1
|
Egger M, Finsterhölzl M, Buetikofer A, Wippenbeck F, Müller F, Jahn K, Bergmann J. Balance function in critical illness survivors and evaluation of psychometric properties of the Mini-BESTest. Sci Rep 2024; 14:12089. [PMID: 38802388 PMCID: PMC11130260 DOI: 10.1038/s41598-024-61745-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 05/09/2024] [Indexed: 05/29/2024] Open
Abstract
Critical illness survivors commonly face impairments, such as intensive care unit-acquired weakness (ICUAW) which is characterized by muscle weakness and sensory deficits. Despite these symptoms indicating potential balance deficits, systematic investigations and validated assessments are lacking. Therefore, we aimed to assess balance function using the Mini-BESTest, evaluate its psychometric properties, and identify associated variables. Balance was assessed post-ICU discharge (V1) and at discharge from inpatient neurorehabilitation (V2) in patients with ≥ 5 days of invasive ventilation. Mini-BESTest measurement characteristics were evaluated in an ambulatory subgroup. A multiple linear regression was conducted. The prospective cohort study comprised 250 patients (34% female, 62 ± 14 years, median ICU stay 55 days). Median Mini-BESTest scores improved significantly from V1 (5 (IQR 0-15)) to V2 (18.5 (10-23)) with a large effect size. Excellent inter-rater and test-retest reliabilities of the Mini-BESTest were observed (ICC = 0.981/0.950). Validity was demonstrated by a very high correlation with the Berg Balance Scale (ρ = 0.90). No floor or ceiling effects were detected. Muscle strength, cognitive function, cerebral disease, critical illness polyneuropathy/myopathy, and depression were significantly associated with balance. Despite significant improvements during the rehabilitation period, balance disorders were prevalent in critical illness survivors. Ongoing therapy is recommended. Due to its excellent psychometric properties, the Mini-BESTest is suitable for use in critical illness survivors.Registration: The study was registered at the German Clinical Trials Register (DRKS00021753, date of registration: 2020-09-03).
Collapse
Affiliation(s)
- Marion Egger
- Research Group, Department of Neurology, Schoen Clinic Bad Aibling, Kolbermoorer Str. 72, 83043, Bad Aibling, Germany.
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Pettenkofer School of Public Health, Munich, Germany.
| | - Melanie Finsterhölzl
- Research Group, Department of Neurology, Schoen Clinic Bad Aibling, Kolbermoorer Str. 72, 83043, Bad Aibling, Germany
| | - Alisa Buetikofer
- Research Group, Department of Neurology, Schoen Clinic Bad Aibling, Kolbermoorer Str. 72, 83043, Bad Aibling, Germany
| | - Franziska Wippenbeck
- Research Group, Department of Neurology, Schoen Clinic Bad Aibling, Kolbermoorer Str. 72, 83043, Bad Aibling, Germany
| | - Friedemann Müller
- Research Group, Department of Neurology, Schoen Clinic Bad Aibling, Kolbermoorer Str. 72, 83043, Bad Aibling, Germany
| | - Klaus Jahn
- Research Group, Department of Neurology, Schoen Clinic Bad Aibling, Kolbermoorer Str. 72, 83043, Bad Aibling, Germany
- German Center for Vertigo and Balance Disorders, University Hospital Grosshadern, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Jeannine Bergmann
- Research Group, Department of Neurology, Schoen Clinic Bad Aibling, Kolbermoorer Str. 72, 83043, Bad Aibling, Germany
- German Center for Vertigo and Balance Disorders, University Hospital Grosshadern, Ludwig-Maximilians-Universität München, Munich, Germany
| |
Collapse
|
2
|
Abdollahi M, Rashedi E, Kuber PM, Jahangiri S, Kazempour B, Dombovy M, Azadeh-Fard N. Post-Stroke Functional Changes: In-Depth Analysis of Clinical Tests and Motor-Cognitive Dual-Tasking Using Wearable Sensors. Bioengineering (Basel) 2024; 11:349. [PMID: 38671771 PMCID: PMC11048064 DOI: 10.3390/bioengineering11040349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/26/2024] [Accepted: 03/28/2024] [Indexed: 04/28/2024] Open
Abstract
Clinical tests like Timed Up and Go (TUG) facilitate the assessment of post-stroke mobility, but they lack detailed measures. In this study, 21 stroke survivors and 20 control participants underwent TUG, sit-to-stand (STS), and the 10 Meter Walk Test (10MWT). Tests incorporated single tasks (STs) and motor-cognitive dual-task (DTs) involving reverse counting from 200 in decrements of 10. Eight wearable motion sensors were placed on feet, shanks, thighs, sacrum, and sternum to record kinematic data. These data were analyzed to investigate the effects of stroke and DT conditions on the extracted features across segmented portions of the tests. The findings showed that stroke survivors (SS) took 23% longer for total TUG (p < 0.001), with 31% longer turn time (p = 0.035). TUG time increased by 20% (p < 0.001) from STs to DTs. In DTs, turning time increased by 31% (p = 0.005). Specifically, SS showed 20% lower trunk angular velocity in sit-to-stand (p = 0.003), 21% longer 10-Meter Walk time (p = 0.010), and 18% slower gait speed (p = 0.012). As expected, turning was especially challenging and worsened with divided attention. The outcomes of our study demonstrate the benefits of instrumented clinical tests and DTs in effectively identifying motor deficits post-stroke across sitting, standing, walking, and turning activities, thereby indicating that quantitative motion analysis can optimize rehabilitation procedures.
Collapse
Affiliation(s)
- Masoud Abdollahi
- Department of Industrial and Systems Engineering, Rochester Institute of Technology, Rochester, NY 14623, USA; (M.A.); (P.M.K.); (S.J.); (B.K.); (N.A.-F.)
| | - Ehsan Rashedi
- Department of Industrial and Systems Engineering, Rochester Institute of Technology, Rochester, NY 14623, USA; (M.A.); (P.M.K.); (S.J.); (B.K.); (N.A.-F.)
| | - Pranav Madhav Kuber
- Department of Industrial and Systems Engineering, Rochester Institute of Technology, Rochester, NY 14623, USA; (M.A.); (P.M.K.); (S.J.); (B.K.); (N.A.-F.)
| | - Sonia Jahangiri
- Department of Industrial and Systems Engineering, Rochester Institute of Technology, Rochester, NY 14623, USA; (M.A.); (P.M.K.); (S.J.); (B.K.); (N.A.-F.)
| | - Behnam Kazempour
- Department of Industrial and Systems Engineering, Rochester Institute of Technology, Rochester, NY 14623, USA; (M.A.); (P.M.K.); (S.J.); (B.K.); (N.A.-F.)
| | - Mary Dombovy
- Department of Rehabilitation and Neurology, Unity Hospital, Rochester, NY 14626, USA;
| | - Nasibeh Azadeh-Fard
- Department of Industrial and Systems Engineering, Rochester Institute of Technology, Rochester, NY 14623, USA; (M.A.); (P.M.K.); (S.J.); (B.K.); (N.A.-F.)
