Psychometric properties of the Stroke Impairment Assessment Set (SIAS)

Feasibility of a 10-week community-based mobile health rehabilitation program using the WalkWithMe application in late sub-acute and chronic stroke survivors in a low resource setting: A pilot study

 Physical functioning can be increased in people with stroke by using a mobile health application. This study aimed to investigate the feasibility of a 10-week community-based program using the WalkWithMe (WWM) application in people with late sub-acute and chronic stroke in Benin. An interventional pilot study with mixed methods research design was used examining the application of an unsupervised individualized mobile Health (mHealth) instructed training program. Main outcome included the application usage, safety, adherence, perceived enjoyment, mHealth quality, patient experiences and pre-post efficacy measures. Nine adults, five males, median age of 60 years and time since stroke of 12 months participated in this study. For most participants adherence with the application was over 70%. However, some usability problems were observed due to incorrect understanding and use by participants and technical problems. The application was very fun, stimulating and enjoyable. Significant improvements were found with median (pre/post measures) of locomotors skill (1.4/3.4); impairments (38/40), Barthel Index (85/95), activity limitation (2.1/3.1), and quality of life (194/218). A trend towards significant improvement was found with 6 minutes walking test (181/220, p = 0.06). The WWM application is perceived as a potential approach to increase physical activity and functioning among people with stroke in Benin.

Validity and Reliability of the Japanese Version of the Frontal Assessment Battery in Patients with Stroke

BACKGROUND

The Frontal Assessment Battery (FAB), which is used to assess executive function, has been translated into several languages and shown to be valid and reliable. However, the validity and reliability of the Japanese version in patients with stroke are unknown. This study aimed to investigate the validity and reliability of the Japanese version of the FAB in patients with stroke.

METHODS

The Japanese version of the FAB for dementia was modified and evaluated in 52 patients with stroke. FAB measurements were obtained twice over a 10-day period. Convergent validity was assessed using the Stroop Color Word Test (SCWT) and the Trail Making Test (TMT) part B. Internal consistency was measured using Cronbach's alpha (Cα). Test-retest evaluations were performed using intraclass correlation coefficient [ICC (2.1)] measurements, and limits of agreement (LOA) were calculated using the total FAB score.

RESULTS

The mean total FAB score was 13.4 ± 2.8 points, the ICC (2.1) was 0.856, and Cα was 0.92. The total FAB score was correlated with SCWT scores for parts I through IV (r = 0.70 to 0.77) and the TMT score for part B (ρ = -0.53). The LOA were -1.7 to 2.9 points.

CONCLUSIONS

The Japanese version of the FAB had higher validity and reliability in patients with stroke.

Relationship between physical activity levels and changes in skeletal muscle characteristics in patients with stroke

PURPOSE

This study aimed to investigate the relationship between physical activity (PA) levels and short-term changes in skeletal muscle characteristics in patients with subacute hemiparetic stroke.

MATERIALS AND METHODS

This prospective observational study included 76 patients with stroke who received inpatient care in a convalescent rehabilitation ward. The PA level was measured as the duration of daily total PA (≥ 1.5 metabolic equivalents) using a triaxial accelerometer for 7 days after admission. The outcomes were changes in the quadriceps muscle quality and quantity on the affected and unaffected sides, as assessed by ultrasonography at admission and 1 month after admission.

RESULTS

Multiple regression analysis indicated that the duration of total PA was significantly associated with a percentage change in quadriceps muscle quality (p = 0.011) and quantity (p = 0.012) on the affected side. However, no significant relationship was observed between the muscle quality and quantity on the unaffected side.

CONCLUSIONS

The results revealed that PA was associated with changes in the quadriceps muscle quality and quantity on the affected side in patients with subacute hemiparetic stroke. These findings highlight the importance of promoting PA in stroke rehabilitation to improve muscle properties and functional outcomes.

Verification of Criterion-Related Validity for Developing a Markerless Hand Tracking Device

Physicians, physical therapists, and occupational therapists have traditionally assessed hand motor function in hemiplegic patients but often struggle to evaluate complex hand movements. To address this issue, in 2019, we developed Fahrenheit, a device and algorithm that uses infrared camera image processing to estimate hand paralysis. However, due to Fahrenheit's dependency on specialized equipment, we conceived a simpler solution: developing a smartphone app that integrates MediaPipe. The objective of this study was to measure hand movements in stroke patients using both MediaPipe and Fahrenheit and to assess their criterion-related validity. The analysis revealed moderate-to-high correlations between the two methods. Consistent results were also observed in the peak angle and velocity comparisons across the severity stages. Because Fahrenheit determines finger recovery status based on these measures, it has the potential to transfer this function to MediaPipe. This study highlighted the potential use of MediaPipe in paralysis estimation applications.

Overestimation associated with walking and balance function in individuals diagnosed with a stroke

BACKGROUND

An estimation error is the difference between motor imagery and actual motor time. Previous studies have reported that overestimation (motor imagery time < actual motor time) is related to physical functions in healthy individuals. However, this finding is unclear among individuals diagnosed with a stroke.

OBJECTIVE

We investigated whether overestimation is related to physical function in individuals diagnosed with a stroke.

METHODS

This study included 71 individuals diagnosed with a stroke (mean age, 67.2 ± 13.4 years; mean time since stroke, 68.4 ± 44.7 days). Imagined timed up and go test (iTUGT) was performed to assess the estimation error. First, the iTUGT was performed; subsequently, the TUGT was performed. The estimation error was calculated by subtracting the TUGT from the iTUGT, with two standard deviations (2 SDs) being calculated. Furthermore, patients were classified into appropriate estimation (AE, within ±2 SD) and overestimation (OE, over -2 SD) groups. Both groups were tested using the estimation error, iTUGT, TUGT, Berg Balance Scale (BBS), and Brunnstrom Recovery Stage (BRS). Subsequently, a correlation analysis was performed.

RESULTS

The OE group had a significantly higher estimation error than the AE group (OE: -7.08 ± 6.87 s, AE: -0.29 ± 1.53 s, P < .001). Moreover, the OE group had significantly lower TUGT and BBS than the AE group. The estimation error was correlated with the TUGT, BBS, and lower-limb BRS (ρ = -0.454, 0.431, 0.291, respectively; P < .05).

CONCLUSIONS

Overestimation was associated with TUGT and balance function in individuals diagnosed with a stroke.

Difficulty resuming driving in acute acquired brain injury: Retrospective observational study using discriminant analysis

OBJECTIVES

We hypothesized that neuropsychological testing and history of falls would be associated with difficulty resume driving after acute acquired brain injury (ABI). This study aimed to analyze ABI facing difficulties in resuming driving in the acute phase.

METHODS

We retrospectively analyzed 63 patients receiving assistance in driving-resumption after ABI. Patients were categorized into two groups: driving-resumption-possible and driving-resumption-difficult. Discriminant analysis delineated characteristics of patients experiencing driving-resumption difficulty. Additionally, significant predictors were analyzed using ROC curves.

RESULTS

42 patients were able to resume driving, and 21 experienced difficulties in driving resumption. Factors predicting difficulty returning to driving were age, history of falls, TMT Part B, and ROCF. Furthermore, cut-off values for each were 72 years, 148 seconds for TMT Part B, and 29.5 points for ROCF.

CONCLUSIONS

Patients with advanced age, history of falls, delayed TMT Part B, and poor ROCF outcomes may face challenges in resuming driving after ABI. These factors may serve as a valuable metric to assess driving resumption difficulties after ABI.

