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Flynn N, Froude E, Cooke D, Dennis J, Kuys S. The sustainability of upper limb robotic therapy for stroke survivors in an inpatient rehabilitation setting. Disabil Rehabil 2022; 44:7522-7527. [PMID: 34904486 DOI: 10.1080/09638288.2021.1998664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE To investigate the sustainability of Robot-assisted upper limb therapy (RT-UL) as part of routine occupational therapy and physiotherapy clinical practice. METHODS Two separate audits, 12 months apart, of RT-UL computer data records were undertaken to determine sustainability in a subacute rehabilitation unit. Records of the two audits were compared in terms of the number of early subacute stroke survivors using RT-UL, the number of RT-UL sessions, duration of RT-UL sessions, and disciplines prescribing RT-UL. RESULTS During Audit 1 58% (n = 18) of stroke survivors received RT-UL compared to 50% (n = 7) in Audit 2. The total number of RT-UL sessions reduced between audits (148 vs. 36 sessions) reflecting the overall reduction in admission rates for stroke survivors. There was no significant difference between audits in the average number of RT-UL sessions per patient (p = 0.203) nor the length of sessions (p = 0.762). Patients engaged in active therapy more than three-quarters of the time when on the robotic device. Physiotherapists were the primary prescribers of RT-UL when compared to occupational therapists. CONCLUSIONS RT-UL was in continued and regular use with stroke survivors 2 years after initial implementation within an inpatient rehabilitation setting. RT-UL practice was intensive and used routinely with patients.IMPLICATIONS FOR REHABILITATIONRT-UL is a sustainable and intensive intervention for stroke survivors within an inpatient rehabilitative setting.The cost-benefits of RT-UL should be evaluated from the perspective of the whole rehabilitation service not just at an individual patient level.RT-UL may be considered a "bridging" form of UL practice for those with more limited active UL movement until there is sufficient UL movement and power for more complex real-world task-specific practice.
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Affiliation(s)
| | | | - Deirdre Cooke
- Mater Private Hospital Rehabilitation Unit, Australian Catholic University, Brisbane, Australia
| | - Jessica Dennis
- Brighton Rehabilitation Unit, Australian Catholic University, Brisbane, Australia
| | - Suzanne Kuys
- Australian Catholic University, Brisbane, Australia
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Spalding K, Gustafsson L, Di Tommaso A. Occupation-based group programs in the inpatient hospital rehabilitation setting: a scoping review. Disabil Rehabil 2020; 44:2138-2148. [PMID: 32931331 DOI: 10.1080/09638288.2020.1813818] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Occupation-based practice involves the inclusion of meaningful occupations in the therapeutic process and is promoted within hospital-based general rehabilitation contexts for individual clients or within a group setting. The purpose of this paper is to summarise the current literature regarding the types of occupation-based group programs used within general inpatient rehabilitation and the reported outcomes. METHODS A scoping review was conducted and included papers if they described an occupation-based intervention, delivered in a group setting, conducted in an inpatient rehabilitation hospital context, with an adult population. Studies were collated, summarized and key findings are presented. RESULTS Ten articles met inclusion criteria. The results indicate that occupation-based groups are used in inpatient rehabilitation across a variety of settings, the approach is valued by the occupational therapy profession and it appears to have an influence on patient satisfaction and experience. However, the impact on a patient's confidence and occupational performance outcomes post-inpatient rehabilitation remains unclear. CONCLUSIONS There is a dearth of evidence on the impact of occupation-based group service focus in the inpatient rehabilitation setting. Considering the importance of occupation to the profession, further investigation into the use of this approach in a group setting is required.Implications for rehabilitationOccupation-based groups are used in inpatient rehabilitation to achieve more therapy time but there is variability in group processes and outcomes measured.Patient centred occupation-based groups appear to have an influence on patient satisfaction and experience.For the occupation-based groups reviewed, providing explicit links between patient goals, therapeutic activity and real life was important for improving outcomes.There is a growing focus for the use of occupation-based groups in occupational therapy and more research is needed to establish effectiveness.
