Use of the UFOV to evaluate and retrain visual attention skills in clients with stroke: a pilot study.

OBJECTIVE: The objective of this pilot study was to examine the use of a visual attention analyzer in the evaluation and retraining of useful field of view in clients with stroke. METHOD: Fifty-two clients with stroke referred to a driving evaluation service were evaluated with a visual attention analyzer referred to as the UFOV. The UFOV assesses three aspects of visual attention: processing speed, divided attention, and selective attention. Seven participants were retested to determine the test-retest reliability of the UFOV. Six participated in the development of a training protocol and in a 20-session visual attention retraining program. RESULTS: UFOV scores indicated substantial reduction in visual attention in clients after stroke, with older participants performing the most poorly. Test-retest reliability was moderate (ICC = .70). Mean UFOV scores improved significantly after retraining. CONCLUSION: Although UFOV scores indicated poor visual attention skills in clients with stroke, preliminary information suggests that UFOV scores significantly improve with training.     

Retraining Visual Processing Skills To Improve Driving Ability After Stroke

Crotty M, George S. Retraining visual processing skills to improve driving ability after stroke.

Objective

To evaluate the effectiveness of retraining using the Dynavision on driving performance of people with stroke.

Design

Randomized controlled trial.

Setting

Outpatient rehabilitation clinic in Australia.

Participants

People with stroke (N=26) referred for driving assessment.

Interventions

Eligible participants were randomized to either receive retraining with the Dynavision apparatus for 18 sessions or to receive no intervention and go onto a waitlist.

Main Outcome Measures

The primary outcome was an assessment of on-road ability. Secondary outcomes included measures of response speed, visual scanning, and self-efficacy. All assessments were conducted by assessors blinded to group assignment.

Results

No significant difference (P=.223) was found between the intervention and control groups in results of on-road assessment in terms of pass or fail; the primary outcome measure; or the results on the secondary outcome measures of response speed, visual scanning, and self-efficacy.

Conclusions

In this small trial, training underlying skills (such as executing a continuous wide scan, combining motor and visual processing into a motor response) using the Dynavision apparatus did not improve the outcomes of an on-road assessment for people after strokes. Larger trials are needed to evaluate devices that claim to retrain underlying skills related to driving.     

Vision, attention, and self-reported driving behaviors in community-dwelling stroke survivors

OBJECTIVE: To elucidate the relationships among vision, attention, driving status, and self-reported driving behaviors in community-dwelling stroke survivors. DESIGN: A cross-sectional design to compare stroke survivors to older adults without stroke on visual measures, attentional measures, and self-reported driving behaviors. SETTING: Rehabilitation center at a university hospital. PARTICIPANTS: Fifty stroke survivors and 105 older adults without neurologic or visual impairment. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Visual acuity, contrast sensitivity, peripheral vision, useful field of view (UFOV), Behavioral Inattention Test, and a driving habits questionnaire. RESULTS: Stroke survivors had impaired contrast sensitivity, peripheral vision, and UFOV compared with older adults in good visual and neurologic health. Driving stroke survivors typically had less attentional impairment than nondrivers. Stroke survivors who returned to driving reported difficulty in challenging driving conditions, drove less, and relied more on other people for transportation than older adults without stroke. CONCLUSIONS: These results suggest that vision and attention, both of which are important for driving, are often impaired in stroke survivors. The severity of these deficits could be an influence on driving status and driving behavior. Stroke survivors who return to driving strategically limit their driving exposure and rely on others for transportation, which suggests that they may deliberately self-regulate their driving behavior.     

Visual testing for readiness to drive after stroke: a multicenter study

OBJECTIVE: The purpose of this study was to determine the ability of a visual-perception assessment tool, the Motor-Free Visual Perception Test, to predict on-road driving outcome in subjects with stroke. DESIGN: This was a retrospective study of 269 individuals with stroke who completed visual-perception testing and an on-road driving evaluation. Driving evaluators from six evaluation sites in Canada and the United States participated. Visual-perception was assessed using the Motor-Free Visual Perception Test. Scores range from 0 to 36, with a higher score indicating better visual perception. A structured on-road driving evaluation was performed to determine fitness to drive. Based on driving behaviors, a pass or fail outcome was determined by the examiner. RESULTS: The results indicated that, using a score on the Motor-Free Visual Perception Test of < or =30 to indicate poor visual-perception and >30 to indicate good visual perception, the positive predictive value of the Motor-Free Visual Perception Test in identifying those who would fail the on-road test was 60.9% (n = 67/110). The corresponding negative predictive value was 64.2% (n = 102/159). Univariate logistic regression analyses revealed that older age, low Motor-Free Visual Perception Test scores and a right hemisphere lesion contributed significantly to identifying those who failed the on-road test. CONCLUSIONS: The predictive validity of the Motor-Free Visual Perception Test is not sufficiently high to warrant its use as the sole screening tool in identifying those who are unfit to undergo an on-road evaluation.     