Association between the initial physical activity and functional recovery after 1 month of inpatient rehabilitation for subacute stroke: stratified analysis by nutritional status

Objectively measured physical activity volume serves as a predictive factor for functional recovery in patients with stroke. Malnutrition, a frequent complication of stroke, may influence the relationship between physical activity and functional recovery. This study aimed to examine the association between physical activity volume and functional recovery in patients with stroke, stratified by their nutritional status. This multicenter prospective observational study included 209 patients with stroke admitted to two Japanese convalescent rehabilitation hospitals. Participants were categorized based on the geriatric nutritional risk index (GNRI) at admission [≥92, high GNRI group ( n  = 133); <92, low GNRI group ( n  = 76)]. Physical activity levels were measured as the duration of total physical activity (TPA), which is the sum of light-intensity physical activity and moderate-to-vigorous physical activity, using a triaxial accelerometer during the first 7 days after admission. Outcome measures are represented as the relative gain of the motor score on functional independence measure (M-FIM effectiveness) during the first month after admission. The multiple regression analysis, adjusting for age, sex, comorbidity, onset to admission intervals, motor paralysis, initial M-FIM, and cognitive FIM, showed that the duration of TPA in the first 7 days was significantly associated with the M-FIM effectiveness over the first month in both low GNRI [ B  = 0.12, 95% confidential intervals (CI) = 0.01; 0.24, P  = 0.049] and high GNRI group ( B  = 0.11, 95% CI = 0.01; 0.21, P  = 0.027). This study demonstrates a positive predictive association between early TPA level and functional recovery in stroke patients, irrespective of their nutritional status.

Effects of robot-assisted gait training using the Welwalk on gait independence for individuals with hemiparetic stroke: an assessor-blinded, multicenter randomized controlled trial

BACKGROUND

Gait disorder remains a major challenge for individuals with stroke, affecting their quality of life and increasing the risk of secondary complications. Robot-assisted gait training (RAGT) has emerged as a promising approach for improving gait independence in individuals with stroke. This study aimed to evaluate the effect of RAGT in individuals with subacute hemiparetic stroke using a one-leg assisted gait robot called Welwalk WW-1000.

METHODS

An assessor-blinded, multicenter randomized controlled trial was conducted in the convalescent rehabilitation wards of eight hospitals in Japan. Participants with first-ever hemiparetic stroke who could not walk at pre-intervention assessment were randomized to either the Welwalk group, which underwent RAGT with conventional physical therapy, or the control group, which underwent conventional physical therapy alone. Both groups received 80 min of physical therapy per day, 7 days per week, while the Welwalk group received 40 min of RAGT per day, 6 days per week, as part of their physical therapy. The primary outcome was gait independence, as assessed using the Functional Independence Measure Walk Score.

RESULTS

A total of 91 participants were enrolled, 85 of whom completed the intervention. As a result, 91 participants, as a full analysis set, and 85, as a per-protocol set, were analyzed. The primary outcome, the cumulative incidence of gait-independent events, was not significantly different between the groups. Subgroup analysis revealed that the interaction between the intervention group and stroke type did not yield significant differences in either the full analysis or per-protocol set. However, although not statistically significant, a discernible trend toward improvement with Welwalk was observed in cases of cerebral infarction for the full analysis and per-protocol sets (HR 4.167 [95%CI 0.914-18.995], p = 0.065, HR 4.443 [95%CI 0.973-20.279], p = 0.054, respectively).

CONCLUSIONS

The combination of RAGT using Welwalk and conventional physical therapy was not significantly more effective than conventional physical therapy alone in promoting gait independence in individuals with subacute hemiparetic stroke, although a trend toward earlier gait independence was observed in individuals with cerebral infarction.

TRIAL REGISTRATION

This study was registered with the Japan Registry of Clinical Trials ( https://jrct.niph.go.jp ; jRCT 042180078) on March 3, 2019.

Association between the executive dysfunction and balance function in patients with stroke

INTRODUCTION

A previous study has shown an association between executive dysfunction (ED) and balance function in patients with stroke. However, it is unclear what factors mediate the association between ED and balance function. Therefore, the aim of this study was to investigate the association between ED and balance function and to identify mediating factors using mediation analysis.

METHODS

This study had a cross-sectional design. The study included 107 patients with stroke. This study was divided into two groups (ED and non-ED) using trail making test (TMT) part B. Two groups were compared for balance function (timed up and go test [TUGT] and Berg balance scale [BBS]) and other variables using paired test. In addition, partial correlation analysis with age, cognitive function as a control factor, and mediation analysis were also performed.

RESULTS

The ED group (N = 55) had significantly lower TUGT and BBS scores than the non-ED group (N = 52). TMT part B correlated with TUGT (ρ = 0.41), BBS (ρ = -0.33), and Brunnstrom recovery stage (BRS) lower limb (ρ = -0.22). The TUGT model of mediation analysis showed a significant indirect effect as a result of mediation of the BRS lower limb between TMT part B and TUGT. The BBS model showed a significant indirect effect as a result of mediation of the activities of daily living (ADL) motor function between TMT part B and BBS.

CONCLUSIONS

ED and balance function were associated, and the degree of paralysis and ADL motor function were associated with them in patients with stroke.

Predictors indicating the continuous need for a knee-ankle-foot orthosis in stroke patients at 1 month after onset

OBJECTIVES

To investigate predictors indicating the continuous need for a knee-ankle-foot orthosis (KAFO) at 1 month after stroke onset in patients who cannot walk without a KAFO in the acute period.

MATERIALS AND METHODS

We enrolled patients with severe hemiplegia (n = 139) who were unable to walk without a KAFO on day 10 from stroke onset. The patients were divided into two groups depending on the need for a KAFO at 1 month after the onset: the KAFO group and non-KAFO group. Logistic regression analysis was used to identify predictors of the continuous need for a KAFO at 1 month after stroke onset. In addition, significant predictors were analyzed using receiver operating characteristic curves.

RESULTS

The number of patients in the KAFO group and non-KAFO group was 72 (51.8 %) and 67 (48.2 %), respectively. Motor deficit, sensation disorder, severity of pusher syndrome, and body mass index were identified as predictors of the continuous need for a KAFO. Moreover, active range of motion of knee extension on the affected side was found to have the highest predictive ability, with an area under the receiver operating characteristic curve of 0.89 (95 % confidence interval, 0.83-0.94).

CONCLUSIONS

In this study, multiple factors were associated with the continuous need for a KAFO at 1 month after stroke onset. In particular, active range of motion of knee extension on the affected side is suggested to be a highly accurate predictor for the need for a KAFO in the subacute phase.

Balance Function Required for Bathing Independence in Patients with Stroke and Hip Fracture

Objectives

Little attention has been paid to the relationship between balance function and bathing independence. This research aimed to determine the degree of balance function needed by patients with stroke and patients with hip fracture (hereinafter referred to as patients with stroke and hip fracture) to bathe independently.

Methods

Retrospective data analysis was performed on 59 patients with hip fracture and 201 patients with stroke. Logistic regression was performed to determine whether bathing independence was associated with the Berg Balance Scale (BBS) in patients with stroke and hip fracture. A receiver operating characteristic curve was generated to calculate cutoff values.

Results

The BBS was significantly associated with bathing independence in patients with stroke and hip fracture. The calculated BBS cutoff value was 48 points for those with stroke (sensitivity, 84.7%; specificity, 79.1%) and 43 points for those with hip fracture (sensitivity, 81.3%; specificity, 77.8%).

