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1.
Jayme S. Knutson Amy S. Friedl Kristine M. Hansen Terri Z. Hisel Mary Y. Harley 《Archives of physical medicine and rehabilitation》2019,100(1):140-143.e1
Objective
To evaluate the convergent validity and responsiveness of the Stroke Upper Limb Capacity Scale (SULCS) in comparison to the Arm Motor Ability Test (AMAT), the Box and Blocks Test (BBT), and the upper limb Fugl-Meyer Assessment (FMA). The SULCS is a relatively new measure that was designed to be easier to score and less time consuming than some existing measures.Design
Prospective repeated-measures design.Setting
Clinical research laboratory of a large public hospital.Participants
Patients (N=61) <2 years poststroke with moderate to severe upper limb hemiparesis.Intervention
Participants received 12 weeks of therapy that included neuromuscular electrical stimulation of the paretic finger and thumb extensors. The SULCS, AMAT, BBT, and FMA were administered at weeks 0, 6, 12 (end of therapy), 20, 28, and 36 (6mo post-therapy).Main Outcome Measures
Convergent validity was evaluated with Spearman’s correlation coefficients between pairs of measures at each time point. Responsiveness from 0 to 12 weeks and 0 to 36 weeks was evaluated with the standardized response mean (SRM).Results
The SULCS demonstrated strong correlation with the AMAT (ρ=0.81-0.93), BBT (ρ=0.73-0.92), and FMA (ρ=0.78-0.92), at all 6 time points. All 4 measures had moderate to large SRMs (SULCS, 0.71-0.77; AMAT, 0.83-0.97; BBT, 0.73-0.82; FMA, 0.75-0.76). There was no significant difference in responsiveness among the 4 measures.Conclusions
The results support the use of the SULCS to measure upper limb capacity in patients who are less than 2 years poststroke with moderate to severe hemiplegia. 相似文献2.
Objective
To assess whether robot-assisted reach training (RART) with an active assistant protocol can improve upper extremity function and kinematic performance in chronic stroke survivors.Design
This study was conducted as a randomized controlled trial.Setting
National rehabilitation center.Participants
Chronic stroke survivors (N=38) were randomized into 2 groups: a robot-assisted reach training with assist-as-needed (RT-AAN) group and a robot-assisted reach training with guidance force (RT-G) group.Intervention
The RT-AAN group received robot-assisted reach training with an assist-as-needed mode for 40 minutes per day, 3 times per week over a 6-week period, and the RT-G group participated in the RART with a guidance mode for 40 minutes per day, 3 times per week over a 6-week period.Main Outcome Measures
Upper extremity functions were measured with Fugl–Meyer Assessment (FMA), Action Research Arm Test (ARAT), and Box and Block Test. In addition, movement velocities were measured as an index for upper extremity kinematic performances in 6 directions.Results
Both groups showed significant improvements in FMA, ARAT, and kinematics (movement velocity) in all directions (targets 1-6, P<.05). However, the RT-AAN group showed significantly more improvement than the RT-G group in FMA and ARAT (P<.05).Conclusions
RART with an active assistant protocol showed improvements of upper extremity function and kinematic performance in chronic stroke survivors. In particular, assist-as-needed robot control was effective for upper extremity rehabilitation. Therefore robot-assisted training may be suggested as an effective intervention to improve upper extremity function in chronic stroke survivors. 相似文献3.
