responsiveness of the Sitting Balance Scale (SBS) and Function in Sitting Test (FIST). No studies have investigated the psychometric properties of these tools in skilled nursing facilities.Objective: The purposes of the study were (1) to examine responsiveness of the SBS and FIST, in people with stroke, receiving rehabilitation in skilled nursing facilities; and (2) to estimate the MDC and MCID of these scales.Methods: Forty participants completed the FIST, SBS, and Barthel Index (BI) at admission and discharge. Internal responsiveness of the FIST and SBS was measured using Effect Size (ES) and Standardized Response Mean (SRM). Examining the association between the difference in scores on the SBS or FIST and the difference in scores on the BI determined external responsiveness. MDC and MCID were estimated for both measures.Results: The ES and the SRM for both scales were large (1.01-2.30) indicating excellent internal responsiveness. Both scales demonstrated satisfactory external responsiveness, showing good association with change in BI scores (p < .01). MDC90 of the SBS and the FIST were 2.3 and 3.9, respectively. Anchor-based MCID estimates were 4.5 and 3.5, and distribution-based were 3.5 and 4.8 for the SBS and FIST, respectively.Conclusions: Both scales demonstrate sufficient responsiveness in the skilled nursing setting. Our findings suggest a change of 5 on the SBS and 4 on the FIST are clinically important, and clinicians may use these values to assess patient progress.
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Affiliation(s)
- Jehad Alzyoud
- School of Physical Therapy, Florida Southern College, Lakeland, FL, USA
| | - Ann Medley
- School of Physical Therapy, Texas Woman's University, Dallas, TX, USA
| | - Mary Thompson
- School of Physical Therapy, Texas Woman's University, Dallas, TX, USA
| | - Linda Csiza
- American Board of Physical Therapy Residency and Fellowship Education, American Physical Therapy Association, Alexandria, VA, USA
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12
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Fukata K, Amimoto K, Inoue M, Sekine D, Inoue M, Fujino Y, Makita S, Takahashi H. Effects of diagonally aligned sitting training with a tilted surface on sitting balance for low sitting performance in the early phase after stroke: a randomised controlled trial. Disabil Rehabil 2019; 43:1973-1981. [PMID: 31714801 DOI: 10.1080/09638288.2019.1688873] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To clarify the effects of diagonally aligned sitting training using a tilted surface on sitting balance for patients with low sitting performance in the early phase after stroke. MATERIALS AND METHODS This was an assessor-blinded randomised controlled trial. The experimental group used a surface tilted 10° backward and down toward the most affected side; the control group trained on a horizontal surface. Both groups were asked to move their trunk diagonally forward toward the least affected side. Participants performed the activity 40 times/session for seven sessions over 8 days. Sitting performances were assessed using the function in sitting test (FIST), subjective postural vertical (SPV) on the diagonal plane, and trunk impairment scale (TIS). RESULTS Thirty-three stroke patients were randomly allocated into two groups. Treatment effects differed significantly: mean differences between groups for FIST (total score, static, dynamic, scooting, and reactive) were 8.96, 2.35, 3.01, 1.27, and 1.72 points, for the mean SPV value was 1.82°, and for the TIS (total score and static) were 1.87 and 1.58 points, respectively. These results were more favourable in the experimental group. CONCLUSIONS Diagonally aligned sitting training on a tilted surface improves sitting balance and modulates the SPV compared with a horizontal surface.
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Affiliation(s)
- Kazuhiro Fukata
- Department of Rehabilitation Center, Saitama Medical University International Medical Center, Saitama, Japan.,Department of Physical Therapy, Tokyo Metropolitan University, Arakawaku, Japan
| | - Kazu Amimoto
- Department of Physical Therapy, Tokyo Metropolitan University, Arakawaku, Japan
| | - Masahide Inoue
- Department of Rehabilitation Center, Saitama Medical University International Medical Center, Saitama, Japan.,Department of Physical Therapy, Tokyo Metropolitan University, Arakawaku, Japan
| | - Daisuke Sekine
- Department of Rehabilitation Center, Saitama Medical University International Medical Center, Saitama, Japan.,Department of Physical Therapy, Tokyo Metropolitan University, Arakawaku, Japan
| | - Mamiko Inoue
- Department of Rehabilitation Center, Saitama Medical University International Medical Center, Saitama, Japan
| | - Yuji Fujino
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Bunkyo-Ku, Japan
| | - Shigeru Makita
- Department of Rehabilitation, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Hidetoshi Takahashi
- Department of Rehabilitation, Saitama Medical University International Medical Center, Hidaka, Japan
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13
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Yamasaki HR, An Q, Kinomoto M, Takahashi K, Fujii T, Kogami H, Yang N, Yamakawa H, Tamura Y, Itkonen M, Sonoo M, Alnajjar FSK, Yamashita A, Otomune H, Hattori N, Asama H, Miyai I, Shimoda S. Organization of functional modularity in sitting balance response and gait performance after stroke. Clin Biomech (Bristol, Avon) 2019; 67:61-69. [PMID: 31075736 DOI: 10.1016/j.clinbiomech.2019.04.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 04/24/2019] [Accepted: 04/29/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Recovery of postural adjustment, especially when seated, is important for performing activities of daily living after stroke. However, conventional clinical measures provide little insight into a common strategy for dynamic sitting balance and gait. We aimed to evaluate functional re-organization of posture and ambulatory performance after stroke. METHODS The subjects of the study included 5 healthy men and 21 post-stroke patients. The spatiotemporal modular organization of ground reaction forces during a balance task in which the leg on the non-affected side was lifted off the ground while seated was quantified by using complex principal component analysis. FINDINGS A 3% decrease in the temporal strength of the primary module in post-stroke patients was an independent predictor of gait performance in the hospital setting with high sensitivity and specificity. Tuning of the temporal strength was accompanied by the recovery of sitting and ambulation. INTERPRETATION Our findings suggest that evaluation of the modular characteristics of ground reaction forces during a sitting balance task allows us to predict recovery and functional adaptation through daily physical rehabilitation.
