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Sakai K, Hosoi Y, Harada Y, Kato Y. Association between the executive dysfunction and balance function in patients with stroke. Brain Behav 2024; 14:e3542. [PMID: 38783598 PMCID: PMC11116755 DOI: 10.1002/brb3.3542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/13/2024] [Accepted: 02/21/2024] [Indexed: 05/25/2024] Open
Abstract
INTRODUCTION A previous study has shown an association between executive dysfunction (ED) and balance function in patients with stroke. However, it is unclear what factors mediate the association between ED and balance function. Therefore, the aim of this study was to investigate the association between ED and balance function and to identify mediating factors using mediation analysis. METHODS This study had a cross-sectional design. The study included 107 patients with stroke. This study was divided into two groups (ED and non-ED) using trail making test (TMT) part B. Two groups were compared for balance function (timed up and go test [TUGT] and Berg balance scale [BBS]) and other variables using paired test. In addition, partial correlation analysis with age, cognitive function as a control factor, and mediation analysis were also performed. RESULTS The ED group (N = 55) had significantly lower TUGT and BBS scores than the non-ED group (N = 52). TMT part B correlated with TUGT (ρ = 0.41), BBS (ρ = -0.33), and Brunnstrom recovery stage (BRS) lower limb (ρ = -0.22). The TUGT model of mediation analysis showed a significant indirect effect as a result of mediation of the BRS lower limb between TMT part B and TUGT. The BBS model showed a significant indirect effect as a result of mediation of the activities of daily living (ADL) motor function between TMT part B and BBS. CONCLUSIONS ED and balance function were associated, and the degree of paralysis and ADL motor function were associated with them in patients with stroke.
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Affiliation(s)
- Katsuya Sakai
- Department of Physical Therapy, Faculty of Health SciencesTokyo Metropolitan UniversityTokyoJapan
| | - Yuichiro Hosoi
- Department of Rehabilitation MedicineKeio University School of MedicineTokyoJapan
- Department of Sports Health SciencesRitsumeikan UniversityKyotoJapan
| | - Yusuke Harada
- Department of RehabilitationReiwa Rehabilitation HospitalChibaJapan
- Graduate School of Human Health SciencesTokyo Metropolitan UniversityTokyoJapan
| | - Yuichi Kato
- Graduate School of Human Health SciencesTokyo Metropolitan UniversityTokyoJapan
- Department of RehabilitationMoriyama Neurological Center HospitalTokyoJapan
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Inoue S, Takagi H, Tan E, Oyama C, Otaka E, Kondo K, Otaka Y. Comparison of usefulness between the Mini-Balance Evaluation Systems Test and the Berg Balance Scale for measuring balance in patients with subacute stroke: a prospective cohort study. FRONTIERS IN REHABILITATION SCIENCES 2024; 4:1308706. [PMID: 38239627 PMCID: PMC10794569 DOI: 10.3389/fresc.2023.1308706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/07/2023] [Indexed: 01/22/2024]
Abstract
Introduction The aim of this study was to compare the clinical applicability of the Mini-Balance Evaluation Systems Test and the Berg Balance Scale for measuring balance in inpatients with subacute stroke. Methods This was a prospective observational study which included 58 consecutive patients admitted to a convalescent rehabilitation hospital with a first-ever stroke and who met the inclusion/exclusion criteria. The Mini-Balance Evaluation Systems Test and the Berg Balance Scale were used to assess patient balance at admission and discharge. The ceiling and floor effects and responsiveness of each balance score were examined. In addition, receiver operating characteristic analysis based on each balance score at admission was used to examine its discriminative power to predict ambulatory independence and falls during hospitalization. Results The mean (standard deviation) change between admission and discharge for each balance scale was 4.4 (4.7) for the Mini-Balance Evaluation Systems Test and 8.3 (10.0) for the Berg Balance Scale, with standard response means, a measure of responsiveness of 0.9 (large) and 0.8 (medium), respectively. Each balance score at admission almost equally predicted gait independence and fallers during hospitalization. On the contrary, only the distribution of scores on the Berg Balance Scale at discharge showed a ceiling effect, with 25 patients (43%) obtaining a perfect score. Discussion The Mini-Balance Evaluation Systems Test may be useful as a balance measure for inpatients with subacute stroke because it is less susceptible to ceiling effects and more responsive than the Berg Balance Scale.
