1
|
Abstract
BACKGROUND Previous systematic reviews and randomised controlled trials have investigated the effect of post-stroke trunk training. Findings suggest that trunk training improves trunk function and activity or the execution of a task or action by an individual. But it is unclear what effect trunk training has on daily life activities, quality of life, and other outcomes. OBJECTIVES To assess the effectiveness of trunk training after stroke on activities of daily living (ADL), trunk function, arm-hand function or activity, standing balance, leg function, walking ability, and quality of life when comparing with both dose-matched as non-dose-matched control groups. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register, CENTRAL, MEDLINE, Embase, and five other databases to 25 October 2021. We searched trial registries to identify additional relevant published, unpublished, and ongoing trials. We hand searched the bibliographies of included studies. SELECTION CRITERIA We selected randomised controlled trials comparing trunk training versus non-dose-matched or dose-matched control therapy including adults (18 years or older) with either ischaemic or haemorrhagic stroke. Outcome measures of trials included ADL, trunk function, arm-hand function or activity, standing balance, leg function, walking ability, and quality of life. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Two main analyses were carried out. The first analysis included trials where the therapy duration of control intervention was non-dose-matched with the therapy duration of the experimental group and the second analysis where there was comparison with a dose-matched control intervention (equal therapy duration in both the control as in the experimental group). MAIN RESULTS: We included 68 trials with a total of 2585 participants. In the analysis of the non-dose-matched groups (pooling of all trials with different training duration in the experimental as in the control intervention), we could see that trunk training had a positive effect on ADL (standardised mean difference (SMD) 0.96; 95% confidence interval (CI) 0.69 to 1.24; P < 0.001; 5 trials; 283 participants; very low-certainty evidence), trunk function (SMD 1.49, 95% CI 1.26 to 1.71; P < 0.001; 14 trials, 466 participants; very low-certainty evidence), arm-hand function (SMD 0.67, 95% CI 0.19 to 1.15; P = 0.006; 2 trials, 74 participants; low-certainty evidence), arm-hand activity (SMD 0.84, 95% CI 0.009 to 1.59; P = 0.03; 1 trial, 30 participants; very low-certainty evidence), standing balance (SMD 0.57, 95% CI 0.35 to 0.79; P < 0.001; 11 trials, 410 participants; very low-certainty evidence), leg function (SMD 1.10, 95% CI 0.57 to 1.63; P < 0.001; 1 trial, 64 participants; very low-certainty evidence), walking ability (SMD 0.73, 95% CI 0.52 to 0.94; P < 0.001; 11 trials, 383 participants; low-certainty evidence) and quality of life (SMD 0.50, 95% CI 0.11 to 0.89; P = 0.01; 2 trials, 108 participants; low-certainty evidence). Non-dose-matched trunk training led to no difference for the outcome serious adverse events (odds ratio: 7.94, 95% CI 0.16 to 400.89; 6 trials, 201 participants; very low-certainty evidence). In the analysis of the dose-matched groups (pooling of all trials with equal training duration in the experimental as in the control intervention), we saw that trunk training had a positive effect on trunk function (SMD 1.03, 95% CI 0.91 to 1.16; P < 0.001; 36 trials, 1217 participants; very low-certainty evidence), standing balance (SMD 1.00, 95% CI 0.86 to 1.15; P < 0.001; 22 trials, 917 participants; very low-certainty evidence), leg function (SMD 1.57, 95% CI 1.28 to 1.87; P < 0.001; 4 trials, 254 participants; very low-certainty evidence), walking ability (SMD 0.69, 95% CI 0.51 to 0.87; P < 0.001; 19 trials, 535 participants; low-certainty evidence) and quality of life (SMD 0.70, 95% CI 0.29 to 1.11; P < 0.001; 2 trials, 111 participants; low-certainty evidence), but not for ADL (SMD 0.10; 95% confidence interval (CI) -0.17 to 0.37; P = 0.48; 9 trials; 229 participants; very low-certainty evidence), arm-hand function (SMD 0.76, 95% CI -0.18 to 1.70; P = 0.11; 1 trial, 19 participants; low-certainty evidence), arm-hand activity (SMD 0.17, 95% CI -0.21 to 0.56; P = 0.38; 3 trials, 112 participants; very low-certainty evidence). Trunk training also led to no difference for the outcome serious adverse events (odds ratio (OR): 7.39, 95% CI 0.15 to 372.38; 10 trials, 381 participants; very low-certainty evidence). Time post stroke led to a significant subgroup difference for standing balance (P < 0.001) in non-dose-matched therapy. In non-dose-matched therapy, different trunk therapy approaches had a significant effect on ADL (< 0.001), trunk function (P < 0.001) and standing balance (< 0.001). When participants received dose-matched therapy, analysis of subgroup differences showed that the trunk therapy approach had a significant effect on ADL (P = 0.001), trunk function (P < 0.001), arm-hand activity (P < 0.001), standing balance (P = 0.002), and leg function (P = 0.002). Also for dose-matched therapy, subgroup analysis for time post stroke resulted in a significant difference for the outcomes standing balance (P < 0.001), walking ability (P = 0.003) and leg function (P < 0.001), time post stroke significantly modified the effect of intervention. Core-stability trunk (15 trials), selective-trunk (14 trials) and unstable-trunk (16 trials) training approaches were mostly applied in the included trials. AUTHORS' CONCLUSIONS There is evidence to suggest that trunk training as part of rehabilitation improves ADL, trunk function, standing balance, walking ability, upper and lower limb function, and quality of life in people after stroke. Core-stability, selective-, and unstable-trunk training were the trunk training approaches mostly applied in the included trials. When considering only trials with a low risk of bias, results were mostly confirmed, with very low to moderate certainty, depending on the outcome.
Collapse
Affiliation(s)
- Liselot Thijs
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Eline Voets
- Department of Neurorehabilitation, KU Leuven, Leuven, Belgium
| | - Stijn Denissen
- AIMS lab, Center for Neurosciences, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
- icometrix, Leuven, Belgium
| | - Jan Mehrholz
- Department of Public Health, Dresden Medical School, Technical University Dresden, Dresden, Germany
| | - Bernhard Elsner
- Department of Public Health, Dresden Medical School, Technical University Dresden, Dresden, Germany
| | - Robin Lemmens
- Department of Neurosciences, Experimental Neurology, KU Leuven, Leuven, Belgium
- Center for Brain & Disease Research, Laboratory of Neurobiology, VIB, Leuven, Belgium
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | | |
Collapse
|
2
|
Zhang S, Liu D, Tian E, Wang J, Guo Z, Kong W. Central vestibular dysfunction: don't forget vestibular rehabilitation. Expert Rev Neurother 2022; 22:669-680. [PMID: 35912850 DOI: 10.1080/14737175.2022.2106129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Vestibular rehabilitation (VR) is now a subject of active studies and has been shown to be effective for multiple vestibular disorders, peripheral or central. VR is a physical therapy that helps train the central nervous system to compensate for vestibular dysfunction. There is moderate to strong evidence that VR is safe and effective for the management of peripheral vestibular dysfunction. Nonetheless, the studies on how VR works on central vestibular dysfunction remains scanty. AREAS COVERED This article addressed the rehabilitation strategies and possible mechanisms, including how central vestibular function might improve upon rehabilitation. In addition, it provides some examples concerning the effect of VR on central vestibular dysfunction. EXPERT OPINION VR works on the vestibular system through repetition of specific physical exercises that activate central neuroplastic mechanisms to achieve adaptive compensation of the impaired functions. VR has become a mainstay in the management of patients with dizziness and balance dysfunction. Individualized VR programs are a safe and effective treatment option for a large percentage of patients with central vestibular disease reporting imbalance and dizziness. Exploration of various treatment strategies and possible mechanisms will help develop the best and personalized VR treatment for patients with central vestibular dysfunction.
Collapse
Affiliation(s)
- Sulin Zhang
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China.,Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China
| | - Dan Liu
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China
| | - E Tian
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China
| | - Jun Wang
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China
| | - Zhaoqi Guo
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China
| | - Weijia Kong
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China.,Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China.,Key Laboratory of Neurological Disorders of Education Ministry, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei, China
| |
Collapse
|
3
|
Lee D, Bae Y. Interactive Videogame Improved Rehabilitation Motivation and Walking Speed in Chronic Stroke Patients: A Dual-Center Controlled Trial. Games Health J 2022; 11:268-274. [PMID: 35648053 DOI: 10.1089/g4h.2021.0123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objective: This study aimed to evaluate the effectiveness of interactive video games (IVGs) in rehabilitation motivation and walking and balance abilities in chronic stroke patients. Materials and Methods: In this dual-center controlled trial, 24 chronic stroke patients from rehabilitation centers A and B were randomly assigned to an experimental (IVGs + traditional neurodevelopment treatment [TNT], n = 12) or a control group (walking training + TNT, n = 12). The patients in both the groups underwent TNT for 4 weeks (5 days/week) before undergoing either IVGs or walking training (4 weeks, 3 days/week) depending on the group. The primary and secondary outcomes were rehabilitation motivation and the Berg Balance Scale (BBS) score, Functional Reach Test (FRT) performance, and walking speed (WS), respectively. Results: The patients in both the groups showed significant increase in the BBS score, FRT performance, and WS; however, the experimental group showed more significant improvements in rehabilitation motivation (P = 0.02, η2 = 0.415) and WS (P = 0.05, η2 = 0.333) than the patients in the control group. Conclusion: This study suggests that the IVGs in combination with TNT provide effective rehabilitation motivation in chronic stroke patients. Clinical Trial Registration number: KCT0003408.