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Affiliation(s)
- Hiroshi R Yamasaki
- Intelligent Behavior Control Unit, RIKEN CBS-TOYOTA Collaboration Center, RIKEN Center for Brain Science, 2271-130 Anagahora, Shimoshidami, Moriyama-ku, Nagoya, Aichi 463-0003, Japan.
| | - Qi An
- Graduate School of Engineering, The University of Tokyo, Tokyo 113-8656, Japan
| | - Makoto Kinomoto
- Neurorehabilitation Research Institute, Morinomiya Hospital, Osaka 536-0025, Japan
| | - Koji Takahashi
- Neurorehabilitation Research Institute, Morinomiya Hospital, Osaka 536-0025, Japan
| | - Takanori Fujii
- Neurorehabilitation Research Institute, Morinomiya Hospital, Osaka 536-0025, Japan
| | - Hiroki Kogami
- Graduate School of Engineering, The University of Tokyo, Tokyo 113-8656, Japan
| | - Ningjia Yang
- Graduate School of Engineering, The University of Tokyo, Tokyo 113-8656, Japan
| | - Hiroshi Yamakawa
- Graduate School of Engineering, The University of Tokyo, Tokyo 113-8656, Japan
| | - Yusuke Tamura
- Graduate School of Engineering, The University of Tokyo, Tokyo 113-8656, Japan
| | - Matti Itkonen
- Intelligent Behavior Control Unit, RIKEN CBS-TOYOTA Collaboration Center, RIKEN Center for Brain Science, 2271-130 Anagahora, Shimoshidami, Moriyama-ku, Nagoya, Aichi 463-0003, Japan
| | - Moeka Sonoo
- Intelligent Behavior Control Unit, RIKEN CBS-TOYOTA Collaboration Center, RIKEN Center for Brain Science, 2271-130 Anagahora, Shimoshidami, Moriyama-ku, Nagoya, Aichi 463-0003, Japan
| | - Fady S K Alnajjar
- Intelligent Behavior Control Unit, RIKEN CBS-TOYOTA Collaboration Center, RIKEN Center for Brain Science, 2271-130 Anagahora, Shimoshidami, Moriyama-ku, Nagoya, Aichi 463-0003, Japan
| | - Atsushi Yamashita
- Graduate School of Engineering, The University of Tokyo, Tokyo 113-8656, Japan
| | - Hironori Otomune
- Neurorehabilitation Research Institute, Morinomiya Hospital, Osaka 536-0025, Japan
| | - Noriaki Hattori
- Neurorehabilitation Research Institute, Morinomiya Hospital, Osaka 536-0025, Japan
| | - Hajime Asama
- Graduate School of Engineering, The University of Tokyo, Tokyo 113-8656, Japan
| | - Ichiro Miyai
- Neurorehabilitation Research Institute, Morinomiya Hospital, Osaka 536-0025, Japan
| | - Shingo Shimoda
- Intelligent Behavior Control Unit, RIKEN CBS-TOYOTA Collaboration Center, RIKEN Center for Brain Science, 2271-130 Anagahora, Shimoshidami, Moriyama-ku, Nagoya, Aichi 463-0003, Japan
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14
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Pournajaf S, Goffredo M, Agosti M, Massucci M, Ferro S, Franceschini M. Community ambulation of stroke survivors at 6 months follow-up: an observational study on sociodemographic and sub-acute clinical indicators. Eur J Phys Rehabil Med 2018; 55:433-441. [PMID: 30543267 DOI: 10.23736/s1973-9087.18.05489-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Despite the importance of walking recovery in real life contexts, only 7% of stroke survivors at discharge from neuro-rehabilitation units recover independent walking in the community. However, studies on outcome indicators of walking ability restoration following stroke rarely regard the community ambulation. AIM The aim of the study is to investigate how sociodemographic and sub-acute clinical characteristics of stroke survivors at admission and at discharge may predict a good participation in community walking activity 6 months post-stroke. DESIGN Retrospective observational study. SETTING Inpatient neuro-rehabilitation centers. POPULATION Three-hundred-ten stroke survivors. METHODS A secondary analysis were performed on collected sociodemographic and clinical data of subjects after first-ever stroke within 72 hours of admission to acute care facilities (T1), at discharge (T2), and subsequently after 6-months post-stroke (T3). The regression analysis between every independent variable at T1 and T2 and Walking Handicap Scale-WHS (negative: 1-3; positive: 4-6) assessed at T3 were performed to identify the most important early predictors. RESULTS At T1, being younger, having a good ability to walk, early mobilization out of bed, not having TACI, and being female are significant positive indicators while, clinical complications are significantly negative for a WHS:4-6 at T3. No correlation was found between WHS and gender, etiology, the side of lesion, the presence of aphasia, and the presence of risk factors. The combination of risk factors indicates a negative WHS at T3. CONCLUSIONS The presence of risk factors and clinical complications delay significantly the walking ability restoration and return to social life. Such status consistently with the patient's compliance must not postpone the rehabilitation relatively, rehabilitation must be facilitated with targeted programs taking care particularly of people with negative indicators for recovery of community ambulation 6 months post-stroke. CLINICAL REHABILITATION IMPACT Early indicators are considerable in order to predict a targeted prognosis and better provide a tailored rehabilitation program.
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Affiliation(s)
- Sanaz Pournajaf
- Department of Neurorehabilitation, San Raffaele Pisana Institute of Research and Care, Rome, Italy -
| | - Michela Goffredo
- Department of Neurorehabilitation, San Raffaele Pisana Institute of Research and Care, Rome, Italy
| | - Maurizio Agosti
- Department of Rehabilitation, Parma University Hospital, Parma, Italy
| | - Maurizio Massucci
- Unit of Rehabilitation, Passignano sul Trasimeno Hospital, Perugia, Italy
| | | | - Marco Franceschini
- Department of Neurorehabilitation, San Raffaele Pisana Institute of Research and Care, Rome, Italy.,San Raffaele University, Rome, Italy
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15
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Sasaki N, Abo M, Hara T, Yamada N, Niimi M, Kakuda W. High-frequency rTMS on leg motor area in the early phase of stroke. Acta Neurol Belg 2017; 117:189-194. [PMID: 27502413 DOI: 10.1007/s13760-016-0687-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 08/01/2016] [Indexed: 10/21/2022]
Abstract
Although repetitive transcranial magnetic stimulation (rTMS) for upper limb motor area in stroke patients is beneficial, it has been poorly investigated in rTMS for leg motor area. Furthermore, no study has examined the usefulness of rTMS for leg motor area in patients in the early phase of stroke. Twenty-one patients with a hemispheric stroke lesion in the early phase were randomly assigned into two groups: the high-frequency (HF)-rTMS group [N = 11] and the sham stimulation group [N = 10]. Patients received rTMS for 5 consecutive days, beginning 10.9 ± 6.6 days on average after the onset. Brunnstrom Recovery Stages (BRS) for the lower limbs and the Ability for Basic Movement Scale Revised (ABMS II) were assessed before and after the intervention. The improvement in BRS for the lower limbs was significant after the intervention in the HF-rTMS group. Although both the HF-rTMS and sham stimulation groups had significant improvements in ABMS II scores, the extent of improvement in the AMBS II was significantly greater in the HF-rTMS group than in the sham stimulation group. Application of HF-rTMS over the bilateral leg motor areas has potential to be a new rehabilitation therapy for patients in the acute phase of stroke.