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Affiliation(s)
- Seigo Inoue
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
| | - Hideyuki Takagi
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
| | - Emiko Tan
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
| | - Chisato Oyama
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
| | - Eri Otaka
- Assistive Robot Center, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Kunitsugu Kondo
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
| | - Yohei Otaka
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Aichi, Japan
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Fujita T, Kasahara R, Kurita M, Jinbo R, Yamamoto Y, Ohira Y, Otsuki K, Iokawa K. Balance Function Required for Bathing Independence in Patients with Stroke and Hip Fracture. Prog Rehabil Med 2023; 8:20230028. [PMID: 37720324 PMCID: PMC10500438 DOI: 10.2490/prm.20230028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 08/17/2023] [Indexed: 09/19/2023] Open
Abstract
Objectives Little attention has been paid to the relationship between balance function and bathing independence. This research aimed to determine the degree of balance function needed by patients with stroke and patients with hip fracture (hereinafter referred to as patients with stroke and hip fracture) to bathe independently. Methods Retrospective data analysis was performed on 59 patients with hip fracture and 201 patients with stroke. Logistic regression was performed to determine whether bathing independence was associated with the Berg Balance Scale (BBS) in patients with stroke and hip fracture. A receiver operating characteristic curve was generated to calculate cutoff values. Results The BBS was significantly associated with bathing independence in patients with stroke and hip fracture. The calculated BBS cutoff value was 48 points for those with stroke (sensitivity, 84.7%; specificity, 79.1%) and 43 points for those with hip fracture (sensitivity, 81.3%; specificity, 77.8%). Conclusions Balance function was independently associated with bathing independence. The level of balance function required for bathing independence may be lower for patients with hip fracture than for those with stroke. This could be a simple and useful indicator for rehabilitation professionals to interpret BBS results when conducting bathing interventions.
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Affiliation(s)
- Takaaki Fujita
- Department of Occupational Therapy, School of Health
Sciences, Fukushima Medical University, Fukushima City, Japan
| | - Ryuichi Kasahara
- Department of Rehabilitation, Kita-Fukushima Medical Center,
Date City, Japan
| | - Megumi Kurita
- Department of Rehabilitation, Kita-Fukushima Medical Center,
Date City, Japan
| | - Ryohei Jinbo
- Department of Rehabilitation, Kita-Fukushima Medical Center,
Date City, Japan
| | - Yuichi Yamamoto
- Department of Rehabilitation, Kita-Fukushima Medical Center,
Date City, Japan
| | - Yoko Ohira
- Department of Rehabilitation, Kita-Fukushima Medical Center,
Date City, Japan
| | - Koji Otsuki
- Department of Rehabilitation, Kita-Fukushima Medical Center,
Date City, Japan
| | - Kazuaki Iokawa
- Department of Occupational Therapy, School of Health
Sciences, Fukushima Medical University, Fukushima City, Japan
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Cui R, Liu H, Li M, Wang J, Mao J, Ni W, Wang F, Pan J, Yu L, Wang Y, Wang Y, Huang P, Li G, Zhao Y, Zhu N, Chen C, Pan Z, Zhang Y, Fu W, Yang J. Effects of "Taking the Waist as the Axis" Therapy on trunk postural control disorder after stroke: A randomized controlled trial. Front Aging Neurosci 2023; 15:1040277. [PMID: 36819714 PMCID: PMC9933551 DOI: 10.3389/fnagi.2023.1040277] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 01/09/2023] [Indexed: 01/28/2023] Open
Abstract
Background Sufficient attention to trunk rehabilitation after stroke is still lacking. Loss of trunk selective activity is considered to be the leading cause of trunk postural control disorder after stroke. "Taking the Waist as the Axis" Therapy (WAT) was developed as a combination of the concept of "Taking the Waist as the Axis" from Tai Chi and the rehabilitation of trunk dysfunction after stroke. The present clinical trial examined and assessed the effects of WAT on stroke patients. Methods A total of 43 stroke hemiplegic patients with trunk postural control disorder, whose Trunk Impairment Scale (TIS) scoring between 8 and 18, participated in the present study and were allocated randomly to the experimental (n = 23) or control groups (n = 20). The experimental group received WAT plus conventional therapy, and the control group received "Trunk Selective Activity" Therapy (TSAT) plus conventional therapy. Both groups received treatment once daily and 5 times per week for 3 weeks. The Trunk Impairment Scale (TIS), Fugl-Meyer Assessment (FMA), Berg Balance Scale (BBS), change of Intra-abdominal Pressure (IAP), static balance ability assessment, rapid ventilation lung function test and the Modified Barthel Index (MBI) were evaluated before and after intervention for both groups. Results The experimental group was superior to the control group in TIS [4 (2, 5) vs. 3 (1.25, 4), p = 0.030], change of IAP [-3 (-8, -1.33) vs. -0.02 (-3.08, 6), p = 0.011], FMA-upper extremity [10 (6, 18) vs. 1 (0, 3), p = 0.002], FMA-lower extremity [2 (1, 4) vs. 1 (0, 2), p = 0.009] and FMA [14 (7, 21) vs. 2 (0.25, 3.75), p = 0.001]. Within experimental group, forced vital capacity (FVC) [81.35 (63.30, 94.88) vs. 91.75 (79.40, 97.90), p = 0.02] was significantly improved. Conclusion WAT was an effective trunk treatment after stroke, which significantly improved the patients' trunk posture control ability, motor function and forced vital capacity. However, the results still need to be interpreted with caution for the intervention only lasted for 3 weeks.
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Affiliation(s)
- Rong Cui
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China,School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Hongtao Liu
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Meng Li
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Jie Wang
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Junjie Mao
- Department of Respiratory and Critical Care Medicine, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Weidong Ni
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Furong Wang
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Jingxian Pan
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Long Yu
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Yan Wang
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Yanmin Wang
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Pufeng Huang
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Gaiyan Li
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Yi Zhao
- Department of Neurology, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Ning Zhu
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Chen Chen
- Shanghai Hongrun Boyuan School, Shanghai, China
| | - Ziyang Pan
- Shanghai Yichuan Middle School, Shanghai, China
| | - Ying Zhang
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China,*Correspondence: Ying Zhang, ; Weijie Fu, ; Jianzhong Yang,
| | - Weijie Fu
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China,*Correspondence: Ying Zhang, ; Weijie Fu, ; Jianzhong Yang,
| | - Jianzhong Yang
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai, China,*Correspondence: Ying Zhang, ; Weijie Fu, ; Jianzhong Yang,
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Aminu AQ, Wondergem R, Van Zaalen Y, Pisters M. Self-Efficacy Is a Modifiable Factor Associated with Frailty in Those with Minor Stroke: Secondary Analysis of 200 Cohort Respondents. Cerebrovasc Dis Extra 2021; 11:99-105. [PMID: 34628411 PMCID: PMC8543288 DOI: 10.1159/000519311] [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: 05/22/2021] [Accepted: 08/23/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Owing to the improvement in acute care, there has been an increase in the number of people surviving stroke and living with its impairments. Frailty is common in people with stroke and has a significant impact on the prognosis after stroke. To reduce frailty progression, potentially modifiable factors should be identified. Increasing levels of self-efficacy influence both behaviour and physical functioning, and therefore it could be a potential target to prevent frailty. METHODS This is a prospective cohort study that involved the secondary analysis of the RISE data to examine the relationship between self-efficacy and frailty. The RISE study is a longitudinal study that consists of 200 adults aged 18+ years after their first stroke event. Data were collected from the respondents at 3 weeks, 6 months, 12 months, and 24 months after their discharge from the hospital. Frailty was assessed using the multidimensional frailty index with scores ranging from 0 to 1, and self-efficacy was assessed using the SESx scale, which was dichotomized as low/moderate or high. Frailty trajectories were examined using the repeated linear model. The generalized estimating equation was used to examine the relationship between self-efficacy and frailty at baseline and in the future (6-24 months). The B coefficients were reported at 95% CI before and after adjusting for potential confounders (age, gender, stroke severity, education, and social support). RESULTS A total of 200 responses were analysed, and the mean age of the respondents was 67.78 ± 11.53. Females made up 64% of the sample, and the mean frailty score at baseline was 0.17 ± 0.09. After adjusting for confounders, respondents with low self-efficacy had an approximately 5% increase in their frailty scores at baseline and in the 24-month follow-up period compared to those with high self-efficacy. CONCLUSION The result from this study showed that self-efficacy was significantly associated with frailty after stroke. Our findings suggest that self-efficacy may play a role in frailty progression among stroke survivors.