Collapse
Affiliation(s)
- Daegyun Lee
- Department of Physical Therapy, Mokdong Hyundae Clinic, Seoul, Republic of Korea
| | - Youngsook Bae
- Department of Physical Therapy, College of Health Science, Gachon University, Incheon, Republic of Korea
| |
Collapse
|
4
|
Nam SM, Lee DY. Effects of Visual Cue Deprivation Balance Training with Head Control on Balance and Gait Function in Stroke Patients. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:629. [PMID: 35630046 PMCID: PMC9148052 DOI: 10.3390/medicina58050629] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/28/2022] [Accepted: 04/29/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Visual cue deprivation is the instability of head control is increased. The purpose of this study is to investigate the effects of visual cue deprivation balance training by applying head control feedback to the balance and gait ability of stroke patients. Materials and Methods: The study was conducted on 41 patients diagnosed with hemiplegia due to stroke. Subjects were randomly assigned to any of the following groups: the experimental group I, the experimental group II or the control group. The randomization method used a simple randomization method. To evaluate changes in balance function, a LOS (Limit of Stability) and a BBS (Berg Balance Scale) were performed. In addition, to evaluate changes in ST (stride time), SL (stride length), and cadence, a LEGSys were performed. Results: A two-way repeated ANOVA was conducted to analyze the differences between groups. There were significant differences between groups in all variables for the balance function. There were significant differences between groups in all variables for the balance function. There were significant differences between groups in SL and cadence for the gait function. Conclusions: Visual cue deprivation balance training applying head control feedback is effective in improving dynamic balance ability and cadence. It is necessary to constantly maintain the head orientation by feedback and to properly control the head movement.
Collapse
Affiliation(s)
- Seung-Min Nam
- Department of Sports Rehabilitation & Exercise Management, Yeungnam University College, Daegu-si 42415, Korea;
| | - Do-Youn Lee
- Department of Physical Therapy, Daegu University, Gyeongsan-si 38541, Korea
| |
Collapse
|
5
|
Pathak A, Gyanpuri V, Dev P, Dhiman NR. The Bobath Concept (NDT) as rehabilitation in stroke patients: A systematic review. J Family Med Prim Care 2021; 10:3983-3990. [PMID: 35136756 PMCID: PMC8797128 DOI: 10.4103/jfmpc.jfmpc_528_21] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 07/03/2021] [Accepted: 07/19/2021] [Indexed: 11/15/2022] Open
Abstract
Background and Objectives: The Bobath approach, also known as neurodevelopmental treatment (NDT), is a widely used concept in the rehabilitation of stroke patients with hemiparesis in many countries. This technique is being used since years all over the world; however, strong evidence of its usefulness is still not present. This review is aimed to find out its effectiveness based on the randomized controlled trials in the rehabilitation of stroke patients with motor disability and to compare it with other therapeutic techniques. Materials and Methods: A systematic literature search on PubMed Central, Science-Direct, Cochrane, Scopus, Clinical Trial Database, and Indian Clinical Trial Registry in English till 31st July 2021 was undertaken. The review is published in Prospective Register of Systematic Reviews (PROSPERO) with registration number “CRD42019125400.” Physiotherapy Evidence-based Database (PEDro) score has been used for the quality assessment of the studies. Randomized clinical trials that studied the comparative effect of the NDT/Bobath concept on motor activity outcomes and cognition/behavior in stroke patients in comparison with other rehabilitative techniques were included. Results: No strong documentation describing the effectiveness of this neuro-developmental treatment or its supporting neuro-developmental treatment in comparison with other advanced neuro-physiotherapeutic techniques has been found so as to consider it as the recommended treatment for post-stroke hemiplegia/hemiparesis. Methodological aspects of selected studies for further research are suggested. Interpretation and Conclusions: This study is inconclusive in determining the effectiveness of the Bobath approach for the movement rehabilitation of stroke patients. These results are similar to the results of previous reviews done on the same topic.
Collapse
Affiliation(s)
- Abhishek Pathak
- Department of Neurology, Institute of Medical Sciences, Banaras Hindu University, Varanasi-UP, India
| | - Vyom Gyanpuri
- Department of Orthopedics, Institute of Medical Sciences, Banaras Hindu University, Varanasi-UP, India
| | - Priya Dev
- Department of Neurology, Institute of Medical Sciences, Banaras Hindu University, Varanasi-UP, India
| | - Neetu Rani Dhiman
- Department of Neurology, Institute of Medical Sciences, Banaras Hindu University, Varanasi-UP, India
| |
Collapse
|
6
|
Multisensory Exercise Improves Balance in People with Balance Disorders: A Systematic Review. Curr Med Sci 2021; 41:635-648. [PMID: 34403086 DOI: 10.1007/s11596-021-2417-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/04/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To examine the effect of multisensory exercise on balance disorders. METHODS PubMed, Scopus and Web of Science were searched to identify eligible studies published before January 1, 2020. Eligible studies included randomized control trials (RCTs), non-randomized studies, case-control studies, and cohort studies. The methodological quality of the included studies was evaluated using JBI Critical Appraisal Checklists for RCTs and for Quasi-Experimental Studies by two researchers independently. A narrative synthesis of intervention characteristics and health-related outcomes was performed. RESULTS A total of 11 non-randomized studies and 9 RCTs were eligible, including 667 participants. The results supported our assumption that multisensory exercise improved balance in people with balance disorders. All of the 20 studies were believed to be of high or moderate quality. CONCLUSION Our study confirmed that multisensory exercise was effective in improving balance in people with balance disorders. Multisensory exercises could lower the risk of fall and enhance confidence level to improve the quality of life. Further research is needed to investigate the optimal strategy of multisensory exercises and explore the underlying neural and molecular mechanisms of balance improvement brought by multisensory exercises.
Collapse
|
7
|
Forster A, Ozer S, Crocker TF, House A, Hewison J, Roberts E, Dickerson J, Carter G, Hulme C, Fay M, Richardson G, Wright A, McKevitt C, McEachan R, Foy R, Barnard L, Moreau L, Prashar A, Clarke D, Hardicre N, Holloway I, Brindle R, Hall J, Burton LJ, Atkinson R, Hawkins RJ, Brown L, Cornwall N, Dawkins B, Meads D, Schmitt L, Fletcher M, Speed M, Grenfell K, Hartley S, Young J, Farrin A. Longer-term health and social care strategies for stroke survivors and their carers: the LoTS2Care research programme including cluster feasibility RCT. PROGRAMME GRANTS FOR APPLIED RESEARCH 2021. [DOI: 10.3310/pgfar09030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
It is reported that the longer-term outcomes for stroke survivors are poor, with a range of unmet needs identified.
Objectives
The aims were to develop and test a longer-term stroke care strategy focused on improving the quality of life of stroke survivors and their carers by addressing unmet needs, and maintenance and enhancement of participation (i.e. involvement in life situations).
Design
Five overlapping workstreams were undertaken – (1) refinement of content by semistructured interviews with stroke survivors and their carers and by a review of the literature to inform content and delivery of the care strategy; (2) exploration of service models by national survey and focus groups with purposely selected services; (3) intervention development by interaction with a reference group of stroke survivors, carers, and health and social care professionals; (4) refinement and pilot implementation of the developed intervention in three stroke services (case studies); and (5) a cluster randomised controlled feasibility trial in 10 stroke services across England and Wales.
Setting
The intervention development work and feasibility trial were in stroke services (inclusive of primary, secondary, community and social care provision) across England and Wales.
Participants
Participants were stroke survivors resident in the community and their carers, and health and social care professionals in the included stroke services.
Data sources
Interviews with 28 stroke survivors and their carers at least 9 months post stroke ascertained their needs and the barriers to and facilitators of addressing those needs. Additional literature reviews identified 23 needs. No evidence-based interventions to address these needs were reported; self-management was highlighted as a possible delivery mechanism. In workstream 2, a national survey revealed that the most common model of stroke service provision was care up to 12 months post stroke, reported by 46 (40%) services. Thirty-five (30%) services provided care up to 6 months post stroke and 35 (30%) provided care beyond 12 months, thus identifying 6 months post stroke as an appropriate delivery point for a new intervention. Through focus groups in a range of services, stroke survivors’ perceived unmet needs and the barriers to and enablers of service provision were identified.
Intervention
Using information obtained in workstreams 1 and 2 and working closely with a stakeholder reference group, we developed an intervention based on the unmet needs prioritised by stroke survivors and their carers (workstream 3). In workstream 4, action groups (clinicians, stroke survivors and researchers) were established in three stroke services that led implementation in their service and contributed to the iterative refinement of the intervention, associated training programme and implementation materials. The intervention (called New Start) was delivered at 6 months post stroke. Key components were problem-solving self-management with survivors and carers, help with obtaining usable information, and helping survivors and their carers build sustainable, flexible support networks.
Results
A cluster randomised feasibility trial (workstream 5) was successfully implemented in 10 stroke services across England and Wales, with associated process and health economic evaluations. Five services were randomised to provide New Start, while five continued with usual care; 269 participants were recruited. Progression criteria – in terms of our pre-determined (red, amber, green) criteria for progress to a full trial: target stroke survivor recruitment rates were achieved, on average, across sites (24.1 per site over 6 months, green); 216 (80.3%) registered stroke survivors returned follow-up questionnaires at 9 months (84.1% in the intervention arm and 75.8% in the usual care arm, green); according to data reported by sites, overall, 95.2% of registered stroke survivors were offered at least one session of the intervention (green); all five intervention sites had at least two facilitators deemed competent, delivered the New Start intervention and provided it to stroke survivors (green). However, at some sites, there were concerns regarding the number of stroke survivors being offered, accepting and receiving the intervention. Only small differences in outcomes and costs were observed between the New Start and usual care groups, and considerable uncertainty around the cost-effectiveness remains.
Conclusions
We report a complex programme of work that has described the longer-term needs of stroke survivors and highlighted evidence and service gaps. Working closely with stroke survivors, an intervention was developed that has been refined in three services and feasibility tested in a cluster randomised controlled trial. Further refinement of the target population and optimisation of the intervention materials is required prior to a full randomised controlled trial evaluation.
Future work
Optimisation of the intervention, and clearer specification of recipients, are required prior to a full trial evaluation.