Conclusions

Balance function was independently associated with bathing independence. The level of balance function required for bathing independence may be lower for patients with hip fracture than for those with stroke. This could be a simple and useful indicator for rehabilitation professionals to interpret BBS results when conducting bathing interventions.

The Clinical Variables Predicting the Acquisition of Independent Ambulation in the Acute Phase of Stroke: A Retrospective Study

BACKGROUND

Predictive factors associated with independent ambulation post-stroke are less commonly reported for patients during the acute phase of stroke. This study aimed to identify the clinical variables predicting ambulation independence in the acute phase of stroke and test the superiority of their prediction accuracy.

METHODS

Sixty-nine patients, hospitalized in the acute phase for an initial unilateral, supratentorial stroke lesion, were divided into independent (n = 24) and dependent ambulation (n = 45) groups, with functional ambulation category scores of 4-5 and ≤ 3, respectively. They were evaluated upon admission using the modified Rankin scale (mRS), Stroke Impairment Assessment Set (SIAS) concerning the motor function of the lower extremities, Ability for Basic Movement Scale modified version 2 (ABMS2), and Functional Independence Measure (FIM).

RESULTS

The scores of the four measures were significantly different between the groups. A univariate logistic regression analysis identified these variables as prognostic factors for independent ambulation. A receiver operating characteristic curve analysis identified the cutoff values (area under the curve) for the mRS, SIAS, FIM, and ABMS2 as 3 (0.74), 12 (0.73), 55 (0.85), and 23 (0.84), respectively.

CONCLUSION

In summary, the FIM and ABMS2 may be more accurate in predicting ambulation independence in patients with stroke during the acute phase.

Validity of functional assessment for control of trunk in patients with subacute stroke: a multicenter, cross-sectional study

[Purpose] The purpose of this study was to clarify the criterion validity, construct validity, and feasibility of the Functional Assessment for Control of Trunk (FACT). [Participants and Methods] This study was a multicenter, cross-sectional study of patients with subacute stroke at three Japanese rehabilitation hospitals. To clarify feasibility, we examined the differences in the measurement time between FACT and the Trunk Impairment Scale (TIS). For the criterion validity of FACT, correlations between FACT, TIS, and the trunk items of the Stroke Impairment Assessment Set (SIAS) were examined using Spearman's rank correlation coefficient. For the construct validity of FACT, we examined the correlations with the other assessments. [Results] Seventy-three patients participated in this study. The measurement time was significantly shorter for FACT (212.6 ± 79.2 s) than TIS (372.4 ± 199.6 s). For criterion validity, FACT correlated significantly with TIS (r=0.896) and two SIAS trunk items (r=0.453, 0.594). For construct validity, significant correlations were found for FACT and other tests (r=0.249-0.797). Areas under the curve for FACT and TIS were 0.809 and 0.812, respectively, and the cutoff values for walking independence were 9 and 13 points, respectively. [Conclusion] For inpatients with stroke, FACT offered feasibility, criterion validity, and construct validity.

Age-stroke related dysfunction interaction associated with home discharge of stroke inpatients in the rehabilitation ward

The purpose of this study was to investigate whether interactions exist among cognitive and physical functions and activities of daily living (ADL) associated with home discharge of stroke patients in the rehabilitation ward. The subjects were 231 patients with a first stroke. Age, gender, affected side, the stroke impairment assessment set, ADL and discharge destination were collected from the medical record. Using a decision tree, a combination of variables that might have an interaction effect associated with home discharge was extracted. The existence of an interaction between the extracted variables was confirmed by logistic regression analysis. A combination of total score of the stroke impairment assessment set (≤27 points) and age (>76.5 years) at admission was extracted from the decision tree. As a result of the logistic regression analysis, this interaction term was significantly associated with home discharge. The findings of the present study suggest that there is an interaction between age and stroke-related dysfunction related to home discharge. Stroke patients aged over 76.5 years with the stroke impairment assessment set score of 27 or less at admission to the rehabilitation ward may need rehabilitation program considering the difficulty of home discharge.

Estimation Error Consisting of Motor Imagery and Motor Execution in Patients with Stroke

Previous studies demonstrate that the difference between motor imagery and actual tasks (estimation error) is related to cognitive and physical functions and that a large estimation error (LE) is related to motor imagery ability, including cognitive and physical functions in healthy subjects. The purpose of this study investigated whether estimation error is related to physical and cognitive function in patients with stroke. The study included 60 patients with stroke. The Timed Up and Go Test (TUGT) was employed to assess estimation error. First, the imagined TUGT (iTUGT) was performed; thereafter, the actual TUGT was performed. The estimation error was calculated by subtracting TUGT from iTUGT, with conversion to the absolute value. The patients were classified into the small estimation error (SE) and LE groups, with comparisons of various clinical scores (Mini-Mental State Examination, Berg Balance Scale, 10-m walking speed, Brunnstrom Recovery Stage, and Functional Independence Measure). As a result, the estimation error was significantly larger in the LE group than in the SE group. Cognitive function and balance ability were significantly lower in the LE group than in the SE group. In conclusion, the estimation error was related to physical and cognitive functions in patients with stroke.

Walking Ability Associated with Executive Dysfunction in Patients with Stroke: A Cross-Sectional Study

Previous studies have shown an association between executive dysfunction and walking ability. However, it remains unclear whether the degree of executive dysfunction is associated with differences in walking ability in patients with stroke. The aim of this study was to investigate whether there are differences in walking ability according to executive dysfunction in patients with stroke. A total of 51 patients with stroke were enrolled in this study. Executive function was measured using the Trail Making Test (TMT) Part B, and walking ability was assessed using the 10 m walk test and the Timed Up and Go Test (TUGT). Cluster analysis was performed using the TMT Part B and compared within each cluster. TMT Part B was categorized into three groups (cluster 1: n = 20, cluster 2: n = 24, and cluster 3: n = 7). Cluster 1 was significantly better than clusters 2 and 3, and cluster 2 was significantly better than cluster 3. The 10 m walk time and TUGT of cluster 1 were significantly better than those of cluster 3. However, the 10 m walk time and TUGT of clusters 1 and 2 did not differ significantly. In conclusion, these findings may indicate differences in walking ability according to executive dysfunction.

Effect of mixed and collective physical activity in chronic stroke rehabilitation: A randomized cross-over trial in low-income settings

BACKGROUND

The prevalence of physical inactivity after stroke is high and exercise training improves many outcomes. However, access to community training protocols is limited, especially in low-income settings.

OBJECTIVE

To investigate the feasibility and efficacy of a new intervention: Circuit walking, balance, cycling and strength training (CBCS) on activity of daily living (ADL) limitations, motor performance, and social participation restrictions in people after stroke.

METHODS

Forty-six community-dwelling individuals with chronic stroke who were no longer in conventional rehabilitation were randomized into an immediate CBCS group (IG; initially received CBCS training for 12 weeks in phase 1), and a delayed CBCS group (DG) that first participated in sociocultural activities for 12 weeks. In phase 2, participants crossed over so that the DG underwent CBCS and the IG performed sociocultural activities. The primary outcome was ADL limitations measured with the ACTIVLIM-Stroke scale. Secondary outcomes included motor performance (balance: Berg Balance Scale [BBS], global impairment: Stroke Impairment Assessment Set [SIAS] and mobility: 6-minute and 10-metre walk tests [6MWT and 10mWT] and psychosocial health [depression and participation]). Additional outcomes included feasibility (retention, adherence) and safety.