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Affiliation(s)
- Kaitlyn Spalding
- Discipline of Occupational Therapy, School of Allied Health Sciences, Griffith University, Queensland, Australia.,Occupational Therapy Department, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Louise Gustafsson
- Discipline of Occupational Therapy, School of Allied Health Sciences, Griffith University, Queensland, Australia
| | - Amelia Di Tommaso
- Discipline of Occupational Therapy, School of Allied Health Sciences, Griffith University, Queensland, Australia
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Flynn N, Froude E, Cooke D, Kuys S. Repetitions, duration and intensity of upper limb practice following the implementation of robot assisted therapy with sub-acute stroke survivors: an observational study. Disabil Rehabil Assist Technol 2020; 17:675-680. [PMID: 32809895 DOI: 10.1080/17483107.2020.1807621] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Robot assisted upper limb (UL) therapy has been identified as an intervention with the potential to help improve the amount of practice performed by stroke survivors. OBJECTIVES This study aimed to measure the amount of UL practice (i.e., repetitions, duration, intensity) performed by subacute stroke survivors, in particular those with severe UL impairment, pre and post implementation of robot assisted upper limb therapy (RT-UL) into an inpatient rehabilitation setting. METHODS Two observational study phases (pre-RT-UL and post-RT-UL) were undertaken of occupational therapy and physiotherapy sessions performed by subacute stroke survivors. Upper limb tasks observed and recorded in therapy were classified as either impairment-related therapy or activity-related. RESULTS In the pre-RT-UL observational phase, 7 subacute stroke survivors were observed across 11 days involving 25 therapy sessions. Post-RT-UL, 12 subacute stroke survivors were observed across 12 days involving 29 therapy sessions. There were no significant differences in characteristics of patients observed in each phase (p > .05). The mean difference (95% CI) between pre and post RT-UL for repetitions (reps) (569 (1 to 1136) and intensity (7 (4-11)) reps/min of practice increased for all patients, including those with severe UL impairment (337 (37-638)) reps and 8 (2-14) reps/minute, with the duration of therapy unchanged. CONCLUSIONS This is the first study to have observed an increase in UL practice with the inclusion of RT-UL as part of routine clinical practice. This increase in practice is considered to be due to RT-UL providing highly supportive and expeditious semi-supervised practice. Notably, RT-UL was able to be implemented within the existing organisational structures with only basic training of therapy staff.IMPLICATIONS FOR REHABILITATIONRobotics presents as a viable intervention to increase the amount and intensity of upper limb practice performed by stroke survivors in routine clinical practiceRobotics were able to be implemented within the existing organisational structures with only basic training of therapy staff.
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Affiliation(s)
- Nicholas Flynn
- School of Allied Health, Australian Catholic University, Banyo, Australia
| | - Elspeth Froude
- School of Allied Health, Australian Catholic University, Banyo, Australia
| | - Deirdre Cooke
- School of Allied Health, Australian Catholic University, Banyo, Australia
| | - Suzanne Kuys
- School of Allied Health, Australian Catholic University, Banyo, Australia
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Barker RN, Hayward KS, Carson RG, Lloyd D, Brauer SG. SMART Arm Training With Outcome-Triggered Electrical Stimulation in Subacute Stroke Survivors With Severe Arm Disability: A Randomized Controlled Trial. Neurorehabil Neural Repair 2017; 31:1005-1016. [DOI: 10.1177/1545968317744276] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background. Stroke survivors with severe upper limb disability need opportunities to engage in task-oriented practice to achieve meaningful recovery. Objective. To compare the effect of SMART Arm training, with or without outcome-triggered electrical stimulation to usual therapy, on arm function for stroke survivors with severe upper limb disability undergoing inpatient rehabilitation. Methods. A prospective, multicenter, randomized controlled trial was conducted with 3 parallel groups, concealed allocation, assessor blinding and intention-to-treat analysis. Fifty inpatients within 4 months of stroke with severe upper limb disability were randomly allocated to 60 min/d, 5 days a week for 4 weeks of (1) SMART Arm with outcome-triggered electrical stimulation and usual therapy, (2) SMART Arm alone and usual therapy, or (3) usual therapy. Assessment occurred at baseline (0 weeks), posttraining (4 weeks), and follow-up (26 and 52 weeks). The primary outcome measure was Motor Assessment Scale item 6 (MAS6) at posttraining. Results. All groups demonstrated a statistically ( P < .001) and clinically significant improvement in arm function at posttraining (MAS6 change ≥1 point) and at 52 weeks (MAS6 change ≥2 points). There were no differences in improvement in arm function between groups (P = .367). There were greater odds of a higher MAS6 score in SMART Arm groups as compared with usual therapy alone posttraining (SMART Arm stimulation generalized odds ratio [GenOR] = 1.47, 95%CI = 1.23-1.71) and at 26 weeks (SMART Arm alone GenOR = 1.31, 95% CI = 1.05-1.57). Conclusion. SMART Arm training supported a clinically significant improvement in arm function, which was similar to usual therapy. All groups maintained gains at 12 months.