| |
Collapse
|
3
|
Shao C, Wang Y, Gou H, Chen T. The factors associated with the deterioration of activities of daily life in stroke patients: A retrospective cohort study. Top Stroke Rehabil 2024; 31:21-28. [PMID: 36961229 DOI: 10.1080/10749357.2023.2194095] [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: 09/30/2022] [Accepted: 03/19/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND The activities of daily life (ADL) of stroke patients generally improves after rehabilitation. However, some patients remain at risk of ADL deterioration in the future. So far, there have been few studies on the factors related to ADL deterioration in stroke patients. OBJECTIVE To identify the factors related to ADL deterioration in stroke patients with independent mobility after discharge. METHODS We assessed 336 stroke patients with independent mobility who were discharged from the rehabilitation center between January 2016 and December 2018. The primary outcome was ADL deterioration, defined as that ADL assessed at 2 years after discharge decreased more than 15 points compared with that assessed at discharge. Univariate and multivariate statistical analyses were conducted to screen for factors related to ADL deterioration. RESULTS Overall, 62 (18.4%) patients exhibited ADL deterioration at 2 years after discharge.Age (OR = 1.114, 95%CI = 1.045-1.188, p = 0.001), vascular risk factors>3 (OR = 3.269, 95%CI = 1.189-8.986, p = 0.022) and with post-stroke depression (OR = 2.486, 95%CI = 1.011-6.114, p = 0.047) were risk factors for ADL deterioration in stroke patients. In contrast, elevated Berg Balance Scale (BBS) scores at discharge was a protective factor for ADL deterioration (OR = 0.484, 95%CI = 0.386-0.606, p < 0.001). CONCLUSIONS Nearly 1 in 5 stroke patients with independent mobility experienced ADL deterioration at 2 years after discharge. Aging, vascular risk factors>3, BBS at discharge, and post-stroke depression (PSD) were identified as factors associated with ADL deterioration.
Collapse
Affiliation(s)
- Chenlan Shao
- The Rehabilitation Medicine Center, People's Hospital of Deyang City, Sichuan Province, China
| | - Yongzheng Wang
- The Rehabilitation Medicine Center, People's Hospital of Deyang City, Sichuan Province, China
| | - Hui Gou
- The Rehabilitation Medicine Center, People's Hospital of Deyang City, Sichuan Province, China
| | - Tingting Chen
- The Rehabilitation Medicine Center, People's Hospital of Deyang City, Sichuan Province, China
| |
Collapse
|
4
|
Xia Q, Zhou P, Li X, Li X, Zhang L, Fan X, Zhao Z, Jiang Y, Zhu J, Wu H, Zhang M. Factors associated with balance impairments in the community-dwelling elderly in urban China. BMC Geriatr 2023; 23:545. [PMID: 37679669 PMCID: PMC10486131 DOI: 10.1186/s12877-023-04219-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 08/05/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Identification of factors relevant to balance performance impairments in the elderly population was critical for developing effective interventions and preventions. However, there have been very limited data available based on large scale studies. The present study identified factors that independently contributed to performance impairments in overall balance, domains of static balance, postural stability, and dynamic balance, and individual items. METHODS A total of 1984 community-dwelling Chinese elderly from urban areas of Shanghai were recruited. Information on demographic characteristic, exercise, and health status were collected with a face-to-face interview. Balance performances were assessed on site by trained investigators based on the X16 balance testing scale. To identify the effectors, ordinal logistic regression analysis was applied for overall balance, static balance, postural stability, and dynamic balance. Binary logistic regression analysis was used for 16 items. RESULTS The community-dwelling elderly residents were aged from 60 to 97 years old. With increases of age, risks of impairments in overall balance increased gradually (ORs from 1.26 to 3.20, all P < 0.01). In the elderly with overweight and obesity, there was higher proportion of balance impairments compared to the elderly with normal BMI (OR = 1.26, P < 0.001). Regular exercise every week was associated with reduced risks of balance impairments (ORs from 0.63 to 0.73, all P < 0.001). Presences with vision lesion (ORs from 1.28 to 1.59, all P < 0.001), moderate hearing impairment (OR = 1.54, P < 0.001), somesthesis dysfunction (ORs from 1.59 to 13.26, all P < 0.001), and cerebrovascular disease (OR = 1.45, P = 0.001) were related to increased risks of balance impairments. Likewise, age, exercise, vision, hearing, somesthesis, and cerebrovascular disease were significantly associated with static balance, postural stability, and dynamic balance. Both overweight and obesity and underweight were associated with higher proportions of dynamic balance impairments. Regular exercise was significantly related to reduced risks of impairments in 15 out of the 16 items. CONCLUSIONS In the elderly, age, overweight and obesity, exercise, vision, hearing, somesthesia, and cerebrovascular disease were dominant factors associated with impairments in overall balance, domains of static balance, postural stability, and dynamic balance, and most individual items. TRIAL REGISTRATION Not applicable.
Collapse
Affiliation(s)
- Qinghua Xia
- Changning Center for Disease Control and Prevention, Shanghai, 200051, China
| | - Peng Zhou
- Changning Center for Disease Control and Prevention, Shanghai, 200051, China
| | - Xia Li
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
| | - Xiaofen Li
- Institute of Nutrition and Diseases, Department of Preventive Medicine, Wenzhou Medical University, Wenzhou, 325035, China
| | - Lei Zhang
- Changning Center for Disease Control and Prevention, Shanghai, 200051, China
| | - Xuefei Fan
- Institute of Nutrition and Diseases, Department of Preventive Medicine, Wenzhou Medical University, Wenzhou, 325035, China
| | - Zhoulan Zhao
- Institute of Nutrition and Diseases, Department of Preventive Medicine, Wenzhou Medical University, Wenzhou, 325035, China
| | - Yu Jiang
- Changning Center for Disease Control and Prevention, Shanghai, 200051, China
| | - Jianhong Zhu
- Institute of Nutrition and Diseases, Department of Preventive Medicine, Wenzhou Medical University, Wenzhou, 325035, China
| | - Hongmei Wu
- Institute of Nutrition and Diseases, Department of Preventive Medicine, Wenzhou Medical University, Wenzhou, 325035, China.
| | - Mengdi Zhang
- Institute of Nutrition and Diseases, Department of Preventive Medicine, Wenzhou Medical University, Wenzhou, 325035, China.
| |
Collapse
|
5
|
Özden F, Özkeskin M, Tümtürk İ, Yalçın M. The investigation of cognition, proprioception, sensory and physical function in stroke patients with urinary incontinence. Int Urol Nephrol 2023:10.1007/s11255-023-03647-5. [PMID: 37253930 DOI: 10.1007/s11255-023-03647-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 05/23/2023] [Indexed: 06/01/2023]
Abstract
PURPOSE This study aimed to investigate cognition, proprioception, and sensory/physical function in stroke patients with urinary incontinence (UI). METHODS A prospective cross-sectional study was conducted on 53 individuals with stroke (23 had UI and 21 matched controls). The Incontinence Impact Questionnaire Short Form (IIQ-7) and Urogenital Distress Inventory (UDI-6) were used to assess the patients' UI symptoms. Participants were also evaluated with Mini-Mental State Examination (MMSE), Barthel Index (BI), Fugl-Meyer Sensory Assessment (FMA-S), Five Times Sit to Stand Test (FTSST), Functional Reach Test (FRT) and Proprioception Test. RESULTS FTSST, FRT and FMA-S were better in stroke subjects without UI (p < 0.05). There was a moderate correlation between IIQ-7 with FMA-S, FTSST and proprioception (left extremity) (r1: - 0.415, r2: 0.440, r3: 0.430, p < 0.05) and a low correlation with BI (r: - 0.356, p < 0.05). CONCLUSION Individuals with UI had worse sensory/motor function and static balance. Stroke patients with UI were more dependent, had less sensory function, and had worse lower extremity muscle strength and proprioception as the level of urinary incontinence increased. To reduce urinary incontinence, emphasis on motor/sensory function, balance, and proprioception should be considered.