Trial registration
Current Controlled Trials ISRCTN38920246.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 9, No. 3. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Anne Forster
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
- Academic Unit for Ageing and Stroke Research, University of Leeds, Leeds, UK
| | - Seline Ozer
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Thomas F Crocker
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Allan House
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
| | - Jenny Hewison
- Division of Health Services Research, School of Medicine, University of Leeds, Leeds, UK
| | | | - Josie Dickerson
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Gill Carter
- Patient and public involvement contributor, York, UK
| | - Claire Hulme
- College of Medicine and Health, University of Exeter, Exeter, UK
- Academic Unit of Health Economics, School of Medicine, University of Leeds, Leeds, UK
| | | | | | - Alan Wright
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Christopher McKevitt
- School of Population Health & Environmental Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, UK
| | - Rosemary McEachan
- Born in Bradford, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Robbie Foy
- Division of Primary Care, Palliative Care and Public Health, School of Medicine, University of Leeds, Leeds, UK
| | - Lorna Barnard
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Lauren Moreau
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Arvin Prashar
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - David Clarke
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
- Academic Unit for Ageing and Stroke Research, University of Leeds, Leeds, UK
| | - Natasha Hardicre
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Ivana Holloway
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Richard Brindle
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Jessica Hall
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Louisa-Jane Burton
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Ross Atkinson
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Rebecca J Hawkins
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
- Academic Unit for Ageing and Stroke Research, University of Leeds, Leeds, UK
| | - Lesley Brown
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Nicola Cornwall
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Bryony Dawkins
- Academic Unit of Health Economics, School of Medicine, University of Leeds, Leeds, UK
| | - David Meads
- Academic Unit of Health Economics, School of Medicine, University of Leeds, Leeds, UK
| | - Laetitia Schmitt
- Academic Unit of Health Economics, School of Medicine, University of Leeds, Leeds, UK
| | - Marie Fletcher
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Michael Speed
- Patient and public involvement contributor, York, UK
| | - Katie Grenfell
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Suzanne Hartley
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - John Young
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Amanda Farrin
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| |
Collapse
|
8
|
Dai S, Piscicelli C, Lemaire C, Christiaens A, de Schotten MT, Hommel M, Krainik A, Detante O, Pérennou D. Recovery of balance and gait after stroke is deteriorated by confluent white matter hyperintensities: Cohort study. Ann Phys Rehabil Med 2021; 65:101488. [PMID: 33450367 DOI: 10.1016/j.rehab.2021.101488] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 12/23/2020] [Accepted: 12/27/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND White matter hyperintensities (WMHs) are well known to affect post-stroke disability, mainly by cognitive impairment. Their impact on post-stroke balance and gait disorders is unclear. OBJECTIVES We aimed to test the hypothesis that WMHs would independently deteriorate post-stroke balance and gait recovery. METHODS This study was performed in 210 individuals of the cohort Determinants of Balance Recovery After Stroke (DOBRAS), consecutively enrolled after a first-ever hemisphere stroke. Clinical data were systematically collected on day 30±3 (D30) post-stroke and at discharge from the rehabilitation ward. WMHs were searched on MRI, graded with the Fazekas scale, and dichotomized as no/mild (absence/sparse) or moderate/severe (confluent). The primary endpoint was the recovery of the single limb stance, assessed with the Postural Assessment Scale for Stroke (PASS). The secondary endpoint was the recovery of independent gait, assessed with the modified Fugl-Meyer Gait Assessment (mFMA). The adjusted hazard ratios (aHRs) of achievements of these endpoints by level of WMHs were estimated by using Cox models, accounting for other relevant clinical and imaging factors. RESULTS Individuals with moderate/severe WMHs (n=86, 41%) had greater balance and gait disorders and were more often fallers than others (n=124, 59%). Overall, they had worse and slower recovery of single limb stance and independent gait (p<0.001). Moderate/severe WMHs was the most detrimental factor for recovery of balance (aHR 0.46, 95% confidence interval [CI] 0.32-0.68, p<0.001) and gait (0.51, 0.35-0.74, p<0.001), along with age, stroke severity, lesion volume and disrupted corticospinal tract. With cerebral infarct, endovascular treatments had an independent positive effect, both on the recovery of balance (aHR 1.65, 95% CI 1.13-2.4, p=0.009) and gait (1.78, 1.24-2.55, p=0.002). CONCLUSIONS WMHs magnify balance and gait disorders after stroke and worsen their recovery. They should be better accounted for in post-stroke rehabilitation, especially to help establish a prognosis of mobility. ClinicalTrials.gov registration: NCT03203109.
Collapse
Affiliation(s)
- Shenhao Dai
- Neurorehabilitation Department, Institute of Rehabilitation, Grenoble Alpes University Hospital, 38434 Echirolles, France; Laboratoire de Psychologie et NeuroCognition, UMR CNRS 5105, Univ. Grenoble Alpes, Grenoble, France; Inserm, U 1216, Grenoble, France
| | - Céline Piscicelli
- Neurorehabilitation Department, Institute of Rehabilitation, Grenoble Alpes University Hospital, 38434 Echirolles, France; Laboratoire de Psychologie et NeuroCognition, UMR CNRS 5105, Univ. Grenoble Alpes, Grenoble, France; Inserm, U 1216, Grenoble, France
| | - Camille Lemaire
- Neurorehabilitation Department, Institute of Rehabilitation, Grenoble Alpes University Hospital, 38434 Echirolles, France; Laboratoire de Psychologie et NeuroCognition, UMR CNRS 5105, Univ. Grenoble Alpes, Grenoble, France; Inserm, U 1216, Grenoble, France
| | - Adélie Christiaens
- Neurorehabilitation Department, Institute of Rehabilitation, Grenoble Alpes University Hospital, 38434 Echirolles, France; Laboratoire de Psychologie et NeuroCognition, UMR CNRS 5105, Univ. Grenoble Alpes, Grenoble, France; Inserm, U 1216, Grenoble, France
| | - Michel Thiebaut de Schotten
- Brain Connectivity and Behaviour Laboratory, Sorbonne Universities, 75013 Paris, France; Groupe d'Imagerie Neurofonctionnelle, Institut des Maladies Neurodégénératives-UMR 5293, CNRS, CEA University of Bordeaux, 33000 Bordeaux, France; Inserm, U 1216, Grenoble, France
| | - Marc Hommel
- Stroke Unit, Neurology Department, Grenoble Alpes University Hospital, 38043 Grenoble, France; Univ. Grenoble Alpes, AGEIS EA 7407, Grenoble, France; Inserm, U 1216, Grenoble, France
| | - Alexandre Krainik
- Department of Neuroradiology, Grenoble Alpes University Hospital, 38043 Grenoble, France; Univ. Grenoble Alpes, Inserm, CNRS, Grenoble Alpes University Hospital, IRMaGe, 38043 Grenoble, France; Inserm, U 1216, Grenoble, France
| | - Olivier Detante
- Stroke Unit, Neurology Department, Grenoble Alpes University Hospital, 38043 Grenoble, France; Univ. Grenoble Alpes, Grenoble Institute of Neurosciences, 38042 Grenoble, France; Inserm, U 1216, Grenoble, France
| | - Dominic Pérennou
- Neurorehabilitation Department, Institute of Rehabilitation, Grenoble Alpes University Hospital, 38434 Echirolles, France; Laboratoire de Psychologie et NeuroCognition, UMR CNRS 5105, Univ. Grenoble Alpes, Grenoble, France; Inserm, U 1216, Grenoble, France.
| |
Collapse
|
9
|
Scrivener K, Dorsch S, McCluskey A, Schurr K, Graham PL, Cao Z, Shepherd R, Tyson S. Bobath therapy is inferior to task-specific training and not superior to other interventions in improving lower limb activities after stroke: a systematic review. J Physiother 2020; 66:225-235. [PMID: 33069609 DOI: 10.1016/j.jphys.2020.09.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 09/01/2020] [Accepted: 09/21/2020] [Indexed: 12/23/2022] Open
Abstract
QUESTION In adults with stroke, does Bobath therapy improve lower limb activity performance, strength or co-ordination when compared with no intervention or another intervention? DESIGN Systematic review of randomised trials with meta-analyses. PARTICIPANTS Adults after stroke. INTERVENTION Bobath therapy compared with another intervention or no intervention. OUTCOME MEASURES Lower limb activity performance (eg, sit to stand, walking, balance), lower limb strength and lower limb co-ordination. Trial quality was assessed using the PEDro scale. RESULTS Twenty-two trials were included in the review and 17 in the meta-analyses. The methodological quality of the trials varied, with PEDro scale scores ranging from 2 to 8 out of 10. No trials compared Bobath therapy to no intervention. Meta-analyses estimated the effect of Bobath therapy on lower limb activities compared with other interventions, including: task-specific training (nine trials), combined interventions (four trials), proprioceptive neuromuscular facilitation (one trial) and strength training (two trials). The pooled data indicated that task-specific training has a moderately greater benefit on lower limb activities than Bobath therapy (SMD 0.48), although the true magnitude of the benefit may be substantially larger or smaller than this estimate (95% CI 0.01 to 0.95). Bobath therapy did not clearly improve lower limb activities more than a combined intervention (SMD -0.06, 95% CI -0.73 to 0.61) or strength training (SMD 0.35, 95% CI -0.37 to 1.08). In one study, Bobath therapy was more effective than proprioceptive neuromuscular facilitation for improving standing balance (SMD -1.40, 95% CI -1.92 to -0.88), but these interventions did not differ on any other outcomes. Bobath therapy did not improve strength or co-ordination more than other interventions. CONCLUSIONS Bobath therapy was inferior to task-specific training and not superior to other interventions, with the exception of proprioceptive neuromuscular facilitation. Prioritising Bobath therapy over other interventions is not supported by current evidence. REGISTRATION PROSPERO CRD42019112451.
