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Nagai K, Amimoto K, Teshima M, Ito T, Nariya H, Ueno R, Ikeda Y. Immediate effects of standing unstable board intervention on the non-paralyzed leg on sitting balance in severe hemiplegia: a randomized controlled trial. Top Stroke Rehabil 2024; 31:446-456. [PMID: 38224997 DOI: 10.1080/10749357.2024.2302730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/29/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Unstable board intervention for patients with stroke improves sitting balance and trunk function. However, because patients with severe stroke are at high risk of falling, it is mostly adapted in mild cases. OBJECTIVE We aimed to examine the effect of standing unstable board intervention for the non-paralyzed lower limbs on sitting balance in patients with hemiplegia. METHODS The participants were 42 patients with stroke who were randomly assigned to a control or intervention group. In the intervention group, the non-paralyzed leg was placed on an unstable board, and the patient wore a knee-ankle-foot orthosis on the paralyzed side and practiced standing and weight-bearing exercises on the unstable board for 3 days. The outcomes were the angle of righting reaction of the neck, trunk, and both lower legs and the movement distance of the center of pressure of the righting reaction from lateral tilted sitting. RESULTS In the intervention group, the righting reaction angle of the trunk to the paralyzed and non-paralyzed sides and the movement distance of the center of pressure were increased significantly after the unstable board intervention. CONCLUSION The standing unstable board intervention for the non-paralyzed lower limb increased sensory input to the non-paralyzed side of the trunk weight-bearing on the lower limb of the paralyzed side. The increase in the righting reaction angle and the movement distance of the center of pressure contributed to improved sitting balance.
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Affiliation(s)
- Koki Nagai
- Department of Rehabilitation, Medical Corporation Sonodenkai, Hanahata Rehabilitation Hospital, Hanahata, Adachi-ku, Tokyo, Japan
- Department of Physical Therapy, Tokyo Metropolitan University Graduate School of Health Sciences, Arakawa-ku, Tokyo, Japan
| | - Kazu Amimoto
- Department of Rehabilitation, Sendai Seiyo Gakuin College, Nagamachi Taihaku-ku, Sendai-shi, Miyagi, Japan
| | - Masato Teshima
- Department of Rehabilitation, Medical Corporation Sonodenkai, Hanahata Rehabilitation Hospital, Hanahata, Adachi-ku, Tokyo, Japan
| | - Takeshi Ito
- Department of Rehabilitation, Medical Corporation Sonodenkai, Hanahata Rehabilitation Hospital, Hanahata, Adachi-ku, Tokyo, Japan
| | - Honoka Nariya
- Department of Rehabilitation, Medical Corporation Sonodenkai, Hanahata Rehabilitation Hospital, Hanahata, Adachi-ku, Tokyo, Japan
| | - Ryuji Ueno
- Department of Rehabilitation, Medical Corporation Sonodenkai, Hanahata Rehabilitation Hospital, Hanahata, Adachi-ku, Tokyo, Japan
| | - Yumi Ikeda
- Department of Physical Therapy, Tokyo Metropolitan University Graduate School of Health Sciences, Arakawa-ku, Tokyo, Japan
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Shimizu N, Hashidate H, Ota T, Kawai Y. Physical activity according to sit-to-stand, standing, and stand-to-sit abilities in subacute stroke with walking difficulty: a cross-sectional study. Physiother Theory Pract 2023; 39:2327-2335. [PMID: 35543544 DOI: 10.1080/09593985.2022.2074928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 05/02/2022] [Accepted: 05/02/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This study investigated the characteristics of physical activity according to sit-to-stand, standing, and stand-to-sit abilities in subacute stroke with walking difficulty. METHODS In this study, 29 participants with subacute stroke and walking difficulty were enrolled and classified into two groups: participants who successfully completed three items (i.e., sit-to-stand, standing, and stand-to-sit) of the Functional Balance Scale (independent group, n = 13) and those who showed incomplete scores on any of the three items (dependent group, n = 16). Light-intensity physical activity (LIPA) and moderate-to-vigorous physical activity (MVPA) were measured using an accelerometer at three periods (i.e. daytime, therapy time, and non-therapy time) for a week. RESULTS Two-way analysis of variance (groups × physical activity intensity) demonstrated a significant interaction in each period. Post-hoc tests showed significantly more LIPAs and MVPAs in the independent group in all periods, except for MVPA in the non-therapy time. Particularly, LIPA showed significant between-group differences in each period. CONCLUSIONS Among individuals with subacute stroke and walking difficulty, those who could completely perform sit-to-stand, standing, and stand-to-sit could perform more LIPAs. Increasing sit-to-stand, standing, and stand-to-sit abilities could be an important factor in increasing the opportunity to perform LIPAs.