Anson B. Rosenfeldt Susan M. Linder Sara Davidson Cynthia Clark Nicole M. Zimmerman John J. Lee Jay L. Alberts 《Archives of physical medicine and rehabilitation》2019,100(5):923-930
Objective
The aim of this project was to determine the effects of lower extremity aerobic exercise coupled with upper extremity repetitive task practice (RTP) on health-related quality of life (HRQOL) and depressive symptomology in individuals with chronic stroke.Design
Secondary analysis of data from 2 randomized controlled trials.Setting
Research laboratory.Participants
Individuals (N=40) with chronic stroke.Interventions
Participants received one of the following interventions: forced exercise+RTP (FE+RTP, n=16), voluntary exercise+RTP (VE+RTP, n=16), or stroke education+RTP (EDU+RTP, n=8). All groups completed 24 sessions, each session lasting 90 minutes.Main Outcome Measures
The Center for Epidemiological Studies-Depression Scale (CES-D) and Stroke Impact Scale (SIS) were used to assess depressive symptomology and HRQOL.Results
There were no significant group-by-time interactions for any of the SIS domains or composite scores. Examining the individual groups following the intervention, those in the FE+RTP and VE+RTP groups demonstrated significant improvements in the following SIS domains: strength, mobility, hand function, activities of daily living, and the physical composite. In addition, the FE+RTP group demonstrated significant improvements in memory, cognitive composite, and percent recovery from stroke. The HRQOL did not change in the EDU+RTP group. Although CES-D scores improved predominantly for those in the FE+RTP group, these improvements were not statistically significant. Overall, results were maintained at the 4-week follow-up.Conclusion
Aerobic exercise, regardless of mode, preceding motor task practice may improve HRQOL in patients with stroke. The potential of aerobic exercise to improve cardiorespiratory endurance, motor outcomes, and HRQOL poststroke justifies its use to augment traditional task practice. 相似文献4.
Ching-Fang Chiang Meng-Ting Lin Ming-Yen Hsiao Yi-Chun Yeh Yun-Chieh Liang Tyng-Guey Wang 《Archives of physical medicine and rehabilitation》2019,100(4):739-750.e4
Objective
To investigate the effectiveness of noninvasive neurostimulation therapies in patients with poststroke dysphagia.Data Sources
Electronic databases, including Embase, PubMed, Scopus, and the Cochrane Library, were searched up to May 31, 2018.Study Selection
All published randomized controlled trials (RCTs) comparing neurostimulation therapies, including repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), surface neuromuscular electrical stimulation (sNMES), and pharyngeal electrical stimulation (PES), in patients with acute and subacute poststroke dysphagia were included. Nineteen RCTs were enrolled in the meta-analysis.Data Extraction
Full texts were independently reviewed. Two independent raters assessed the risk of bias of RCTs with the Cochrane risk-of-bias tool. The primary outcome measure was swallowing function evaluated before and after neurostimulation therapy.Data Synthesis
Both pairwise and network meta-analysis revealed that rTMS, tDCS, and sNMES significantly improved poststroke dysphagia compared with placebo. Differences in functional improvement between PES and placebo were not significant. Based on probability ranking, rTMS seemed the best treatment among the 4 neurostimulation therapies. In the network meta-analysis, rTMS showed the best efficacy compared with placebo (standardized mean difference=1.02, 95% confidence interval, 0.61-1.43).Conclusions
Among the 4 noninvasive neurostimulation therapies, rTMS, tDCS, and sNMES were effective for treating poststroke dysphagia; furthermore, rTMS may be the most effective therapy according to probability ranking. 相似文献5.
Tatsuro Inoue Shogo Misu Toshiaki Tanaka Hiroki Sakamoto Kentaro Iwata Yuki Chuman Rei Ono 《Archives of physical medicine and rehabilitation》2019,100(1):32-38
Objective
To investigate whether postoperative voluntary energy intake (EI) affects functional recovery with hip fracture during the acute phase.Design
Prospective cohort study.Setting
Three acute care hospitals.Participants
Hip fracture patients (N=200) who were consecutively admitted to 3 acute hospitals because of falling.Interventions
Not applicable.Main Outcome Measures
Patients were stratified into 3 groups based on the ratio of measured EI to estimated total energy expenditure (TEE) as inadequate (EI/TEE<0.7), intermediate (0.7≤EI/TEE<1), and adequate (EI/TEE≥1) groups. The functional status was evaluated using the motor domain of a FIM. We calculated efficiency based on the motor FIM scores (change in postoperative motor FIM scores/length of the rehabilitation period) to assess the beneficial effect of rehabilitation.Results
The median hospital stay was 24 days. The inadequate group comprised 73 (36.5%) patients (median EI/TEE, 0.54; interquartile range, 0.42-0.64); intermediate group comprised 92 (46.0%) patients (median EI/TEE, 0.87; interquartile range, 0.78-0.94), and adequate group comprised 35 (17.5%) patients (median EI/TEE, 1.10; interquartile range, 1.04-1.15). Absolute functional gain (AFG) and efficiency of motor FIM gain (EFG) scores were higher in the adequate group than in the others (P<.01). After adjustment for potential confounders, a significant association between postoperative EI/TEE group and logarithm of EFG scores was observed to persist (inadequate group, standardized β =?0.14; reference: adequate group; P=0.03; R2 for the entire model =0.25).Conclusions
Postoperative EI that is less than 70% of TEE diminishes functional recovery with hip fracture. 相似文献6.