Collapse
Affiliation(s)
- Fatih Özden
- Köyceğiz Vocational School of Health Services, Department of Health Care Services, Muğla Sıtkı Koçman University, Köyceğiz, 48800, Muğla, Turkey.
| | - Mehmet Özkeskin
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Ege University, İzmir, Turkey
| | - İsmet Tümtürk
- Institute of Health Sciences, Department of Physiotherapy and Rehabilitation, Süleyman Demirel University, Isparta, Turkey
| | - Mustafa Yalçın
- Department of Physiotherapy and Rehabilitation, Bursa Çekirge State Hospital, Bursa, Turkey
| |
Collapse
|
6
|
Khan F, Abusharha S, Alfuraidy A, Nimatallah K, Almalki R, Basaffar R, Mirdad M, Chevidikunnan MF, Basuodan R. Prediction of Factors Affecting Mobility in Patients with Stroke and Finding the Mediation Effect of Balance on Mobility: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16612. [PMID: 36554493 PMCID: PMC9779513 DOI: 10.3390/ijerph192416612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 12/04/2022] [Accepted: 12/07/2022] [Indexed: 06/17/2023]
Abstract
(1) Background: Regaining mobility after stroke is essential to facilitate patient independency in activities of daily living. Predicting post-stroke mobility is clinically important and plays a significant part in rehabilitation programs. The purpose of this study is to find the factors affecting mobility in patients with stroke and to analyze the mediation effect of balance on mobility. (2) Methods: This cross-sectional study included forty-one patients with stroke averaging an age of 57.2 ± 88.6. The Rivermead Mobility Index (RMI) was used for measuring the mobility, Timed Up and Go (TUG) to measure the walking speed, Berg Balance Scale (BBS) to assess the balance and a handheld dynamometer (HHD) was used for measuring the isometric strength of the ankle and knee. (3) Results: In regression analysis balance (β=0.58; p≤ 0.0001) and walking speed (β=-0.27; p=0.04) were the significant factors predicting mobility. (4) Conclusions: Balance and gait speed were the factors that influenced mobility in stroke patients, indicating the utility of measuring these aspects in order to provide appropriate rehabilitation programs.
Collapse
Affiliation(s)
- Fayaz Khan
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Sami Abusharha
- Department of Occupational Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Aljowhara Alfuraidy
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Khadeeja Nimatallah
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Raghad Almalki
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Rafa’a Basaffar
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Mawada Mirdad
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Mohamed Faisal Chevidikunnan
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Reem Basuodan
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
| |
Collapse
|
7
|
Gu X, Zeng M, Cui Y, Fu J, Li Y, Yao Y, Shen F, Sun Y, Wang Z, Deng D. Aquatic strength training improves postural stability and walking function in stroke patients. Physiother Theory Pract 2022:1-10. [PMID: 35285397 DOI: 10.1080/09593985.2022.2049939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Xudong Gu
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Jiaxing University, the Second Hospital of Jiaxing City, Jiaxing City, ZJ, China
| | - Ming Zeng
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Jiaxing University, the Second Hospital of Jiaxing City, Jiaxing City, ZJ, China
| | - Yao Cui
- Department of Physical Therapy, Beijing Bo’ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Jianming Fu
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Jiaxing University, the Second Hospital of Jiaxing City, Jiaxing City, ZJ, China
| | - Yan Li
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Jiaxing University, the Second Hospital of Jiaxing City, Jiaxing City, ZJ, China
| | - Yunhai Yao
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Jiaxing University, the Second Hospital of Jiaxing City, Jiaxing City, ZJ, China
| | - Fang Shen
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Jiaxing University, the Second Hospital of Jiaxing City, Jiaxing City, ZJ, China
| | - Ya Sun
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Jiaxing University, the Second Hospital of Jiaxing City, Jiaxing City, ZJ, China
| | - Zhongli Wang
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Jiaxing University, the Second Hospital of Jiaxing City, Jiaxing City, ZJ, China
| | - Dingyi Deng
- Department of Rehabilitation, Qianjiang Central Hospital, Qianjiang City Hubei Province, China
| |
Collapse
|
8
|
Jeong SA, Park C, Oh SJ, You JSH. Multiple relationships between cognition-motor impairment and activity-based clinical outcome measures in 218 hemiplegic stroke patients. NeuroRehabilitation 2021; 49:553-563. [PMID: 34776427 DOI: 10.3233/nre-210195] [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: 11/15/2022]
Abstract
BACKGROUND The World Health Organization has developed the International Classification of Functions, Disabilities, and Health (ICF) model providing a theoretical basis for physical therapy diagnosis and interventions related to health conditions. However, the multiple relationship between body structure/function and activity domain variables is unknown on the cognition, spasticity, trunk and lower extremity recovery of the sensorimotor function and activity. OBJECTIVE Our study aimed to determine the relationship between body structure/functions and body activity domain variables in adults with stroke. METHODS A total of 218 hemiplegic survivors (102 females, mean age 64.98±13.53) were recruited from the Chungdam Hospital Center for our retrospective study. We used Mini-Mental State Examination (MMSE), Fugl-Meyer Assessment for lower extremity (FMA-LE), Modified Ashworth Scale (MAS), Berg Balance Scale (BBS), Modified Barthel Index (MBI), and Trunk Impairment Scale (TIS) as clinical outcome measures. The Pearson correlation coefficient was used to determine the multiple relationships among the variables at P < 0.05. RESULTS The correlations between body structure/function domain (MMSE, FMA-LE, MAS) and activity domain variables (BBS, MBI, and TIS) were significant, rending from pre -intervention r = -0.216 to 0.766 and post-intervention r = -0.213 to 0.776, P < 0.05, except for MMSE and MAS. CONCLUSIONS Establishing a significant difference between body structure/functions and activity domain variables in our research implies important multiple relationships between cognitive function, lower extremity function, lower extremity spasticity, and balance, and performance of ADL and trunk control coordination after stroke.