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16
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Birnbaum M, Hill K, Kinsella R, Black S, Clark R, Brock K. Comprehensive clinical sitting balance measures for individuals following stroke: a systematic review on the methodological quality. Disabil Rehabil 2016; 40:616-630. [PMID: 28029054 DOI: 10.1080/09638288.2016.1261947] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE The aim of this systematic review was to examine the psychometric properties of published clinical sitting measurement scales containing dynamic tasks in individuals following stroke. METHOD Databases, including Cumulative Index of Nursing and Allied Health Literature (CINAHL), MEDLINE, EMBASE, Cochrane, PubMed and Allied and Complementary Medicine Database (AMED) were searched from inception to December 2015. The search strategy included terms relating to sitting, balance and postural control. Two reviewers independently selected and extracted data from the identified articles and assessed the methodological quality of the papers using the COnsensus-based Standards for selection of health status Measurement INstruments (COSMIN) checklist. RESULTS Fourteen clinical sitting measurement scales (39 papers) containing dynamic tasks met the inclusion criteria and various measurement properties were evaluated. The methodological quality of the majority of the included studies was rated as poor to fair using the COSMIN checklist, with common limitations including small sample size and inappropriate use of statistical methods. CONCLUSIONS This review was unable to identify measures with sufficient psychometric properties to enable recommendation as preferred tools. However, measures were identified that warrant further specific psychometric investigations to fulfil requirements for a high quality measure. Implications for Rehabilitation Fourteen clinical sitting balance scales containing dynamic tasks are available to measure sitting balance with individuals following stroke. No single scale has sufficient psychometric properties to enable recommendation as a preferred tool for measuring sitting balance with stroke survivors. Use of a balance scale or dedicated sitting balance measure containing static and dynamic sitting items should be utilised to monitor progress for individuals following stroke with more severe deficits.
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Affiliation(s)
- Melissa Birnbaum
- a Physiotherapy Department , St. Vincent's Hospital Melbourne , Melbourne , Victoria , Australia.,b School of Physiotherapy and Exercise Science , Curtin University , Perth , Western Australia , Australia
| | - Keith Hill
- b School of Physiotherapy and Exercise Science , Curtin University , Perth , Western Australia , Australia
| | - Rita Kinsella
- a Physiotherapy Department , St. Vincent's Hospital Melbourne , Melbourne , Victoria , Australia
| | - Susan Black
- a Physiotherapy Department , St. Vincent's Hospital Melbourne , Melbourne , Victoria , Australia
| | - Ross Clark
- c Faculty of Science, Health, Education and Engineering , University of the Sunshine Coast , Sunshine Coast , Queensland , Australia
| | - Kim Brock
- a Physiotherapy Department , St. Vincent's Hospital Melbourne , Melbourne , Victoria , Australia
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17
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Sackley CM, Hill HJ, Pound K, Foxall A. The intra-rater reliability of the Balance Performance Monitor when measuring sitting symmetry and weight-shift activity after stroke in a community setting. Clin Rehabil 2016; 19:746-50. [PMID: 16250193 DOI: 10.1191/0269215505cr863oa] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To examine the intra-rater reliability of sitting symmetry and weight-shift activity measurements in poststroke adults. Design: An intra-rater reliability study. Setting: A community setting. Subjects: Adult stroke survivors attending stroke support groups within the community of Nottingham (UK). Main measures: The Balance Performance Monitor used to measure sitting symmetry and weight-shift activity. Intraclass correlation coefficients (ICCs) and their 95% confidence intervals (95% CI) were calculated. The Bland-Altman method for assessing agreement is also presented. Results: We tested 49 participants (median age 73 years; interquartile range 68-81 years). Between-test reliability for sitting symmetry was high: ICC (1,1) = 0.93 (95% CI 0.87 ≤ ICC5 ≤ 0.96). The mean difference between the measures (d̄) was-0.08 (95% CI-0.48 ≤ d̄ ≤ 0.31); the standard deviation of the differences (SDdiff) was 1.383. The coefficient of repeatability was 2.76; the 95% limits of agreement were -2.850 and 2.682. Between-test reliability for weight-shift activity was also high: ICC (1,1) = 0.86 (95% CI 0.775 ≤; ICC5 ≤; 0.92). Bland-Altman d̄= - 0.08 (95%CI-0.19 ≤ d̄ ≤ 0.35), SDdiff = 0.936. The coefficient of repeatability was 1.87; the 95% limits of agreement were-1.792 and 1.952. Conclusions: The 95% CI for d for both parameters crossed zero, indicating that between-test bias is unlikely. Sitting symmetry and weight-shift activity measures demonstrated acceptable levels of reliability.
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Affiliation(s)
- Cath M Sackley
- School of Health Sciences, University of Birmingham, 52 Prichatts Road, Edgbaston, Birmingham B15 1TT, UK.