Collapse
Affiliation(s)
| | - Simone Dorsch
- Faculty of Health Sciences, Australian Catholic University, Australia; The StrokeEd Collaboration, Sydney, Australia
| | - Annie McCluskey
- The StrokeEd Collaboration, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Karl Schurr
- The StrokeEd Collaboration, Sydney, Australia
| | - Petra L Graham
- Centre for Economic Impacts of Genomic Medicine (GenIMPACT), Macquarie University, Sydney, Australia
| | | | - Roberta Shepherd
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Sarah Tyson
- School of Health Sciences, University of Manchester, Manchester, UK
| |
Collapse
|
10
|
Ha SY, Sung YH. Effects of Fresnel prism glasses on balance and gait in stroke patients with hemiplegia: A randomized controlled trial pilot study. Technol Health Care 2020; 28:625-633. [PMID: 32280072 DOI: 10.3233/thc-191973] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Fresnel prism shifts the field of view and converts object position in space, but its effect on stroke patients without unilateral neglect has not been examined. OBJECTIVE We aimed to investigate the effect of Fresnel prism glasses on balance and gait in stroke patients with hemiplegia. METHODS This study included 17 stroke patients with hemiplegia without unilateral neglect. Balance and gait training were applied in the control group (n= 9), and Fresnel prism glasses were applied with balance and gait training in the experimental group (n= 8). In all groups, interventions were done for 30 min/day for 5 times/week for 4 weeks. Motor-free visual perception test for visual perception (MVPT), Berg Balance Scale (BBS), and functional reach test (FRT) for dynamic balance ability, and gait were performed. Measurements were done before and after interventions. RESULTS MVPT showed no significant difference between the groups (p> 0.05). A significant increase in BBS and FRT results was found before and after interventions in the experimental group (p< 0.05). Gait variables showed significant difference in the experimental group (p< 0.05). CONCLUSION Fresnel prism glasses may effectively improve dynamic balance and gait functions by shifting body weight to the affected side of stroke patients with hemiplegia without vision loss.
Collapse
Affiliation(s)
- Sun-Young Ha
- Department of Physical Therapy, Graduate School, Kyungnam University, Korea
| | - Yun-Hee Sung
- Department of Physical Therapy, Graduate School, Kyungnam University, Korea.,Department of Physical Therapy, College of Health Sciences, Kyungnam University, Korea
| |
Collapse
|
11
|
Miyata K, Hasegawa S, Iwamoto H, Otani T, Kaizu Y, Shinohara T, Usuda S. Comparing the measurement properties and relationship to gait speed recovery of the Mini-Balance Evaluation Systems Test and the Berg Balance Scale in ambulatory individuals with subacute stroke. Phys Ther Res 2020; 23:72-78. [PMID: 32850282 DOI: 10.1298/ptr.e10004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 12/09/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Although the Mini-Balance Evaluation Systems Test (Mini-BESTest) is known to be a reliable and valid measure of balance in individuals with stroke, the utility of this tool in relation to subacute stroke walking speed and the recovery of gait ability has not been explored. Here, we compared the measurement properties and their relationship to gait speed on the Mini-BESTest and the Berg Balance Scale (BBS) in middle and older ambulatory individuals with subacute stroke, and we investigated which balance assessment tool is more likely to capture the status of the recovery of gait speed. METHODS We retrospectively analyzed the cases of 88 individuals 50 years or older with stroke who had been evaluated using the Mini-BESTest by using the BBS and by assessing their comfortable walking speed (CWS). The proportion of subjects who showed improvement was calculated for 34 stroke survivors from data obtained at admission to and discharge from the hospital. RESULTS Compared with the BBS, the Mini-BESTest showed a better distribution of total scores without a ceiling effect. The two scales showed correlations with gait speed (Mini-BESTest: r=0.702; BBS: r=0.592) and discrimination between fast and slow walkers. The responsiveness of the Mini-BESTest was excellent, with an area under the curve of 0.894, thus discriminating between gait speed improvement versus non-improvement. CONCLUSIONS These results indicate that the Mini-BESTest is more useful than the BBS in terms of its measurement properties and ability to measure gait recovery in middle and older ambulatory individuals with subacute stroke.
Collapse
Affiliation(s)
- Kazuhiro Miyata
- Department of Physical Therapy, Ibaraki Prefectural University of Health Science
| | - Satoshi Hasegawa
- Department of Rehabilitation, Public Nanokaichi Hospital.,Department of Rehabilitation Sciences, Gunma University Graduate School of Health Sciences
| | - Hiroki Iwamoto
- Department of Rehabilitation Centre, Hidaka Rehabilitation Hospital
| | | | - Yoichi Kaizu
- Department of Rehabilitation Sciences, Gunma University Graduate School of Health Sciences.,Department of Rehabilitation Centre, Hidaka Hospital
| | - Tomoyuki Shinohara
- Department of Physical Therapy, Faculty of Health Care, Takasaki University of Health and Welfare
| | - Shigeru Usuda
- Department of Rehabilitation Sciences, Gunma University Graduate School of Health Sciences
| |
Collapse
|
12
|
Harro CC, Kelch A, Hargis C, DeWitt A. Comparing Balance Performance on Force Platform Measures in Individuals with Parkinson's Disease and Healthy Adults. PARKINSON'S DISEASE 2018; 2018:6142579. [PMID: 30687494 PMCID: PMC6304814 DOI: 10.1155/2018/6142579] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 10/23/2018] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Postural instability is a known contributing factor to balance dysfunction and increased fall risk in those with Parkinson's disease (PD). Computerized posturography employing a force platform system provides objective, quantitative assessments of postural control impairments. This study examines balance performance as measured by force platform (FP) tests in persons with PD compared to age-matched healthy adults. Secondarily, we examine if these FP measures provide diagnostic and clinically meaningful information about the underlying balance impairments in the PD population. METHODS Participants-42 individuals with PD (Hoehn and Yahr stage = 2.33 ± 0.77) and 55 age-matched healthy adults-were assessed on three standardized balance measures on a computerized force platform system. Between groups, comparisons of FP performance were analyzed using independent t-test. Within the group, comparisons for the PD cohort were analyzed using ANOVA for comparing disease stage and Mann-Whitney U test for PD subtypes. RESULTS The PD cohort demonstrated significantly greater postural instability on the sensory organization test (SOT) measures (P=0.013, CI-95% = 1.286 to 10.37) and slower movement velocity on the limits of stability (LOS) test (P=0.001, CI-95% = 0.597 to 1.595) than the healthy cohort, suggesting that these tests were sensitive to detect sensory integration and voluntary postural control deficits in the PD cohort. Within the PD group, the SOT differentiated between H&Y stages 1-3. The motor control test (MCT) detected changes in reactive postural control mainly in later disease stages. All three FP tests distinguished between PD subtypes, with the Posture Gait Instability subtype demonstrating poorer balance performance than Tremor Dominant subtype. CONCLUSION These findings suggest FP measures provide clinically meaningful, diagnostic information in the examination of balance impairments in individuals with PD. FP measures may inform clinicians regarding intrinsic balance deficits and guide them in designing targeted balance interventions to reduce fall risk in persons with PD.
Collapse
Affiliation(s)
- Cathy C. Harro
- Assistance Professor, Physical Therapy, College of Health Professions, Grand Valley State University, Cook DeVos Center for Health Sciences, 301 Michigan Street NE, Suite 268, Grand Rapids, MI 49503, USA
| | - Amanda Kelch
- Mary Free Bed Rehabilitation Hospital, 235 Wealthy Street SE, Grand Rapids, MI 49503, USA
| | - Cora Hargis
- Mary Free Bed Rehabilitation Hospital, 235 Wealthy Street SE, Grand Rapids, MI 49503, USA
| | - Abigail DeWitt
- PT Solutions, 1321 Tusculum Blvd., Greeneville, TN 37743, USA
| |
Collapse
|
13
|
Rod and frame test and posture under optokinetic stimulation used to explore two complementary aspects of the visual influence in postural control after stroke. Gait Posture 2017; 58:171-175. [PMID: 28783558 DOI: 10.1016/j.gaitpost.2017.07.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 07/09/2017] [Accepted: 07/11/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Balance rehabilitation should consider individual comportments according to visual input (VI). Indeed, visual dependence (VD), defined as the predominance given to the VI whatever the circumstances, frequent after stroke it could disturb balance. Because the term VD is a bit restrictive and cannot be deduced from clinical tests, the term visual sensitivity (VS) is preferred here. HYPOTHESIS VI could have different influence depending on the task for a given individual. METHODS We retrospectively compared 2 VS tests routinely used: the rod and frame test (RFT) and optokinetic stimulation (OKS). In RFT, VS was defined by a misperception of the visual verticality induced by a tilted frame (VS RFT) and in OKS by tilted sitting posture induced by rotational OKS (VS OKS). We studied the relations between VS RFT and VS OKS. RESULTS We analysed data for 84 patients, mean age 55±10years, 45±30days after stroke. Scores for both tests were correlated with autonomy measured by the functional independence measure (r=-0.3, p=0.01 and r=-0.2, p=0.02). VS OKS score was also correlated with balance measured by the postural assessment scale for stroke (r=-0.3, p=0.03). VS RFT score was not correlated with VS OKS score (p=0.4, r=0.04). DISCUSSION - CONCLUSION A patient may display VS for one test without sensitivity for the other because these tests investigate different neural organisation - perception for RFT or action for OKS. Their relation to balance disorders should be further investigated to build individualized rehabilitation programs.