Collapse
Affiliation(s)
- Seon Ah Jeong
- Sports Movement Artificial Intelligence Robotics Technology (SMART) Institute, Department of Physical Therapy, Yonsei University, Wonju, Republic of Korea.,Department of Physical Therapy, Yonsei University, Wonju, Republic of Korea
| | - Chanhee Park
- Sports Movement Artificial Intelligence Robotics Technology (SMART) Institute, Department of Physical Therapy, Yonsei University, Wonju, Republic of Korea.,Department of Physical Therapy, Yonsei University, Wonju, Republic of Korea
| | - Seung Jun Oh
- Department of Physical Therapy, College of Nursing and Health, Kyungwoon University, Gumi, Republic of Korea
| | - Joshua Sung H You
- Sports Movement Artificial Intelligence Robotics Technology (SMART) Institute, Department of Physical Therapy, Yonsei University, Wonju, Republic of Korea.,Department of Physical Therapy, Yonsei University, Wonju, Republic of Korea
| |
Collapse
|
9
|
Lynch P, Monaghan K. Effects of sensory substituted functional training on balance, gait, and functional performance in neurological patient populations: A systematic review and meta-analysis. Heliyon 2021; 7:e08007. [PMID: 34604558 PMCID: PMC8473554 DOI: 10.1016/j.heliyon.2021.e08007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/14/2021] [Accepted: 09/13/2021] [Indexed: 01/14/2023] Open
Abstract
Introduction Sensory Substitution (SS) is the use of one sensory modality to supply environmental information normally gathered by another sense while still preserving key functions of the original sense. Objective This systematic literature review and meta-analysis summarises and synthesise current evidence and data to estimate the effectiveness of SS supplemented training for improving balance, gait and functional performance in neurological patient populations. Methods A systematic literature search was performed in Cochrane Library, PubMed, Web of Science, and ScienceDirect. Randomized controlled trials (RCTs) using a SS training intervention were included. Results Nine RCTs were included. Outcome measures/training paradigms were structured according to the balance framework of Shumway-Cook and Woollacott: Static steady-state, Dynamic steady-state and Proactive balance. Meta-analyses revealed significant overall effects of SS training for all three outcomes, as well as self-assessment and functional capacity outcomes, with Dynamic Steady-State balance and ability of stroke survivors to support bodyweight independently on paretic side lower limb found to have had the largest statistical and clinical effects. Meta-analyses also revealed non-significant retention effects. Conclusion This review provides evidence in favour of a global positive effect of SS training in improving Static steady-state, Dynamic steady-state and Proactive balance measures, as well as measures of self-assessment and functional capacity in neurological patient populations. Retention of effects were not significant at follow-up assessments, although no intervention met training dosage recommendations. It is important for future research to consider variables such as specific patient population, sensor type, and training modalities in order identify the most effective type of training paradigms.
Collapse
Affiliation(s)
- Peter Lynch
- Clinical Health and Nutrition Centre (CHANCE), School of Science, Institute of Technology (IT) Sligo, Ireland
- Neuroplasticity Research Group, Clinical Health and Nutrition Centre (CHANCE), School of Science, Institute of Technology (IT) Sligo, Ireland
- Corresponding author.
| | - Kenneth Monaghan
- Clinical Health and Nutrition Centre (CHANCE), School of Science, Institute of Technology (IT) Sligo, Ireland
- Neuroplasticity Research Group, Clinical Health and Nutrition Centre (CHANCE), School of Science, Institute of Technology (IT) Sligo, Ireland
| |
Collapse
|
10
|
Zaborova V, Fesyun A, Gurevich K, Oranskaya A, Rylsky A, Kryuchkova K, Malakhovskiy V, Shestakov D. Changes in kinesiostabilogram parameters and movement speed of stroke patients while increasing their physical activity due to the use of biofeedback method. Eur J Transl Myol 2021; 31. [PMID: 34595898 PMCID: PMC8758953 DOI: 10.4081/ejtm.2021.9360] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 08/13/2021] [Indexed: 11/23/2022] Open
Abstract
Balance disorders are complications of stroke survivors. Aim of this study was the establish effectiveness of the biofeedback approach. In this intervention study 245 patients with early diagnosis of acute disturbance of cerebral circulation (ADCC) were examined. Patients able to move independently were treated by standard conservative ADCC therapy on an outpatient approach, but they continued to have problems with coordination of movement in upright position. Then they were submitted to an increasing physical activity based on five sessions of biofeedback, i.e., a complex rehabilitation of patients with motor pathology "Trust-M" according to TU 9442-001-63704475-2010. Mobility rates were assessed using a web camera. Patients' quality of life was evaluated by SF-36 questionnaire and the Hospital Anxiety and Depression Scale (HADS). All parameters were recorded before and after 5 sessions of biofeedback. After treatment, the stability indicators improved and all patients showed a significant increase in motion rate and quality of life. At the same time, the severity of pain and of depression and anxiety decreased. Negative correlations of average strength between the quadrant and patient HADS scaling rates were obtained. In conclusion, our work shows effectiveness of the biofeedback technique for correcting coordination in stroke survivors.
Collapse
Affiliation(s)
- Victoria Zaborova
- Department of Sports Medicine and Medical Rehabilitation, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; Sports Adaptology Laboratory, Moscow Institute of Physics and Technology (National Research University), Moscow Region, Dolgoprudniy.
| | - Anatoly Fesyun
- FSBI "National Medical Research Center for Rehabilitation and Resortology" Ministry of Public Health of Russia, Moscow.
| | - Konstantin Gurevich
- FSBI "National Medical Research Center for Rehabilitation and Resortology" Ministry of Public Health of Russia, Moscow, Russia; UNESCO chair "Healthy life style for sustainable development" "Moscow State University of Medicine and Dentistry. A.I. Evdokimov", Ministry of Health of the Russian Federation, Moscow, Russia; Research Institute of Healthcare Organization and Medical Management of the Moscow Department of Healthcare, Moscow .
| | - Alevtina Oranskaya
- UNESCO chair "Healthy life style for sustainable development" "Moscow State University of Medicine and Dentistry. A.I. Evdokimov", Ministry of Health of the Russian Federation, Moscow.
| | - Alexey Rylsky
- Moscow scientific and practical center for medical rehabilitation, rehabilitation and sports medicine, Department of Health of Moscow, Moscow.
| | - Kira Kryuchkova
- Department of Sports Medicine and Medical Rehabilitation, Sechenov First Moscow State Medical University (Sechenov University), Moscow.
| | - Vladimir Malakhovskiy
- Department of Sports Medicine and Medical Rehabilitation, Sechenov First Moscow State Medical University (Sechenov University), Moscow.
| | - Dmitry Shestakov
- Department of Orthopedics and Complex Trauma of the Moscow Clinical Research Center A.S. Loginov, Moscow.