RESULTS

ADL capacity significantly improved pre to post CBCS training (ACTIVLIM-stroke, +3,4 logits, p < 0.001; effect size [ES] 0.87), balance (BBS, +21 points, p < 0.001; ES 0.9), impairments (SIAS, +11 points, p < 0.001; ES 0.9), and mobility (+145 m for 6MWT and +0.37 m/s for 10mWT; p < 0.001; ES 0.7 and 0.5 respectively). Similar improvements in psychosocial health occurred in both groups. Adherence and retention rates were 95% and 100%, respectively.

CONCLUSION

CBCS was feasible, safe and improved functional independence and motor abilities in individuals in the chronic stage of stroke. Participation in CBCS improved depression and social participation similarly to participation in sociocultural activities. The benefits persisted for at least 3 months after intervention completion.

PROTOCOL REGISTRATION NUMBER

PACTR202001714888482.

Pathophysiological and motor factors associated with collision avoidance behavior in individuals with stroke

BACKGROUND

High collision rates and frequency of entering the opening from non-paretic sides are associated with collision in individuals with stroke.

OBJECTIVE

To identify factors associated with collision avoidance behavior when individuals with stroke walked through narrow openings.

METHODS

Participants with subacute or chronic stroke walked through a narrow opening and had to avoid colliding with obstacles. Multiple regression analyses were conducted with pathophysiology, motor function, and judgment ability as predictor variables; collision rate and frequency of entering the opening from non-paretic sides were outcome variables.

RESULTS

Sixty-one eligible individuals with stroke aged 63±12 years were enrolled. Thirty participants collided twice or more and 37 entered the opening from the non-paretic side. Higher collision occurrence was associated with slower Timed Up and Go tests and left-right sway (odds ratios, 1.2 and 5.6; 95% confidence intervals, 1.1-1.3 and 1.3-28.2; p = .008 and.025, respectively). Entering from non-paretic sides was associated with lesions in the thalamus, left-sided hemiplegia, and Brunnstrom stage 3 or lower (odds ratios, 6.6, 8.7, and 6.7; 95% confidence intervals, 1.3-52.5, 2.5-36.5, and 1.2-57.5; and p = .038,.001, and.048, respectively).

CONCLUSION

Walking ability is associated with avoiding obstacle collision, while pathophysiological characteristics and degree of paralysis are associated with a preference for which side of the body enters an opening first. Interventions to improve walking ability may improve collision avoidance. Avoidance behavior during intervention varies depending on the lesion position.

Efficacy of lateral truncal tilt training with a wedge on postural vertical and activities of daily living in recovery phase after stroke: A randomized crossover trial

BACKGROUND: The subjective postural vertical (SPV) is affected by training that requires participants to maintain balance; training to achieve sitting balance may also help SPV recovery and activities of daily living (ADLs). OBJECTIVE: This study aimed to assess the medium-term effects of balance training on the postural vertical (PV) and ADLs in patients with stroke. METHODS: Thirty-three patients with stroke were enrolled in this randomized crossover trial. The outcomes were SPV, SPV with eyes opened (SPV-EO), and the Functional Independent Measure (FIM) after the 14-day intervention of experimental or control training. Experimental training consisted of a maximum lateral truncal tilt to the paretic side at 0.25 Hz with or without a 10° wedge, repeated 60 times. Repeated-measures two-way analysis of variance was performed with two factors: intervention and the intervention period. RESULTS: There was no interaction between the control condition and the PV, but there was interaction between the intervention period and using a wedge for SPV variability errors. FIM showed an interaction between the intervention period and the use of a wedge. CONCLUSIONS: Balance training while sitting with a wedge significantly improved the SPV and FIM. This improved cognition and perception, which facilitate difficult dynamic tasks in ADLs.

Relationship of the brief-balance evaluation systems test with physical functioning and activities of daily living: A cross-sectional study among hospitalized acute stroke patients

BACKGROUND: The Brief-Balance Evaluation Systems Test (Brief-BESTest) has the potential to be used effectively for interventions on specific balance components. However, it has not been utilized for acute stroke cases. OBJECTIVE: This study determined the characteristics of the distribution of the Brief-BESTest scores of patients who suffered acute stroke and examined its relationship with physical function and activities of daily living ability. METHODS: The Brief-BESTest, sub-items of Stroke Impairment Assessment Set (SIAS), and Functional Independence Measure (FIM) were conducted among 41 hospitalized acute stroke patients (71.3±9.5 years, 32 males). The skewness of the Brief-BESTest and Spearman’s rank correlation (ρ) between Brief-BESTest, SIAS, and FIM were analyzed. RESULTS: The skewness of the total score of the Brief-BESTest was -0.038. There were no ceiling or floor effects. The total score of the Brief-BESTest had a weak positive correlation with the SIAS lower extremity motor function (ρ= 0.457) and muscle tone (ρ= 0.374), and the total score on FIM (ρ= 0.365). Each sub-item of the Brief-BESTest was associated with different physical functions. CONCLUSIONS: The Brief-BESTest was unaffected by floor and ceiling functions among hospitalized acute stroke patients, and different physical functions were associated with each balance component.

Simplified Post-stroke Functioning Assessment Based on ICF via Dichotomous Mokken Scale Analysis and Rasch Modeling

Purpose

This study aims to accomplish two tasks for International Classification of Functioning, Disability and Health (ICF) application among persons with stroke: (1) to make an ICF tool for measuring personal abilities with simplified assessment operations; (2) to quantitatively evaluate ICF categories for being functioning rather than being disabled.

Methods

A total of 130 inpatients with stroke via convenience sampling were evaluated by the extended comprehensive ICF core set for stroke, modified Rankin scale, and modified Barthel index (MBI). This study investigated the responses to 118 stroke-related ICF items (59 items in b and d domains individually) using Mokken scale analysis followed with Rasch modeling.

Results

A Mokken scale with 47 items was extracted from the binary data (1 as no-impairment or mild-impairment and 0 as moderate to complete impairment). A Rasch model with 45 items was derived from the Mokken scale. The conversion chart was available involving the original ordinal scores to Rasch-transformed scores from 0 to 100 (interval scale). Total scores exhibited a high correlation with the personal abilities estimated by the Rasch model. The personal ability also demonstrated a significantly strong correlation with the score of the MBI. Thus, the 45 ICF items were suggested to rate potential functional ability as a single measurement.

Conclusion

Based on simple “functioning or disabled” judgment tasks, ICF assessment can be simplified to a questionnaire with answering “yes-or-no” questions for each category. Functioning level for each person and difficulty of being functioning for each category can be estimated by the Rasch model of this questionnaire.

Relationship between the vividness of motor imagery and physical function in patients with subacute hemiplegic stroke: a cross-sectional preliminary study

PURPOSE

The study aimed to clarify whether the vividness of motor imagery is related to lower limb function and walking ability in patients with hemiplegic stroke.

MATERIALS AND METHODS

The study was a cross-sectional preliminary study. The subjects were 15 patients with hemiplegic stroke. The vividness of motor imagery was assessed using the kinesthetic and visual imagery questionnaire. The kinesthetic imagery (KI) involves the sensation of one's own movement, whereas the visual imagery (VI) involves the imagination of a third-person performing the self-movement. Their physical functions were assessed using the Brunnstrom recovery stage, stroke impairment assessment set, 10-m maximum walking speed test, and functional independence measure. KI and VI were compared using the t test. Correlation analysis was performed between KI or VI and various variables as well as between the motor imagery gap (difference between KI and VI) and various variables.