Samantha Backhaus Dawn Neumann Devan Parrott Flora M. Hammond Claire Brownson James Malec 《Archives of physical medicine and rehabilitation》2019,100(2):195-204.e1
Objectives
This study aimed to (1) examine the efficacy of a treatment to enhance a couple’s relationship after brain injury particularly in relationship satisfaction and communication; and (2) determine couples’ satisfaction with this type of intervention.Design
Randomized waitlist-controlled trial.Setting
Midwestern outpatient brain injury rehabilitation center.Participants
Participants (N=44; 22 persons with brain injury and their intimate partners) were randomized by couples to the intervention or waitlist-controlled group, with 11 couples in each group.Interventions
The Couples Caring and Relating with Empathy intervention is a 16-week, 2-hour, manualized small group treatment utilizing psychoeducation, affect recognition, empathy training, cognitive-behavioral and dialectical-behavioral strategies, communication skills training, and Gottman’s theoretical framework for couples adjusted for individuals with brain injury.Main Outcome Measures
The Dyadic Adjustment Scale, Quality of Marriage Index (QMI), and the Four Horsemen of the Apocalypse communication questionnaire were implemented. Measures were completed by the person with brain injury and that person’s partner at 3 time points: baseline, immediate postintervention, 3-month follow-up.Results
The experimental group showed significant improvement at posttest and follow-up on the Dyadic Adjustment Scale and the Horsemen questionnaire compared to baseline and to the waitlist-controlled group which showed no significant changes on these measures. No significant effects were observed on the QMI for either group. Satisfaction scores were largely favorable.Conclusions
Results suggest this intervention can improve couples’ dyadic adjustment and communication after brain injury. High satisfaction ratings suggest this small group intervention is feasible with couples following brain injury. Future directions for this intervention are discussed. 相似文献7.
Annick Van Gils Sarah Meyer Margaretha Van Dijk Liselot Thijs Marc Michielsen Christophe Lafosse Veronik Truyens Kristine Oostra Andre Peeters Vincent Thijs Hilde Feys Lena Krumlinde-Sundholm Daphne Kos Geert Verheyden 《Archives of physical medicine and rehabilitation》2018,99(12):2513-2522
Objective
To investigate interrater and intrarater reliability, measurement error, and convergent and discriminative validity of the Adult Assisting Hand Assessment Stroke (Ad-AHA Stroke).Design
Cross-sectional observational study.Setting
A total of 7 stroke rehabilitation centers.Participants
Stroke survivors (reliability sample: n=30; validity sample: N=118) were included (median age 67y; interquartile range [IQR], 59-76); median time poststroke 81 days (IQR 57-117).Interventions
N/A.Main Outcome Measures
Ad-AHA Stroke, Action Research Arm Test (ARAT), upper extremity Fugl-Meyer Assessment (UE-FMA). The Ad-AHA Stroke is an observation-based instrument assessing the effectiveness of the spontaneous use of the affected hand when performing bimanual activities in adults poststroke. Reliability of Ad-AHA Stroke was examined using intraclass correlation coefficients (ICCs), Bland–Altman plots, and weighted kappa statistics for reliability on item level. SEM was calculated based on Ad-AHA units. Convergent validity was assessed by calculating Spearman rank correlation coefficients between Ad-AHA Stroke and ARA test and UE-FMA. Comparison of Ad-AHA Stroke scores between subgroups of patients according to hand dominance, neglect, and age evaluated discriminative validity.Results
Intrarater and interrater agreement showed an ICC of 0.99 (95% confidence interval, 0.99-0.99), an SEM of 2.15 and 1.64 out of 100, respectively, and weighted kappa for item scores were all above 0.79. The relation between Ad-AHA and other clinical assessments was strong (ρ=0.9). Patients with neglect had significantly lower Ad-AHA scores compared to patients without neglect (P=.004).Conclusions
The Ad-AHA Stroke captures actual bimanual performance. Therefore, it provides an additional aspect of upper limb assessment with good to excellent reliability and low SEM for patients with subacute stroke. High convergent validity with the ARA test and UE-FMA and discriminative validity were supported. 相似文献8.