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Affiliation(s)
- Natsuki Shimizu
- Department of Kaifukuki-suppot, Hatsudai Rehabilitation Hospital, Shibuya, Japan
| | - Hiroyuki Hashidate
- Department of Physical Therapy, Kyorin University School of Health Sciences, Mitaka-city, Japan
| | - Tomohiro Ota
- Department of Kaifukuki-suppot, Hatsudai Rehabilitation Hospital, Shibuya, Japan
| | - Yumi Kawai
- Department of Kaifukuki-suppot, Hatsudai Rehabilitation Hospital, Shibuya, Japan
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Ghoseiri K, Zucker-Levin A. Long-term locked knee ankle foot orthosis use: A perspective overview of iatrogenic biomechanical and physiological perils. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1138792. [PMID: 37214128 PMCID: PMC10192684 DOI: 10.3389/fresc.2023.1138792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 04/03/2023] [Indexed: 05/24/2023]
Abstract
A knee ankle foot orthosis (KAFO) may be prescribed to the person with severe neuromusculoskeletal impairment of the lower limb to promote walking stability. The locked knee ankle foot orthosis (L-KAFO) is among the KAFO's routinely prescribed; however, long-term use of the L-KAFO is associated with musculoskeletal (arthrogenic and myogenic) and integumentary changes, and gait asymmetry with increased energy expenditure. Consequently, the risk of developing low back pain, osteoarthritis of the lower limbs and spinal joints, skin dermatitis, and ulceration increases, all of which impact quality of life. This article synthesizes the iatrogenic biomechanical and physiological perils of long-term L-KAFO use. It promotes using recent advances in rehabilitation engineering to improve daily activities and independence for proper patient groups.
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Hayashi Y, Yamazaki K, Takeda K, Ueda S, Mikawa S, Hatori K, Honaga K, Takakura T, Hayashi A, Fujiwara T. The development of Ambulation Independence Measure: A new measurement tool to assess gait ability in acute stroke patients. NeuroRehabilitation 2022; 50:409-416. [PMID: 35068419 PMCID: PMC9277666 DOI: 10.3233/nre-210289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND: The assessment of gait function is important for stroke rehabilitation. Gait function of patients with stroke often depends on the type of orthosis. There are however few gait assessments that assess the type of orthosis. OBJECTIVE: The purpose of this study was to investigate the reliability and validity of our newly developed Ambulation Independence Measure (AIM), which assesses the gait function, type of orthoses and physical assistance, for acute stroke patients. METHODS: A total of 73 acute stroke patients participated in this prospective study. The AIM discriminates 7 levels of gait ability on the basis of the amount of physical assistance required and orthoses that are used during walking. Interrater reliability, concurrent validity with the Functional Ambulation Category (FAC) and predictive validity were examined. RESULTS: The weighted kappas of AIM at the start of gait training (baseline) and discharge were 0.990 and 0.978, respectively. The AIM scores were significantly correlated with the FAC scores at both baseline (r = 0.808) and discharge (r = 0.934). Multiple regression analyses showed that the AIM at baseline was a stronger predictor of the FAC at discharge (R2 = 0.80). CONCLUSIONS: The AIM has excellent reliability, concurrent validity, predictive validity, and good responsiveness in acute stroke patients.
