1
|
Zeynep KU, Damla C, Ebru U. Which Acute Stroke Patients can Walk while Returning Home? Factors Predicting Ambulation. Neurol India 2024; 72:824-829. [PMID: 39216041 DOI: 10.4103/neurol-india.ni_188_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 03/09/2023] [Indexed: 09/04/2024]
Abstract
PURPOSE Regaining gait is the primary goal in stroke rehabilitation. In this study, we aimed to investigate the effect of premorbid features of acute stroke patients on the ambulatory level. METHODS The study included 174 patients who applied to our rehabilitation clinic within the first month after the onset of stroke. Demographic characteristics of patients, pre-stroke symptoms, and stroke characteristics were questioned from patient files and historical data. The ambulation levels of patients before and after rehabilitation were evaluated with the functional ambulation category. The relationship between demographic characteristics, pre-stroke symptoms, stroke characteristics, and ambulation levels of patients before and after rehabilitation was examined. RESULTS The presence of coronary heart diseases, atrial fibrillation, and nausea/vomiting before stroke were independent negative risk factors on both pre- and post-rehabilitation ambulation levels (P < 0.05). Additionally, advanced age, oxygen, and mechanical ventilation requirement were other negative independent risk factors on post-rehabilitation ambulation levels (P < 0.05). CONCLUSIONS Knowing some of the pre-stroke characteristics of patients while applying rehabilitation programs may be useful in estimating the ambulatory levels on returning home.
Collapse
Affiliation(s)
- Kirac Unal Zeynep
- Physical Medicine and Rehabilitation Clinic, Dr Hulusi Alataş Elmadağ State Hospital, Ankara, Turkey
| | | | | |
Collapse
|
2
|
Wouda NC, Knijff B, Punt M, Visser-Meily JMA, Pisters MF. Predicting Recovery of Independent Walking After Stroke: A Systematic Review. Am J Phys Med Rehabil 2024; 103:458-464. [PMID: 38363655 DOI: 10.1097/phm.0000000000002436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
ABSTRACT Patients recovering from a stroke experience reduced participation, especially when they are limited in daily activities involving walking. Understanding the recovery of independent walking, can be used by clinicians in the decision-making process during rehabilitation, resulting in more personalized stroke rehabilitation. Therefore, it is necessary to gain insight in predicting the recovery of independent walking in patients after stroke. This systematic review provided an overview of current evidence about prognostic models and its performance to predict recovery of independent walking after stroke. Therefore, MEDLINE, CINAHL, and Embase were searched for all relevant studies in English and Dutch. Descriptive statistics, study methods, and model performance were extracted and divided into two categories: subacute phase and chronic phase. This resulted in 16 articles that fulfilled all the search criteria, which included 30 prognostic models. Six prognostic models showed an excellent performance (area under the curve value and/or overall accuracy ≥0.90). The model of Smith et al. (2017) showed highest overall accuracy (100%) in predicting independent walking in the subacute phase after stroke ( Neurorehabil Neural Repair 2017;31(10-11):955-64.). Recovery of independent walking can be predicted in the subacute and chronic phase after stroke. However, proper external validation and the applicability in clinical practice of identified prognostic models are still lacking.
Collapse
Affiliation(s)
- Natasja Charon Wouda
- From the Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, the Netherlands (NCW, JMAV-M); De Hoogstraat Rehabilitation, Department of Neurorehabilitation, Utrecht, the Netherlands (NCW); Research Group Lifestyle and Health, University of Applied Sciences Utrecht, Utrecht, the Netherlands (BK, MP); Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands (JMAV-M, MFP); Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, the Netherlands (MFP); and Research Group Empowering Healthy Behaviour, Department of Health Innovations and Technology, Fontys University of Applied Sciences, Eindhoven, the Netherlands (MFP)
| | | | | | | | | |
Collapse
|
3
|
Barclay R, Webber SC, Ripat J, Nowicki S, Tate R. Self-reported factors associated with community ambulation after stroke: The Canadian Longitudinal Study on Aging. PLoS One 2024; 19:e0299569. [PMID: 38547187 PMCID: PMC10977696 DOI: 10.1371/journal.pone.0299569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 02/13/2024] [Indexed: 04/02/2024] Open
Abstract
Community ambulation is frequently limited for people with stroke. It is, however, considered important to people with stroke. The objectives were to identify factors associated with self-reported community ambulation in Canadians aged 45+ with stroke and to identify factors associated with community ambulation specific to Canadian males and to Canadian females with stroke. Data were utilized from the Canadian Longitudinal Study on Aging Tracking Cohort. Multivariate logistic regression models were developed for community ambulation. Mean age was 68 (SE 0.5) years (45% female). In the final community ambulation model (n = 855), factors associated with being less likely to 'walk outdoors sometimes or often' included difficulty or being unable to walk 2-3 blocks (decreased endurance) vs. no difficulty. Being more likely to walk outdoors was associated with 'better weather' months and being 55-64 years of age vs 75-85. Differences were noted between the models of only males and only females. Decreased walking endurance is associated with a decreased likelihood of walking in the community-a factor that can be addressed by rehabilitation professionals and in community based programs.