Collapse
|
14
|
Vaughan-Graham J, Cott C. "Letter to the Editor" Author response to: Mepsted R, Tyson S. The Bobath concept. A guru-led set of teachings unsupported by emerging evidence. A response to Vaughan-Graham and Cott. (J Eval Clin Pract. 2016. doi: 10.1111/jep.12751). J Eval Clin Pract. 2017. https://doi.org/10.1111/jep.12791. J Eval Clin Pract 2017; 23:1129-1131. [PMID: 28960729 DOI: 10.1111/jep.12822] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 08/07/2017] [Indexed: 11/29/2022]
Affiliation(s)
| | - Cheryl Cott
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
15
|
Nilsen DM, Gillen G, Geller D, Hreha K, Osei E, Saleem GT. Effectiveness of interventions to improve occupational performance of people with motor impairments after stroke: an evidence-based review. Am J Occup Ther 2015; 69:6901180030p1-9. [PMID: 25553742 DOI: 10.5014/ajot.2015.011965] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We conducted a review to determine the effectiveness of interventions to improve occupational performance in people with motor impairments after stroke as part of the American Occupational Therapy Association's Evidence-Based Practice Project. One hundred forty-nine studies met inclusion criteria. Findings related to key outcomes from select interventions are presented. Results suggest that a variety of effective interventions are available to improve occupational performance after stroke. Evidence suggests that repetitive task practice, constraint-induced or modified constraint-induced movement therapy, strengthening and exercise, mental practice, virtual reality, mirror therapy, and action observation can improve upper-extremity function, balance and mobility, and/or activity and participation. Commonalities among several of the effective interventions include the use of goal-directed, individualized tasks that promote frequent repetitions of task-related or task-specific movements.
Collapse
Affiliation(s)
- Dawn M Nilsen
- Dawn M. Nilsen, EdD, OTL, is Assistant Professor of Rehabilitation and Regenerative Medicine (Occupational Therapy), Columbia University, New York, NY;
| | - Glen Gillen
- Glen Gillen, EdD, OTR/L, FAOTA, is Associate Professor of Rehabilitation and Regenerative Medicine (Occupational Therapy), Columbia University, New York, NY
| | - Daniel Geller
- Daniel Geller, MS, MPH, OTR/L, Kimberly Hreha, OTR/L, Ellen Osei, MS, OTR/L, and Ghazala T. Saleem, MS, OTR/L, are Doctoral Students, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Kimberly Hreha
- Daniel Geller, MS, MPH, OTR/L, Kimberly Hreha, OTR/L, Ellen Osei, MS, OTR/L, and Ghazala T. Saleem, MS, OTR/L, are Doctoral Students, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Ellen Osei
- Daniel Geller, MS, MPH, OTR/L, Kimberly Hreha, OTR/L, Ellen Osei, MS, OTR/L, and Ghazala T. Saleem, MS, OTR/L, are Doctoral Students, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Ghazala T Saleem
- Daniel Geller, MS, MPH, OTR/L, Kimberly Hreha, OTR/L, Ellen Osei, MS, OTR/L, and Ghazala T. Saleem, MS, OTR/L, are Doctoral Students, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| |
Collapse
|
16
|
Yelnik A, Tasseel Ponche S, Andriantsifanetra C, Provost C, Calvalido A, Rougier P. Walking with eyes closed is easier than walking with eyes open without visual cues: The Romberg task versus the goggle task. Ann Phys Rehabil Med 2015; 58:332-5. [DOI: 10.1016/j.rehab.2015.08.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 08/24/2015] [Accepted: 08/29/2015] [Indexed: 11/16/2022]
|
17
|
Tasseel-Ponche S, Yelnik A, Bonan I. Motor strategies of postural control after hemispheric stroke. Neurophysiol Clin 2015; 45:327-33. [DOI: 10.1016/j.neucli.2015.09.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Accepted: 09/07/2015] [Indexed: 10/22/2022] Open
|
18
|
Kim YW, Moon SJ. Effects of treadmill training with the eyes closed on gait and balance ability of chronic stroke patients. J Phys Ther Sci 2015; 27:2935-8. [PMID: 26504328 PMCID: PMC4616129 DOI: 10.1589/jpts.27.2935] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 06/17/2015] [Indexed: 11/29/2022] Open
Abstract
[Purpose] The purpose of this study was to compare the effect of treadmill walking with
the eyes closed and open on the gait and balance abilities of chronic stroke patients.
[Subjects and Methods] Thirty patients with chronic stroke participated in this study. The
treadmill gait training for each group lasted 40 minutes, and sessions were held 3 times a
week for 4 weeks. Gait ability was measured using a Biodex Gait Trainer Treadmill System.
Balance ability was measured using a Biodex Balance System. [Results] After the treadmill
training‚ the treadmill training with eyes closed (TEC) group showed significant
improvements in walking distance‚ step length‚ coefficient of variation‚ and limit of
stability (overall‚ lateral affected‚ forward lateral unaffected) compared to the
treadmill training with eyes open (TEO) group. [Conclusion] The walking and balance
abilities of the TEC participants showed more improvement after the treadmill walking
sessions than those of the TEO participants. Therefore‚ treadmill walking with visual
deprivation may be useful for the rehabilitation of patients with chronic stroke.
Collapse
Affiliation(s)
- Yong-Wook Kim
- Department of Physical Therapy, College of Medical Sciences, Jeonju University: 303 Cheonjam-ro, Wansan-gu, Jeonju, Jeonbuk-do 560-759, Republic of Korea
| | - Sung-Jun Moon
- Department of Physical Therapy, Jeonbuk University Hospital of Rehabilitation Medicine, Republic of Korea
| |
Collapse
|
19
|
Serra-Añó P, López-Bueno L, García-Massó X, Pellicer-Chenoll MT, González LM. POSTURAL CONTROL MECHANISMS IN HEALTHY ADULTS IN SITTING AND STANDING POSITIONS. Percept Mot Skills 2015; 121:119-34. [PMID: 26108061 DOI: 10.2466/26.25.pms.121c10x4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study explored differences in the center of pressure in healthy people in a sitting and standing position and with eyes open and closed. With this purpose, 32 healthy participants (16 men, 16 women; M age=25.2 yr., SD=10.0, range=18-55) were measured with an extensiometric force plate. Using a two-way repeated-measures multivariate analysis of variance (MANOVA), the root mean square, velocity, range, and sway, in both visual conditions, had higher values in the standing task than in the sitting task. In the frequency domain, the low-frequency band had higher values during the standing task. For control mechanism variables, mean distance and time were greater when standing while mean peaks were greater when sitting. Thus, stability is worse in the standing position and more neuromuscular activity is required to maintain balance.
Collapse
Affiliation(s)
- Pilar Serra-Añó
- 1 Department of Physiotherapy, University of Valencia, Spain
| | | | - Xavier García-Massó
- 2 Department of Teaching of Musical, Visual and Corporal Expression, University of Valencia, Spain
| | | | | |
Collapse
|
20
|
Lee SH, Lee D, Lee Y, Jee Y, Lee G, Park DS. Influence of light touch using the fingertips on postural stability of poststroke patients. J Phys Ther Sci 2015; 27:469-72. [PMID: 25729193 PMCID: PMC4339163 DOI: 10.1589/jpts.27.469] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 09/02/2014] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to investigate the influence of fingertip light touch on the postural control in poststroke patients. [Subjects] In the study, the subjects were recruited through a rehabilitation hospital, and 21 patients were screened from among 30 volunteers. [Methods] The subjects participated in an experiment that measured postural sway during the static standing posture without light touch and postural sway during the static standing posture with light touch as follows: visual information not blocked without light touch, visual information blocked without light touch, visual information blocked with light touch using fingertips, and visual information not blocked with light touch using fingertips. The measurements were performed using a force platform. The variables measured by the force platform included sway velocities of the COP in the anterior and posterior directions and, medial and lateral directions and sway velocity moments. [Results] In the results of the study, there were significant differences between the state without light touch and state with light touch in terms of the postural sway velocity and velocity moment under all conditions. The rate of decease of the sway velocity and moment velocity under the eyes closed condition were higher compared with those under the eyes open condition. [Conclusion] Through this study, we confirmed the influence of fingertip light touch on the decrease in postural sway. The results show that active light touch may be supplemental means of improving postural sway in stroke patients.
Collapse
Affiliation(s)
- Se-Han Lee
- Division of Mechanical Engineering, Kyungnam University, Republic of Korea
| | - DongGeon Lee
- Department of Physical Therapy, Hansol Medical Foundation Changwon Hanseo Hospital, Republic of Korea ; Department of Physical Therapy, Kyungnam University, Republic of Korea
| | - YunBok Lee
- Department of Nursing, Dongseo University, Republic of Korea
| | - YoungJu Jee
- Department of Nursing, Kyungnam University, Republic of Korea
| | - GyuChang Lee
- Department of Physical Therapy, Kyungnam University, Republic of Korea
| | - Dong-Sik Park
- Department of Rehabilitation Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Republic of Korea
| |
Collapse
|
21
|
Bambirra C, Rodrigues MCDB, Faria CDCDM, Paula FRD. Clinical evaluation of balance in hemiparetic adults: a systematic review. FISIOTERAPIA EM MOVIMENTO 2015. [DOI: 10.1590/0103-5150.028.001.ar03] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction Hemiparesis is a common post-stroke impairment often associated with balance deficits. Standardized instruments for balance assessment may be useful in identifying individuals at risk of falling and evaluating intervention outcomes. Objectives To identify instruments with adequate psychometric properties and clinical application to assess balance in hemiparetic cases within the scope of physiotherapy and to verify tools most frequently used in studies that evaluated the effects of therapeutic interventions in order to improve the balance of hemiparetic patients. Methods A search was conducted in the Medline, Lilacs, PEDro, and Web of Science databases by two independent researchers, who selected and analyzed studies that evaluated the reliability and validity of balance assessment instruments and intervention results. Results and discussion The Berg Balance Scale was the most frequently used instrument in the intervention studies. Nine single-task tests (timed up and go, functional reach test, step test, four-square step test, side step test, supported standing balance, standing arm raise, static tandem standing, and weight shifting) and six multiple-task tests (Berg balance scale, Brunel balance assessment, Fugl-Meyer Assessment/balance section, mini balance evaluation systems test, and postural assessment scale for stroke patients) demonstrated adequate psychometric properties and clinical applications to assess balance in hemiparetic individuals. Conclusions The Berg Balance Scale had the most widely studied psychometric properties and was the most frequently used scale in the intervention studies. Further studies are required to validate and adapt other instruments for the Brazilian population.