RESULTS

KI was significantly lower than VI (p < .01). KI was correlated not only with lower limb function (r = 0.68) but also with walking speed (r = -0.64). The motor imagery gap was correlated with hip joint function (r = -0.53).

CONCLUSIONS

KI and motor imagery gap were associated with lower limb function and walking ability.

Factors related to daily step counts of stroke patients during hospitalization in a convalescent rehabilitation ward

OBJECTIVES

Clarifying the factors related to decreased physical activity in post-stroke patients is essential for effective disease management. This study aimed to examine the factors influencing the amount of daily steps taken by post-stroke patients in a convalescent rehabilitation ward during activities other than rehabilitation (non-rehabilitation steps).

MATERIALS AND METHODS

Eighty-nine post-stroke patients (60.8±14.4 years; 55 men) were enrolled. The inclusion criteria were walking independently within the ward and having a walking speed of ≥24 m/min. Data on patient clinical characteristics including age, sex, body mass index, stroke type, hemiparetic side, and time from stroke onset were collected. Stroke impairment and motor and cognitive functional disabilities were assessed using the Stroke Impairment Assessment Set and the Functional Independence Measure, respectively. The non-rehabilitation steps were calculated by subtracting the steps during the rehabilitation activities from the total steps using Fitbit Flex2.

RESULTS

The average number of non-rehabilitation steps was 4,523±2,339 steps/day. The hierarchical multiple regression analysis revealed that sex, motor disability, and the interaction term of stroke impairment with cognitive disability were significantly related to non-rehabilitation steps. Simple slope analysis demonstrated that the stroke impairment slope was steeper at lower levels than at higher levels of cognitive disability for non-rehabilitation steps.

CONCLUSIONS

In addition to independent effects of sex and motor disability, this study found that stroke impairment and cognitive disability were interactively related to non-rehabilitation steps in post-stroke patients in a convalescent rehabilitation ward. These findings may provide useful information for managing physical activity in post-stroke patients after hospital discharge.

Impact of Alternate Gait Training Using Knee-Ankle-Foot Orthoses with Oil Damper Ankle Hinge in Patients with Subacute Severe Hemiplegia

Patients with severe hemiplegia along with knee instability require knee–ankle–foot orthoses (KAFOs) for gait training. However, in these patients, it is unclear which type of walking training is more effective to improve gait function. Providing alternate gait training (AGT) improves walking function in patients with spinal cord injury, but it is still unclear whether this is effective in hemiplegic stroke patients. In this study, we defined “unified AGT” as AGT performed with the same therapeutic concept by physiotherapists. We then investigated whether AGT improved gait function quicker than our traditional gait training in hemiplegic stroke patients. We enrolled 15 subjects with severe hemiplegia and knee instability who had undergone unified AGT using KAFOs with hinged oil dampers at the ankles, and 30 historical control (HC) subjects who had undergone traditional gait training. We used multiple comparison and survival analyses to analyze the differences in the functional independence measure (FIM) gait score changes between the two groups. The multiple comparison revealed a significant increase (p < 0.05) in the FIM gait score compared with its initial score in the subjects with unified AGT. However, this improvement was not seen in the HC subjects. Additionally, the survival analysis of time taken to recover revealed a significant difference between the subjects with unified AGT and HC subjects (p < 0.05). These findings suggest that unified AGT using a KAFO facilitates gait improvement in patients with severe hemiplegia and knee instability.

Effects of different rehabilitation provision systems on functional recovery in patients with subacute stroke

INTRODUCTION

The extent of rehabilitation is a key element in promoting functional recovery in patients with stroke. However, the type of rehabilitation therapy that should be provided to improve functional outcomes remains unclear.

OBJECTIVE

This study aimed to compare the effects of three different rehabilitation provision systems, namely conventional rehabilitation therapy, conventional rehabilitation therapy plus physical therapy (PT) on weekends, and conventional rehabilitation therapy plus PT and occupational therapy (OT) on weekends, on functional recovery in patients with subacute stroke.

DESIGN

Retrospective observational cohort study.

SETTING

Convalescence Rehabilitation Hospital.

PATIENTS

Three hundred and one patients with subacute stroke (mean age, 69.7 ± 12.8 years).

INTERVENTIONS

Patients were classified into three groups according to rehabilitation therapy they received: a conventional group (only weekdays PT and OT; n = 70), an additional PT group (additional PT on weekends; n = 119), and an additional PT + OT group (additional PT and OT on weekends; n = 112).

MAIN OUTCOME MEASURE

Functional Independence Measure (FIM) effectiveness was calculated as (discharge FIM - admission FIM/maximum FIM - admission FIM) × 100. A multivariate general linear model was used to assess the difference in FIM effectiveness among the groups.

RESULTS

The mean FIM effectiveness in the conventional, additional PT, and additional PT + OT groups were 39.3 ± 30.1, 43.4 ± 33.2, and 54.3 ± 29.1, respectively. The multivariate analysis revealed a significant difference in FIM effectiveness among the three groups (P = 0.036), and the η_p ² was 0.02, indicating a small effect. The additional PT + OT group showed significantly greater improvements in FIM effectiveness than the conventional group (mean difference = 8.78, SE = 3.58, 95% confidence interval: 0.17-17.39).

CONCLUSIONS

This study showed that the additional PT + OT group had better functional recovery than did the conventional group. This indicates that increasing the amount of both PT and OT can promote post-stroke functional recovery. This article is protected by copyright. All rights reserved.

Interactions of Cognitive and Physical Functions Associated with Toilet Independence in Stroke Patients

OBJECTIVES

The purpose of this study was to clarify the interaction among cognitive and physical functions associated with toilet independence in stroke patients.

MATERIALS AND METHODS

We retrospectively examined 125 stroke patients. We performed decision tree analysis to detect the interaction associated with toilet independent using assessment of motor function on the affected side, muscle strength on unaffected side, trunk function, neglect, motivation, and cognitive function. The interactions detected via decision tree confirmed the existence and influence using logistic regression.

RESULTS

The verticality test of the Stroke Impairment Assessment Set (3 or ≤2 points) was selected at the first level, and the Revised Hasegawa's dementia scale (≥19 or ≤18 points) and age (≥70 or ≤69 y) were selected at the second level of decision tree. Interaction terms created by these factors were significantly associated with toilet independence after adjusting for the independent influence of each factor using logistic regression.

CONCLUSIONS

Our results show an interaction of trunk and cognitive functions or trunk function and age associated with toilet independence. The probability of toilet independence dramatically changes if two factors of each interaction were satisfied in stroke patients.

Gait and Muscle Activity Changes in Patients in the Recovery Phase of Stroke with Continuous Use of Ankle-Foot Orthosis with Plantarflexion Resistance

Objective:

Previous studies have suggested that the use of an ankle–foot orthosis may cause disuse atrophy of the tibialis anterior muscle. The objective of this study was to explore gait and muscle activity changes in patients in the recovery phase of stroke with 2-month use of an ankle–foot orthosis that provided plantarflexion resistance.

Methods:

The participants were 19 patients in the recovery phase of stroke who were prescribed an ankle–foot orthosis that provided plantarflexion resistance. We measured ankle and shank tilt angles as well as electromyography activity of the tibialis anterior and the soleus during 10-m walk tests. Measurements were taken on three occasions. The first was 2 weeks after delivery of the orthosis, 1 and 2 months after the initial measurement, and the third 2 months later. Changes in gait parameters were analyzed between the first and second measurements and between the second and third measurements.