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Affiliation(s)
- Abodunrin Quadri Aminu
- School of Nursing, Midwifery and Paramedic Practice, Robert Gordon University, Aberdeen, United Kingdom
| | - Roderick Wondergem
- Department of Health Innovations and Technology, Fontys University of Applied Sciences, Eindhoven, The Netherlands.,The Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, The Netherlands.,Department of Rehabilitation, Physical Therapy Science and Sport, Brain Center, University Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Yvonne Van Zaalen
- Department of Health Innovations and Technology, Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - Martijn Pisters
- Department of Health Innovations and Technology, Fontys University of Applied Sciences, Eindhoven, The Netherlands.,The Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, The Netherlands.,Department of Rehabilitation, Physical Therapy Science and Sport, Brain Center, University Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
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Core Stability Exercises Yield Multiple Benefits for Patients with Chronic Stroke - Randomized Controlled Trial. Am J Phys Med Rehabil 2021; 101:314-323. [PMID: 34001840 DOI: 10.1097/phm.0000000000001794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study examines the effect of core stability exercises on trunk control, core muscle strength, standing weight-bearing symmetry and balance confidence of people with chronic stroke. DESIGN This was an assessor-blinded randomized controlled trial involving 84 ambulatory patients with middle cerebral artery stroke, randomly assigned to three training groups. Two experimental groups practiced core stability exercises either on stable or unstable support surfaces. In contrast, the control group received standard physiotherapy. All the participants an hour-long training session a day, thrice a week over a six-week duration, and followed-up after 12 months. Trunk Impairment Scale, core muscle strength, weight-bearing asymmetry in standing and Activities-specific Balance Confidence scale were the outcome measures. RESULTS Compared to the control group, the two experimental groups demonstrated a significant improvement on all the outcome measures from baseline to post-training and from baseline to 12-month follow-up (P < 0.001). The two experimental groups demonstrated no significant difference between them on all the measures (P > 0.05). CONCLUSION Core stability exercises on stable and unstable support surfaces are equally beneficial in improving trunk control, core muscle strength, standing weight-bearing symmetry and balance confidence of ambulatory patients with chronic stroke than the standard physiotherapy.
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Khan F, Chevidikunnan MF. Prevalence of Balance Impairment and Factors Associated with Balance among Patients with Stroke. A Cross Sectional Retrospective Case Control Study. Healthcare (Basel) 2021; 9:healthcare9030320. [PMID: 33805643 PMCID: PMC7998930 DOI: 10.3390/healthcare9030320] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/07/2021] [Accepted: 03/11/2021] [Indexed: 11/16/2022] Open
Abstract
Stroke is a major cause of disability worldwide, and balance impairments are common disabling factors in patients with stroke, leading to falls. Thus, the study objectives were as follows: (i) To find the prevalence of balance impairment among patients with stroke. (ii) To find out the factors associated with balance impairment in patients with stroke. This cross-sectional retrospective case control study involved eighty-one post stroke patients with a mean age of 58.36 ± 14.06, recruited from six hospitals, who underwent an assessment of balance, walking speed, depression and isometric strength of the ankle and knee. These patients were later categorized into subjects with good balance (<45) in the Berg balance scale (BBS) and those with poor balance (≥45), as cases and controls, to assess the factors associated with balance impairment using binary logistic regression. The prevalence of balance impairment among patients with stroke was 48.1%. The reduction in power of knee flexors (OR = 0.858), knee extensors (OR = 0.880) and ankle dorsiflexors (OR = 0.820) was found to be significantly associated with balance impairment, along with speed (OR = 1.187 (95% CI = 1.100, 1.280)), depression (OR = 1.331 (95% CI = 1.055-1.679)) and activities of daily living (OR = 0.313 (95% CI = 0.150-0.650)). In summary, around half of the patients with stroke exhibited balance impairments, with females being more prone.