Collapse
|
22
|
Vaughan-Graham J, Cott C, Wright FV. The Bobath (NDT) concept in adult neurological rehabilitation: what is the state of the knowledge? A scoping review. Part II: intervention studies perspectives. Disabil Rehabil 2014; 37:1909-28. [DOI: 10.3109/09638288.2014.987880] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
23
|
Kim TW, Kim YW. Treadmill sideways gait training with visual blocking for patients with brain lesions. J Phys Ther Sci 2014; 26:1415-8. [PMID: 25276026 PMCID: PMC4175247 DOI: 10.1589/jpts.26.1415] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 03/09/2014] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The aim of this study was to verify the effect of sideways treadmill training
with and without visual blocking on the balance and gait function of patients with brain
lesions. [Subjects] Twenty-four stroke and traumatic brain injury subjects participated in
this study. They were divided into two groups: an experimental group (12 subjects) and a
control group (12 subjects). [Methods] Each group executed a treadmill training session
for 20 minutes, three times a week, for 6 weeks. The sideways gait training on the
treadmill was performed with visual blocking by the experimental group and with normal
vision by the control group. A Biodex Gait Trainer 2 was used to assess the gait function.
It was used to measure walking speed, walking distance, step length, and stance time on
each foot. The Five-Times-Sit-To-Stand test (FTSST) and Timed Up and Go test (TUG) were
used as balance measures. [Results] The sideways gait training with visual blocking group
showed significantly improved walking speed, walking distance, step length, and stance
time on each foot after training; FTSST and TUG times also significantly improved after
training in the experimental group. Compared to the control group, the experimental group
showed significant increases in stance time on each foot. [Conclusion] Sideways gait
training on a treadmill with visual blocking performed by patients with brain lesions
significantly improved their balance and gait function.
Collapse
Affiliation(s)
- Tea-Woo Kim
- Department of Rehabilitation Science, The Graduate School, Jeonju University, Republic of Korea
| | - Yong-Wook Kim
- Department of Physical Therapy, College of Medical Sciences, Jeonju University, Republic of Korea
| |
Collapse
|
24
|
Chisholm AE, Malik RN, Blouin JS, Borisoff J, Forwell S, Lam T. Feasibility of sensory tongue stimulation combined with task-specific therapy in people with spinal cord injury: a case study. J Neuroeng Rehabil 2014; 11:96. [PMID: 24906679 PMCID: PMC4057581 DOI: 10.1186/1743-0003-11-96] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 06/02/2014] [Indexed: 11/30/2022] Open
Abstract
Background Previous evidence suggests the effects of task-specific therapy can be further enhanced when sensory stimulation is combined with motor practice. Sensory tongue stimulation is thought to facilitate activation of regions in the brain that are important for balance and gait. Improvements in balance and gait have significant implications for functional mobility for people with incomplete spinal cord injury (iSCI). The aim of this case study was to evaluate the feasibility of a lab- and home-based program combining sensory tongue stimulation with balance and gait training on functional outcomes in people with iSCI. Methods Two male participants (S1 and S2) with chronic motor iSCI completed 12 weeks of balance and gait training (3 lab and 2 home based sessions per week) combined with sensory tongue stimulation using the Portable Neuromodulation Stimulator (PoNS). Laboratory based training involved 20 minutes of standing balance with eyes closed and 30 minutes of body-weight support treadmill walking. Home based sessions consisted of balancing with eyes open and walking with parallel bars or a walker for up to 20 minutes each. Subjects continued daily at-home training for an additional 12 weeks as follow-up. Results Both subjects were able to complete a minimum of 83% of the training sessions. Standing balance with eyes closed increased from 0.2 to 4.0 minutes and 0.0 to 0.2 minutes for S1 and S2, respectively. Balance confidence also improved at follow-up after the home-based program. Over ground walking speed improved by 0.14 m/s for S1 and 0.07 m/s for S2, and skilled walking function improved by 60% and 21% for S1 and S2, respectively. Conclusions Sensory tongue stimulation combined with task-specific training may be a feasible method for improving balance and gait in people with iSCI. Our findings warrant further controlled studies to determine the added benefits of sensory tongue stimulation to rehabilitation training.
Collapse
Affiliation(s)
- Amanda E Chisholm
- School of Kinesiology, University of British Columbia, Vancouver, Canada.
| | | | | | | | | | | |
Collapse
|
25
|
Maciaszek J, Borawska S, Wojcikiewicz J. Influence of posturographic platform biofeedback training on the dynamic balance of adult stroke patients. J Stroke Cerebrovasc Dis 2014; 23:1269-74. [PMID: 24774437 DOI: 10.1016/j.jstrokecerebrovasdis.2013.10.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 09/04/2013] [Accepted: 10/14/2013] [Indexed: 11/26/2022] Open
Abstract
The aim of the experiment was to analyze the influence of posturographic platform biofeedback training on the dynamic balance of patients who experienced ischemic stroke. The study included 21 patients treated at the Rehabilitation Center of the District Hospital in Białogard, in the Ward of Neurological Rehabilitation with the Stroke Division. The age of the patients (11 in the experimental and 10 in the control group) ranged between 55 and 65 years. The level of dynamic balance was determined with Timed Up and Go Test. The experimental group was subjected to the biofeedback training, practicing maintenance of body balance (forced sway training) on posturographic platform for 15 consecutive days. The perception of dynamic balance in the group subjected to biofeedback training improved to a markedly greater extent (P < .05) as compared with conventionally rehabilitated group. Participation in biofeedback training exerted stronger effect on the dynamic balance of patients who experienced the stroke of the left hemisphere with right-sided hemiparesis than in those with right hemisphere stroke and left-sided hemiparesis. The utilization of feedback mechanisms during training on a posturographic platform can be reflected by enhanced stimulation and further improvement of the control of performed motor tasks.
Collapse
Affiliation(s)
- Janusz Maciaszek
- Department of Theory of Physical Education and Anthropomotorics, University School of Physical Education in Poznań, Poznań, Poland.
| | - Sylwia Borawska
- Neurological Rehabilitation Unit, Rehabilitation Center of the Hospital in Białogard, Poland
| | - Jacek Wojcikiewicz
- Neurological Rehabilitation Unit, Rehabilitation Center of the Hospital in Białogard, Poland
| |
Collapse
|
26
|
Song YB, Chun MH, Kim W, Lee SJ, Yi JH, Park DH. The effect of virtual reality and tetra-ataxiometric posturography programs on stroke patients with impaired standing balance. Ann Rehabil Med 2014; 38:160-6. [PMID: 24855609 PMCID: PMC4026601 DOI: 10.5535/arm.2014.38.2.160] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 10/14/2013] [Indexed: 11/05/2022] Open
Abstract
Objective To investigate the effect of virtual reality (VR) and a tetra-ataxiometric posturography (Tetrax) program on stroke patients with impaired standing balance. Methods Thirty acute stroke patients with impaired standing balance were recruited and randomly assigned to a VR, Tetrax, or control group. All patients received conventional balance training as a baseline; and VR and Tetrax patients received VR or Tetrax treatment, in addition. The primary outcome measures to evaluate the overall standing balance were the Berg Balance Scale (BBS) and the falling index (FI). The secondary outcome measures were the stability index (SI) and the weight distribution index (WDI), which were used to evaluate the balance status according to specific body positions. The FI, SI, and WDI were measured using the Tetrax instrument. Results The BBS and FI scores were improved in all groups, with no significant differences between groups. In open-eyed positions, the VR group showed significantly greater improvement in SI and WDI scores than the control group (p<0.017). In closed-eyed positions, the Tetrax group showed significantly greater improvement in SI and WDI scores than the control group (p<0.017). Conclusion The inclusion of VR and Tetrax programs did not lead to an overall benefit in balance. VR and Tetrax did, however, demonstrate a benefit in specific positions. A Tetrax program may benefit patients with abnormal proprioceptive function, whereas a VR program may benefit patients with normal sensory function.
