Design: A randomised, controlled, assessor-blinded trial.
Setting: Rehabilitation institute.
Participants: Thirty-six chronic poststroke (15.89?±?9.01 months) hemiparetic subjects (age: 46.44?±?7.89 years, 30 men and functional ambulation classification of median level 3).
Interventions: Activity-based MT comprised movements such as ball-rolling, rocker-board, and pedalling. The activities were provided on the less-affected side in front of the mirror while hiding the affected limb. The movement of the less-affected lower limb was projected as over the affected limb. Conventional motor therapy based on neurophysiological approaches was also provided to the experimental group. The control group received only conventional management.
Main outcome measures: Brunnstrom recovery stages (BRS), Fugl-Meyer assessment lower extremity (FMA-LE), Rivermead visual gait assessment (RVGA), and 10-metre walk test (10-MWT).
Results: Postintervention, the experimental group exhibited significant and favourable changes for FMA-LE (mean difference?=?3.29, 95% CI?=?1.23–5.35, p?=?.003) and RVGA (mean difference?=?5.41, 95% CI?=?1.12–9.71, p?=?.015) in comparison to the control group. No considerable changes were observed on 10-MWT.
Conclusions: Activity-based MT facilitates motor recovery of the lower limb as well as reduces gait deviations among chronic poststroke hemiparetic subjects. 相似文献
Aim: To examine how the presence or absence of distinct dimensions of social support facilitate or hinder resilience in recently bereaved informal carers.
Participants: 44 bereaved carers, who had been identified by GP as ‘main carer’ of someone recently deceased (3–12 months), aged between 38 and 87 years old (mean= 67).
Methods: Thematic analysis then the Ecological Framework of Resilience as an organisational tool to develop overarching themes in the data. We used the Sherbourne and Stewart model to identify social support that was lacking as well as social support that was present.
Results: A range of social support types were identified. There was an emphasis on the importance of relationships with both health professionals and family members, including the care recipient. However, social support was not necessary for resilience if the participant had other resources.
Conclusions: Social support for carers providing end of life care is almost exclusively based around end of life care ‘work’. In comparison to other research our study suggests that relationships with family and health professionals are paramount. Multidimensional support is needed for carers to enhance their resilience. 相似文献
Method: Exploratory phenomenological qualitative design. A social circus program was offered for nine months. Perceived participation level was documented through pre and post semi-structured interviews. A pretested interview guide was used. Interviews were transcribed and coded by two independent researchers.
Results: The average age of the participants (n = 9) was 20.0 ± 1.4 years with 2/9 being female. Participation was perceived as being improved after the intervention from both perspectives (participants and parents) mainly for communication, mobility, relationships, community life and responsibilities. The intervention was perceived as strengthening self-perception and self-efficacy, which in turn enhanced participation level and decreased parents’ bounding.
Conclusion: The results show promises for social circus as a new approach in adult physical rehabilitation for this population in transition. 相似文献
Objectives: To determine the usefulness and psychometric validity of the upper-limb subscale of the STREAM in an acute stroke population.
Methods: Rasch Analysis, including unidimensionality assumption testing, determining model fit, and analysis of: reliability, residual correlations, and differential item functioning.
Results: 125 individuals were assessed using the upper-limb subscale of the Stroke Rehabilitation Assessment of Movement (STREAM) tool. Rasch analysis suggests the STREAM is a unidimensional measure. However, when scored using the originally proposed method (0–2), or using the response pattern (0–5) neither variant fit the Rasch model (p < 0.05). Although, the reliability was good (Person-Separation Index – 0.847 and 0.903, respectively). Correcting for the disordered thresholds, and thereby producing the new scoring pattern, led to substantial improvement in the overall fit (chi-square probability of fit – 22%), however, the reliability was slightly reduced (PSI – 0.806).
Conclusions: The study proposes a new scoring method for the upper-limb subscale of the STREAM outcome measure in the acute stroke population. 相似文献
Aims: To investigate whether when tools are used to measure language abilities beyond the single-word and sentence levels, such as analysing discourse production, improvement in the post-morbidly more proficient language may be observed.
Methods & Procedures: A Hebrew-English bilingual person with mild-moderate non-fluent agrammatic aphasia was recruited. He received 36 h of Verb Network Strengthening Treatment (VNeST) in English only, with pre- and post- treatment assessment of his language abilities in both English and Hebrew.
Outcome & Results: Significant improvement was observed in the treated language (English) for noun and verb retrieval in object and action picture naming and within sentence production, but not for the untreated language (Hebrew). In discourse, greater and more widespread improvement was observed in the untreated language (Hebrew) than in the treated language (English).