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Affiliation(s)
- Fayaz Khan
- Correspondence: ; Tel.: +966-533-034-058
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Karthikbabu S, Verheyden G. Relationship between trunk control, core muscle strength and balance confidence in community-dwelling patients with chronic stroke. Top Stroke Rehabil 2020; 28:88-95. [PMID: 32574524 DOI: 10.1080/10749357.2020.1783896] [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] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND OBJECTIVE Impaired trunk control and core muscle weakness affect balance capacity after stroke, but confirmatory literature is lacking. The objective was to examine the relationship between trunk control, core muscle strength and self-confidence on balance efficacy in community-dwelling chronic stroke survivors and to identify trunk performance measures for determining balance confidence. METHODS Patients with a median post-stroke duration of 12 (IQR 7-18) months and independent walking ability participated in this cross-sectional study. Trunk control, core muscle strength and balance confidence were measured using trunk impairment scale 2.0 (TIS 2.0), handheld dynamometer and activity-specific balance confidence scale, respectively. Correlation among TIS 2.0, core muscle strength and balance confidence were tested by Pearson's correlation coefficient. Stepwise multivariate linear regression analysis was conducted to examine the most important trunk performance variables determining balance confidence. RESULTS Of 177 study participants, the median (IQR) score for TIS 2.0 was 10 (7-12) out of 16 and for balance confidence 41 (27-61) out of 100. Trunk control was highly correlated to overall core muscles strength (r = 0.61-0.70, p <.001) and balance confidence (r = 0.66, p <.001). The major trunk determinants of balance confidence were TIS 2.0 total score (partial R2 = 0.433) and dynamic sitting balance, i.e. trunk lateral flexion (partial R2 = 0.376) in chronic stroke. CONCLUSION A significant and strong positive association exists among trunk control, core muscles strength and balance confidence in community-dwelling patients with chronic stroke, warranting further investigation of the effect of targeted trunk rehabilitation strategies on functional balance.
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Affiliation(s)
- Suruliraj Karthikbabu
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal Hospital , Bangalore, India
| | - Geert Verheyden
- Department of Rehabilitation Sciences, KU Leuven University of Leuven , Leuven, Belgium
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Abasıyanık Z, Özdoğar AT, Sağıcı Ö, Kahraman T, Baba C, Ertekin Ö, Özakbaş S. Explanatory factors of balance confidence in persons with multiple sclerosis: Beyond the physical functions. Mult Scler Relat Disord 2020; 43:102239. [PMID: 32512478 DOI: 10.1016/j.msard.2020.102239] [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: 04/16/2020] [Revised: 05/12/2020] [Accepted: 05/23/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Balance confidence is considered a psychological element of falls and balance-demanding activities. The relationship of balance confidence with physical factors has been investigated; however, psychosocial correlates are not well known. The aim was to investigate the relationship between balance confidence and physical and psychosocial factors and to reveal the determinants of balance confidence in persons with MS (pwMS). METHODS A total of 445 pwMS were enrolled in the study. Balance confidence was assessed with the Activities-Specific Balance Confidence (ABC) Scale. Psychosocial-based measures included the Modified Fatigue Impact Scale (MFIS), Epworth Sleepiness Scale (ESS), Beck Depression Scale (BDI), and Symbol Digit Modalities Test (SDMT). The Godin Leisure-Time Exercise Questionnaire (GLTEQ), Timed 25-Foot Walk (T25FW), Six-Minute Walk Test (6MWT), and Single Leg Stance Test (SLS) were used to assess physical functions. RESULTS There was a significant correlation between the ABC score and all physical and psychosocial measures (p<0.05). Hierarchical linear regression analyses indicated that psychosocial factors were significantly associated with ABC accounting for 41% of the variance. The addition of physical variables explained an additional 35% of variance over psychosocial variables. The MFIS, SDMT, BDI, T25FW, 6MWT, and SLS were significantly predictive of the ABC. CONCLUSION This study emphasizes the importance of considering both physical and psychosocial factors for understanding balance confidence in pwMS. Besides, intervention strategies for enhancing balance confidence should aim to improve fatigue, depression, and cognition in addition to physical components.