Results:

Between the second and third measurements, significant increases were observed in plantarflexion and shank forward tilt angles and the activity ratio of the tibialis anterior during loading response compared with other phases.

Conclusions:

Plantarflexion movement induced by an ankle–foot orthosis with plantarflexion resistance could increase the activity ratio of the tibialis anterior during loading response.

Sarcopenic Obesity and Activities of Daily Living in Stroke Rehabilitation Patients: A Cross-Sectional Study

Reports investigating the relationship between sarcopenic obesity and activities of daily living in older patients with stroke were limited. This study aimed to examine the prevalence of sarcopenic obesity and its association with activities of daily living in older post-stroke patients in convalescent rehabilitation wards. This study was performed in older post-stroke patients admitted to convalescent rehabilitation wards between January 2017 and March 2019. Sarcopenia was diagnosed based on the skeletal muscle mass index and hand grip strength according to the criteria of the 2019 Asian Working Group for Sarcopenia. Obesity was diagnosed according to the body fat percentage; ≥27% in men, ≥38% in women. The primary outcome was the Functional Independence Measure (FIM) score upon admission, which was analyzed using multiple linear regression. In total, 376 participants (women 44%; mean age 77.5 years) were analyzed and classified as normal (22%), simple obesity (17%), sarcopenia without obesity (32%), and sarcopenic obesity (28%). The presence of sarcopenic obesity was independently associated with the FIM score (95% CI, -16.157 to -5.353), whereas simple obesity and sarcopenia without obesity were not. In conclusion, sarcopenic obesity was independently associated with lower activities of daily living capability in older patients with stroke.

Influence of right versus left unilateral spatial neglect on the functional recovery after rehabilitation in sub-acute stroke patients

Unilateral spatial neglect (USN) may lead to poor functional rehabilitation outcomes. However, studies investigating the rehabilitation outcomes of right-sided USN are lacking. We aimed to investigate (1) the clinical impacts of USN, including right-sided USN, for stroke patients in sub-acute rehabilitation, and (2) evaluate the differences in clinical characteristics and rehabilitation outcomes between right- and left-sided USN patients. We retrospectively screened the medical records of 297 inpatients at the Tokyo-Bay Rehabilitation Hospital who experienced a cerebrovascular accident with supratentorial lesions between January 1st, 2014 and December 31st, 2016. We performed independent multiple regression analysis in patients with left and right hemisphere damage. The Behavioral Inattention Test was a significant independent variable for predicting the motor, cognitive, and total functional independence measure (FIM), compared to the Stroke Impairment Assessment Set and Mini-Mental State Examination. USN affects motor FIM recovery more than cognitive FIM recovery regardless of the damaged hemisphere. Our study results confirm that both right- and left-sided USN influence the functional recovery of stroke patients. USN occurs, slightly less frequently, following a left hemisphere stroke. However, USN negatively affected rehabilitation outcomes, regardless of the neglected side. Therefore, USN treatment is necessary for patients with left and right hemisphere damage.

Functions necessary for gait independence in patients with stroke: A study using decision tree

BACKGROUND

Little is known about the existence and impact of interactions among multiple impairments to gait independence. The purpose of this study is to reveal the interaction of physical functions and its impact on gait independence in stroke patients.

METHODS

This retrospective study included 108 subacute stroke patients. We conducted a decision tree analysis to examine the existence of interactions in relation to gait independence among the gross motor function of lower limb, knee extension strength, sensory function, and trunk function. Further, we confirmed the existence and impact of interaction detected via the decision tree after adjusting for the effects of confounding factors using logistic regression.

RESULTS

The knee extension strength and proprioception on the affected side were selected in the first and second level of the decision tree. In addition, the knee extension strength was selected in the third level. The interaction of the knee extension strength and proprioception on the affected side was significantly associated with gait independence, both before and after adjusting for age, visuospatial perception, and cognitive functions.

CONCLUSIONS

Our results suggest that the interaction of the knee extension strength and proprioception on the affected side is strongly associated with gait independence in stroke patients.

Activity and participation in stroke survivors in a low-income setting: A cross-sectional study

OBJECTIVES

To describe patients' activity and participation levels and to compare these levels across different groups of stroke survivors according to their walking speed (WS).

METHODS

In this cross-sectional study, 67 stroke survivors (43 men, mean age: 58.4 ± 12.9 years old) were assessed using the stroke impairment assessment set (SIAS), ACTIVLIM-Stroke, 10-m walk test (10MWT), 6-min walk test (6MWT) and Reintegration to Normal Living Index (RNLI). The sample was afterwards split into three WS sub-groups (<0.4 m/s, 0.4-0.8 m/s and >0.8 m/s) based on 10MWT scores.

RESULTS

ACTIVLIM-Stroke, 10MWT and 6MWT mean scores (±SD) were, respectively, 69.4 ± 20.2%, 0.9 ± 0.6 m/s and 282.1 ± 182 m. RNLI median score (range) was 5 (0-20). Sub-group analyses indicated that 26.9% (n = 18) obtained WS < 0.4 m/s, 13.4% (n = 9) WS between 0.4 and 0.8 m/s, and 59.7% (n = 40) WS > 0.8 m/s. Significant differences (p < .001) were found between WS sub-groups for both activity and participation.

CONCLUSION

Stroke survivors in Kinshasa presented a good performance for basic-activities of daily life (basic-ADLs). However, some of them still had difficulties with some community activities. Differences in WS seemed to discriminate well stroke survivors in terms of activity and participation, since the higher WS, the more they performed in basic-ADLs, walking distance and participation, and inversely.

Clinical assessment of motor imagery and physical function in mild stroke patients

[Purpose] The aim of this study was to clarify whether the motor imagery of walking and physical function are related in mild hemiplegic stroke patients. [Participants and Methods] Sixteen mild hemiplegic stroke patients were included in this study. We evaluated motor imagery with a 10-m walking, the estimation error and the kinesthetic and visual imagery questionnaire. Physical function was evaluated with the actual 10-m walk test time, Brunnstrom recovery stage, stroke impairment assessment set, and functional independent measure. The correlation coefficient was calculated using Spearman’s correlation coefficient for all evaluation methods. [Results] The 10-m walking motor imagery took an average of 23.36 ± 22.14 s. The actual 10-m walk test averaged 24.87 ± 21.41 s. The 10-m walking motor imagery and the 10-m walking speed were significantly correlated. There was a significant correlation between the 10-m walking motor imagery and the Brunnstrom recovery stage, stroke impairment assessment set, and functional independent measure. There were no significant correlations between the estimation error and all the assessments. [Conclusion] These results show that the motor imagery of walking is related to physical function in mild hemiplegic stroke patients.

Voluntary contraction enhances spinal reciprocal inhibition induced by patterned electrical stimulation in patients with stroke

BACKGROUND

Reciprocal inhibition (RI) may be important for recovering locomotion after stroke. Patterned electrical stimulation (PES) can modulate RI in a manner that could be enhanced by voluntary muscle contraction (VC).

OBJECTIVE

To investigate whether VC enhances the PES-induced spinal RI in patients with stroke.

METHODS

Twelve patients with chronic stroke underwent three 20 min tasks, each on different days: (1) PES (10 pulses, 100 Hz every 2 s) applied to the common peroneal nerve; (2) VC consisting of isometric contraction of the affected-side tibialis anterior muscle; (3) PES combined with VC (PES + VC). RI from the tibialis anterior to the soleus muscle was assessed before, immediately after, and 10, 20, and 30 min after the task.