| |
Collapse
|
11
|
Ooi TC, Singh DKA, Shahar S, Rajab NF, Vanoh D, Sharif R, Tan MP. Incidence and multidimensional predictors of occasional and recurrent falls among Malaysian community-dwelling older persons. BMC Geriatr 2021; 21:154. [PMID: 33653312 PMCID: PMC7927222 DOI: 10.1186/s12877-021-02103-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 02/22/2021] [Indexed: 01/09/2023] Open
Abstract
Background Falls incidence rate and comprehensive data on factors that predict occasional and repeated falls from large population-based studies are scarce. In this study, we aimed to determine the incidence of falls and identify predictors of occasional and recurrent falls. This was done in the social, medical, physical, nutritional, biochemical, cognitive dimensions among community-dwelling older Malaysians. Methods Data from 1,763 Malaysian community-dwelling older persons aged ≥ 60 years were obtained from the LRGS-TUA longitudinal study. Participants were categorized into three groups according to the presence of a single fall (occasional fallers), ≥two falls (recurrent fallers), or absence of falls (non-fallers) at an 18-month follow-up. Results Three hundred and nine (17.53 %) participants reported fall occurrences at an 18-month follow-up, of whom 85 (27.51 %) had two or more falls. The incidence rate for occasional and recurrent falls was 8.47 and 3.21 per 100 person-years, respectively. Following multifactorial adjustments, being female (OR: 1.57; 95 % CI: 1.04–2.36), being single (OR: 5.31; 95 % CI: 3.36–37.48), having history of fall (OR: 1.86; 95 % CI: 1.19–2.92) higher depression scale score (OR: 1.10; 95 % CI: 1.02–1.20), lower hemoglobin levels (OR: 0.90; 95 % CI: 0.81-1.00) and lower chair stand test score (OR: 0.93; 95 % CI: 0.87-1.00) remained independent predictors of occasional falls. While, having history of falls (OR: 2.74; 95 % CI: 1.45–5.19), being a stroke survivor (OR: 8.57; 95 % CI: 2.12–34.65), higher percentage of body fat (OR: 1.04; 95 % CI: 1.01–1.08) and lower chair stand test score (OR: 0.87; 95 % CI: 0.77–0.97) appeared as recurrent falls predictors. Conclusions Having history of falls and lower muscle strength were predictors for both occasional and recurrent falls among Malaysian community-dwelling older persons. Modifying these predictors may be beneficial in falls prevention and management strategies among older persons.
Collapse
Affiliation(s)
- Theng Choon Ooi
- Centre for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
| | - Devinder Kaur Ajit Singh
- Centre for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia.
| | - Suzana Shahar
- Centre for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
| | - Nor Fadilah Rajab
- Centre for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
| | - Divya Vanoh
- Nutrition & Dietetics Programme, School of Health Sciences, Health Campus, Universiti Sains Malaysia, 16100, Kubang Kerian, Kelantan, Malaysia
| | - Razinah Sharif
- Centre for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
| | - Maw Pin Tan
- Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.,Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| |
Collapse
|
12
|
Koh JSG, Hill AM, Hill KD, Etherton-Beer C, Francis-Coad J, Bell E, Bainbridge L, de Jong LD. Evaluating a Novel Multifactorial Falls Prevention Activity Programme for Community-Dwelling Older People After Stroke: A Mixed-Method Feasibility Study. Clin Interv Aging 2020; 15:1099-1112. [PMID: 32764897 PMCID: PMC7360420 DOI: 10.2147/cia.s251516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 06/17/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose The overall purpose of this study was to explore participants’ and physiotherapists’ experiences regarding the acceptability, implementation, and practicality of a novel group-based multifactorial falls prevention activity programme for community-dwelling older people after stroke. Specifically, the purpose was to explore if and how participating could impact on the participants’ health-related quality of life (HRQoL) in terms of their daily lived experience regarding physical, mental, emotional and social well-being. A secondary purpose was to explore whether participating in the programme could positively influence participants’ balance, strength, falls efficacy, mobility and motor impairment of the trunk. Materials and Methods This was an exploratory mixed-method Phase I feasibility study. A convenience sample of five older community-dwelling people after stroke participated in a novel eight-week multifactorial activity programme which included falls education, a mix of individually tailored and group-based strength and balance exercises, exploring limits of stability and safe landing techniques and a social element. Qualitative data from post-intervention interview transcripts with the participants and the physiotherapists who delivered the programme were thematically analysed using both deductive and inductive approaches to explore the participants’ and therapists’ experiences with the programme. Quantitative outcomes included balance, strength, falls efficacy, mobility and motor impairment of the trunk. Results The programme was deemed feasible in terms of acceptability, implementation and practicality by the participants as well as the physiotherapists delivering the programme. The overarching theme regarding HRQoL identified that participating in the programme was perceived to empower the participants living with stroke and positively influenced their daily physical, mental, emotional and social well-being. Participant outcomes showed a change in the direction of improvements in balance, strength, mobility, motor impairment of the trunk and reduced concerns about falling. Subjectively, participants only reported perceived improvements in balance and strength. Conclusion Running a novel multifactorial falls prevention activity programme for older community-dwelling people after stroke was feasible. Participating in the programme helped participants to perceive improved balance, strength and empower them to make meaningful changes, improving their daily lived experiences. A future fully powered study could build on these results to investigate physical improvements, prevention of falls and improvements to domains of HRQoOL.
Collapse
Affiliation(s)
- Jun Sheng Gary Koh
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Bentley, Perth, WA 6102, Australia
| | - Anne-Marie Hill
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Bentley, Perth, WA 6102, Australia
| | - Keith D Hill
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Bentley, Perth, WA 6102, Australia.,Rehabilitation, Ageing and Independent Living Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Christopher Etherton-Beer
- WA Centre for Health and Ageing, Royal Perth Hospital Unit, School of Medicine and Pharmacology and Centre for Medical Research, University of Western Australia, Perth, Western Australia, Australia
| | - Jacqueline Francis-Coad
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Bentley, Perth, WA 6102, Australia
| | - Elizabeth Bell
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Bentley, Perth, WA 6102, Australia
| | - Liz Bainbridge
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Bentley, Perth, WA 6102, Australia
| | - Lex D de Jong
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Bentley, Perth, WA 6102, Australia
| |
Collapse
|
13
|
Molina F, Lomas-Vega R, Obrero-Gaitán E, Rus A, Almagro DR, Del-Pino-Casado R. Misperception of the subjective visual vertical in neurological patients with or without stroke: A meta-analysis. NeuroRehabilitation 2019; 44:379-388. [PMID: 31227659 DOI: 10.3233/nre-182642] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The interpretation of the verticality of the environment is crucial for a proper body balance. The subjective visual vertical test (SVV) is a widely used method to determine the visual perception of the verticality, whose alteration has been related with poor functional status. OBJECTIVE To analyze the visual perception of the verticality in neurological patients in comparison with healthy controls. METHODS We searched PubMed, Scopus, and Scielo from the start of the databases until October 2017 and manually searched the reference lists of studies comparing SVV values between neurological patients and controls. Standardized mean difference (SMD) and subgroup analysis were used to analyze differences between neurological patients and healthy subjects and between stroke and non-stroke patients, respectively. RESULTS A total of 1,916 subjects from 31 studies were included. Neurological patients misestimate the true vertical in comparison with controls (SMD = 1.05; 95% CI: 0.81, 1.28). The misperception of the verticality was higher in stroke patients (SMD = 1.35; 95% CI: 1.02, 1.68) than in patients with other neurological conditions (SMD = 0.48; 95% CI: 0.29, 0.68). CONCLUSIONS Neurological patients showed a misperception of the verticality, estimated using the SVV. The neurological pathology that most alters the SVV is stroke.