Collapse
Affiliation(s)
- Yoon Bum Song
- Department of Rehabilitation Medicine, Asan Medical Center, Seoul, Korea
| | - Min Ho Chun
- Department of Rehabilitation Medicine, Asan Medical Center, Seoul, Korea
| | - Won Kim
- Department of Rehabilitation Medicine, Asan Medical Center, Seoul, Korea
| | - Sook Joung Lee
- Department of Rehabilitation Medicine, Dong-A University Hospital, Busan, Korea
| | - Jin Hwa Yi
- Department of Rehabilitation Medicine, Asan Medical Center, Seoul, Korea
| | - Dae Hwan Park
- Department of Rehabilitation Medicine, Asan Medical Center, Seoul, Korea
| |
Collapse
|
27
|
Pollock A, Baer G, Campbell P, Choo PL, Forster A, Morris J, Pomeroy VM, Langhorne P. Physical rehabilitation approaches for the recovery of function and mobility following stroke. Cochrane Database Syst Rev 2014; 2014:CD001920. [PMID: 24756870 PMCID: PMC6465059 DOI: 10.1002/14651858.cd001920.pub3] [Citation(s) in RCA: 206] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Various approaches to physical rehabilitation may be used after stroke, and considerable controversy and debate surround the effectiveness of relative approaches. Some physiotherapists base their treatments on a single approach; others use a mixture of components from several different approaches. OBJECTIVES To determine whether physical rehabilitation approaches are effective in recovery of function and mobility in people with stroke, and to assess if any one physical rehabilitation approach is more effective than any other approach.For the previous versions of this review, the objective was to explore the effect of 'physiotherapy treatment approaches' based on historical classifications of orthopaedic, neurophysiological or motor learning principles, or on a mixture of these treatment principles. For this update of the review, the objective was to explore the effects of approaches that incorporate individual treatment components, categorised as functional task training, musculoskeletal intervention (active), musculoskeletal intervention (passive), neurophysiological intervention, cardiopulmonary intervention, assistive device or modality.In addition, we sought to explore the impact of time after stroke, geographical location of the study, dose of the intervention, provider of the intervention and treatment components included within an intervention. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (last searched December 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 12, 2012), MEDLINE (1966 to December 2012), EMBASE (1980 to December 2012), AMED (1985 to December 2012) and CINAHL (1982 to December 2012). We searched reference lists and contacted experts and researchers who have an interest in stroke rehabilitation. SELECTION CRITERIA Randomised controlled trials (RCTs) of physical rehabilitation approaches aimed at promoting the recovery of function or mobility in adult participants with a clinical diagnosis of stroke. Outcomes included measures of independence in activities of daily living (ADL), motor function, balance, gait velocity and length of stay. We included trials comparing physical rehabilitation approaches versus no treatment, usual care or attention control and those comparing different physical rehabilitation approaches. DATA COLLECTION AND ANALYSIS Two review authors independently categorised identified trials according to the selection criteria, documented their methodological quality and extracted the data. MAIN RESULTS We included a total of 96 studies (10,401 participants) in this review. More than half of the studies (50/96) were carried out in China. Generally the studies were heterogeneous, and many were poorly reported.Physical rehabilitation was found to have a beneficial effect, as compared with no treatment, on functional recovery after stroke (27 studies, 3423 participants; standardised mean difference (SMD) 0.78, 95% confidence interval (CI) 0.58 to 0.97, for Independence in ADL scales), and this effect was noted to persist beyond the length of the intervention period (nine studies, 540 participants; SMD 0.58, 95% CI 0.11 to 1.04). Subgroup analysis revealed a significant difference based on dose of intervention (P value < 0.0001, for independence in ADL), indicating that a dose of 30 to 60 minutes per day delivered five to seven days per week is effective. This evidence principally arises from studies carried out in China. Subgroup analyses also suggest significant benefit associated with a shorter time since stroke (P value 0.003, for independence in ADL).We found physical rehabilitation to be more effective than usual care or attention control in improving motor function (12 studies, 887 participants; SMD 0.37, 95% CI 0.20 to 0.55), balance (five studies, 246 participants; SMD 0.31, 95% CI 0.05 to 0.56) and gait velocity (14 studies, 1126 participants; SMD 0.46, 95% CI 0.32 to 0.60). Subgroup analysis demonstrated a significant difference based on dose of intervention (P value 0.02 for motor function), indicating that a dose of 30 to 60 minutes delivered five to seven days a week provides significant benefit. Subgroup analyses also suggest significant benefit associated with a shorter time since stroke (P value 0.05, for independence in ADL).No one physical rehabilitation approach was more (or less) effective than any other approach in improving independence in ADL (eight studies, 491 participants; test for subgroup differences: P value 0.71) or motor function (nine studies, 546 participants; test for subgroup differences: P value 0.41). These findings are supported by subgroup analyses carried out for comparisons of intervention versus no treatment or usual care, which identified no significant effects of different treatment components or categories of interventions. AUTHORS' CONCLUSIONS Physical rehabilitation, comprising a selection of components from different approaches, is effective for recovery of function and mobility after stroke. Evidence related to dose of physical therapy is limited by substantial heterogeneity and does not support robust conclusions. No one approach to physical rehabilitation is any more (or less) effective in promoting recovery of function and mobility after stroke. Therefore, evidence indicates that physical rehabilitation should not be limited to compartmentalised, named approaches, but rather should comprise clearly defined, well-described, evidenced-based physical treatments, regardless of historical or philosophical origin.
Collapse
Affiliation(s)
- Alex Pollock
- Glasgow Caledonian UniversityNursing, Midwifery and Allied Health Professions Research UnitBuchanan HouseCowcaddens RoadGlasgowUKG4 0BA
| | - Gillian Baer
- Queen Margaret UniversityDepartment of PhysiotherapyQueen Margaret University DriveEdinburghUKEH21 6UU
| | - Pauline Campbell
- Glasgow Caledonian UniversityNursing, Midwifery and Allied Health Professions Research UnitBuchanan HouseCowcaddens RoadGlasgowUKG4 0BA
| | - Pei Ling Choo
- Glasgow Caledonian UniversitySchool of Health & Life SciencesGlasgowUK
| | - Anne Forster
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust/University of LeedsAcademic Unit of Elderly Care and RehabilitationTemple Bank House, Bradford Royal InfirmaryDuckworth LaneBradfordUKBD9 6RJ
| | - Jacqui Morris
- University of DundeeSchool of Nursing and Midwifery11 Airlie PlaceDundeeUKDD1 4HJ
| | - Valerie M Pomeroy
- University of East AngliaSchool of Rehabilitation SciencesNorwichUKNR4 7TJ
| | - Peter Langhorne
- University of GlasgowAcademic Section of Geriatric Medicine3rd Floor, Centre BlockRoyal InfirmaryGlasgowUKG4 0SF
| | | |
Collapse
|
28
|
Pollock A, Baer G, Campbell P, Choo PL, Forster A, Morris J, Pomeroy VM, Langhorne P. Physical rehabilitation approaches for the recovery of function and mobility following stroke. Hippokratia 2014. [PMID: 24756870 DOI: 10.1002/14651858.cd001920.pub3#sthash.keppcclr.dpuf] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Various approaches to physical rehabilitation may be used after stroke, and considerable controversy and debate surround the effectiveness of relative approaches. Some physiotherapists base their treatments on a single approach; others use a mixture of components from several different approaches. OBJECTIVES To determine whether physical rehabilitation approaches are effective in recovery of function and mobility in people with stroke, and to assess if any one physical rehabilitation approach is more effective than any other approach.For the previous versions of this review, the objective was to explore the effect of 'physiotherapy treatment approaches' based on historical classifications of orthopaedic, neurophysiological or motor learning principles, or on a mixture of these treatment principles. For this update of the review, the objective was to explore the effects of approaches that incorporate individual treatment components, categorised as functional task training, musculoskeletal intervention (active), musculoskeletal intervention (passive), neurophysiological intervention, cardiopulmonary intervention, assistive device or modality.In addition, we sought to explore the impact of time after stroke, geographical location of the study, dose of the intervention, provider of the intervention and treatment components included within an intervention. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (last searched December 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 12, 2012), MEDLINE (1966 to December 2012), EMBASE (1980 to December 2012), AMED (1985 to December 2012) and CINAHL (1982 to December 2012). We searched reference lists and contacted experts and researchers who have an interest in stroke rehabilitation. SELECTION CRITERIA Randomised controlled trials (RCTs) of physical rehabilitation approaches aimed at promoting the recovery of function or mobility in adult participants with a clinical diagnosis of stroke. Outcomes included measures of independence in activities of daily living (ADL), motor function, balance, gait velocity and length of stay. We included trials comparing physical rehabilitation approaches versus no treatment, usual care or attention control and those comparing different physical rehabilitation approaches. DATA COLLECTION AND ANALYSIS Two review authors independently categorised identified trials according to the selection criteria, documented their methodological quality and extracted the data. MAIN RESULTS We included a total of 96 studies (10,401 participants) in this review. More than half of the studies (50/96) were carried out in China. Generally the studies were heterogeneous, and many were poorly reported.Physical rehabilitation was found to have a beneficial effect, as compared with no treatment, on functional recovery after stroke (27 studies, 3423 participants; standardised mean difference (SMD) 0.78, 95% confidence interval (CI) 0.58 to 0.97, for Independence in ADL scales), and this effect was noted to persist beyond the length of the intervention period (nine studies, 540 participants; SMD 0.58, 95% CI 0.11 to 1.04). Subgroup analysis revealed a significant difference based on dose of intervention (P value < 0.0001, for independence in ADL), indicating that a dose of 30 to 60 minutes per day delivered five to seven days per week is effective. This evidence principally arises from studies carried out in China. Subgroup analyses also suggest significant benefit associated with a shorter time since stroke (P value 0.003, for independence in ADL).We found physical rehabilitation to be more effective than usual care or attention control in improving motor function (12 studies, 887 participants; SMD 0.37, 95% CI 0.20 to 0.55), balance (five studies, 246 participants; SMD 0.31, 95% CI 0.05 to 0.56) and gait velocity (14 studies, 1126 participants; SMD 0.46, 95% CI 0.32 to 0.60). Subgroup analysis demonstrated a significant difference based on dose of intervention (P value 0.02 for motor function), indicating that a dose of 30 to 60 minutes delivered five to seven days a week provides significant benefit. Subgroup analyses also suggest significant benefit associated with a shorter time since stroke (P value 0.05, for independence in ADL).No one physical rehabilitation approach was more (or less) effective than any other approach in improving independence in ADL (eight studies, 491 participants; test for subgroup differences: P value 0.71) or motor function (nine studies, 546 participants; test for subgroup differences: P value 0.41). These findings are supported by subgroup analyses carried out for comparisons of intervention versus no treatment or usual care, which identified no significant effects of different treatment components or categories of interventions. AUTHORS' CONCLUSIONS Physical rehabilitation, comprising a selection of components from different approaches, is effective for recovery of function and mobility after stroke. Evidence related to dose of physical therapy is limited by substantial heterogeneity and does not support robust conclusions. No one approach to physical rehabilitation is any more (or less) effective in promoting recovery of function and mobility after stroke. Therefore, evidence indicates that physical rehabilitation should not be limited to compartmentalised, named approaches, but rather should comprise clearly defined, well-described, evidenced-based physical treatments, regardless of historical or philosophical origin.