Driving evaluation practices of clinicians working in the United States and Canada.

OBJECTIVE: To determine off-road and on-road driving evaluation practices of clinicians in the United States and Canada who assess individuals with disabilities for fitness to drive. PARTICIPANTS: Participants were 114 clinician attendees at the 2003 annual Association of Driver Educators for the Disabled with driving assessment experience ranging from 1 month to 25 years. MEASURES: Information was elicited regarding the clinician, clientele, referral practices, and off-road and on-road driving evaluation practices and retraining practices using a self-administered questionnaire. RESULTS: Participants were largely occupational therapists (68%) who worked in 42 different states and provinces. The most prevalent clientele were persons with traumatic brain injury (97%) and stroke (96%). Testing times greater than 60 min were common for both the off-road (61%) and on-road (49%) evaluations. Commonly performed off-road assessments included the Brake Reaction Timer; Trail Making Test, Parts A and B; and the Motor Free Visual Perception Test, used by 73%, 72%, and 66%, respectively; comprehensive computer-based driving evaluation was rare. Sixty-one percent indicated that all clients underwent on-road evaluation regardless of the off-road results. Finally, 78% used a standard driving route, whereas 24% used a scoring system to evaluate on-road driving. CONCLUSION: Driving assessment in Canada and the United States is multidimensional and time-intensive. Although the domains being assessed are similar across clincians, specific off-road and on-road assessment practices vary greatly. The majority use nonstandardized on-road assessments.     

Measuring the effectiveness of bioptic telescopes for persons with central vision loss

PURPOSE: 1) To evaluate a vision rehabilitation program aimed at training persons with central vision loss to use a bioptic telescope for improving life skills, including driving and 2) to compare the outcomes of subjects who are given bioptic telescopes and training, with subjects who are prescribed telescopic lenses without training. METHODS: Twenty-five subjects ranging in age from 16 to 78 years were included in the study. Each subject was randomized to one of three groups: Group 1 received bioptic telescopes and training during the first approximately 3-month-long period of the approximately 6-month-long study; Group 2 received lenses and training during the second approximately 3-month-long period of the study; and Group 3 received the lenses for approximately 3 months without any training. An assessment battery consisting of clinical vision tests, functional tasks evaluated by an orientation and mobility specialist, driving skills evaluated by a kinesiotherapist specializing in driver's education, and psychophysical measures was administered to Groups 1 and 2 at baseline, and at approximately 3 and 6 months, and to Group 3 at baseline and at approximately 3 months. The tasks were categorized into 6 major functional categories: Recognition, Mobility, Peripheral Identification, Scanning, Tracking, and Visual Memory. Training consisted of 5 weeks of laboratory-based training focusing on skills within these 6 categories, and 8 weeks of on-road driving training. RESULTS: There was significant improvement in all task categories with use of the telescopes. There was improvement in all task groups with training, though a significant difference between the trained and untrained groups existed only in the Recognition, Peripheral Identification, and Scanning Categories, but not in Mobility, Tracking, or Visual Memory. When the tasks involving driving-related skills were analyzed separately, training also had a significant effect. CONCLUSION: There was significant improvement in visual skills with the use of a bioptic telescope. This improvement was greater with training in the use of the lenses in a number of visual skills categories including driving-related skills.     