Gabrielle Alvarez Stacy J. Suskauer Beth Slomine 《Archives of physical medicine and rehabilitation》2019,100(4):687-694
Objectives
To investigate behavioral and demographic features of levels of consciousness in young children with brain injury, including the classifications of consciousness: conscious state (CS), minimally conscious state (MCS), and vegetative state (VS), and to investigate the course of recovery in children with disorders of consciousness (DOC).Design
Retrospective chart review and post hoc analysis.Setting
Pediatric inpatient rehabilitation unit.Participants
Children aged 6 months to 5 years (N=54) admitted for inpatient rehabilitation directly from an acute care hospital following new neurologic injury from 2011 to 2016.Interventions
Not applicable.Main Outcome Measures
Clinically abstracted behavioral features of DOC and levels of consciousness at admission and discharge, based on established guidelines from the Aspen Neurobehavioral Conference Workgroup.Results
Children in MCS were younger than children in CS. Commonly observed behaviors in children in VS were mouth movements or vocalizations, flexion withdrawal or motor posturing, visual or auditory startle, and localization to sound. Common features of MCS were contingent affect, visual fixation or pursuit, automatic motor behavior, and contingent communicative intent. No children in MCS showed command following or intelligible verbalizations. All children in CS showed functional object use, while functional communication was observed in a subset. By discharge, more than half of children in VS emerged to MCS, and a third emerged from MCS to CS. No child emerged from VS to CS.Conclusions
Visual and motor skills may be most applicable, and language-based skills may be least applicable for the assessment of DOC in very young children. Accurate classifications of consciousness may have important prognostic implications, and additional research is needed to develop clear guidelines for assessment of DOC in this population. 相似文献9.
10.
Sarah A. Morrison Douglas Lorenz Carol P. Eskay Gail F. Forrest D. Michele Basso 《Archives of physical medicine and rehabilitation》2018,99(3):555-562
Objective
To determine the impact of long-term, body weight–supported locomotor training after chronic, incomplete spinal cord injury (SCI), and to estimate the health care costs related to lost recovery potential and preventable secondary complications that may have occurred because of visit limits imposed by insurers.Design
Prospective observational cohort with longitudinal follow-up.Setting
Eight outpatient rehabilitation centers that participate in the Christopher & Dana Reeve Foundation NeuroRecovery Network (NRN).Participants
Individuals with motor incomplete chronic SCI (American Spinal Injury Association Impairment Scale C or D; N=69; 0.1–45y after SCI) who completed at least 120 NRN physical therapy sessions.Interventions
Manually assisted locomotor training (LT) in a body weight–supported treadmill environment, overground standing and stepping activities, and community integration tasks.Main Outcome Measures
International Standards for Neurological Classification of Spinal Cord Injury motor and sensory scores, orthostatic hypotension, bowel/bladder/sexual function, Spinal Cord Injury Functional Ambulation Inventory (SCI-FAI), Berg Balance Scale, Modified Functional Reach, 10-m walk test, and 6-minute walk test. Longitudinal outcome measure collection occurred every 20 treatments and at 6- to 12-month follow-up after discharge from therapy.Results
Significant improvement occurred for upper and lower motor strength, functional activities, psychological arousal, sensation of bowel movement, and SCI-FAI community ambulation. Extended training enabled minimal detectable changes at 60, 80, 100, and 120 sessions. After detectable change occurred, it was sustained through 120 sessions and continued 6 to 12 months after treatment.Conclusions
Delivering at least 120 sessions of LT improves recovery from incomplete chronic SCI. Because walking reduces rehospitalization, LT delivered beyond the average 20-session insurance limit can reduce rehospitalizations and long-term health costs. 相似文献11.