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18
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Bank J, Charles K, Morgan P. What is the effect of additional physiotherapy on sitting balance following stroke compared to standard physiotherapy treatment: a systematic review. Top Stroke Rehabil 2015; 23:15-25. [PMID: 26086177 DOI: 10.1179/1945511915y.0000000005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Sitting balance dysfunction is commonly experienced following stroke. Physiotherapists utilize interventions to address this problem but it is unclear whether treatment type, target or practice intensity may affect outcomes. OBJECTIVE To compare the effects of standard physiotherapy to standard physiotherapy plus an additional physiotherapy treatment after stroke. DATA SOURCES The databases of Cochrane Library, CINAHL, Embase, Ovid Medline, AMED, and the Physiotherapy Evidence Database (PEDro) up to December 2014 were searched. STUDY SELECTION Randomized controlled trials in English reported in peer-reviewed journals regarding the effect of additional physiotherapy on sitting balance were retrieved. DATA EXTRACTION The PEDro scale was used to assess study quality. RESULTS Eleven studies met inclusion criteria. Nine targeted the ICF (International Classification of Function, Disability and Health) domain of Activity. The Trunk control test (TCT) was used as a primary outcome measure in five studies, and the Trunk Impairment Scale (TIS) was used in four. There was a significant effect (mean difference = 1.67, 95% CI = 0.54-2.80) favoring intervention, as measured by the TIS. There was no evidence to support the effect of additional treatment on sitting balance as measured by the TCT (mean difference = - 1.53, 95% CI = - 9.37 to 6.32). CONCLUSION The current evidence supports strategies that target deficits at the activity level and increase total treatment time. The TIS is most responsive as a measure of treatment efficacy. Further research is required using recommended outcome measures to facilitate generation of a minimum data set and data pooling.
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Affiliation(s)
- Jessica Bank
- Department of Physiotherapy, Monash University , Frankston, VIC, Australia
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19
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Mückel S, Mehrholz J. Immediate effects of two attention strategies on trunk control on patients after stroke. A randomized controlled pilot trial. Clin Rehabil 2014; 28:632-6. [PMID: 24452700 DOI: 10.1177/0269215513513963] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 10/30/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare the immediate effects of an external focus to enhance lateral body weight shift after stroke. DESIGN Randomized controlled trial. SETTING Inpatient rehabilitation hospital. SUBJECTS Twenty patients after stroke (11 males; mean (SD) age 72.2 (7.4) years; duration of illness 56 (14) days; there were 9 (45%) left-sided strokes) with impaired sitting balance were randomly allocated into two groups either external focus (n = 10) or internal focus (n = 10). INTERVENTION Patients in the external focus group, while sitting, were instructed to shift as much weight as they could sidewards to an external point next to their hip. Patients in the internal focus group were instructed to shift as much weight as they could sidewards to their hip. MAIN OUTCOME MEASURES Immediate lateral body weight shift as well as anterior-posterior deviation was measured in centimetres with a sensor mat. RESULTS Patients in the external focus group achieved greater lateral body weight shift than those in the internal focus group (mean shift (SD) 8.7 (2.6) cm vs. 4.5 (3.3) cm, respectively; P = 0.006). However, there were no significant differences in anterior-posterior deviation (mean shift (SD) 2.3 (1.3) cm vs. 1.2 (1.2) cm, respectively; P = 0.08). CONCLUSION Using an external focus may lead immediately to an enhanced lateral body weight shift while sitting, without increasing anterior-posterior deviation.
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Affiliation(s)
- Simone Mückel
- Wissenschaftliches Institut, Klinik Bavaria, Kreischa, Germany
| | - Jan Mehrholz
- Wissenschaftliches Institut, Klinik Bavaria, Kreischa, Germany Department of Public Health, Technical University Dresden, Germany
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Tsang RCC, Chau RMW, Cheuk THW, Cheung BSP, Fung DMY, Ho EYL, Ip EML, Ko BPH, Lee JYL, Liu AKL, Ng VPL, Tang RSK, To KWS, Tsang CPL. The measurement properties of modified Rivermead mobility index and modified functional ambulation classification as outcome measures for Chinese stroke patients. Physiother Theory Pract 2014; 30:353-9. [DOI: 10.3109/09593985.2013.876563] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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21
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Tyson S, DeSouza L. A Systematic Review of Methods to Measure Balance and Walking Post-Stroke. Part 1: Ordinal Scales. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/108331902235001589] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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22
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Kunkel D, Pickering RM, Burnett M, Littlewood J, Burridge JH, Ashburn A. Functional electrical stimulation with exercises for standing balance and weight transfer in acute stroke patients: a feasibility randomized controlled trial. Neuromodulation 2012; 16:168-77. [PMID: 22861816 DOI: 10.1111/j.1525-1403.2012.00488.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To test parameters needed for the design of a larger trial including the following: 1) identifying eligible participants, recruitment, and retention rates; 2) the feasibility and acceptability of delivering functional electrical stimulation (FES) to the gluteus maximus and quadriceps femoris for acute stroke patients in a hospital rehabilitation setting; 3) the outcome measures; 4) obtaining initial estimates of effect size; and 5) clarifying the relevant control group. MATERIALS AND METHODS Twenty-one people with acute stroke-mean age = 68 (min to max: 33-87) years; weeks postonset = 4.6 (min to max: 1-14)-were randomized to three groups to receive two weeks of balance training with FES, balance training alone, or usual care. Symmetry in normal standing, weight transfer onto the affected limb, balance, mobility, and speed of walking were assessed before, shortly after the end of training, and two weeks later by a blinded assessor. RESULTS 1) FES was successfully delivered but not with the planned eight sessions; 2) no trends in favor of FES were found; and 3) 4% of those screened took part but approaching 20% might be recruited in the future, no single outcome measure was suitable for all participants, and more routine physiotherapy was delivered to the control group. CONCLUSIONS FES is feasible in this patient group but further feasibility and definitive trials are required.
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Affiliation(s)
- Dorit Kunkel
- Faculty of Health Sciences, Southampton General Hospital, University of Southampton, Southampton, UK.