A National Survey of Older Driver Refresher Programs: Practice Readiness for a Rapidly Growing Need

ABSTRACT

Objectives. This national survey identified the content and structure of existing older driver refresher programs in Canada, along with the perceived facilitators and barriers for providing such services. Methods. A cross-Canada telephone survey was conducted with a convenience sample of 27 program managers representing 18 driver refresher programs and nine general health promotion programs for older individuals. Results. Two types of driver programs were identified: pre-road training (including classroom-style group education programs) and on-road training. Only one of the 18 driver refresher programs included visual perception and physical retraining: both interventions have some evidence of effectiveness in improving driving performance. Most program managers emphasized a strong perceived value of supporting/creating driver refresher programs to maintain safe driving. Conclusion. Findings of this study support the urgent need for evidence-based policy development and a strategic plan to ready our nation for the growing number of older drivers who require refresher programs.     

Driving skills in elderly persons with stroke: comparison of two new assessment options

OBJECTIVE: To compare the effectiveness of two methods of assessing off-road driving skills that claim to predict on-road driving fitness of persons with stroke. METHOD: Fifty-six persons with stroke (age 44 to 82 yrs; mean, 60.2 yrs) completed the 2 off-road driving assessments along with standard clinical and on-road driving tests. MAIN OUTCOME MEASURES: Linear stepwise regression on 4 variables of the Dynavision Performance Assessment Battery (DPAB), the Cognitive Behavioral Driver's Inventory (CBDI) variable (composite score), and the variables of age, gender, and lesion side. RESULTS: A 4-minute endurance subtest from the DPAB was superior to the CBDI in predicting success/failure in the on-road driving test (75%). However, success on both the 4-minute endurance subtest from the DPAB and the CBDI tests significantly improved the prediction of on-road success. If participants passed the CBDI and the endurance test from the DPAB, they also passed the on-road assessment. CONCLUSION: Driving fitness of elderly persons with stroke can be assessed with reasonable accuracy using off-road tests, minimizing the expense and risk associated with on-road assessments in this population.     

Assessing functional status: exploring the relationship between the multiple sclerosis functional composite and driving

OBJECTIVE: To explore the relationship between the Multiple Sclerosis Functional Composite (MSFC), which is comprised of 3 clinical dimensions (arm and hand function, leg function and ambulation, cognition), and an everyday functional skill, driving performance. DESIGN: Cohort study. SETTING: Medical rehabilitation research organization. PARTICIPANTS: Twenty-nine individuals with documented multiple sclerosis (MS) and limited motor decrements. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Driving-related skills were measured by using the overall category rating from the Useful Field of View (UFOV) Test, its 3 subtests, the error and latency scores from the Neurocognitive Driving Test (NDT), subjective (self-report) and objective (Department of Motor Vehicles [DMV] reports) reported driving experience, and number of motor vehicle crashes. Within the group, differences were explored between participants rated as low risk versus moderate-high risk on the UFOV overall score and between participants who reported a change in driving habits after MS versus those who reported no change. RESULTS: The overall MSFC score correlated significantly with the UFOV overall score, the visual-information processing and selective attention subtests of the UFOV, the NDT latency score, as well as with the number of days a week the individual drove and the number of crashes reported by the DMV. An examination of the MSFC components revealed that the cognition component was significantly related to the UFOV overall score, all 3 subtests of the UFOV, and the NDT latency score. The arm and hand function component correlated significantly with NDT latency and the selective attention subtest of the UFOV. Individuals classified as low risk on the UFOV overall had more education, better MSFC scores, and lower NDT latency scores. Only the overall MSFC score distinguished those who reported a change in driving habits after onset of MS. CONCLUSIONS: Problems with everyday functional skills such as driving are accurately identified through the use of the overall MSFC and its components.     

Use of visual feedback in retraining balance following acute stroke

BACKGROUND AND PURPOSE: Visual feedback related to weight distribution and center-of-pressure positioning has been shown to be effective in increasing stance symmetry following stroke, although it is not clear whether functional balance ability also improves. This study compared the relative effectiveness of visual feedback training of center-of-gravity (CoG) positioning with conventional physical therapy following acute stroke. SUBJECTS: Forty-six people who had strokes within 80 days before the study, resulting in unilateral hemiparesis, and who were in need of balance retraining participated. METHODS AND MATERIALS: Initially, subjects were randomly assigned to visual feedback or conventional physical therapy groups for balance retraining until 16 subjects per group were recruited. The next 14 subjects were assigned to a control group. All subjects received physical therapy and occupational therapy (regular therapy) 2 hours a day, and subjects in the 2 experimental groups received additional balance training 30 minutes a day until discharge. The visual feedback group received information about their CoG position as they shifted their weight during various activities. The conventional therapy group received verbal and tactile cues to encourage symmetrical stance and weight shifting. Static (postural sway) and activity-based measures of balance (Berg Balance Scale, gait speed, and the Timed "Up & Go" Test) were contrasted across the 3 groups at baseline, at discharge, and at 1 month following discharge using an analysis of variance for repeated measures. RESULTS: All groups demonstrated marked improvement over time for all measures of balance ability, with the greatest improvements occurring in the period from baseline to discharge. No between-group differences were detected in any of the outcome measures. CONCLUSION AND DISCUSSION: Visual feedback or conventional balance training in addition to regular therapy affords no added benefit when offered in the early stages of rehabilitation following stroke.     