Collapse
Affiliation(s)
- Francisco Molina
- Department of Health Science, University of Jaén, Paraje Las Lagunillas s/n, Jaén, Spain
| | - Rafael Lomas-Vega
- Department of Health Science, University of Jaén, Paraje Las Lagunillas s/n, Jaén, Spain
| | - Esteban Obrero-Gaitán
- Department of Health Science, University of Jaén, Paraje Las Lagunillas s/n, Jaén, Spain
| | - Alma Rus
- Department of Cell Biology, University of Granada, Campus Fuentenueva, Granada, Spain
| | | | | |
Collapse
|
14
|
Factors Predicting Falls and Mobility Outcomes in Patients With Stroke Returning Home After Rehabilitation Who Are at Risk of Falling. Arch Phys Med Rehabil 2017. [DOI: 10.1016/j.apmr.2017.05.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
15
|
Lee HC, Huang CL, Ho SH, Sung WH. The Effect of a Virtual Reality Game Intervention on Balance for Patients with Stroke: A Randomized Controlled Trial. Games Health J 2017; 6:303-311. [PMID: 28771379 DOI: 10.1089/g4h.2016.0109] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate the effects of virtual reality (VR) balance training conducted using Kinect for Xbox® games on patients with chronic stroke. MATERIALS AND METHODS Fifty patients with mild to moderate motor deficits were recruited and randomly assigned to two groups: VR plus standard treatment group and standard treatment (ST) group. In total, 12 training sessions (90 minutes a session, twice a week) were conducted in both groups, and performance was assessed at three time points (pretest, post-test, and follow-up) by a blinded assessor. The outcome measures were the Berg Balance Scale (BBS), Functional Reach Test, and Timed Up and Go Test (cognitive; TUG-cog) for balance evaluations; Modified Barthel Index for activities of daily living ability; Activities-specific Balance Confidence Scale for balance confidence; and Stroke Impact Scale for quality of life. The pleasure scale and adverse events were also recorded after each training session. RESULTS Both groups exhibited significant improvement over time in the BBS (P = 0.000) and TUG-cog test (P = 0.005). The VR group rated the experience as more pleasurable than the ST group during the intervention (P = 0.027). However, no significant difference was observed in other outcome measures within or between the groups. No serious adverse events were observed during the treatment in either group. CONCLUSIONS VR balance training by using Kinect for Xbox games plus the traditional method had positive effects on the balance ability of patients with chronic stroke. The VR group experienced higher pleasure than the ST group during the intervention.
Collapse
Affiliation(s)
- Hsin-Chieh Lee
- 1 Department of Physical Medicine and Rehabilitation, Taipei Medical University Shuang-Ho Hospital , Taipei, Taiwan .,2 Department of Physical Therapy and Assistive Technology, National Yang-Ming University , Taipei, Taiwan
| | - Chia-Lin Huang
- 1 Department of Physical Medicine and Rehabilitation, Taipei Medical University Shuang-Ho Hospital , Taipei, Taiwan
| | - Sui-Hua Ho
- 1 Department of Physical Medicine and Rehabilitation, Taipei Medical University Shuang-Ho Hospital , Taipei, Taiwan
| | - Wen-Hsu Sung
- 2 Department of Physical Therapy and Assistive Technology, National Yang-Ming University , Taipei, Taiwan
| |
Collapse
|
16
|
Memis D, Kozanoglu E, Kelle B, Goncu MK. Assessment of demographic and clinical characteristics on functional status and disability of patients with stroke. ACTA ACUST UNITED AC 2017; 21:352-357. [PMID: 27744465 PMCID: PMC5224434 DOI: 10.17712/nsj.2016.4.20160212] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the effects of demographic and clinical characteristics on mobility, disability, and activities of daily life of patients with stroke. METHODS This cross-sectional clinical study was performed in the Department of Physical Medicine and Rehabilitation in Cukurova University Faculty of Medicine in Adana, Turkey, between February 2011 and December 2011. The study included 126 patients with stroke. The Brunnstrom recovery scale (BRS), functional ambulation classification scale (FACS), modified Barthel index (MBI), modified Rankin scale (MRS), and Rivermead mobility index (RMI) were used in the evaluation of the functional status of stroke patients. Correlations between each scale and parameters including age, etiology, and duration of hemiplegia were assessed. RESULTS The major etiology of stroke was found as ischemic (77%). Hypertension was a major risk factor in both genders (72% for males, 85% for females). Statistically significant differences were found between ischemic and hemorrhagic stroke patients regarding the RMI, MBI, BRS, and the FACS (p<0.001). Age had a poor negative correlation with the FACS and RMI. CONCLUSION It is suggested that age is an important risk factor for the development of stroke, but it has no strong effect on functional status and disability in patients with stroke. The BRS, FACS, MBI, MRS, and RMI scales can be used in stroke patients whether they are under or over 65 years old in order to evaluate functional status and disability.
Collapse
Affiliation(s)
- Derya Memis
- Department of Physical Medicine and Rehabilitation, Adana Numune Education and Research Hospital, Adana, Turkey
| | | | | | | |
Collapse
|
17
|
Rodriguez J, Blaber AP, Kneihsl M, Trozic I, Ruedl R, Green DA, Broadbent J, Xu D, Rössler A, Hinghofer-Szalkay H, Fazekas F, Goswami N. Poststroke alterations in heart rate variability during orthostatic challenge. Medicine (Baltimore) 2017; 96:e5989. [PMID: 28383399 PMCID: PMC5411183 DOI: 10.1097/md.0000000000005989] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Older adults following recovery from ischemic stroke have a higher incidence of orthostatic hypotension, syncope, and fall risk, which may be related to impaired autonomic responses limiting the ability to maintain cerebral blood flow. Thus, we investigated cerebrovascular and cardiovascular regulation in 23 adults ≥55 years of age, 10 diagnosed with ischemic stroke, and 13 age-matched healthy controls when sitting at rest and upon standing to compare differences of autonomic variables at ∼7 months (218 ± 41 days) poststroke.Arterial blood pressure via finger plethysmography, muscle-pump baroreflex via electromyography, heart rate variability via 3-lead ECG, and cerebral blood flow velocity via transcranial Doppler were analyzed while sitting for 5 minutes and then during quiet standing for 5 minutes.From the seated to standing position, the stroke group had significantly greater decline in the low frequency component of heart rate variability (164 [79] vs 25 [162] ms; P = 0.043). All other cardiovascular parameters and assessments of autonomic function were not significantly different between the two groups.Our findings support the hypothesis of continued autonomic dysfunction after recovery from ischemic stroke, with potential attenuation of the cardiovascular response to standing. However, further investigation is required to determine the mechanisms underlying the increased risk of orthostatic hypotension, syncope, and falls poststroke.