RESULTS

Compared to the baseline, PES + VC significantly increased the changes in reciprocal inhibition at immediately after and 10 min after the task. PES alone significantly increased this change immediately after the task, while VC alone showed no significant increase.

CONCLUSION

VC enhanced the PES-induced plastic changes in RI in patients with stroke. This effect can potentially increase the success rate of newer neurorehabilitative approaches in achieving functional recovery after stroke.

Distortion of Visuo-Motor Temporal Integration in Apraxia: Evidence From Delayed Visual Feedback Detection Tasks and Voxel-Based Lesion-Symptom Mapping

Limb apraxia is a higher brain dysfunction that typically occurs after left hemispheric stroke and its cause cannot be explained by sensory disturbance or motor paralysis. The comparison of motor signals and visual feedback to generate errors, i.e., visuo-motor integration, is important in motor control and motor learning, which may be impaired in apraxia. However, in apraxia after stroke, it is unknown whether there is a specific deficit in visuo-motor temporal integration compared to visuo-tactile and visuo-proprioceptive temporal integration. We examined the precision of visuo-motor temporal integration and sensory-sensory (visuo-tactile and visuo-proprioception) temporal integration in apraxia after stroke by using a delayed visual feedback detection task with three different conditions (tactile, passive movement, and active movement). The delay detection threshold and the probability curve for delay detection obtained in this task were quantitative indicators of the respective temporal integration functions. In addition, we performed subtraction and voxel-based lesion-symptom mapping to identify the brain lesions responsible for apraxia and deficits in visuo-motor temporal integration. The behavioral experiments showed that the delay detection threshold was extended and that the probability curve for delay detection was less steep in apraxic patients compared to controls (pseudo-apraxic patients and unaffected patients), only for the active movement condition, and not for the tactile and passive movement conditions. Furthermore, the severity of apraxia was significantly correlated with the delay detection threshold and the steepness of the probability curve in the active movement condition. These results indicated that multisensory (i.e., visual, tactile, and proprioception) feedback was normally temporally integrated, but motor prediction and visual feedback were not correctly temporally integrated in apraxic patients. That is, apraxic patients had difficulties with visuo-motor temporal integration. Lesion analyses revealed that both apraxia and the distortion of visuo-motor temporal integration were associated with lesions in the fronto-parietal motor network, including the left inferior parietal lobule and left inferior frontal gyrus. We suppose that damage to the left inferior fronto-parietal network could cause deficits in motor prediction for visuo-motor temporal integration, but not for sensory-sensory (visuo-tactile and visuo-proprioception) temporal integration, leading to the distortion of visuo-motor temporal integration in patients with apraxia.

Time-dependent decline of body-specific attention to the paretic limb in chronic stroke patients

OBJECTIVE

To examine whether reduced body-specific attention to a paretic limb is found in chronic stroke patients in a time-dependent manner.

METHODS

Twenty-one patients with chronic hemiparesis (10 left and 11 right hemiparesis) after subcortical stroke and 18 age-matched healthy controls were recruited in this study. Standard neuropsychological examinations showed no clear evidence of spatial neglect in any patient. In order to quantitatively measure spatial attention to the paretic hand, a visual detection task for detecting a target appearing on the surface of either a paretic or dummy hand was used. This task can measure the body facilitation effect, which makes faster detection of a target on the body compared with one far from the body.

RESULTS

In stroke patients, there was no difference in the reaction time for a visual target between the paretic and the dummy hands, while the healthy participants showed faster detection for the visual target on the real hand than on the dummy one. The index of the body facilitation effect, subtracting the reaction time for the target-on-paretic hand from that for the target-on-dummy one, was correlated with the duration since onset and with finger function test on the Stroke Impairment Assessment Set.

CONCLUSIONS

The reduction of the body facilitation effect in the paretic limb suggests the decline of body-specific attention to the paretic one in patients with chronic hemiparesis. This decline of body-specific attention, leading to neglect for the paretic limb, will be one of the most serious problems for rehabilitation based on use-dependent plasticity.

A "matched" sensory reference can guide goal-directed movements of the affected hand in central post-stroke sensory ataxia

Patients with central post-stroke sensory ataxia (CPSA) suffer from not only somatosensory dysfunction but also the ataxic movement disorder of the affected limb. These sensory and motor impairments possibly interfere each other, but such interference is still unclear. We evaluated smoothness of grasp movements in CPSA patients using a kinematic analysis, and verified the effect of somatosensory reference from the intact hand on grasp movements. Eight CPSA patients were enrolled. We recorded their reach-and-pinch movements of both affected and intact hands toward the tip of the 3-cm-diameter vertical bar, using a three-dimensional measurement system. When executing these movements of one hand, the patients simultaneously pinched the same diameter bar as the goal tip (matched-reference condition: Matched-Ref) or the 5-cm-diameter thicker bar (mismatched-reference condition: Mismatched-Ref) by the other hand. The normalized jerk index (i.e., movement smoothness) of the affected hand was disturbed compared with the intact hand. The kinematic data of the finger opening and closing phases were also disturbed. These disturbances were partially improved with Matched-Ref but not Mismatched-Ref of the intact hand. We successfully evaluated the features of CPSA, indicating that the somatosensory reference method could be useful for rehabilitation in sensory ataxia.

Cognitive and physical functions related to the level of supervision and dependence in the toileting of stroke patients

PURPOSE

This study aimed to clarify which cognitive and physical factors are associated with the need for toileting assistance in stroke patients and to calculate cut-off values for discriminating between independent supervision and dependent toileting ability.

METHOD

This cross-sectional study included 163 first-stroke patients in nine convalescent rehabilitation wards. Based on their FIM^Ⓡ instrument score for toileting, the patients were divided into an independent-supervision group and a dependent group. Multiple logistic regression analysis and receiver operating characteristic analysis were performed to identify factors related to toileting performance. The Minimental State Examination (MMSE); the Stroke Impairment Assessment Set (SIAS) score for the affected lower limb, speech, and visuospatial functions; and the Functional Assessment for Control of Trunk (FACT) were analyzed as independent variables.

RESULT

The multiple logistic regression analysis showed that the FIM^Ⓡ instrument score for toileting was associated with the SIAS score for the affected lower limb function, MMSE, and FACT. On receiver operating characteristic analysis, the SIAS score for the affected lower limb function cut-off value was 8/7 points, the MMSE cut-off value was 25/24 points, and the FACT cut-off value was 14/13 points.

CONCLUSION

Affected lower limb function, cognitive function, and trunk function were related with the need for toileting assistance. These cut-off values may be useful for judging whether toileting assistance is needed in stroke patients.

Clinical utility of the modified trunk impairment scale for stroke survivors

OBJECTIVE

The present study aimed to determine the discriminant power of the modified Trunk Impairment Scale (mTIS) in stroke survivors versus healthy adults.

DESIGN

Cross-sectional.

SETTING

Inpatient rehabilitation center.

PARTICIPANTS

Fifty-five subjects with stroke and 29 healthy adults.

METHODS

Subjects were examined using the mTIS, Berg Balance Scale, and Timed Up and Go test for balance; 5-m Walk Test and Functional Ambulation Category for gait; Fugl-Meyer Assessment for motor function; Postural Assessment Scale for Stroke-Trunk Control and Trunk Control Test for trunk control; and Modified Barthel Index for activities of daily living performance.