云南省"盲人定向行走"社区康复训练效果分析

目的分析云南省“盲人定向行走”社区康复训练示范项目的效果,为推广盲人社区康复提供依据。方法根据“盲人定向行走技能评估”标准,对云南省3个示范县（区）内已经进入随访阶段的310例康复对象的训练档案进行定向行走能力的评估。结果盲人定向行走社区康复训练的总有效率为98.7%;训练后能够进行短距离、长距离和不同路面独立行走者分别为44.5%、34.5%、19.7%;不同性别、文化程度、视力状况的康复对象之间康复效果没有显著性差异（P〉0.05）;不同年龄和不同致残原因康复对象之间训练效果有显著性差异（P〈0.05）,中青年的训练效果较高龄者为优,先天失明者的训练效果较后天失明者为优。结论盲人定向行走社区康复训练是补偿视力残疾者视觉缺陷,实现其走出家门,融入社会的有效方法,且投入成本低,效果显著,简便易行,具有良好的社会效益,非常适宜在城市和农村推广。     

On the road again after traumatic brain injury: driver safety and behaviour following on-road assessment and rehabilitation

Purpose: To examine pre- and post-injury self-reported driver behaviour and safety in individuals with traumatic brain injury (TBI) who returned to driving after occupational therapy driver assessment and on-road rehabilitation. Method: A self-report questionnaire, administered at an average of 4.5 years after completing an on-road driver assessment, documenting pre- and post-injury crash rates, near-crashes, frequency of driving, distances driven, driving conditions avoided and navigation skills, was completed by 106 participants, who had either passed the initial driver assessment (pass group n?=?74), or required driver rehabilitation, prior to subsequent assessments (rehabilitation group n?=?32). Results: No significant difference was found between pre- and post-injury crash rates. Compared to pre-injury, 36.8% of drivers reported limiting driving time, 40.6% drove more slowly, 41.5% reported greater difficulty with navigating and 20.0% reported more near-crashes. The rehabilitation group (with greater injury severity) was significantly more likely to drive less frequently, shorter distances, avoid: driving with passengers, busy traffic, night and freeway driving than the pass group. Conclusions: Many drivers with moderate/severe TBI who completed a driver assessment and rehabilitation program at least 3 months post-injury, reported modifying their driving behaviour, and did not report more crashes compared to pre-injury. On-road driver training and training in navigation may be important interventions in driver rehabilitation programs.

• Implications for Rehabilitation

• Driver assessment and on-road retraining are important aspects of rehabilitation following traumatic brain injury.

• Many drivers with moderate/severe TBI, reported modifying their driving behaviour to compensate for ongoing impairment and continued to drive safely in the longer term.

• Navigational difficulties were commonly experienced following TBI, suggesting that training in navigation may be an important aspect of driver rehabilitation.

     

Treadmill gait retraining following fractured neck-of-femur.

The rehabilitation outcome of two methods of gait retraining, was studied in 40 elderly women who had fractured the neck-of-femur. Twenty control subjects received conventional gait retraining, and 20 experimental subjects participated in a treadmill gait retraining program. Rehabilitation outcome was determined by temporal-distance gait parameters and mobility level (house-bound, limited, or unlimited). Muscle strength and range of movement of the lower limb were measured. Previously reported predictors of poor outcome (age, prefracture mobility, admission from sites other than own home, availability of caring person, type of ambulatory aid, presence or absence of senile dementia, and number of concomitant medical diseases) were recorded. Subjects were assessed on admission to the gait retraining program and at discharge from hospital. A 3 x 2 chi-square analysis on discharge mobility level showed the mobility level of the treadmill group to be significantly (p less than .05) higher than the mobility level attained by the control group. Analysis of variance showed no significant differences between the two groups at either assessment time. However, a significant increase in within-group variance from admission to discharge (p less than .01) was noted, and this led to the analysis of a subgroup containing six pairs of subjects matched for number of predictors of poor outcome.(ABSTRACT TRUNCATED AT 250 WORDS)     