Collapse
Affiliation(s)
- Joel Rodriguez
- Gravitational Physiology and Medicine Research Unit, Institute of Physiology, Medical University of Graz, Graz, Austria
- Centre of Human and Aerospace Physiological Sciences, King's College London, London, UK
| | - Andrew Philip Blaber
- Aerospace Physiology Laboratory, Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, Canada
| | - Markus Kneihsl
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Irhad Trozic
- Gravitational Physiology and Medicine Research Unit, Institute of Physiology, Medical University of Graz, Graz, Austria
| | - Rebecca Ruedl
- Gravitational Physiology and Medicine Research Unit, Institute of Physiology, Medical University of Graz, Graz, Austria
| | - David A. Green
- Centre of Human and Aerospace Physiological Sciences (CHAPS), King's College London, Faculty of Life Sciences and Medicine, Guy's Campus, London, UK
- KBRwyle, European Astronaut Centre, Linder Höhe, Cologne, Germany
| | - James Broadbent
- Gravitational Physiology and Medicine Research Unit, Institute of Physiology, Medical University of Graz, Graz, Austria
- Centre of Human and Aerospace Physiological Sciences, King's College London, London, UK
| | - Da Xu
- Aerospace Physiology Laboratory, Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, Canada
| | - Andreas Rössler
- Gravitational Physiology and Medicine Research Unit, Institute of Physiology, Medical University of Graz, Graz, Austria
| | - Helmut Hinghofer-Szalkay
- Gravitational Physiology and Medicine Research Unit, Institute of Physiology, Medical University of Graz, Graz, Austria
| | - Franz Fazekas
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Nandu Goswami
- Gravitational Physiology and Medicine Research Unit, Institute of Physiology, Medical University of Graz, Graz, Austria
| |
Collapse
|
18
|
Pedreira da Fonseca E, da Silva Ribeiro NM, Pinto EB. Therapeutic Effect of Virtual Reality on Post-Stroke Patients: Randomized Clinical Trial. J Stroke Cerebrovasc Dis 2016; 26:94-100. [PMID: 27693404 DOI: 10.1016/j.jstrokecerebrovasdis.2016.08.035] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 08/15/2016] [Accepted: 08/23/2016] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES The study aimed to check the therapeutic effect of virtual reality associated with conventional physiotherapy on gait balance and the occurrence of falls after a stroke. METHODS This was a randomized, blinded clinical trial conducted with post-stroke patients, randomized into two groups-treatment group and control group-and subjected to balance assessments by the Dynamic Gait Index and investigation of falls before and after 20 intervention sessions. Statistically significant difference was considered at P < .05. RESULTS We selected 30 patients, but there were three segment losses, resulting in a total of 13 patients in the control group and 14 in the treatment group. There was an improvement in gait balance and reduced occurrence of falls in both groups. After intervention, the differences in gait balance in the control group (P = .047) and the reduction in the occurrence of falls in the treatment group (P = .049) were significant. However, in intergroup analysis, there was no difference in the two outcomes. CONCLUSIONS Therapy with games was a useful tool for gait balance rehabilitation in post-stroke patients, with repercussions on the reduction of falls.
Collapse
Affiliation(s)
- Erika Pedreira da Fonseca
- Católica University of Salvador, Salvador, Bahia, Brazil; Bahia School of Medicine and Public Health, Salvador, Brazil.
| | | | | |
Collapse
|
19
|
Tsuchiya K, Fujita T, Sato D, Midorikawa M, Makiyama Y, Shimoda K, Tozato F. Post-stroke depression inhibits improvement in activities of daily living in patients in a convalescent rehabilitation ward. J Phys Ther Sci 2016; 28:2253-9. [PMID: 27630408 PMCID: PMC5011572 DOI: 10.1589/jpts.28.2253] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 05/07/2016] [Indexed: 02/04/2023] Open
Abstract
[Purpose] There have been no investigations into the improvement of activities of daily
living among patients suffering from post-stroke depression on admission to convalescent
rehabilitation wards in Japan. This study aimed to assess the improvement of activities in
daily living in patients with or without post-stroke depression at the time of admission
to a convalescent rehabilitation ward. [Subjects and Methods] This retrospective study
included 108 stroke patients divided into two groups according to their Geriatric
Depression Scale 15-item short form scores. Activities of daily living were assessed using
the Functional Independence Measure. The degree of improvement on the Functional
Independence Measure was defined as the difference between scores on admission and at
discharge. [Results] The Functional Independence Measure gain score was significantly
different from the Functional Independence Measure total score. There was a significant
interaction between time period and post-stroke depression factors for the Functional
Independence Measure total score. A multiple regression analysis revealed a significant
association between Geriatric Depression Scale score and Functional Independence Measure
total score. [Conclusion] The present study suggests that post-stroke depression has a
negative impact on recovery of activities of daily living and on rehabilitation outcomes
in a convalescent rehabilitation ward setting.
Collapse
Affiliation(s)
- Kenji Tsuchiya
- Department of Rehabilitation Sciences, Gunma University Graduate School of Health Sciences, Japan
| | - Takaaki Fujita
- Department of Rehabilitation Sciences, Gunma University Graduate School of Health Sciences, Japan
| | - Daisuke Sato
- Department of Rehabilitation, Aida Memorial Rehabilitation Hospital, Japan
| | - Manabu Midorikawa
- Department of Rehabilitation, Aida Memorial Rehabilitation Hospital, Japan
| | - Yasushi Makiyama
- Department of Rehabilitation, Aida Memorial Rehabilitation Hospital, Japan
| | - Kaori Shimoda
- Department of Rehabilitation, Gunma Prefectural Cancer Center, Japan
| | - Fusae Tozato
- Department of Rehabilitation Sciences, Gunma University Graduate School of Health Sciences, Japan
| |
Collapse
|
20
|
Motaqhey M, Ghanjal A, Mastri Farahani R, Ghabaee M, Kaka G, Noroziyan M, Fadaee Fathabadi F. Sex Differences in Neuroanatomy of the Human Mirror Neuron System: Impact on Functional Recovery of Ischemic Hemiparetic Patients. IRANIAN RED CRESCENT MEDICAL JOURNAL 2015; 17:e28363. [PMID: 26430528 PMCID: PMC4586897 DOI: 10.5812/ircmj.28363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 04/11/2015] [Accepted: 04/30/2015] [Indexed: 12/05/2022]
Abstract
Background: Considering the higher activity of mirror neuron system in females, they frequently have better performance in empathy, interpersonal sensitivity, and emotional recognition compared to males. Objectives: The purpose of this study was to assess whether gender difference in neuroanatomy of the human mirror neuron system has any impact on functional recovery of ischemic hemiparetic patients. Patients and Methods: This single-blind clinical trial was conducted on 24 patients with cerebrovascular accident (CVA) in the age range of 45 - 60 years, referring at a rehabilitation center in Tehran, Iran, during 2013 - 2014. Sampling method was stratified random sampling. The subjects were assigned to 2 groups of 12 males and 12 females. Then, each group was randomly divided into 2 groups (totally 4 groups, n = 6 for each group): women watching functional movies, control women, men watching functional movies, and control men. Movies were shown to patients and then, they were evaluated by Timed Up and Go (TUG), Six-minute walk test (SMW), Barthel index (BI), and Berg balance scale (BBS). Results: Comparison of all variables related to functional activities of all groups before and after watching movies revealed significant differences. The highest percentage of change and improvement was observed in groups 1 and 3 watching the functional movies (P = 0.0001). Percentage of improvement in women of groups 1 and 2 was higher than men in groups 3 and 4 (P = 0.0003). The changes in group of females watching the functional movies (group 1) were significantly greater than in other groups (P < 0.0001). Conclusions: The Sex differences in the neuroanatomy of the human mirror neuron system affect functional recovery of patients with hemiparesis. The improvement in studied women was found to be significantly greater than studied men. The results indicate a higher chance of recovery among hemiparetic women, especially those watching functional movies.