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Affiliation(s)
| | - Kathryn S. Hayward
- The University of Queensland, Brisbane, Queensland, Australia
- James Cook University, Mount Isa, Queensland, Australia
| | - Richard G. Carson
- The University of Queensland, Brisbane, Queensland, Australia
- Trinity College Dublin, Dublin, Ireland
- Queen’s University Belfast, Belfast, UK
| | - David Lloyd
- The University of Queensland, Brisbane, Queensland, Australia
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Steel KA, Mudie K, Sandoval R, Anderson D, Dogramaci S, Rehmanjan M, Birznieks I. Can Video Self-Modeling Improve Affected Limb Reach and Grasp Ability in Stroke Patients? J Mot Behav 2017; 50:117-126. [DOI: 10.1080/00222895.2017.1306480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Kylie Ann Steel
- School of Science and Health, Western Sydney University, Australia
- Brain, Behavior and Development, The MARCS Institute, Sydney, Australia
| | - Kurt Mudie
- School of Science and Health, Western Sydney University, Australia
- Institute of Sport, Exercise and Active Living (ISEAL), Victoria University, Melbourne, Australia
| | - Remi Sandoval
- School of Science and Health, Western Sydney University, Australia
| | - David Anderson
- Department of Kinesiology, San Francisco State University, California
| | - Sera Dogramaci
- New South Wales Institute of Sport, Sydney Markets, Australia
| | | | - Ingvars Birznieks
- School of Science and Health, Western Sydney University, Australia
- School of Medical Sciences, University of New South Wales, Sydney, Australia
- Neuroscience Research Australia, Randwick, Australia
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Sidaway M, Głowacka-Popkiewicz J, Krawczyk M, Waraksa T. Early upper limb physiotherapy in stroke patients. Questions without answers. ADVANCES IN REHABILITATION 2017. [DOI: 10.1515/rehab-2015-0060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Stroke is still the most common cause of disability in Poland and in western countries. As many as 80% of patients report reduced upper limb function in the acute phase after stroke. It is estimated that only 5% to 20% of patients experience full functional recovery of an upper limb. In clinical practice, paretic upper limb stimulation after stroke is usually treated as of secondary importance. However, it constantly poses a challenge to physical therapists. The existing procedures do not provide detailed guidelines regarding upper limb rehabilitation model particularly in the first four weeks after stroke. It is hard to predict biological limitations and the effectiveness of upper limb rehabilitation. The aim of this work is to make an attempt at reviewing the knowledge of the current state of early upper limb physiotherapy, its intensity and strategy type as well as neurobiological foundations of the improvement process. Ample scientific evidence confirms that early post-stroke rehabilitation is crucial. There are relatively few foreign (and virtually no Polish) reports related to early upper limb rehabilitation that would take into account the type of exercises and their therapeutic dose. There are still no solid foundations for determining optimal intensity and type of upper limb rehabilitation (including physical and occupational therapy). There is a scarcity of extensive and uniform (in terms of research groups and tools) multicentre investigations aimed at defining an optimal model of upper limb rehabilitation at an early stage after stroke. Thus, a number of questions still remain unanswered.
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Parsons JGM, Plant SE, Slark J, Tyson SF. How active are patients in setting goals during rehabilitation after stroke? A qualitative study of clinician perceptions. Disabil Rehabil 2016; 40:309-316. [DOI: 10.1080/09638288.2016.1253115] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- John G. M. Parsons
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- The Institute of Healthy Ageing, Waikato District Health Board, Hamilton, New Zealand
| | - Sarah E. Plant
- Stroke & Vascular Research Centre, School of Nursing, Midwifery & Social Work, University of Manchester, Manchester, United Kingdom
| | - Julia Slark
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- The Institute of Healthy Ageing, Waikato District Health Board, Hamilton, New Zealand
| | - Sarah F. Tyson
- Stroke & Vascular Research Centre, School of Nursing, Midwifery & Social Work, University of Manchester, Manchester, United Kingdom
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Gee BM, Lloyd K, Devine N, Tyrrell E, Evans T, Hill R, Dineen S, Magalogo K. Dosage Parameters in Pediatric Outcome Studies Reported in 9 Peer-Reviewed Occupational Therapy Journals from 2008 to 2014: A Content Analysis. Rehabil Res Pract 2016; 2016:3580789. [PMID: 26949547 PMCID: PMC4754491 DOI: 10.1155/2016/3580789] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 12/28/2015] [Accepted: 12/31/2015] [Indexed: 11/17/2022] Open
Abstract
Occupational therapists determine the dosage when establishing the plan of care for their pediatric clients. A content analysis was conducted using 123 pediatric occupational therapy outcomes studies from 9 scholarly international occupational therapy journals. The parameters of dosage were calculated using descriptive statistics in order to obtain a representation of dosage available within the current collage of pediatric occupational therapy outcomes studies. The results revealed that most studies reported portions of dosage parameters within the published studies. The average findings for the subcomponents related to dosage were session length (minutes) M = 58.7, duration of plan of care (weeks) M = 12.1, session frequency (per week) M = 3.4, and total hours of therapy (hours) M = 18.1. This first attempt at describing and calculating dosage related to pediatric occupational therapy practice indicates that evidence is lacking within the published literature to adequately guide OT dosage decisions. Further research related to dosage in pediatric occupational therapy practice is needed.