The effect of time on CPR and automated external defibrillator skills in the Public Access Defibrillation Trial

BACKGROUND: The time to skill deterioration between primary training/retraining and further retraining in cardiopulmonary resuscitation (CPR) and automated external defibrillation (AED) for lay-persons is unclear. The Public Access Defibrillation (PAD) trial was a multi-center randomized controlled trial evaluating survival after CPR-only versus CPR+AED delivered by onsite non-medical volunteer responders in out-of-hospital cardiac arrest. AIMS: This sub-study evaluated the relationship of time between primary training/retraining and further retraining on volunteer performance during pretest AED and CPR skill evaluation. METHODS: Volunteers at 1260 facilities in 24 North American regions underwent training/retraining according to facility randomization, which included an initial session and a refresher session at approximately 6 months. Before the next retraining, a CPR and AED skill test was completed for 2729 volunteers. Primary outcome for the study was assessment of global competence of CPR or AED performance (adequate versus not adequate) using chi(2)-test for trends by time interval (3, 6, 9, and 12 months). Confirmatory (GEE) logistic regression analysis, adjusted for site and potential confounders was done. RESULTS: The proportion of volunteers judged to be competent did not diminish by interval (3, 6, 9, and 12 months) for either CPR or AED skills. After adjusting for site and potential confounders, longer intervals to further retraining was associated with a slightly lower likelihood of performing adequate CPR but not with AED scores. CONCLUSIONS: After primary training/retraining, the CPR skills of targeted lay responders deteriorate nominally but 80% remain competent up to 1 year. AED skills do not deteriorate significantly and 90% of volunteers remain competent up to 1 year.     

Computerized video tasks as training techniques for driving-related perceptual deficits of persons with brain damage: a pilot evaluation

This pilot study investigated the modifiability of perceptual deficits by training which consisted of performing microcomputer-generated video tasks. These commercially available remedial programs tapped a range of skills, such as right/left discrimination, color matching, visual scanning, judgment of line orientation, visual search, shape discrimination, visual memory, eye tracking, visuomotor coordination, and visual imagery. Four subjects with acquired brain damage were given 10 hours of training. Perceptual skills were assessed with a battery of seven paper-and-pencil tests administered both before and after the training. Following the training two subjects showed some improvement on several of the perceptual tests used, while two other subjects showed improvement on only a limited number of tests. Based on these results and on the performance changes on the video tasks themselves, a comprehensive evaluation of the potential benefits of this type of training on driving performance is recommended.     

An assessment of measures to predict the outcome of driving evaluations in patients with cerebral damage

The evaluation of the ability of patients to return to driving after cerebral damage stands out as one of the most important tasks confronted by rehabilitation professionals. The present study was designed to critically assess evaluations that were developed at one facility to determine fitness to drive: an offroad, predriver evaluation of skills regarded as important in driving and an on-road, behind-the-wheel evaluation of abilities needed to drive in actual traffic situations. The evaluation results of 3-patients with cerebral damage due to traumatic head injury or cerebrovascular accident were studied retrospectively. Only 4 out of 21 items on the predriver evaluation significantly predicted the outcome of the predriver evaluation and none of the predriver evaluation items predicted the outcome of the behind-the-wheel evaluation. Only 6 of the 26 tasks on the behind-the-wheel evaluation significantly predicted the outcome of the behind-the-wheel evaluation. None of the items on the predriver evaluation or the behind-the-wheel evaluation explained a significant portion of variance related to outcome. The lack of internal and predictive validity of driver evaluations is discussed in light of these findings, and recommendations are given for improving the predictive power of driving evaluations.     