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Affiliation(s)
- Zuhal Abasıyanık
- Graduate School of Health Sciences, Dokuz Eylül University, Inciralti, Izmir 35340, Turkey.
| | - Asiye Tuba Özdoğar
- Graduate School of Health Sciences, Dokuz Eylül University, Inciralti, Izmir 35340, Turkey
| | - Özge Sağıcı
- Graduate School of Health Sciences, Dokuz Eylül University, Inciralti, Izmir 35340, Turkey
| | - Turhan Kahraman
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey
| | - Cavid Baba
- Department of Neurology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Özge Ertekin
- School of Physical Therapy and Rehabilitation, Dokuz Eylül University, Izmir, Turkey
| | - Serkan Özakbaş
- Department of Neurology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
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Rand D. Mobility, balance and balance confidence – correlations with daily living of individuals with and without mild proprioception deficits post-stroke. NeuroRehabilitation 2018; 43:219-226. [DOI: 10.3233/nre-172398] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Debbie Rand
- Department of Occupational Therapy, Sackler Faculty of Medicine, Tel Aviv University, PO 39040, Tel Aviv 6997801, Israel. Tel.: +972 3 640 6551; Fax: +972 3 6409933; E-mail:
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A structural equation model of the relationship between muscle strength, balance performance, walking endurance and community integration in stroke survivors. PLoS One 2017; 12:e0185807. [PMID: 29049293 PMCID: PMC5648126 DOI: 10.1371/journal.pone.0185807] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 09/19/2017] [Indexed: 11/19/2022] Open
Abstract
Purpose To use structural equation modelling (SEM) to determine (1) the direct and indirect associations of strength of paretic lower limb muscles with the level of community integration, and (2) the direct association of walking endurance and balance performance with the level of community integration in community-dwelling stroke survivors. Materials and methods In this cross-sectional study of 105 stroke survivors, the Subjective Index of Physical and Social Outcome (SIPSO) was used to measure the level of community integration. Lower-limb strength measures included isometric paretic ankle strength and isokinetic paretic knee peak torque. The Berg Balance Scale (BBS) and the 6-minute walk test (6MWT) were used to evaluate balance performance and walking endurance, respectively. Results SEM revealed that the distance walked on the 6MWT had the strongest direct association with the SIPSO score (β = 0.41, p <0.001). An increase of one standard deviation in the 6MWT distance resulted in an increase of 0.41 standard deviations in the SIPSO score. Moreover, dorsiflexion strength (β = 0.18, p = 0.044) and the BBS score (β = 0.21, p = 0.021) had direct associations with the SIPSO score. Conclusions The results of the proposed model suggest that rehabilitation training of community-dwelling stroke survivors could focus on walking endurance, balance performance and dorsiflexor muscle strengthening if the aim is to augment the level of community integration.
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Impact of Spasticity on Balance Control during Quiet Standing in Persons after Stroke. Stroke Res Treat 2017; 2017:6153714. [PMID: 29098109 PMCID: PMC5618773 DOI: 10.1155/2017/6153714] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 06/29/2017] [Accepted: 07/26/2017] [Indexed: 11/18/2022] Open
Abstract
Background Balance impairments, falls, and spasticity are common after stroke, but the effect of spasticity on balance control after stroke is not well understood. Methods In this cross-sectional study, twenty-seven participants with stroke were divided into two groups, based on ankle plantar flexor spasticity level. Fifteen individuals with high spasticity (Modified Ashworth Scale (MAS) score of ≥2) and 12 individuals with low spasticity (MAS score <2) completed quiet standing trials with eyes open and closed conditions. Balance control measures included centre of pressure (COP) root mean square (RMS), COP velocity, and COP mean power frequency (MPF) in anterior-posterior and mediolateral (ML) directions. Trunk sway was estimated using a wearable inertial measurement unit to measure trunk angle, trunk velocity, and trunk velocity frequency amplitude in pitch and roll directions. Results The high spasticity group demonstrated greater ML COP velocity, trunk roll velocity, trunk roll velocity frequency amplitude at 3.7 Hz, and trunk roll velocity frequency amplitude at 4.9 Hz, particularly in the eyes closed condition (spasticity by vision interaction). ML COP MPF was greater in the high spasticity group. Conclusion Individuals with high spasticity after stroke demonstrated greater impairment of balance control in the frontal plane, which was exacerbated when vision was removed.