Collapse
Affiliation(s)
- Ruth Barclay
- Department of Physical Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sandra C. Webber
- Department of Physical Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jacquie Ripat
- Department of Occupational Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Scott Nowicki
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Robert Tate
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
4
|
Gait asymmetry in stroke patients with unilateral spatial neglect. Med Biol Eng Comput 2023; 61:651-659. [PMID: 36577925 DOI: 10.1007/s11517-022-02738-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 12/09/2022] [Indexed: 12/29/2022]
Abstract
The recovery of independent gait represents one of the main functional goals of the rehabilitative interventions after stroke but it can be hindered by the presence of unilateral spatial neglect (USN). The aim of the paper is to study if the presence of USN in stroke patients affects lower limb gait parameters between the two body sides, differently from what could be expected by the motor impairment alone, and to explore whether USN is associated to specific gait asymmetry. Thirty-five stroke patients (right or left lesion and ischemic or hemorrhagic etiology) who regained independent gait were assessed for global cognitive functioning and USN. All patients underwent a gait analysis session by using a wearable inertial system, kinematic parameters were computed. Enrolled patients presented altered motion parameters. Stroke patients with USN showed specific asymmetries in the following parameters: stance phase, swing phase, and knee range of motion. No differences in the clinical scores were found as the presence of USN. The presence of USN was associated with a specific form of altered gait symmetry. These findings may help clinicians to develop more tailored rehabilitative training to enhance gait efficacy of patients with motor defects complicated by the presence of selected cognitive impairments. Overview of the experiment setup. The workflow shows: diagnosis of unilateral spatial neglect by the neuropsychologist, sensors placement, gait analysis protocol and evaluation of the gait asymmetry together with the statistically significant features.
Collapse
|
5
|
Using rhythm for rehabilitation: the acceptability of a novel haptic cueing device in extended stroke rehabilitation. JOURNAL OF ENABLING TECHNOLOGIES 2022. [DOI: 10.1108/jet-01-2021-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeRestoration of walking ability is a key goal to both stroke survivors and their therapists. However, the intensity and duration of rehabilitation available after stroke can be limited by service constraints, despite the potential for improvement which could reduce health service demands in the long run. The purpose of this paper is to present qualitative findings from a study that explored the acceptability of a haptic device aimed at improving walking as part of an extended intervention in stroke rehabilitation.Design/methodology/approachPre-trial focus groups and post-trial interviews to assess the acceptability of Haptic Bracelets were undertaken with seven stroke survivors.FindingsFive themes were identified as impacting on the acceptability of the Haptic Bracelet: potential for improving quality of life; relationships with technology; important features; concerns; response to trial and concentration. Participants were interested in the haptic bracelet and hoped it would provide them with more confidence making them: feel safer when walking; have greater ability to take bigger strides rather than little steps; a way to combat mistakes participants reported making due to tiredness and reduced pain in knees and hips.Originality/valueHaptic Bracelets are an innovative development in the field of rhythmic cueing and stroke rehabilitation. The haptic bracelets also overcome problems encountered with established audio-based cueing, as their use is not affected by external environmental noise.Peer reviewThe peer review history for this article is available at: https://publons.com/publon 10.1108/JET-01-2021-0003
Collapse
|
6
|
Embrechts E, Van Criekinge T, Schröder J, Nijboer T, Lafosse C, Truijen S, Saeys W. The association between visuospatial neglect and balance and mobility post-stroke onset: A systematic review. Ann Phys Rehabil Med 2020; 64:101449. [PMID: 33152521 DOI: 10.1016/j.rehab.2020.10.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 10/09/2020] [Accepted: 10/11/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although previous narrative reviews have highlighted a potential association between visuospatial neglect (VSN) and balance disorders, to what extent different areas of balance and mobility could be affected is still unclear. OBJECTIVES This systematic review updates previous literature findings and systematically reviews sitting balance, standing balance and mobility outcomes. METHODS PubMed, Web of Science, ScienceDirect, Naric-Rehabdata, PEDro and the Cochrane Trials Library were systematically searched. Methodological quality was assessed by the National Heart, Lung, and Blood Institute Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. The association between VSN and sitting balance, standing balance and mobility (walking, stair climbing/descending and transfers) was investigated. RESULTS In total, 48 studies were included (4595 stroke survivors): at least 1319 (29%) showed symptoms of VSN. VSN was associated with less independence during sitting, with an asymmetric posture toward the affected body side. For standing balance, we revealed a significant negative association between VSN and mediolateral stability and weight shifting, whereas only activities of daily living-related VSN was associated with weight-bearing asymmetry during static stance. While walking, patients with VSN laterally deviated from their path. Results were inconclusive regarding other aspects of mobility. The association between VSN and balance/mobility seemed to decrease over time. CONCLUSIONS Despite great heterogeneity in results, this study suggests that stroke survivors with VSN show specific deviations in posture and movement in the mediolateral direction. Although the association between VSN and balance/mobility has been extensively investigated, explanatory studies evaluating underlying mechanisms of the frequently present association are lacking. Future studies should address this by combining clinical and instrumented assessment of balance and gait performance, preferably longitudinally to investigate the associations over time.