Conclusions: We advocate for more wide-ranging measurement tools in the field to reduce the risk of missing valuable information regarding generalisation. Only with a more representative understanding of the effects of language treatment in bilinguals with aphasia can we better understand the mechanisms behind cross-language generalisation. 相似文献
Material and Methods: review of the literature was done.
Results: PD patients show remarkable heterogeneity in their response to L-dopa and this profound interindividual heterogeneity suggests that there is a genetic predisposition.
Conclusions: The impact of the genetic makeup of every individual on PD treatment appears to be of great importance in order to achieve not only the optimum therapeutic effect, but also with minimal side effects. 相似文献
Aims: To review, summarise, and discuss literature relating to four themes which have emerged from the work of Professor Worrall: (1) Research capacity building; (2) Implementation of research evidence in clinical practice; (3) Meaningful outcome measurement; and (4) Improvement of psychological and emotional outcomes.
Main contribution: A review of the literature, with examples of practical applications.
Conclusions: The work of Professor Worrall has greatly influenced the field of aphasia; her legacy is the research capacity she has built in Australia and around the world. 相似文献
Objective: This study reports perceptions of persons with stroke and their caregivers in an existing continuum of stroke care, social services, and rehabilitation in the Province of Quebec.
Methods: A total of 10 focus groups were held, 5 with persons with stroke (n = 37, mean age 59.6 years (SD = 11.6); 21 men) and 5 others with caregivers (n = 31; mean age 58.8 years (SD = 15.1); 8 men). Discussions were transcribed and were the object of thematic content analysis using Nvivo.
Results: Participants expressed their general satisfaction toward the care received in inpatient, hospital, and rehabilitation settings. The information received about acute care, however, was deemed insufficient and fragmented, and access of rehabilitation services was often perceived to be difficult. In the community integration phase of the continuum, most participants stated that they had experienced poor accessibility to services of any kind.
Conclusions: Persons with stroke and their relatives’ perspectives about the services that they obtained throughout the rehabilitation continuum vary importantly according to the services examined. Adopting a continuum perspective is helpful to target priorities for improvement. 相似文献
Objectives: This study aimed to determine how well specific Canadian Best Practice Recommendations for PSD screening were adopted within a stroke rehabilitation outpatient clinic before and after the utilization of a standardized clinical form.
Methods: Practices were evaluated through retrospective chart review before and after the implementation of the standardized form which cued physicians to administer the Patient Health Questionnaire 9 (PHQ-9) at the first outpatient visit. Participants included those aged ≥18 years with a primary diagnosis of stroke.
Results: One hundred thirty-five subjects’ charts were reviewed. Form implementation was associated with increased rates of PSD screening (93.8% versus 0%) and charting regarding mood (55.4% versus 15.7%).
Conclusion: This study highlights the frequency of depressive symptoms in an outpatient cohort and demonstrates how screening rates can be improved by using a standardized form. Routine PHQ-9 completion at the first outpatient visit was associated with more physician–patient discussion and documentation regarding mood. 相似文献
Method: The validation sample for the translated checklist included 22 pairs of men between the ages of 18 and 52, matched by age and degree of intellectual impairment.
Results: The translated checklist achieved coefficients of 0.92 for internal consistency, 0.90 for test-retest reliability and 0.65 for inter-rater reliability. These psychometric properties are commensurate with those of the original checklist.
Conclusion: Therefore, the translated checklist developed in this study can be considered a valid screening instrument for the detection of FXS in men with intellectual disabilities.
Abbreviations: FXS: fragile X syndrome; FMR1: fragile X mental retardation 1 (gene) 相似文献
Objective: The aim of this study was to identify whether gait speed is a predictor of CM and QoL in patients with stroke following a multimodal rehabilitation program (MRP).
Methods: This was a baseline control trial with 6-months follow-up in an outpatient rehabilitation setting at a university hospital. Twenty-six stroke survivors completed the MRP (24 sessions, 2 days/wk, 1 hr/session). The MRP consisted of aerobic exercise, task-oriented exercises, balance exercises and stretching. Participants also performed an ambulation program at home. Outcome variables were: walking speed (10-m walking test) and QoL (physical and psychosocial domains of Euroquol and Sickness Impact Profile).
Results: At the end of the intervention, comfortable and fast walking speed increased by an average of 0.16 (SD 0.21) (*p < .05) and 0.40 (SD 0.51) (**p < .001) m/s, respectively. After the intervention, all participants achieved independent outdoor ambulation with an increase of 34.14 of walking minutes/day in the community and a decrease of sitting time of 95.45 minutes/day. Regarding QoL there were increased mean scores on the physical and psychosocial dimensions of Euroquol and the Sickness Impact Profile, respectively (**p < .001).
Conclusions: The results suggest that improved walking speed after the MRP is associated with CM and higher scores in QoL. These findings support the need to implement rehabilitation programs to promote increased speed. 相似文献
Methods: Three alternative strategies for assigning more than one case to each stagger position are examined.