Jasmine Heath Hearn Imogen Cotter Katherine Anne Finlay 《Archives of physical medicine and rehabilitation》2019,100(1):17-25
Objectives
To explore the feasibility and efficacy of web-based mindfulness training for carers of people with spinal cord injury (SCI).Design
Randomized controlled feasibility study with 3-month follow-up.Setting
Community setting.Participants
Spouses or family caregivers (N=55) of people with SCI and chronic neuropathic pain were recruited via the direct care team and advertisements. Participants were older than 18 years (no upper age limit), with Internet access for the duration of the study. Participants were randomly allocated to an 8-week online mindfulness training intervention (n=28), or to receive 8 weeks of psychoeducational materials on SCI and chronic pain (n=27).Interventions
An established web-based, mindfulness training course was delivered over 8 weeks. Participants completed 10 minutes of mindfulness practices, twice per day, 6 days per week, totaling 960 minutes. The control group received a weekly e-mail with psychoeducational materials (based on the established elements) on SCI and pain for 8 weeks.Main Outcome Measure
Depression severity.Results
Mindfulness reduced depression severity more than psychoeducation at T2 (mean difference= ?.891; 95% confidence interval,?1.48 to ?.30) and T3 (mean difference=?1.96; 95% confidence interval, ?2.94 to ?.97). Mindfulness training also reduced anxiety at T2 (mean difference=?.888; 95% confidence interval, ?1.40 to ?.38) and T3 (mean difference=?2.44; 95% confidence interval, ?3.20 to ?1.69).Conclusions
Results indicate that Internet-delivered mindfulness training offers unique benefits and is viable for caregivers of people with SCI and chronic neuropathic pain. Further work should explore the feasibility of combined education and mindfulness training incorporating both patient and caregiver, for optimum benefit. 相似文献12.
Kênia Kiefer Parreiras de Menezes Lucas Rodrigues Nascimento Louise Ada Patrick Roberto Avelino Janaine Cunha Polese Maria Tereza Mota Alvarenga Mariana Hoffman Barbosa Luci Fuscaldi Teixeira-Salmela 《Archives of physical medicine and rehabilitation》2019,100(2):205-212
Objective
To examine whether high-intensity home-based respiratory muscle training, that is, with higher loads, delivered more frequently and for longer duration, than previously applied, would increase the strength and endurance of the respiratory muscles, reduce dyspnea and respiratory complications, and improve walking capacity post-stroke.Design
Randomized trial with concealed allocation, blinded participants and assessors, and intention-to-treat analysis.Setting
Community-dwelling patients.Participants
Patients with stroke, who had respiratory muscle weakness (N=38).Interventions
The experimental group received 40-minute high-intensity home-based respiratory muscle training, 7 days per week, for 8 weeks, progressed weekly. The control group received a sham intervention of similar dose.Main Outcome Measures
Primary outcome was inspiratory muscle strength (via maximal inspiratory pressure), whereas secondary outcomes were expiratory muscle strength (maximal expiratory pressure), inspiratory muscle endurance, dyspnea (Medical Research Council score), respiratory complications (hospitalizations), and walking capacity (6-minute walk test). Outcomes were measured at baseline, after intervention, and 1 month beyond intervention.Results
Compared to the control, the experimental group increased inspiratory (27cmH2O; 95% confidence interval [95% CI], 15 to 40) and expiratory (42cmH2O; 95% CI, 25 to 59) strength, inspiratory endurance (33 breaths; 95% CI, 20 to 47), and reduced dyspnea (-1.3 out of 5.0; 95% CI, -2.1 to -0.6), and the benefits were maintained at 1 month beyond training. There was no significant between-group difference for walking capacity or respiratory complications.Conclusion
High-intensity home-based respiratory muscle training was effective in increasing strength and endurance of the respiratory muscles and reducing dyspnea for people with respiratory muscle weakness post-stroke, and the magnitude of the effect was higher, than that previously reported in studies, which applied standard protocols. 相似文献13.