Collapse
Affiliation(s)
- Monireh Motaqhey
- Department of Anatomy and Cell Biology, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Ali Ghanjal
- Health Management Research Centre, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Reza Mastri Farahani
- Department of Anatomy and Cell Biology, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
- Corresponding Author: Reza Mastri Farahani, Department of Anatomy and Cell Biology, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel: +98-9122197092, Fax: +98-2188057022, E-mail:
| | - Mojdeh Ghabaee
- Department of Neurology, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Gholamreza Kaka
- Neuroscience Research Centre, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Mohsen Noroziyan
- Department of Anatomy and Cell Biology, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Fatemeh Fadaee Fathabadi
- Department of Anatomy and Cell Biology, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| |
Collapse
|
21
|
Cho K, Yu J, Rhee H. Risk factors related to falling in stroke patients: a cross-sectional study. J Phys Ther Sci 2015; 27:1751-3. [PMID: 26180313 PMCID: PMC4499976 DOI: 10.1589/jpts.27.1751] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 02/14/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to investigate a comprehensive understanding of the factors associated with falls in poststroke patients. [Subjects] Forty-eight stroke patients (22 males and 26 females; age 63.79 years) participated in this study. [Methods] This study applied a cross-sectional design. Fear of falling [Falls Efficacy Scale (FES)], balance function [Berg Balance Scale (BBS) and Modified Rivermead Mobility Index (MRMI)], ADL performance level [Modified Barthel Index (MBI)] and cognitive function [Loewenstein Occupational Therapy Cognitive Assessment for Geriatric Populations (LOTCA-G)] were assessed. [Results] Falls efficacy was moderately correlated with ADL performance, balance, and cognition. In addition, stepwise linear regression analysis revealed that ADL performance was the explanatory variable closely associated with falls efficacy in stroke patients. [Conclusion] ADL performance was the primary explanatory variable of falls efficacy according to regression analysis. Thus, we suggest that these results may be used as basic data for developing rehabilitation programs for prevention of falls in stroke patients.
Collapse
Affiliation(s)
- Kihun Cho
- Department of Rehabilitative and Assistive Technology, Korea National Rehabilitation Research Institute, Republic of Korea
| | - Jaeho Yu
- Department of Physical Therapy, Sun Moon University, Republic of Korea
| | - Hyeonsook Rhee
- Department of Occupational Therapy, Shin Sung University, Republic of Korea
| |
Collapse
|
22
|
Does motor training of the nonparetic side influences balance and function in chronic stroke? A pilot RCT. ScientificWorldJournal 2014; 2014:769726. [PMID: 25506618 PMCID: PMC4251094 DOI: 10.1155/2014/769726] [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: 07/28/2014] [Revised: 08/28/2014] [Accepted: 09/24/2014] [Indexed: 11/18/2022] Open
Abstract
Background. Balance and functional abilities are controlled by both sides of the body. The role of nonparetic side has never been explored for such skills. Objective. The objective of the present study was to examine the effect of a motor therapy program primarily involving the nonparetic side on balance and function in chronic stroke. Method. A randomized controlled, double blinded trial was conducted on 39 poststroke hemiparetic subjects (21, men; mean age, 42 years; mean poststroke duration, 13 months). They were randomly divided into the experimental group (n = 20) and control group (n = 19). The participants received either motor therapy focusing on the nonparetic side along with the conventional program or conventional program alone for 8 weeks (3 session/week, 60 minutes each). The balance ability was assessed using Berg Balance Scale (BBS) and Functional Reach Test (FRT) while the functional performance was measured by Barthel Index (BI). Result. After intervention, the experimental group exhibited significant (P < 0.05) change on BBS (5.65 versus 2.52) and BI (12.75 versus 2.16) scores in comparison to the control group. Conclusion. The motor therapy program incorporating the nonparetic side along with the affected side was found to be effective in enhancing balance and function in stroke.
Collapse
|
23
|
Arya KN, Pandian S, Abhilasha CR, Verma A. Does the motor level of the paretic extremities affect balance in poststroke subjects? Rehabil Res Pract 2014; 2014:767859. [PMID: 24967104 PMCID: PMC4055229 DOI: 10.1155/2014/767859] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 03/28/2014] [Accepted: 04/23/2014] [Indexed: 12/03/2022] Open
Abstract
Background. Poststroke impairment may lead to fall and unsafe functional performance. The underlying mechanism for the balance dysfunction is unclear. Objective. To analyze the relation between the motor level of the affected limbs and balance in poststroke subjects. Method. A prospective, cross-sectional, and nonexperimental design was conducted in a rehabilitation institute. A convenience sample of 44 patients was assessed for motor level using Brunnstrom recovery stage (BRS) and Fugl-Meyer Assessment: upper (FMA-UE) and lower extremities (FMA-LE). The balance was measured by Berg Balance Scale (BBS), Postural Assessment Scale for Stroke Patients (PASS), and Functional Reach Test (FRT). Results. BRS showed moderate correlation with BBS (ρ = 0.54 to 0.60; P < 0.001), PASS (r = 0.48 to 0.64; P < 0.001) and FRT (ρ = 0.48 to 0.59; P < 0.001). FMA-UE also exhibited moderate correlation with BBS (ρ = 0.59; P < 0.001) and PASS (ρ = 0.60; P < 0.001). FMA-LE showed fair correlation with BBS (ρ = 0.50; P = 0.001) and PASS (ρ = 0.50; P = 0.001). Conclusion. Motor control of the affected limbs plays an important role in balance. There is a moderate relation between the motor level of the upper and lower extremities and balance. The findings of the present study may be applied in poststroke rehabilitation.
Collapse
Affiliation(s)
- Kamal Narayan Arya
- Pandit Deendayal Upadhyaya Institute for the Physically Handicapped (University of Delhi), Ministry of Social Justice and Empowerment, Government of India, 4 VD Marg, New Delhi 110002, India
| | - Shanta Pandian
- Pandit Deendayal Upadhyaya Institute for the Physically Handicapped (University of Delhi), Ministry of Social Justice and Empowerment, Government of India, 4 VD Marg, New Delhi 110002, India
| | - C. R. Abhilasha
- Pandit Deendayal Upadhyaya Institute for the Physically Handicapped (University of Delhi), Ministry of Social Justice and Empowerment, Government of India, 4 VD Marg, New Delhi 110002, India
| | - Ashutosh Verma
- Pandit Deendayal Upadhyaya Institute for the Physically Handicapped (University of Delhi), Ministry of Social Justice and Empowerment, Government of India, 4 VD Marg, New Delhi 110002, India
| |
Collapse
|