Collapse
Affiliation(s)
- Elissa Embrechts
- Research group MOVANT, Department of Rehabilitation Sciences & Physiotherapy, University of Antwerp, Wilrijk, Belgium.
| | - Tamaya Van Criekinge
- Research group MOVANT, Department of Rehabilitation Sciences & Physiotherapy, University of Antwerp, Wilrijk, Belgium
| | - Jonas Schröder
- Research group MOVANT, Department of Rehabilitation Sciences & Physiotherapy, University of Antwerp, Wilrijk, Belgium
| | - Tanja Nijboer
- Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands; Center of Excellence for Rehabilitation Medicine, UMC Brain Center, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Christophe Lafosse
- Department of Neurorehabilitation, RevArte Rehabilitation Hospital, Edegem, Belgium
| | - Steven Truijen
- Research group MOVANT, Department of Rehabilitation Sciences & Physiotherapy, University of Antwerp, Wilrijk, Belgium
| | - Wim Saeys
- Research group MOVANT, Department of Rehabilitation Sciences & Physiotherapy, University of Antwerp, Wilrijk, Belgium; Department of Neurorehabilitation, RevArte Rehabilitation Hospital, Edegem, Belgium
| |
Collapse
|
7
|
Nascimento LR, de Menezes KKP, Scianni AA, Faria-Fortini I, Teixeira-Salmela LF. Deficits in motor coordination of the paretic lower limb limit the ability to immediately increase walking speed in individuals with chronic stroke. Braz J Phys Ther 2020; 24:496-502. [PMID: 31561961 PMCID: PMC7779964 DOI: 10.1016/j.bjpt.2019.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 08/01/2019] [Accepted: 09/04/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To explore the relationships between clinical measures and the ability to increase walking speed in ambulatory people with chronic stroke and to identify which measures would best predict walking speed reserve. METHODS An exploratory, cross-sectional study was conducted with 114 individuals with chronic stroke. The outcome of interest was walking speed reserve, defined as the difference between individuals' comfortable and maximal walking speeds. Predictors were characteristics of the participants (age, sex, time since stroke, relative lower-limb dominance) and motor impairments (tonus, strength, and motor coordination). RESULTS The characteristics of the participants did not significantly correlate with walking speed reserve. All measures of motor impairments, i.e., tonus, strength, and motor coordination, were significantly correlated with walking speed reserve (p < 0.01), but only motor coordination was kept in the regression model. Motor coordination alone explained 35% (F = 61.5; p < 0.001) of the variance in walking speed reserve. CONCLUSIONS The level of motor coordination of the paretic lower limb is associated with the walking speed reserve of individuals with stroke. Interventions aimed at improving motor coordination may have the potential to improve everyday situations that require immediate increases in walking speed.
Collapse
Affiliation(s)
- Lucas Rodrigues Nascimento
- Center of Health Sciences, Discipline of Physiotherapy, Universidade Federal do Espírito Santo (UFES), Vitória, ES, Brazil; NeuroGroup, Discipline of Physiotherapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.