Kimberley A. Wattchow Michelle N. McDonnell Susan L. Hillier 《Archives of physical medicine and rehabilitation》2018,99(2):367-382
Objective
To investigate the therapeutic interventions reported in the research literature and synthesize their effectiveness in improving upper limb (UL) function in the first 4 weeks poststroke.Data Sources
Electronic databases and trial registries were searched from inception until June 2016, in addition to searching systematic reviews by hand.Study Selection
Randomized controlled trials (RCTs), controlled trials, and interventional studies with pre/posttest design were included for adults within 4 weeks of any type of stroke with UL impairment. Participants all received an intervention of any physiotherapeutic or occupational therapeutic technique designed to address impairment or activity of the affected UL, which could be compared with usual care, sham, or another technique.Data Extraction
Two reviewers independently assessed eligibility of full texts, and methodological quality of included studies was assessed using the Cochrane Risk of Bias Tool.Data Synthesis
A total of 104 trials (83 RCTs, 21 nonrandomized studies) were included (N=5225 participants). Meta-analyses of RCTs only (20 comparisons) and narrative syntheses were completed. Key findings included significant positive effects for modified constraint-induced movement therapy (mCIMT) (standardized mean difference [SMD]=1.09; 95% confidence interval [CI], .21–1.97) and task-specific training (SMD=.37; 95% CI, .05–.68). Evidence was found to support supplementary use of biofeedback and electrical stimulation. Use of Bobath therapy was not supported.Conclusions
Use of mCIMT and task-specific training was supported, as was supplementary use of biofeedback and electrical simulation, within the acute phase poststroke. Further high-quality studies into the initial 4 weeks poststroke are needed to determine therapies for targeted functional UL outcomes. 相似文献14.
Genevieve Hendrey Ross A. Clark Anne E. Holland Benjamin F. Mentiplay Carly Davis Cristie Windfeld-Lund Melissa J. Raymond Gavin Williams 《Archives of physical medicine and rehabilitation》2018,99(12):2430-2446
Objective
To establish the feasibility and effectiveness of a 6-week ballistic strength training protocol in people with stroke.Design
Randomized, controlled, assessor-blinded study.Setting
Subacute inpatient rehabilitation.Participants
Consecutively admitted inpatients with a primary diagnosis of first-ever stroke with lower limb weakness, functional ambulation category score of ≥3, and ability to walk ≥14 m were screened for eligibility to recruit 30 participants for randomization.Interventions
Participants were randomized to standard therapy or ballistic strength training 3 times per week for 6 weeks.Main Outcome Measures
The primary aim was to evaluate feasibility and outcomes included recruitment rate, participant retention and attrition, feasibility of the exercise protocol, therapist burden, and participant safety. Secondary outcomes included measures of mobility, lower limb muscle strength, muscle power, and quality of life.Results
A total of 30 participants (11% of those screened) with mean age of 50 years (SD 18) were randomized. The median number of sessions attended was 15 of 18 and 17 of 18 for the ballistic and control groups, respectively. Earlier than expected discharge to home (n=4) and illness (n=7) were the most common reasons for nonattendance. Participants performed the exercises safely, with no study-related adverse events. There were significant (P<.05) between-group changes favoring the ballistic group for comfortable gait velocity (mean difference [MD] 0.31m/s, 95% confidence interval [CI]: 0.08-0.52), muscle power, as measured by peak jump height (MD 8cm, 95% CI: 3-13), and peak propulsive velocity (MD 64cm/s, 95% CI: 17-112).Conclusions
Ballistic training was safe and feasible in select ambulant people with stroke. Similar rates of retention and attrition suggest that ballistic training was acceptable to patients. Secondary outcomes provide promising results that warrant further investigation in a larger trial. 相似文献15.