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Validity and reliability of the Chinese version of the Daily Living Self-Efficacy Scale among stroke patients. Int J Rehabil Res 2016; 39:219-25. [DOI: 10.1097/mrr.0000000000000170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Winstein CJ, Stein J, Arena R, Bates B, Cherney LR, Cramer SC, Deruyter F, Eng JJ, Fisher B, Harvey RL, Lang CE, MacKay-Lyons M, Ottenbacher KJ, Pugh S, Reeves MJ, Richards LG, Stiers W, Zorowitz RD. Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2016; 47:e98-e169. [PMID: 27145936 DOI: 10.1161/str.0000000000000098] [Citation(s) in RCA: 1519] [Impact Index Per Article: 189.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE The aim of this guideline is to provide a synopsis of best clinical practices in the rehabilitative care of adults recovering from stroke. METHODS Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council's Scientific Statement Oversight Committee and the AHA's Manuscript Oversight Committee. The panel reviewed relevant articles on adults using computerized searches of the medical literature through 2014. The evidence is organized within the context of the AHA framework and is classified according to the joint AHA/American College of Cardiology and supplementary AHA methods of classifying the level of certainty and the class and level of evidence. The document underwent extensive AHA internal and external peer review, Stroke Council Leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the AHA Science Advisory and Coordinating Committee. RESULTS Stroke rehabilitation requires a sustained and coordinated effort from a large team, including the patient and his or her goals, family and friends, other caregivers (eg, personal care attendants), physicians, nurses, physical and occupational therapists, speech-language pathologists, recreation therapists, psychologists, nutritionists, social workers, and others. Communication and coordination among these team members are paramount in maximizing the effectiveness and efficiency of rehabilitation and underlie this entire guideline. Without communication and coordination, isolated efforts to rehabilitate the stroke survivor are unlikely to achieve their full potential. CONCLUSIONS As systems of care evolve in response to healthcare reform efforts, postacute care and rehabilitation are often considered a costly area of care to be trimmed but without recognition of their clinical impact and ability to reduce the risk of downstream medical morbidity resulting from immobility, depression, loss of autonomy, and reduced functional independence. The provision of comprehensive rehabilitation programs with adequate resources, dose, and duration is an essential aspect of stroke care and should be a priority in these redesign efforts. (Stroke.2016;47:e98-e169. DOI: 10.1161/STR.0000000000000098.).
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Torkia C, Best KL, Miller WC, Eng JJ. Balance Confidence: A Predictor of Perceived Physical Function, Perceived Mobility, and Perceived Recovery 1 Year After Inpatient Stroke Rehabilitation. Arch Phys Med Rehabil 2016; 97:1064-71. [PMID: 27060032 DOI: 10.1016/j.apmr.2016.03.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 11/16/2015] [Accepted: 03/02/2016] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To estimate the effect of balance confidence measured at 1 month poststroke rehabilitation on perceived physical function, mobility, and stroke recovery 12 months later. DESIGN Longitudinal study (secondary analysis). SETTING Multisite, community-based. PARTICIPANTS Community-dwelling individuals (N=69) with stroke living in a home setting. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Activities-specific Balance Confidence scale; physical function and mobility subscales of the Stroke Impact Scale 3.0; and a single item from the Stroke Impact Scale for perceived recovery. RESULTS Balance confidence at 1 month postdischarge from inpatient rehabilitation predicts perceived physical function (model 1), mobility (model 2), and recovery (model 3) 12 months later after adjusting for important covariates. The covariates included in model 1 were age, sex, basic mobility, and depression. The covariates selected for model 2 were age, sex, balance capacity, and anxiety, and the covariates in model 3 were age, sex, walking capacity, and social support. The amount of variance in perceived physical function, perceived mobility, and perceived recovery that balance confidence accounted for was 12%, 9%, and 10%, respectively. CONCLUSIONS After discharge from inpatient rehabilitation poststroke, balance confidence predicts individuals' perceived physical function, mobility, and recovery 12 months later. There is a need to address balance confidence at discharge from inpatient stroke rehabilitation.