Acquired brain injury, visual attention, and the useful field of view test: A pilot study

OBJECTIVE: To compare the findings of the Useful Field of View (UFOV) test with those of conventional neuropsychologic tests to determine the utility of the UFOV test as a measure of attention in a population with brain injury. DESIGN: Cohort study. SETTING: Freestanding rehabilitation hospital. PARTICIPANTS: Fifteen inpatients with severe brain injury. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: UFOV test, FIM\T instrument, length of stay (LOS), and standard neuropsychologic testing. RESULTS: The UFOV subtest UF2 correlated strongly with the other 2 subtests, UF1 and UF3. The UF2 subtest correlated most strongly with paper and pencil tests of visual attention. The UF2 predicted 52% of the FIM change and 60% of the LOS variance, second only to admission FIM score, which predicted 75% and 80% of FIM change and LOS variance, respectively. CONCLUSIONS: Among the patients in our study, the UFOV test can be used to determine the visual divided attention of patients with acquired brain injury. The results also showed that the UFOV test correlated with LOS and FIM change in patients with acquired brain injury recovering in a rehabilitation facility. Because the UFOV test is much more quickly administered and scored than other measures of attention and divided attention, these results suggest that the UFOV test may provide an easy means to measure a critical variable in the population with head injury.     

Development of the Adelaide driving self-efficacy scale

OBJECTIVE: To describe the development of the Adelaide Driving Self-Efficacy Scale (ADSES) and to report on its reliability and validity. METHODS: A set of 12 driving behaviours, developed through literature review, clinical experience and expert review, were rated for self-efficacy using a Likert scale. Internal consistency was investigated using a Cronbach's alpha coefficient and construct validity by comparing ADSES scores of stroke and non-stroke drivers. Criterion-related validity was examined by comparing ADSES scores with the result on a standardized on-road assessment. SETTING: A rehabilitation hospital in Adelaide, South Australia. PARTICIPANTS: Staff from the hospital and stroke patients from the rehabilitation unit. Data from a non-stroke sample (n -/ 79) and stroke patients (n -/ 81) were used to test internal consistency and construct validity. A separate group of 45 people recommended for a driving assessment, of whom 34 were stroke patients, were used to test criterion validity. RESULTS: Cronbach's alpha coefficient was 0.98, indicating high internal consistency. The non-stroke and stroke groups showed significant differences in ADSES scores (t(158)-/ 5.5, P B < 0.05), demonstrating construct validity. Differences in ADSES scores for those participants who passed or failed the on-road assessment were significant for both the entire driving assessment group (t(43)-/ 3.2, P B < 0.05) and the stroke subgroup (t(43)-/ 3.2, P B < 0.05), indicating criterion validity. CONCLUSION: The ADSES has demonstrated internal consistency and construct validity with the stroke and non-stroke population. The scale demonstrated criterion validity in its relationship with outcome of an on-road driving assessment. It appears to be a reliable and valid measure of driving self-efficacy.     

Effects of home-based sensory and motor amplitude electrical stimulation on arm dysfunction in chronic stroke

OBJECTIVE: To examine the effects of a home-based arm exercise programme of sensory and motor amplitude electrical stimulation. DESIGN: Non-concurrent, multiple-baseline, single-subject design. SUBJECTS: Ten adults with chronic arm hemiparesis following stroke. Subjects ranged in age from 38 to 74 years and were 2-16 years post stroke. Three subjects had right-sided involvement; seven had left. INTERVENTION: Subjects completed an eight-week, individualized, home programme of neuromuscular and sensory amplitude electrical stimulation. All subjects engaged in stimulation-assisted task-specific exercises for 15 minutes 2 -3 times daily. Participants with sensory deficits received an additional 15 minutes of sensory amplitude stimulation twice daily. The Action Research Arm Test was used to examine arm function; the Stroke Rehabilitation Assessment of Movement was used to examine movement quality; and the Modified Ashworth Assessment of Spasticity was used to examine muscle tone. RESULTS: A statistically significant improvement was demonstrated by six of the 10 subjects on the Action Research Arm Test, and five subjects on the Stroke Rehabilitation Assessment of Movement. Four subjects had > or = 10% improvement on the Modified Ashworth Assessment of Spasticity. Two subjects demonstrated significant improvement on all three outcome measures; six subjects improved on two or more measures; and seven subjects improved on one or more measure. Subjects who improved on two or more measures tended to have had more recent onset of stroke, were older and had higher baseline motor and functional capacity. CONCLUSION: Subjects with chronic stroke can experience impairment and functional improvements following a home-based programme of motor and sensory amplitude electrical stimulation.