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23
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Dean CM, Ada L, Bampton J, Morris ME, Katrak PH, Potts S. Treadmill walking with body weight support in subacute non-ambulatory stroke improves walking capacity more than overground walking: a randomised trial. J Physiother 2010; 56:97-103. [PMID: 20482476 DOI: 10.1016/s1836-9553(10)70039-4] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
QUESTIONS Is treadmill walking with body weight support during inpatient rehabilitation detrimental to walking quality compared with assisted overground walking? Does it result in better walking capacity, perception of walking or community participation? DESIGN Analysis of secondary outcomes of a randomised trial with concealed allocation, assessor blinding and intention-to-treat analysis. PARTICIPANTS 126 patients unable to walk within 4 weeks of a stroke who were undergoing inpatient rehabilitation. INTERVENTION The experimental group undertook up to 30 minutes of treadmill walking with body weight support via an overhead harness per day while the control group undertook up to 30 minutes of overground walking. OUTCOME MEASURES The secondary outcomes were walking quality and capacity, walking perception, community participation and falls. RESULTS Six months after entering the study, there was no difference between the groups of independent walkers in terms of speed (MD 0.10 m/s, 95% CI -0.06 to 0.26) or stride (MD 6 cm, 95% CI -7 to 19). The independent walkers in the experimental group walked 57 m further (95% CI 1 to 113) in the 6 min walk than those in the control group. The experimental group (walkers and non-walkers) rated their walking 1 point out of 10 (95% CI 0.1 to 1.9) higher than the control group. There was no difference between the groups in community participation or number of falls. CONCLUSION Treadmill training with body weight support results in better walking capacity and perception of walking compared to overground walking without deleterious effects on walking quality.
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Affiliation(s)
- Catherine M Dean
- Discipline of Physiotherapy, University of Sydney, Lidcombe, NSW, 1825, Australia.
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24
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Ada L, Dean CM, Morris ME, Simpson JM, Katrak P. Randomized Trial of Treadmill Walking With Body Weight Support to Establish Walking in Subacute Stroke. Stroke 2010; 41:1237-42. [DOI: 10.1161/strokeaha.109.569483] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background and Purpose—
The main objective of this randomized trial was to determine whether treadmill walking with body weight support was effective at establishing independent walking more often and earlier than current physiotherapy intervention for nonambulatory stroke patients.
Methods—
A randomized trial with concealed allocation, blinded assessment, and intention-to-treat analysis was conducted. One hundred twenty-six stroke patients who were unable to walk were recruited and randomly allocated to an experimental or a control group within 4 weeks of stroke. The experimental group undertook up to 30 minutes per day of treadmill walking with body weight support via an overhead harness whereas the control group undertook up to 30 minutes of overground walking. The primary outcome was the proportion of participants achieving independent walking within 6 months.
Results—
Kaplan–Meier estimates of the proportion of experimental participants who achieved independent walking were 37% compared with 26% of the control group at 1 month, 66% compared with 55% at 2 months, and 71% compared with 60% at 6 months (
P
=0.13). The experimental group walked 2 weeks earlier, with a median time to independent walking of 5 weeks compared to 7 weeks for the control group. In addition, 14% (95% CI, −1–28) more of the experimental group were discharged home.
Conclusions—
Treadmill walking with body weight support is feasible, safe, and tends to result in more people walking independently and earlier after stroke.
Trial Registration—
ClinicalTrial.gov (NCT00167531).
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Affiliation(s)
- Louise Ada
- From Discipline of Physiotherapy (L.A., C.M.D.), School of Public Health (J.M.S.), The University of Sydney, Australia, Sydney, Australia; Melbourne School of Health Sciences (M.E.M.), The University of Melbourne, Melbourne, Australia; Neurological Rehabilitation (P.K.), Prince Henry/Prince of Wales Hospital, Sydney, Australia
| | - Catherine M. Dean
- From Discipline of Physiotherapy (L.A., C.M.D.), School of Public Health (J.M.S.), The University of Sydney, Australia, Sydney, Australia; Melbourne School of Health Sciences (M.E.M.), The University of Melbourne, Melbourne, Australia; Neurological Rehabilitation (P.K.), Prince Henry/Prince of Wales Hospital, Sydney, Australia
| | - Meg E. Morris
- From Discipline of Physiotherapy (L.A., C.M.D.), School of Public Health (J.M.S.), The University of Sydney, Australia, Sydney, Australia; Melbourne School of Health Sciences (M.E.M.), The University of Melbourne, Melbourne, Australia; Neurological Rehabilitation (P.K.), Prince Henry/Prince of Wales Hospital, Sydney, Australia
| | - Judy M. Simpson
- From Discipline of Physiotherapy (L.A., C.M.D.), School of Public Health (J.M.S.), The University of Sydney, Australia, Sydney, Australia; Melbourne School of Health Sciences (M.E.M.), The University of Melbourne, Melbourne, Australia; Neurological Rehabilitation (P.K.), Prince Henry/Prince of Wales Hospital, Sydney, Australia
| | - Pesi Katrak
- From Discipline of Physiotherapy (L.A., C.M.D.), School of Public Health (J.M.S.), The University of Sydney, Australia, Sydney, Australia; Melbourne School of Health Sciences (M.E.M.), The University of Melbourne, Melbourne, Australia; Neurological Rehabilitation (P.K.), Prince Henry/Prince of Wales Hospital, Sydney, Australia
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Tyson SF, Connell LA. How to measure balance in clinical practice. A systematic review of the psychometrics and clinical utility of measures of balance activity for neurological conditions. Clin Rehabil 2009; 23:824-40. [PMID: 19656816 DOI: 10.1177/0269215509335018] [Citation(s) in RCA: 144] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To identify psychometrically robust and clinically feasible measurement tools of balance activity in people with neurological conditions to recommend for use in clinical practice. DATA SOURCES MEDLINE, CINAHL, EMBASE, PEDro and AMED. REVIEW METHODS Independent reviewers selected and extracted data from articles that assessed the reliability, validity, sensitivity to change and clinical utility of measures of balance activity in adult neurological conditions. Quality assessment was based on Jorstad et al. Measures with 'good' psychometrics and > or =9/10 clinical utility scores were recommended. RESULTS Nineteen measurement tools were selected. Of these, the Brunel Balance Assessment, Berg Balance Scale, Trunk Impairment Scale, arm raise and forward reach tests in sitting and standing, weight shift, step/tap and step-up tests reached the required standards and are usable in clinical practice. The Brunel Balance Assessment and its associated functional performance tests have the additional advantages of being a hierarchical scale with established lack of redundancy. CONCLUSION The measurement tools identified above are psychometrically robust and feasible to use in clinical practice. Future objective measure development should consider the theoretical construct of the measure, the minimal detectable change and use in clinical populations other than stroke.
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Affiliation(s)
- S F Tyson
- Centre for Rehabilitation and Human Performance Research, University of Salford, Frederick Road Campus, Salford M6 6PU, UK.