Results: The three recommended strategies achieve the objective while maintaining the study’s internal and statistical-conclusion validities.
Conclusions: ExPRT, a freely available Excel-based randomization-test package, can be used to assist in both the design and statistical analysis associated with each of the strategies. 相似文献
Methods: Prospective study of nine outcomes for consecutively enrolled children in outpatient AB-LT. To evaluate sensitivity to change, linear-mixed models were constructed and adjusted for covariates: age at and time since SCI. To evaluate responsiveness, standardized response means and 95% confidence intervals were estimated per outcome.
Results: SATCo scores increased significantly (p < 0.05) regardless of chronicity, initial score, and injury level. The SATCo was the most responsive measure and the only outcome demonstrating a large effect size after 3 months of therapy.
Conclusions: Children with SCI receiving AB-LT improved trunk control regardless of chronicity, initial impairment, or prior experience. SATCo sensitivity and responsiveness support its usefulness in measuring trunk control in children with SCI. 相似文献
Method: Actigraphic data and questionnaires on sleep, sleepiness, and PA were compared between fifteen adults with ASD (ADOS range 7–19; ages 22.8 ± 4.5 years) and TDC.
Results: In comparison to the TDC group, the ASD group slept longer on average per night but took longer to fall asleep. In relationship to PA levels, the objective PA levels were lower in the ASD group than the TDC group. Fewer wake minutes during the sleep period in the ASD sample were associated with more PA the following day.
Conclusion: The findings support previous research that demonstrates differences in sleep parameters and PA between ASD and TDC. Interventions aimed at increasing PA in an ASD population may be beneficial for improved sleep. 相似文献
Methods: We collected demographic, medical and cognitive data, and social and educational outcome at a mean time since the end of treatments of 14.9 years in 58 adults, aged 19–35 years, consecutively treated in a single cancer center between 1989 and 2005.
Results: Ten survivors had severe intellectual disability, 12 were still studying, 23 had a regular employment and 13 were unemployed. Full Scale Intellectual Quotient, assessed 6.6 years after the end of treatments, ranged from 46 to 131. It was strongly associated with educational achievement and significantly lower in patients who experienced postoperative cerebellar mutism, and when parental education level was low.
Conclusion: These factors should be systematically considered at diagnosis in order to offer adequate and timely assessments and interventions. 相似文献
Methods: Infants were assessed at 4 and 12 months of age. Prechtl's GM assessment and the Alberta Infant Motor Scale were used.
Results: In Case 1, the mother presented confirmed ZIKV infection in the 10th week of gestation and the infant was born full-term with brain abnormalities and microcephaly. Fidgety movements were absent at 16 weeks after term and motor development was severely impaired at 12 months of age. In Case 2, the mother presented confirmed ZIKV infection in the 34th week of gestation and the infant was born full-term with no signs of brain changes or microcephaly. Fidgety movements at 13 weeks were normal in presentation and motor outcome was typical at 12 months.
Conclusion: GM assessment can be useful for ZIKV-exposed infants. These findings represent the first information on GMs and long-term motor outcomes in ZIKV-exposed infants. 相似文献
Objective: Evaluate the muscle compartment in patients presenting spinocerebellar ataxia (SCA) type 3 and 10.
Methods: Forty-six patients presenting SCA type 3 and 10 were assessed and 76 volunteers were selected to the control group. In order to evaluate the muscle compartment, muscle mass anthropometric measurements were assessed and total skeletal muscle mass calculated through a predictive equation.
Results: Women with SCA3 presented greater weight loss and muscle mass reduction compared to those with SCA10 and the control group. Among the predictive measurements, calf muscle circumference showed a more significant correlation with total skeletal muscle mass (p = 0.718).
Conclusion: Patients presenting both types of ataxia did not show severe depletion in their nutritional status; however, those with SCA3 displayed greater weight loss and muscle mass reduction compared to the SCA10 group. 相似文献
Methods: We surveyed physicians in pediatric intensive care, neurology, and rehabilitation units in Swiss hospitals. The questionnaire explored participants’ attitudes toward life-threatening situations in two scenarios: a child with profound intellectual and multiple disabilities (PIMD) and an infant with spinal muscular atrophy (SMA) type I.
Results: The participation rate was 55% (52/95). There was a consensus favoring non-invasive ventilation and comfort care as well as avoiding tracheostomy and invasive ventilation. For the child with PIMD, 61% of participants opposed cardiopulmonary resuscitation (CPR), 51% for the child with SMA. Physicians with over 20 years of experience were significantly more opposed to providing CPR than less experienced colleagues.
Conclusions: Physicians held different views, influenced by personal factors. This highlights the importance of standardizing multidisciplinary processes toward approaching these complex situations. 相似文献