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Affiliation(s)
- Yusuke Hayashi
- Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Rehabilitation Medicine, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Kota Yamazaki
- Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Rehabilitation Medicine, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Kouichi Takeda
- Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Rehabilitation Medicine, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Shujiro Ueda
- Department of Rehabilitation Medicine, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Saiko Mikawa
- Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Rehabilitation Medicine, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Kozo Hatori
- Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Rehabilitation Medicine, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Kaoru Honaga
- Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tomokazu Takakura
- Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Akito Hayashi
- Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Rehabilitation Medicine, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Toshiyuki Fujiwara
- Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Physical Therapy, Juntendo University Faculty of Health Science, Tokyo, Japan
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Sato K, Inoue T, Maeda K, Shimizu A, Murotani K, Ueshima J, Ishida Y, Ogawa T, Suenaga M. Early Wearing of Knee-Ankle-Foot Orthosis Improves Functional Prognosis in Patients after Stroke. J Stroke Cerebrovasc Dis 2022; 31:106261. [PMID: 35032757 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106261] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/25/2021] [Accepted: 11/29/2021] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES Knee-ankle-foot orthosis (KAFO) is sometimes used for gait training in stroke patients. The impact of the time of wearing KAFO on activities of daily living (ADL) recovery has not been clarified. This study aimed to examine the relationship between the days from onset to KAFO wearing and functional prognosis in patients after stroke. MATERIALS AND METHODS This retrospective, observational study was conducted with stroke patients who were prescribed a KAFO. Patients were divided into early and delayed groups according to the median days from onset to KAFO wearing. Baseline characteristics were evaluated at the initiation of KAFO wearing. The primary outcome was the Functional Independence Measure (FIM) gain, which was scored by the nurse at baseline and discharge. RESULTS 112 participants (mean age 67.9 ± 14.0 years, 51.8% male) were included. The time period measure from day of onset to KAFO wearing for the early group was significantly shorter than the delayed group (35.8 ± 6.6 days vs. 73.5 ± 28.9 days). The early group had a higher FIM at discharge (84.9 ± 28.0% vs. 65.1 ± 29.0%, P < 0.001) and higher FIM gain (36.9 ± 19.8% vs. 26.8 ± 22.3, P = 0.013) than did the delayed group. Multiple regression analysis showed that the early group was associated with FIM gain (coefficient = 8.607, P = 0.032). CONCLUSIONS Early wearing of KAFO, irrespective of the difference in ADL at the time of KAFO wearing, may have a positive impact on the improvement of ADL in patients after stroke.
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Affiliation(s)
- Keisuke Sato
- Okinawa Chuzan Clinical Research Center, Chuzan Hospital, Okinawa, Japan
| | - Tatsuro Inoue
- Department of Physical Therapy Niigata University of Health and Welfare, Niigata, Japan
| | - Keisuke Maeda
- Okinawa Chuzan Clinical Research Center, Chuzan Hospital, Okinawa, Japan; Department of Geriatric Medicine, Hospital, National Center for Geriatrics and Gerontology, Obu, Japan.; Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan..
| | - Akio Shimizu
- Department of Nutrition, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | | | - Junko Ueshima
- Department of Clinical Nutrition and Food Service, NTT Medical Center Tokyo, Tokyo, Japan
| | - Yuria Ishida
- Department of Nutrition, Aichi Medical University, Nagakute, Japan
| | - Takahiro Ogawa
- Okinawa Chuzan Clinical Research Center, Chuzan Hospital, Okinawa, Japan; Department of Rehabilitation Medicine, Chuzan Hospital, Okinawa, Japan
| | - Masaki Suenaga
- Department of Rehabilitation Medicine, Chuzan Hospital, Okinawa, Japan
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Ramstrand N, Stevens PM. Clinical outcome measures to evaluate the effects of orthotic management post-stroke: a systematic review. Disabil Rehabil 2021; 44:3019-3038. [PMID: 33438496 DOI: 10.1080/09638288.2020.1859630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To identify, and classify, according to International Classification of Functioning, Disability and Health (ICF), clinically applicable outcome measures that have been used to evaluate lower limb orthotic management post-stroke and to investigate which outcome measures recorded the largest effect sizes. MATERIALS AND METHODS Electronic searches were performed in Pubmed, Cochrane, Web of Science, Cinahl, Scopus and Embase databases from inception to May 2020. Articles were included if they investigated clinical outcomes in people post-stroke who had received a lower-limb orthotic intervention. RESULTS 88 articles underwent full-text review and 54 were included in the review, which was performed in accordance with the Preferred Reporting Items for Systematic Review (PRISMA) principles. 48 different outcome measures were identified; effect sizes were able to be calculated from 39 studies. The most frequently applied outcome measures were the 10-metre Walk Test and the timed-up-and-go test. Outcome measures that recorded large effect sizes in two or more studies were the 10-metre Walk Test, Functional Reach Test, and Physiological Cost Index. When coded according to the ICF, the most frequently represented codes were d450 (Walking) and d455 (moving around). CONCLUSIONS Results suggest that outcome measures related to mobility (ICF chapter d4) are most often applied to evaluate orthotic management post-stroke. Effect sizes appear to be greatest in outcome measures related to velocity, balance, and energy expenditure.IMPLICATIONS FOR REHABILITATIONThe 10-meter Walk Test appears to have the greatest effect size when evaluating orthotic management post-stroke.While outcome measures related to mobility are commonly applied when evaluating orthotic management post-stroke, rehabilitation professionals should consider complementing these with measures representing the participation domain of the ICF.
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Affiliation(s)
- Nerrolyn Ramstrand
- CHILD Research Group, Department of Rehabilitation, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Phillip M Stevens
- Department of Clinical and Scientific Affairs, Hanger Clinic, Salt Lake City, UT, USA.,Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, UT, USA
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