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Amusat N. Assessment of sitting balance of patients with stroke undergoing inpatient rehabilitation. Physiother Theory Pract 2009; 25:138-44. [DOI: 10.1080/09593980802686839] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Katz-Leurer M, Fisher I, Neeb M, Schwartz I, Carmeli E. Reliability and validity of the modified functional reach test at the sub-acute stage post-stroke. Disabil Rehabil 2009; 31:243-8. [DOI: 10.1080/09638280801927830] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Ada L, Dean CM, Morris ME. Supported treadmill training to establish walking in non-ambulatory patients early after stroke. BMC Neurol 2007; 7:29. [PMID: 17803825 PMCID: PMC2031889 DOI: 10.1186/1471-2377-7-29] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2007] [Accepted: 09/06/2007] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND It has been reported that only half of the non-ambulatory stroke patients admitted to inpatient rehabilitation in Australia learn to walk again 1. Treadmill walking with partial weight support via an overhead harness is a relatively new intervention that is designed to train walking. The main objective of this randomised controlled trail is to determine whether treadmill walking with partial weight support via an overhead harness is effective at establishing independent walking (i) more often, (ii) earlier and (iii) with a better quality of walking, than current physiotherapy intervention for non-ambulatory stroke patients. METHODS A prospective, randomised controlled trial of inpatient intervention with a 6 month follow-up with blinded assessment will be conducted. 130 stroke patients who are unable to walk independently early after stroke will be recruited and randomly allocated to a control group or an experimental group. The control group will undertake 30 min of routine assisted overground walking while the experimental group will undertake 30 min of treadmill walking with partial weight support via an overhead harness per day. The proportion of participants achieving independent walking, the quality of walking, and community participation will be measured. The study has obtained ethical approval from the Human Research Ethics Committees of each of the sites involved in the study. DISCUSSION Given that the Australian population is ageing and people after stroke can expect to live for longer, attainment of safe, independent walking is more likely to be associated with long-term health and well being. In its National Research Priorities, the Government has recognised that it will be important to promote healthy ageing and that this endeavour will be underpinned by research. The results of this study will clearly identify effective intervention to establish early quality walking, thereby promoting an increase in community participation in the longer term.
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Affiliation(s)
- Louise Ada
- Physiotherapy, Faculty of Health Sciences, The University of Sydney, PO Box 170, Lidcombe, NSW, 1825, Australia
| | - Catherine M Dean
- Physiotherapy, Faculty of Health Sciences, The University of Sydney, PO Box 170, Lidcombe, NSW, 1825, Australia
| | - Meg E Morris
- School of Physiotherapy, The University of Melbourne, 200 Berkeley St, Melbourne, Victoria, 3010, Australia
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Tessem S, Hagstrøm N, Fallang B. Weight distribution in standing and sitting positions, and weight transfer during reaching tasks, in seated stroke subjects and healthy subjects. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2007; 12:82-94. [PMID: 17536646 DOI: 10.1002/pri.362] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND PURPOSE The recovery of sitting balance after a stroke is assumed to be essential to obtain independence in other vital functions. The purpose of the present study was to investigate weight distribution while sitting and standing still, and weight transfer during seated reaching tasks performed by stroke subjects and healthy subjects. METHOD The study was cross-sectional. Twenty-one stroke subjects and 21 healthy subjects, matched by age and gender, participated. Main measures were weight distribution while standing and sitting still, and displacements of centre ofpressure (COP) during seated reaching tasks. Data were collected using a balance performance monitor (BPM), including software. RESULTS Stroke subjects had less symmetrical weight distribution in standing than that of healthy subjects (p < 0.001). No significant differences between the groups were found while sitting still, and no associations between asymmetries in standing still and sitting positions within individual stroke subjects were found. Neither did the degree of weight distribution in sitting correspond to COP displacements in seated reaching tasks. However, COP displacement patterns in reaching tasks in the seated position were different in stroke subjects from those of healthy subjects. Stroke subjects showed more lateral displacement when reaching forwards (p < 0.001), and less lateral displacement when reaching sideways to the unaffected side (p = 0.01). CONCLUSION COP displacement patterns in stroke subjects deviate more than those of healthy subjects in seated reaching tasks. The deviating COP displacement patterns are discussed as a possible dysfunction in the ability to make postural adjustments and learn an efficient movement pattern.
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Affiliation(s)
- Siri Tessem
- Physiotherapy Programme, Faculty of Health Sciences, Oslo University College, Oslo, Norway.
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Scheets PL, Sahrmann SA, Norton BJ. Use of movement system diagnoses in the management of patients with neuromuscular conditions: a multiple-patient case report. Phys Ther 2007; 87:654-69. [PMID: 17504829 DOI: 10.2522/ptj.20050349] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND AND PURPOSE Medical diagnoses are not sufficient to guide physical therapy intervention. To provide a rational basis for treatment selection by physical therapists, we developed a set of diagnoses at the level of impairment that are relevant to the human movement system. The diagnoses describe the primary human movement system problem and provide a basis for matching a specific problem with appropriate treatment. The purposes of this 3-patient case report are to illustrate an updated version of the diagnostic system and to show how treatment decisions can be made relative to both the movement system diagnosis and the patient's prognosis. CASE DESCRIPTION AND OUTCOMES We diagnosed 3 patients with hemiplegia due to stroke as having 3 different movement system problems: force production deficit, fractionated movement deficit, and perceptual deficit. Specific intervention and actual patient outcomes for each case are outlined. DISCUSSION Use of movement system diagnoses may have multiple benefits for patient care. The possible benefits include decreasing the variability in management of patients with neuromuscular conditions, minimizing the trial-and-error approach to treatment selection, improving communication among health care professionals, and advancing research by enabling creation of homogenous patient groupings.
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Affiliation(s)
- Patricia L Scheets
- Therapy Services, Department of Rehabilitation, Carle Foundation Hospital, Urbana, IL 61801, USA.