Collapse
Affiliation(s)
- Alex Pollock
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Buchanan House, Cowcaddens Road, Glasgow, UK, G4 0BA
| | | | | | | | | | | | | | | |
Collapse
|
29
|
Veerbeek JM, van Wegen E, van Peppen R, van der Wees PJ, Hendriks E, Rietberg M, Kwakkel G. What is the evidence for physical therapy poststroke? A systematic review and meta-analysis. PLoS One 2014; 9:e87987. [PMID: 24505342 PMCID: PMC3913786 DOI: 10.1371/journal.pone.0087987] [Citation(s) in RCA: 675] [Impact Index Per Article: 67.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 12/30/2013] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Physical therapy (PT) is one of the key disciplines in interdisciplinary stroke rehabilitation. The aim of this systematic review was to provide an update of the evidence for stroke rehabilitation interventions in the domain of PT. METHODS AND FINDINGS Randomized controlled trials (RCTs) regarding PT in stroke rehabilitation were retrieved through a systematic search. Outcomes were classified according to the ICF. RCTs with a low risk of bias were quantitatively analyzed. Differences between phases poststroke were explored in subgroup analyses. A best evidence synthesis was performed for neurological treatment approaches. The search yielded 467 RCTs (N = 25373; median PEDro score 6 [IQR 5-7]), identifying 53 interventions. No adverse events were reported. Strong evidence was found for significant positive effects of 13 interventions related to gait, 11 interventions related to arm-hand activities, 1 intervention for ADL, and 3 interventions for physical fitness. Summary Effect Sizes (SESs) ranged from 0.17 (95%CI 0.03-0.70; I(2) = 0%) for therapeutic positioning of the paretic arm to 2.47 (95%CI 0.84-4.11; I(2) = 77%) for training of sitting balance. There is strong evidence that a higher dose of practice is better, with SESs ranging from 0.21 (95%CI 0.02-0.39; I(2) = 6%) for motor function of the paretic arm to 0.61 (95%CI 0.41-0.82; I(2) = 41%) for muscle strength of the paretic leg. Subgroup analyses yielded significant differences with respect to timing poststroke for 10 interventions. Neurological treatment approaches to training of body functions and activities showed equal or unfavorable effects when compared to other training interventions. Main limitations of the present review are not using individual patient data for meta-analyses and absence of correction for multiple testing. CONCLUSIONS There is strong evidence for PT interventions favoring intensive high repetitive task-oriented and task-specific training in all phases poststroke. Effects are mostly restricted to the actually trained functions and activities. Suggestions for prioritizing PT stroke research are given.
Collapse
Affiliation(s)
- Janne Marieke Veerbeek
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Erwin van Wegen
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Roland van Peppen
- Department of Physiotherapy, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Philip Jan van der Wees
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Erik Hendriks
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
| | - Marc Rietberg
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Gert Kwakkel
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
- Department of Neurorehabilitation, Reade Center for Rehabilitation and Rheumatology, Amsterdam, The Netherlands
| |
Collapse
|
30
|
Cho SR. Balance and Coordination Training for Brain Disorders. BRAIN & NEUROREHABILITATION 2013. [DOI: 10.12786/bn.2013.6.2.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Sung-Rae Cho
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Korea
| |
Collapse
|
31
|
Abstract
This chapter addresses the important and undertreated problem of balance disorders. The chapter has a simplified summary of the physiology of balance problems in order to set the scene. The issue of assessment is next addressed with discussion of important tests including the Berg Balance Scale and the Get Up and Go Test, and others. Posturography is discussed as well as assessment of the gravitional vertical. The assessment of vestibular function is of key importance and discussed in some detail. The focus of the chapter is on balance rehabilitation. Re-training of postural alignment and of sensory strategies are key but adaptation of the environment and re-training of cognitive strategies are also helpful in individual cases. Vestibular exercises can also be used. The chapter then critically analyses the efficacy of these treatments in specific balance disorders such as in stroke, Parkinson disease, polyneuropathies, multiple sclerosis, and vestibular disorders. Overall, there is a growing body of evidence that balance rehabilitation improves symptoms, function, and quality of life for those troubled by these disabling problems.
Collapse
|
32
|
Abstract
Falls are common at all stages after stroke, occurring in the acute, rehabilitative, and chronic phases. Consequences of falls include death or serious injury, minor injuries, functional limitations, reduced mobility and activity, and fear of falling. These consequences can have implications for independence and quality of life after stroke. The high frequency of falls may be due to a combination of existing falls risk factors prior to the stroke as well as impairments from the stroke, such as decreased strength and balance, hemineglect, perceptual problems, and visual problems. This paper reviews the magnitude of the problem of falls in people with stroke, highlights risk factors, and summarizes the limited randomized controlled trial evidence on falls prevention in this population. There is a need for further high quality research investigating the effectiveness of interventions to reduce falls and injury in people with stroke from onset through to the chronic stage.
Collapse
Affiliation(s)
- Frances A Batchelor
- National Ageing Research Institute, Royal Melbourne Hospital, Parkville, Victoria, Australia.
| | | | | | | |
Collapse
|
33
|
Yiu J, Miller WC, Eng JJ, Liu Y. Longitudinal Analysis of Balance Confidence in Individuals With Stroke Using a Multilevel Model for Change. Neurorehabil Neural Repair 2012; 26:999-1006. [DOI: 10.1177/1545968312437941] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Confidence about balance may be an important factor affecting self-efficacy for daily activities after stroke. Objective. The authors investigated whether confidence changes and the parameters that may predict changes in self-perceived balance within the first year of community reintegration. Methods. In this prospective study, 98 hemiparetic participants who could walk at least 10 m independently were assessed 1, 3, 6, and 12 months postdischarge from rehabilitation by the Berg Balance Scale, Timed Up and Go, 6-minute walking distance, and depression and anxiety scales. The 98 age-/sex-matched controls were assessed at enrollment and the same intervals. Multilevel modeling was used to determine if assessed covariates predicted changes in balance confidence by the Activities-Specific Balance Confidence Scale. Results. Stroke subjects had lower initial balance confidence than controls and showed a statistically significant increase in confidence over 1 year at each assessment. Poor balance and high state anxiety were associated with lower balance confidence. Significant interactions were observed between greater depression, along with more impaired walking capacity and balance tests, in predicting lower change trajectories in confidence. Falls predicted a reduced rate of improvement. Conclusions. Balance confidence after stroke remained lower than controls over the first year. Physical therapies and supportive interventions designed to treat confidence should be initiated at discharge from inpatient rehabilitation.
Collapse
Affiliation(s)
- Jeanne Yiu
- Vancouver General Hospital, Vancouver, British Columbia, Canada
- University of British Columbia, Vancouver, British Columbia, Canada
- GF Strong Rehabilitation Research Lab, Vancouver, British Columbia, Canada
| | - William C. Miller
- University of British Columbia, Vancouver, British Columbia, Canada
- GF Strong Rehabilitation Research Lab, Vancouver, British Columbia, Canada
| | - Janice J. Eng
- University of British Columbia, Vancouver, British Columbia, Canada
- GF Strong Rehabilitation Research Lab, Vancouver, British Columbia, Canada
| | - Yan Liu
- University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
34
|
Graven C, Brock K, Hill K, Joubert L. Are rehabilitation and/or care co-ordination interventions delivered in the community effective in reducing depression, facilitating participation and improving quality of life after stroke? Disabil Rehabil 2011; 33:1501-20. [DOI: 10.3109/09638288.2010.542874] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
35
|
The effect of balance training on balance performance in individuals poststroke: a systematic review. J Neurol Phys Ther 2010; 34:127-37. [PMID: 20716987 DOI: 10.1097/npt.0b013e3181ef764d] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND PURPOSE Stroke is a leading cause of long-term disability, and impaired balance after stroke is strongly associated with future function and recovery. Until recently there has been limited evidence to support the use of balance training to improve balance performance in this population. Information about the optimum exercise dosage has also been lacking. This review evaluated recent evidence related to the effect of balance training on balance performance among individuals poststroke across the continuum of recovery. On the basis of this evidence, we also provide recommendations for exercise prescription in such programs. METHODS A systematic search was performed on literature published between January 2006 and February 2010, using multiple combinations of intervention (eg, "exercise"), population (eg, "stroke"), and outcome (eg, "balance"). Criteria for inclusion of a study was having at least 1 standing balance exercise in the intervention and 1 study outcome to evaluate balance. RESULTS Twenty-two published studies met the inclusion criteria. We found moderate evidence that balance performance can be improved following individual, "one-on-one" balance training for participants in the acute stage of stroke, and either one-on-one balance training or group therapy for participants with subacute or chronic stroke. Moderate evidence also suggests that in the acute stage, intensive balance training for 2 to 3 times per week may be sufficient, whereas exercising for 90 minutes or more per day, 5 times per week may be excessive. DISCUSSION AND CONCLUSIONS This review supports the use of balance training exercises to improve balance performance for individuals with moderately severe stroke. Future high-quality, controlled studies should investigate the effects of balance training for individuals poststroke who have severe impairment, additional complications/comorbidities, or specific balance lesions (eg, cerebellar or vestibular). Optimal training dosage should also be further explored. Studies with long-term follow-up are needed to assess outcomes related to participation in the community and reduction of fall risk.
Collapse
|
36
|
|
37
|
Use of virtual reality to enhance balance and ambulation in chronic stroke: a double-blind, randomized controlled study. Am J Phys Med Rehabil 2009; 88:693-701. [PMID: 19692788 DOI: 10.1097/phm.0b013e3181b33350] [Citation(s) in RCA: 121] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine an additive effect of virtual reality on balance and gait function in patients with chronic hemiparetic stroke. DESIGN Twenty-four adults with hemiparetic stroke were randomly assigned to either an experimental group (n = 12) or a control group. Both groups underwent conventional physical therapy, 40 mins a day, 4 days a week for 4 wks. The experimental group received an additional 30 mins of virtual reality therapy each session. Balance performance was determined by the Balance Performance Monitor and Berg Balance Scale tests. Gait performance was determined by the 10-m walking test and Modified Motor Assessment Scale, and spatiotemporal parameters were obtained using GAITRite. Analysis of variance and correlation statistics were performed at P < 0.05. RESULTS In the balance test, the experimental group had improved Berg Balance Scale scores, balance and dynamic balance angles (ability to control weight shifting) compared with the controls (P < 0.05). In the gait performance test, the experimental group showed significant improvements in velocity, Modified Motor Assessment Scale scores, cadence, step time, step length, and stride length (P < 0.05). Improvement in dynamic balance angles was correlated with velocity and cadence (P < 0.01). CONCLUSIONS This study demonstrates that virtual reality has an augmented effect on balance and associated locomotor recovery in adults with hemiparetic stroke when added to conventional therapy.
Collapse
|