Kara K. Patterson Jennifer S. Wong Svetlana Knorr Jessica A. Grahn 《Archives of physical medicine and rehabilitation》2018,99(5):945-951
Objectives
To assess rhythm abilities, to describe their relation to clinical presentation, and to determine if rhythm production independently contributes to temporal gait asymmetry (TGA) poststroke.Design
Cross-sectional.Setting
Large urban rehabilitation hospital and university.Participants
Individuals (N=60) with subacute and chronic stroke (n=39) and data for healthy adults extracted from a preexisting database (n=21).Interventions
Not applicable.Main Outcome Measures
Stroke group: National Institutes of Health Stroke Scale (NIHSS), Chedoke-McMaster Stroke Assessment (CMSA) leg and foot scales, Montreal Cognitive Assessment (MoCA), rhythm perception and production (Beat Alignment Test [BAT]), and spatiotemporal gait parameters were assessed. TGA was quantified with the swing time symmetry ratio. Healthy group: age and beat perception scores assessed by the BAT. Rhythm perception of the stroke group and healthy adults was compared with analysis of variance. Spearman correlations quantified the relation between rhythm perception and production abilities and clinical measures. Multiple linear regression assessed the contribution of rhythm production along with motor impairment and time poststroke to TGA.Results
Rhythm perception in the stroke group was worse than healthy adults (F1,56=17.5, P=.0001) Within the stroke group, rhythm perception was significantly correlated with CMSA leg (Spearman ρ=.33, P=.04), and foot (Spearman ρ=.49, P=.002) scores but not NIHSS or MoCA scores. The model for TGA was significant (F3,35=12.8, P<.0001) with CMSA leg scores, time poststroke, and asynchrony of rhythm production explaining 52% of the variance.Conclusions
Rhythm perception is impaired after stroke, and temporal gait asymmetry relates to impairments in producing rhythmic movement. These results may have implications for the use of auditory rhythmic stimuli to cue motor responses poststroke. Future work will explore brain responses to rhythm processing poststroke. 相似文献16.
Ting-ting Yeh Ku-chou Chang Ching-yi Wu 《Archives of physical medicine and rehabilitation》2019,100(5):821-827
Objective
To investigate the efficacy of a sequential combination of aerobic exercise and cognitive training on cognitive function and other health-related outcomes in stroke survivors with cognitive decline.Design
Intervention study and randomized controlled trial.Setting
Hospital-based rehabilitation units.Participants
Survivors of stroke with cognitive decline (N=30) were randomized to sequential combination training (SEQ) (n=15) or an active control (n=15) group.Interventions
The SEQ group received 30 minutes of aerobic exercise, followed by 30 minutes of computerized cognitive training. The control group received 30 minutes of nonaerobic physical exercise, followed by 30 minutes of unstructured mental activities.Main Outcome Measures
The primary outcome measure was cognitive function. Secondary outcome measures included physical function, social participation, and quality of life.Results
Compared with the control group, the SEQ group had significantly improved Montreal Cognitive Assessment scores (P=.03) and Wechsler Memory Scale span scores (P=.012) after training. The endurance and mobility level measured by the 6-minute walk test (P=.25) was also enhanced in the SEQ group relative to the control group. However, the transfer of sequential training to social participation (Community Integration Questionnaire) and quality of life (EuroQoL questionnaire) was limited (P>.05 for both).Conclusions
Aerobic exercise combined with computerized cognitive training has better effects on the cognitive functional status of survivors of stroke than an active control. The cognitive functional status of stroke survivors was better after participation in aerobic exercise combined with computerized training than after active control therapy, demonstrating the clinical significance of this combination therapy. 相似文献17.
Erica C. Kaye Melanie Gattas Ashley Kiefer Jason Reynolds Kristina Zalud Chen Li Zhaohua Lu Justin N. Baker 《Journal of pain and symptom management》2019,57(2):241-250
Context
Approximately 500,000 children in the United States suffer from life-limiting illnesses each year, many of whom are hospice eligible each year. Few hospice agencies, however, offer formal pediatric programs.Objective
To determine the levels of experience and comfort of hospice nurses who provide care to children and families in the community.Methods
A cross-sectional survey was developed to assess hospice nurse experience/comfort across the domains of symptom management, end-of-life care, goals of care, family-centered care, and bereavement. The survey was pilot tested and distributed to hospice nurses across a tristate region.Results
A total of 551 respondents across 71 hospices completed surveys. The majority of nurses reported no training in pediatric palliative or hospice care (89.8%), with approximately half reporting <5 years of hospice experience (53.7%) and no pediatric hospice experience (49.4%). Those with pediatric hospice experience reported limited opportunities to maintain or build their skills, with the majority providing care to children several times a year or less (85.7%). Nurses reported feeling somewhat or very uncomfortable providing services to children during the illness trajectory and at the end of life across all domains.Conclusion
Children with serious illness who receive care from local hospices often interface with nurses who lack training, experience, and comfort in the provision of palliative and hospice care to pediatric patients. These findings should inform future development and investigation of educational resources, training programs, and child- and family-centered policies to improve the delivery of palliative and hospice care to children in the community. 相似文献18.