| | | | - Aline Alvim Scianni
- NeuroGroup, Discipline of Physiotherapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Iza Faria-Fortini
- NeuroGroup, Discipline of Physiotherapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil; Department of Occupational Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | | |
Collapse
|
8
|
Tashiro H, Isho T, Takeda T, Nakamura T, Kozuka N, Hoshi F. Utility of Dynamic Balance Measurements in Discriminating Community Ambulation Levels Among Individuals with Stroke: A Cross-sectional Study. J Stroke Cerebrovasc Dis 2020; 29:104603. [PMID: 31932210 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104603] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/25/2019] [Accepted: 12/12/2019] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To examine the association between dynamic balance measurements and community ambulation levels among individuals with chronic stroke. METHODS This cross-sectional study was performed in 2-day care facilities for older adults located in urban areas. Forty-seven community-dwelling poststroke adults who could walk independently were participated. Community ambulation performance was assessed using the Functional Ambulation Classification of the Hospital at Sagunto (FACHS). Dynamic balance and mobility were measured with the Mini-Balance Evaluation Systems Test (Mini-BESTest), the Timed Up and Go (TUG) test, and 10 m maximum walking speed. RESULTS Participants were classified into 3 groups according to FACHS scores: household (n = 15), neighborhood (n = 19), and community walkers (n = 13). Neighborhood and community walkers scored significantly higher on the Mini-BESTest and had a shorter TUG test time than household walkers. Community walkers had a significantly faster walking speed than household walkers, whereas neighborhood walkers did not have a faster walking speed than household walkers. Ordinal logistic regression analyses revealed the Mini-BESTest score (odds ratio [OR] 1.24; 95% confidence interval [CI]: 1.07-1.44) and the TUG test time (OR .91; 95% CI: .85-.98) were significantly associated with ambulation levels after adjusting for confounders. CONCLUSIONS Dynamic balance measurement tools may have better responsiveness in detecting community ambulation levels among individuals with chronic stroke than walking speed.
Collapse
Affiliation(s)
- Hideyuki Tashiro
- Department of Physical Therapy, School of Health Sciences, Sapporo Medical University, Hokkaido, Japan; Graduate School of Health Sciences, Sapporo Medical University, Hokkaido, Japan.
| | - Takuya Isho
- Rehabilitation Center, Fujioka General Hospital, Gunma, Japan
| | - Takanori Takeda
- Department of Rehabilitation Technique, Ageo Central General Hospital, Saitama, Japan
| | - Takahito Nakamura
- Department of Physical Therapy, School of Health and Social Science, Saitama Prefectural University, Saitama, Japan
| | - Naoki Kozuka
- Department of Physical Therapy, School of Health Sciences, Sapporo Medical University, Hokkaido, Japan
| | - Fumihiko Hoshi
- Department of Physical Therapy, School of Health and Social Science, Saitama Prefectural University, Saitama, Japan
| |
Collapse
|
9
|
Simpson DB, Bird ML, English C, Gall SL, Breslin M, Smith S, Schmidt M, Callisaya ML. "Connecting patients and therapists remotely using technology is feasible and facilitates exercise adherence after stroke". Top Stroke Rehabil 2019; 27:93-102. [PMID: 31762412 DOI: 10.1080/10749357.2019.1690779] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: Repetitive task practice after stroke is important to improve function, yet adherence to exercise is low. The aim of this study was to determine whether using the internet, a tablet application, and a chair sensor that connected to a therapist was feasible in monitoring adherence and progressing a functional exercise at home.Methods: Ten participants with stroke completed a 4-week sit-to-stand exercise using the technology at home (ACTRN12616000051448). A therapist remotely monitored exercise adherence, progressed goals, and provided feedback via the app. Measures of feasibility (design, recruitment/withdrawals, adherence, safety, participant satisfaction and estimates of effect on function) were collected.Results: Participants' mean age was 73.6 years [SD 9.9 years]. The system was feasible to deliver and monitor exercise remotely. All participants completed the study performing a mean 125% of prescribed sessions and 104% of prescribed repetitions. Participants rated the system usability (78%), enjoyment (70%) and system benefit (80%) as high. No adverse events were reported. The mean pre- and post-intervention difference in the total short performance physical battery score was 1.4 (95% CI 0.79, 2.00).Conclusions: It was feasible and safe to prescribe and monitor exercises using an app and sensor-based system. A definitive trial will determine whether such technology could facilitate greater exercise participation after stroke.
Collapse
Affiliation(s)
- Dawn B Simpson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Marie-Louise Bird
- GF Strong Rehabilitation Research Laboratory, University of British Colombia, Vancouver, Canada
| | - Coralie English
- School of Health Sciences, University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, University of Newcastle Priority Research Centre for Stroke and Brain Injury, Newcastle, Australia
| | - Seana L Gall
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Monique Breslin
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Stuart Smith
- Division of Research, Southern Cross University, Coffs Harbour, Australia
| | - Matthew Schmidt
- School of Health Sciences, University of Tasmania, Hobart, Australia
| | - Michele L Callisaya
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| |
Collapse
|
10
|
Mulder M, Nijland RH, van de Port IG, van Wegen EE, Kwakkel G. Prospectively Classifying Community Walkers After Stroke: Who Are They? Arch Phys Med Rehabil 2019; 100:2113-2118. [DOI: 10.1016/j.apmr.2019.04.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 03/20/2019] [Accepted: 04/29/2019] [Indexed: 10/26/2022]
|