RESULTS

The mTIS results differed significantly between stroke survivors and healthy adults (p < 0.001). In addition, mTIS scores were significantly correlated with the Berg Balance Scale (r = 0.82), Timed Up and Go test (r = -0.70), 5-m Walk Test (r = 0.73), Functional Ambulation Category (r = 0.54), Fugl-Meyer Assessment (r = 0.37-0.80), Postural Assessment Scale for Stroke-Trunk Control and Trunk Control Test (r = 0.55-0.63), and Modified Barthel Index score (r = 0.56) results (p < 0.05-0.01). The mTIS also showed 66% influence on the Berg Balance Scale, 49% on the Timed Up and Go test, 53% on the 5-m Walk Test, 28% on the Functional Ambulation Category, 12% on the Fugl-Meyer Assessment-upper extremity, 64% on the Fugl-Meyer Assessment-lower extremity, and 30% on the Modified Barthel Index. The cutoff value of the mTIS for the Modified Barthel Index classification was >10.5 points, while the area under the curve had a moderate accuracy of 73%.

CONCLUSION

The mTIS can be used to examine the degree of trunk control or the level of trunk impairment, which is seen as a prerequisite for balance, gait, motor function, and activities of daily living performance in stroke survivors. Implications for Rehabilitation The modified Trunk Impairment Scale can be used as an assessment tool to classify the degree of trunk control or its level of impairment in stroke survivors. The modified Trunk Impairment Scale may have a favorable correlation with assessing physical functions such as balance, gait, motor function, and ADL in stroke survivors.

Clinical tools to measure trunk performance after stroke: a systematic review of the literature

Objective : To give a systematic review of clinical measurement scales used to assess trunk performance after stroke.

Data sources : The databases CINAHL, Cochrane, Pedro and PubMed were searched with the terms `sitting balance' plus `stroke' and `trunk' plus `stroke' mentioned in the title or abstract. Databases were searched from inception to January 2006.

Review methods : All articles were selected which reported or included a clinical measure of trunk performance used in an adult stroke population. Reference lists were searched as secondary sources of articles.

Results : A total of 458 articles resulted from the database search. Thirty-two articles were eligible for inclusion. Earlier studies mentioned ordinal single items or a combination of items which are part of a larger scale used to assess sitting balance as a derived measure of trunk performance. Three clinical tools were available which specifically evaluated trunk performance after stroke; the Trunk Control Test and two Trunk Impairment Scales.

Conclusion : Ordinal single items or subscales of existing larger scales lack a systematic evaluation of psychometric characteristics. Both Trunk Impairment Scales have been extensively examined. A comparative study assessing psychometric properties of the Trunk Control Test and two Trunk Impairment Scales could determine which should be the measure of choice when assessing trunk performance after stroke.

Feasibility of a self-rehabilitation program for the upper limb for stroke patients in Benin

INTRODUCTION

Stroke is a major cause of disability and represents a very high cost in developing countries. Self-rehabilitation programs represent a new and original treatment for stroke patients, likely to reduce upper limb impairments and improve activity and participation. The goal of this study is to evaluate the feasibility of a self-rehabilitation protocol in Benin.

METHODS

Twelve chronic stroke patients carried out the upper limb self-rehabilitation program (3 hours/day, 5 days/week for 2 weeks). The performance of these patients was evaluated before and after the self-rehabilitation program, by measuring the number of exercises that patients were able to achieve during a three-hour session, and by assessing their gross manual dexterity.

RESULTS

Twelve patients were effectively able to complete the entire program. The number of unimanual exercises and self-mobilizations performed during a three-hour session as well as the score of the Box and Block test were improved by the self-rehabilitation program (P<0.05).

DISCUSSION AND CONCLUSION

Self-rehabilitation programs are feasible and inexpensive as they do not involve a therapist. It is then a promising approach in stroke rehabilitation, particularly in developing countries, where rehabilitation costs are usually supported by patients.

Identification of the affected lower limb and unaffected side motor functions as determinants of activities of daily living performance in stroke patients using partial correlation analysis

[Purpose] This study aimed to clarify the independent impact of the affected upper and lower limb, trunk, and unaffected side motor functions on activities of daily living in stroke patients using partial correlation analysis. [Subjects and Methods] This retrospective study included 77 stroke patients. Motor functions were assessed using the Stroke Impairment Assessment Set, and the activities of daily living performance was assessed using the Barthel index or Functional Independence Measure. Further, simple and partial correlation analyses were conducted between each motor function and activities of daily living parameter. [Results] Simple correlation analysis identified significant positive correlations for each pair. In contrast, partial correlation analysis only identified significant positive correlations between the affected lower limb or unaffected side functions and the Barthel index or Functional Independence Measure. This discrepancy between the two tests was explained by the significant interaction between the affected upper and lower limb functions and between the trunk and unaffected side functions. [Conclusion] The present study identified the affected lower limb and unaffected side motor functions as the major determinants of activities of daily living performance in stroke patients. These findings suggest that rehabilitation programs can be improved by targeting these areas.

Changes in serum growth factors in stroke rehabilitation patients and their relation to hemiparesis improvement

Predicting recovery from hemiparesis after stroke is important for rehabilitation. A few recent studies reported that the levels of some growth factors shortly after stroke were positively correlated with the clinical outcomes during the chronic phase. The aim of this study was to examine the relationships between the serum levels of growth factors (vascular endothelial growth factor [VEGF], insulin-like growth factor-I [IGF-I], and hepatocyte growth factor [HGF]) and improvement in hemiparesis in stroke patients who received rehabilitation in a postacute rehabilitation hospital. Subjects were 32 stroke patients (cerebral infarction: 21 and intracerebral hemorrhage [ICH]: 11). We measured serum levels of VEGF, IGF-I, and HGF and 5 items of the Stroke Impairment Assessment Set (SIAS) for hemiparesis on admission and at discharge. Age-matched healthy subjects (n=15) served as controls. Serum levels of VEGF and HGF in cerebral infarct patients on admission were higher than those in control subjects, and the serum levels of IGF-I in stroke patients were lower than those in controls. The level of HGF in ICH patients on admission was negatively correlated with gains in SIAS, and higher outliers in HGF concentration were correlated with lower gains in SIAS. Focusing on the extremely high levels of these factors may be a predictor of the low recovery from hemiparesis after stroke.

The Canine Orthopedic Index. Step 2: Psychometric testing

OBJECTIVE

To perform psychometric testing an owner self-administered questionnaire, the Canine Orthopedic Index (COI), designed to assess outcome in dogs with orthopedic disease.

STUDY DESIGN

Original study.

SAMPLE POPULATION

Owners (n = 20) of dogs with osteoarthritis (OA) for item (question) pretesting, and 80 owners of dogs with OA for reliability and validity testing.

METHODS

Standard methodology for the stepwise development and testing of instruments designed to assess subjective states was followed. Items generated in previous studies were pretested for readability, ambiguity, and inter-item correlations; poorly performing items were removed; and the reduced set of items subjected to factor analysis, reliability, and validity testing.

RESULTS

Four factors were identified and named on the basis of the items contained in them: "Stiffness," "Gait," "Function," and "Quality of Life." Cronbach's α ranged from 0.76 to 0.86, suggesting the items in each factor could be assessed as a group to compute factor scores (i.e., stiffness, gait, function, and quality of life scores). The test-retest analysis revealed κ values from 0.68 to 0.80. Overall, the scores amongst the 4 factors correlated moderately well (r = 0.52-0.58), with a mild correlation (r = 0.35) between gait and function scores.

CONCLUSIONS

The COI is a psychometrically sound owner completed instrument that can assess 4 domains in dogs with OA: Stiffness, Gait, Function, and Quality of Life.