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Tyson SF, Hanley M, Chillala J, Selley AB, Tallis RC. The Relationship Between Balance, Disability, and Recovery After Stroke: Predictive Validity of the Brunel Balance Assessment. Neurorehabil Neural Repair 2007; 21:341-6. [PMID: 17353462 DOI: 10.1177/1545968306296966] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective. To examine the influence of balance disability on function and the recovery of function after stroke and consequently to assess the predictive validity of the Brunel Balance Assessment (BBA). Methods. Cross-sectional study of 102 patients admitted consecutively to 6 National Health Service hospitals with weakness 2 to 4 weeks after their first anterior circulation stroke; 75 of whom completed follow-up assessment at 3 months. The BBA was assessed during admission and compared to the Barthel Index and Rivermead Mobility Index at 3 months. Results. Balance disability was the strongest predictor of function (in terms of activities of daily living [ADLs] and mobility disability) in the acute stages. Weakness was also an independent predictor. Recovery of ADLs was independently predicted by balance disability, weakness, age, and premorbid disability, whereas recovery of mobility disability was predicted by balance and age alone. At 3 months, a minority of people with limited sitting balance (0%-22%) and standing balance (25%-50%) recovered independent functional mobility. Most people who could walk initially recovered independent functional mobility (66%-84%), but 16% suffered a decline in their mobility and 44% had enduring limitations in everyday mobility activities. Conclusion. Initial balance disability is a strong predictor of function and recovery after stroke. These results demonstrate the predictive validity of the BBA.
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Affiliation(s)
- Sarah F Tyson
- Centre for Rehabilitation and Human Performance Research, University of Salford, Salford, UK.
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Dean CM, Channon EF, Hall JM. Sitting training early after stroke improves sitting ability and quality and carries over to standing up but not to walking: a randomised controlled trial. ACTA ACUST UNITED AC 2007; 53:97-102. [PMID: 17535145 DOI: 10.1016/s0004-9514(07)70042-9] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
QUESTION What is the effect of a sitting training protocol in people early after stroke on sitting ability and quality, and does it carry over to mobility? DESIGN Randomised placebo-controlled trial with concealed allocation, assessor blinding and intention-to-treat analysis. PARTICIPANTS Twelve individuals who had a stroke less than three months previously and were able to sit unsupported. INTERVENTION The experimental group completed a 2-week sitting training protocol that involved practising reaching tasks beyond arm's length. The control group completed a 2-week sham sitting training protocol that involved practising cognitive-manipulative tasks within arm's length. OUTCOME MEASURES The primary outcome was sitting ability (maximum reach distance). Secondary outcomes were sitting quality (reach movement time and peak vertical force through affected foot during reaching) and carry over to mobility (peak vertical force through affected foot during standing up and walking speed during 10 m Walk Test). Outcome measures were taken before and after training and six months later. RESULTS After 2 weeks' training, the experimental group had increased their maximum reach distance by 0.17 m (95% CI 0.12 to 0.21), decreased their movement time by 0.5 s (95% CI -0.8 to -0.2), increased their peak vertical force through the affected foot during reaching by 13% of body weight (95% CI 6 to 20) and increased their peak vertical force through the affected foot during standing up by 21% of body weight (95% CI 14 to 28) compared with the control group. After 6 months, significant between-group differences were maintained for maximum reach distance and peak vertical force through the affected foot during standing up. CONCLUSIONS The sitting training protocol was both feasible and effective in improving sitting and standing up early after stroke and somewhat effective six months later.
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Abstract
BACKGROUND AND PURPOSE Balance disability is common after stroke, but there is little detailed information about it. The aims of this study were to investigate the frequency of balance disability; to characterize different levels of disability; and to identify demographics, stroke pathology factors, and impairments associated with balance disability. SUBJECTS The subjects studied were 75 people with a first-time anterior circulation stroke; 37 subjects were men, the mean age was 71.5 years (SD=12.2), and 46 subjects (61%) had left hemiplegia. METHODS Prospective hospital-based cross-sectional surveys were carried out in 2 British National Health Service trusts. The subjects' stroke pathology, demographics, balance disability, function, and neurologic impairments were recorded in a single testing session 2 to 4 weeks after stroke. RESULTS A total of 83% of the subjects (n=62) had a balance disability; of these, 17 (27%) could sit but not stand, 25 (40%) could stand but not step, and 20 (33%) could step and walk but still had limited balance. Subjects with the most severe balance disability had more severe strokes, impairments, and disabilities. Weakness and sensation were associated with balance disability. Subject demographics, stroke pathology, and visuospatial neglect were not associated with balance disability. DISCUSSION AND CONCLUSION Subjects with the most severe balance disability had the most severe strokes, impairments, and disabilities. Subject demographics, stroke pathology, and visuospatial neglect were not associated with balance disability.
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Affiliation(s)
- Sarah F Tyson
- Centre for Rehabilitation and Human Performance Research, University of Salford, Salford, M6 6PU United Kingdom.
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Hsu WL, Yang YR, Hong CT, Wang RY. Ankle Muscle Activation During Functional Reach in Hemiparetic and Healthy Subjects. Am J Phys Med Rehabil 2005; 84:749-55. [PMID: 16205430 DOI: 10.1097/01.phm.0000176573.64931.94] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare the differences of reaching ability and electromyography of ankle muscles between healthy and hemiparetic subjects. DESIGN This is a cross-sectional control trial. A total of 31 subjects with hemiparesis and 31 age-matched healthy adults meeting our selection criteria participated in this study. Subjects performed forward reach and lateral reach, in random sequence, in a sitting position. The average reaching velocity, reaching distance, and onset time and mean muscle activity of bilateral tibialis anterior and soleus were recorded. RESULTS Subjects with hemiparesis had slower movement velocity and less reaching distance than that of healthy subjects (P < 0.05). The distance for the lateral reach was shorter than that of the forward reach (P < 0.05). The high correlations between contralateral tibialis anterior and soleus were noted in forward (r = 0.66, P < 0.01) and lateral (r = 0.68, P < 0.01) reaching in healthy subjects, but such correlations were not established in subjects with hemiparesis. Except for the ipsilateral soleus, normalized electromyographic activities (percentage of maximal voluntary isometric contraction) during forward and lateral reach were higher for the hemiparetic subjects than that for the healthy subjects (P < 0.05). CONCLUSION The functional reach abilities and the ankle electromyographic activity patterns in hemiparetic subjects were significantly different from those of healthy subjects. The muscles in the affected ankle cannot be recruited timely and efficiently for the reaching task, even with relative recovery.