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Affiliation(s)
- Bryan M. Gee
- Department of Physical and Occupational Therapy, Idaho State University, Campus Mail Box 8045, Pocatello, ID 83201-8045, USA
| | - Kimberly Lloyd
- Department of Physical and Occupational Therapy, Idaho State University, Campus Mail Box 8045, Pocatello, ID 83201-8045, USA
| | - Nancy Devine
- Department of Physical and Occupational Therapy, Idaho State University, Campus Mail Box 8045, Pocatello, ID 83201-8045, USA
| | - Erin Tyrrell
- Idaho State University, Pocatello, ID 83201-8045, USA
| | - Trisha Evans
- Idaho State University, Pocatello, ID 83201-8045, USA
| | - Rebekah Hill
- Idaho State University, Pocatello, ID 83201-8045, USA
| | - Stacee Dineen
- Idaho State University, Pocatello, ID 83201-8045, USA
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Exploring the Role of Accelerometers in the Measurement of Real World Upper-Limb Use After Stroke. BRAIN IMPAIR 2015. [DOI: 10.1017/brimp.2015.21] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The ultimate goal of upper-limb rehabilitation after stroke is to promote real-world use, that is, use of the paretic upper-limb in everyday activities outside the clinic or laboratory. Although real-world use can be collected through self-report questionnaires, an objective indicator is preferred. Accelerometers are a promising tool. The current paper aims to explore the feasibility of accelerometers to measure upper-limb use after stroke and discuss the translation of this measurement tool into clinical practice. Accelerometers are non-invasive, wearable sensors that measure movement in arbitrary units called activity counts. Research to date indicates that activity counts are a reliable and valid index of upper-limb use. While most accelerometers are unable to distinguish between the type and quality of movements performed, recent advancements have used accelerometry data to produce clinically meaningful information for clinicians, patients, family and care givers. Despite this, widespread uptake in research and clinical environments remains limited. If uptake was enhanced, we could build a deeper understanding of how people with stroke use their arm in real-world environments. In order to facilitate greater uptake, however, there is a need for greater consistency in protocol development, accelerometer application and data interpretation.
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Hayward KS, Brauer SG. Dose of arm activity training during acute and subacute rehabilitation post stroke: a systematic review of the literature. Clin Rehabil 2015; 29:1234-43. [PMID: 25568073 DOI: 10.1177/0269215514565395] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 12/01/2014] [Indexed: 11/16/2022]
Abstract
AIM To determine the dose of activity-related arm training undertaken by stroke survivors during acute and subacute rehabilitation. METHODS A systematic review of PubMed, CINAHL and EMBASE up to December 2014 was completed. Studies were eligible if they defined the dose (time or repetitions) of activity-related arm training using observational methods for a cohort of adult stroke survivors receiving acute or subacute rehabilitation. All studies were quality appraised using an evidence-based learning critical appraisal checklist. Data was analysed by method of documented dose per session (minutes, repetitions), environment (acute or subacute rehabilitation) and therapy discipline (physiotherapy, occupational therapy). RESULTS Ten studies were included: two observed stroke survivors during acute rehabilitation and eight during subacute rehabilitation. During acute rehabilitation, one study reported 4.1 minutes per session during physiotherapy and 11.2 minutes during occupational therapy, while another study reported 5.7 minutes per session during physiotherapy only. During inpatient rehabilitation, activity-related arm training was on average undertaken for 4 minutes per session (range 0.9 to 7.9, n = 4 studies) during physiotherapy and 17 minutes per session (range 9.3 to 28.9, n = 3 studies) during occupational therapy. Repetitions per session were reported by two studies only during subacute rehabilitation. One study reported 23 repetitions per session during physiotherapy and occupational therapy, while another reported 32 repetitions per session across both disciplines. CONCLUSION The dose of activity-related arm training during acute and subacute rehabilitation after stroke is limited.
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Affiliation(s)
- Kathryn S Hayward
- Division of Physiotherapy, The University of Queensland, Brisbane, Australia
| | - Sandra G Brauer
- Division of Physiotherapy, The University of Queensland, Brisbane, Australia
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