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Affiliation(s)
- Caryne Torkia
- Graduate Program in Rehabilitation Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; GF Strong Rehabilitation Centre, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Krista L Best
- Graduate Program in Rehabilitation Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; GF Strong Rehabilitation Centre, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - William C Miller
- Graduate Program in Rehabilitation Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; GF Strong Rehabilitation Centre, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada; Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
| | - Janice J Eng
- Graduate Program in Rehabilitation Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; GF Strong Rehabilitation Centre, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada; Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Gatica-Rojas V, Méndez-Rebolledo G. Virtual reality interface devices in the reorganization of neural networks in the brain of patients with neurological diseases. Neural Regen Res 2014; 9:888-96. [PMID: 25206907 PMCID: PMC4146258 DOI: 10.4103/1673-5374.131612] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2014] [Indexed: 11/04/2022] Open
Abstract
Two key characteristics of all virtual reality applications are interaction and immersion. Systemic interaction is achieved through a variety of multisensory channels (hearing, sight, touch, and smell), permitting the user to interact with the virtual world in real time. Immersion is the degree to which a person can feel wrapped in the virtual world through a defined interface. Virtual reality interface devices such as the Nintendo® Wii and its peripheral nunchuks-balance board, head mounted displays and joystick allow interaction and immersion in unreal environments created from computer software. Virtual environments are highly interactive, generating great activation of visual, vestibular and proprioceptive systems during the execution of a video game. In addition, they are entertaining and safe for the user. Recently, incorporating therapeutic purposes in virtual reality interface devices has allowed them to be used for the rehabilitation of neurological patients, e.g., balance training in older adults and dynamic stability in healthy participants. The improvements observed in neurological diseases (chronic stroke and cerebral palsy) have been shown by changes in the reorganization of neural networks in patients' brain, along with better hand function and other skills, contributing to their quality of life. The data generated by such studies could substantially contribute to physical rehabilitation strategies.
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Affiliation(s)
- Valeska Gatica-Rojas
- Laboratory of Human Motor Control, Faculty of Health Sciences, University of Talca, Talca, Chile
| | - Guillermo Méndez-Rebolledo
- Laboratory of Human Motor Control, School of Kinesiology, Faculty of Health Sciences, University of Talca, Talca, Chile
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Cho K, Lee G. Impaired dynamic balance is associated with falling in post-stroke patients. TOHOKU J EXP MED 2014; 230:233-9. [PMID: 23933665 DOI: 10.1620/tjem.230.233] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Falling is one of the most common complications of stroke. The purpose of this study was to investigate the impact of falling on cognitive and physical function in post-stroke patients. Further, the predictive factors associated with independence of activity of daily living (ADL) in stroke patients with falls experience were investigated. Sixty-six participants were divided into 2 groups according to history of falling: faller (n = 34) and non-faller (n = 32). All participants were examined for cognitive and physical function. Static balance was measured by postural sway using a force platform. Dynamic balance was measured using the Berg Balance Scale (BBS) and the Modified Rivermead Mobility Index (MRMI), which shows the degree of performance for balance tasks. ADL was measured using the Modified Barthel Index (MBI), which shows the degree of independence. The fallers showed lower cognitive and physical function than the non-fallers (p < 0.05). This finding indicates that falling is associated with reduced physical function, as well as reduced cognitive function. In the fallers, the ADL (MBI) was moderately correlated with each of cognition [MMSE (r = 0.388, p = 0.023)], dynamic balance [MRMI (r = 0.514, p = 0.002) and BBS (r = 0.572, p < 0.000)]. In addition, regression analysis showed that BBS was a primary predictor for ADL performance (R(2) = 0.327, β = 0.572, p < 0.000). Our findings indicate that enhancement of dynamic balance is needed to improve in activities necessary for normal self-care of stroke patients with falls experience.
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Affiliation(s)
- KiHun Cho
- Department of Physical Therapy, Seoul Bukbu Hospital, Seoul, Republic of Korea
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