Tessa Hart John Whyte Monica Vaccaro Amanda R. Rabinowitz 《Archives of physical medicine and rehabilitation》2019,100(5):987-989
Objective
Determine agreement between self-reported dose and dose reflected in administrative records of outpatient physical, occupational, and speech therapies at 6 and 12 months after severe traumatic brain injury (TBI), for the purpose of examining accuracy and predictors of accuracy of self-reported health care utilization in this population.Design
Secondary analysis of survey used in a larger study; participants were queried about therapy doses using a structured interview, either alone or assisted by relatives if they so chose, with responses compared to administrative records.Setting
Rehabilitation center providing outpatient TBI therapies.Participants
Sixty-five people with severe TBI living in the community provided 6-month data (N=65); 54 provided 12-month data.Interventions
Not applicable.Main Outcome Measures
Degree of agreement with administrative records of scheduled and billed therapy appointments, measured using intraclass correlation coefficients (ICCs), with linear regression used to predict accuracy from demographic variables and cognitive status.Results
ICCs were in the moderate range at 6 months, but were more variable, with some in the poor range, at 12 months. Agreement was higher for scheduled than for billed (attended) appointments. Assisted and unassisted patients provided comparable agreement with records. No demographic factors were associated with accuracy, but lower cognitive FIM scores, as hypothesized, tended to predict lower agreement at 6 months.Conclusions
People with severe TBI can provide reasonable estimates of commonly prescribed outpatient therapy doses at 6 months postinjury. Accuracy may be improved by inviting patients to request assistance from relatives and by asking them to consider attended (vs scheduled) sessions. 相似文献19.
Rose Y. Hardy Richard C. Lindrooth Richard K. Peach Charles Ellis 《Archives of physical medicine and rehabilitation》2019,100(2):254-260
Objective
Although residence is a key contributor to cost and utilization in stroke patient care, its contribution to the care of persons with aphasia (PWA) is unknown. The objective of this study was to use discharge-level hospital inpatient data to examine the influence of patient residence (rural vs urban) and race-ethnicity on service utilization and cost of care among PWA.Design
Cross-sectional.Setting
Administrative data from acute care hospitals in the state of North Carolina.Participants
Individuals (N=4381) with poststroke aphasia.Interventions
N/A.Main Outcome Measures
Length of stay (LOS), speech-language pathology (SLP) service utilization, costs of care.Methods
The 2011-2012 Healthcare Cost and Utilization Project State Inpatient Database data were analyzed to examine the effect of rural or urban residence on LOS, SLP service utilization, as well as total inpatient and SLP service costs. These outcomes were further analyzed across both residence and racial groups (non-Hispanic white and non-Hispanic black). Outcomes were analyzed using generalized linear model.Results
Both rural and urban black PWA experienced longer average LOS after controlling for demographics, illness severity, and the hospital where they received care. Rural blacks experienced longer LOS, received greater SLP services, and incurred greater average total hospital costs than their rural white counterparts after adjusting for differences in their demographics and stroke or illness severity. The differences were attenuated after controlling for the hospital where they received care.Conclusions
For PWA, race-ethnicity has a larger effect on average total medical costs, SLP service utilization, and LOS than residence. It is unclear how and why blacks with aphasia have greater service utilization and costs in acute care, yet their aphasia outcomes are worse. Future studies are required to explore potential factors such as quality of care. 相似文献20.
Ghazala T. Saleem Jewel E. Crasta Beth S. Slomine Gabriela Lucila Cantarero Stacy J. Suskauer 《Archives of physical medicine and rehabilitation》2019,100(4):724-738