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Affiliation(s)
- Wei-Li Hsu
- Faculty and Institute of Physical Therapy, National Yang-Ming University, Shih-Pai, Taipei, Taiwan
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Tsang YL, Mak MK. Sit-and-reach test can predict mobility of patients recovering from acute stroke11No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated. Arch Phys Med Rehabil 2004; 85:94-8. [PMID: 14970975 DOI: 10.1016/s0003-9993(03)00377-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To establish the test-retest reliability of the sit-and-reach test (SRT) and to determine the capacity of the SRT to predict mobility of patients recovering from acute stroke. DESIGN Study 1 consisted of repeating the SRT to examine its reliability over trials (same day) and sessions (alternate days). Study 2 consisted of measuring performance in the SRT 7 to 10 days poststroke and measuring mobility at discharge for prospective analysis. SETTING Medical and rehabilitation wards in hospital in Hong Kong. PARTICIPANTS Thirty-six subjects with acute stroke (study 1, n=10; study 2, n=26). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Between 7 and 10 days of stroke onset, distance reached on the SRT was measured. Mobility at discharge was assessed using the transfer and locomotion scale of the FIM instrument (FIM mobility) and a timed walk test. RESULTS The intertrial and intersession reliability of the SRT were rated good, with intraclass correlation coefficients of .98 and .79, respectively. Distance reached on the SRT correlated with the FIM mobility score on discharge (r=.572, P=.002) and the distance achieved on the timed walk test (r=.524, P=.006). Distance reached on the SRT accounted for 32.7% and 27.5% of the variance in the FIM mobility score at discharge and the distance achieved on the timed walk test, respectively. CONCLUSIONS Performance in the SRT is reliable and can significantly predict the mobility of patients with acute stroke at discharge.
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Affiliation(s)
- Yuk Lan Tsang
- Department of Physiotherapy, Caritas Medical Center, Hong Kong, ROC
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Dean C, Shepherd R, Adams R. Sitting balance I: trunk-arm coordination and the contribution of the lower limbs during self-paced reaching in sitting. Gait Posture 1999; 10:135-46. [PMID: 10502647 DOI: 10.1016/s0966-6362(99)00026-0] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The effects of reach distance and type of task on the functional relationship between the trunk, upper limb segments and the lower limbs during self-paced reaching in sitting were examined. Two-dimensional kinematic, kinetic and electromyography (EMG) data were collected as six healthy subjects reached forward under three distance (60, 100, 140% arm's length) and two task (reaching to press a switch, reaching to grasp a glass) conditions. The results demonstrate that type of task affected primarily the temporal aspects of coordination, with the grasp task taking consistently longer than the press task. In contrast, reach distance affected both the spatio-temporal aspects of coordination between the trunk and arm segments and the active contribution of the lower limbs. As reach distance increased, the magnitude of trunk and upper-arm segmental motion increased, whereas forearm segmental motion decreased. However, at each reach distance the path of the hand was relatively straight and there was remarkable consistency in the relationship between trunk and arm segments both within and between subjects suggesting that despite the presence of redundant degrees of freedom, the individual uses a parsimonious coordinative pattern. The vertical ground reaction force (GRF) and EMG data demonstrated that the lower limbs actively contributed to support the body mass when the object was located at 140% arm's length.
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Affiliation(s)
- C Dean
- School of Physiotherapy, Faculty of Health Sciences, The University of Sydney, PO Box 170, Lidcombe,
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Abstract
OBJECTIVES To observe the mobility outcomes of an inpatient population of stroke patients grouped according to the Oxfordshire Community Stroke Project classification. STUDY DESIGN "Mobility milestones," standardized measures of functional movement, were used to examine mobility recovery. PARTICIPANTS Two hundred thirty-eight stroke patients admitted to the Western General Hospital, Edinburgh. MAIN OUTCOME MEASURES Times taken to achieve four mobility milestones: 1-minute sitting balance, 10-second standing balance, a 10-step walk, and a 10-meter walk. RESULTS For all subjects the median times to achieve the milestones were as follows: 1-minute sitting balance, day of stroke; 10-second standing balance, 3 days; 10-step walk, 6 days; and a 10-meter walk, 9 days. Subjects sustaining a partial anterior circulation infarct, lacunar infarct, or posterior circulation infarct achieved the mobility milestones most rapidly and generally had a shorter hospital stay. CONCLUSIONS A hierarchical pattern of recovery of mobility reflecting variation between subgroups was observed. Predicted timescales for recovery of mobility are suggested.
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Affiliation(s)
- M T Smith
- Department of Physiotherapy, Royal Victoria Hospital, Edinburgh, Scotland, UK
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Dean CM, Shepherd RB. Task-related training improves performance of seated reaching tasks after stroke. A randomized controlled trial. Stroke 1997; 28:722-8. [PMID: 9099186 DOI: 10.1161/01.str.28.4.722] [Citation(s) in RCA: 220] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND PURPOSE After stroke, the ability to balance in sitting is critical to independence. Although impairments in sitting balance are common, little is known about the effectiveness of rehabilitation strategies designed to improve it. The purpose of this randomized placebo-controlled study was to evaluate the effect of a 2-week task-related training program aimed at increasing distance reached and the contribution of the affected lower leg to support and balance. METHODS Twenty subjects at least 1 year after stroke were randomized into an experimental or control group. The experimental group participated in a standardized training program involving practice of reaching beyond arm's length. The control group received sham training involving completion of cognitive-manipulative tasks within arm's length. Performance of reaching in sitting was measured before and after training using electromyography, videotaping, and two force plates. Variables tested were movement time, distance reached, vertical ground reaction forces through the feet, and muscle activity. Subjects were also tested on sit-to-stand, walking, and cognitive tasks. Nineteen subjects completed the study. RESULTS After training, experimental subjects were able to reach faster and further, increase load through the affected foot, and increase activation of affected leg muscles compared with the control group (P < .01). The experimental group also improved in sit-to-stand. The control group did not improve in reaching or sit-to-stand. Neither group improved in walking. CONCLUSIONS This study provides strong evidence of the efficacy of task-related motor training in improving the ability to balance during seated reaching activities after stroke.
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Affiliation(s)
- C M Dean
- Faculty of Health Sciences, University of Sydney, Australia.
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Nitz J, Gage A. Post stroke recovery of balanced sitting and ambulation ability. ACTA ACUST UNITED AC 1995; 41:263-7. [DOI: 10.1016/s0004-9514(14)60435-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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