Effect of six-month standardized tertiary rehabilitation program on the activities of dally living in stroke patients with hemiplegia

BACKGROUND: At present, there are many studies on the rehabilitation therapy of stroke patients with hemiplegia, but there is deficiency of corresponding standardized rehabilitation program. OBJECTIVE: To explore the effects of standardized tertiary rehabilitation on the activities of daily living in stroke patients with hemiplegia within 6 months after attack. DESIGN: A clinical observation. SETTING: Department of Rehabilitation Medicine, Huashan Hospital of Fudan University. PARTICIPANTS: Eighty-two outpatients and inpatients with acute stroke were selected from the Department of Neurology, Shanghai Huashan Hosptial from January 1999 to June 2003, including 49 males and 33 females, 40–80 years of age, with a mean age of (65±11) years old. Inclusive criteria: According to the diagnostic standards for cerebrovascular diseases set by Fourth National Academic Meeting for Cerebrovascular Disease in 1995, the patients were diagnosed as new attack of cerebral infarction or cerebral hemorrhage, and confirmed by CT or MRI to be initial patients; They should be accorded with the following conditions, including within 1 week after stabilization of life signs, Glasgow coma score > 8 points, 40–80 years of age, with disturbance of limb function. Informed consents were obtained from all the patients or their relatives. Exclusive criteria: Patients were excluded due to active liver disease, liver and kidney malfunction, congestive heart failure, malignant tumor, history of dementia, failure in respiratory function, tetraplegia; cerebral infarction or cerebral hemorrhage for more than 3 weeks; unable to be followed up due to in other cities and provinces; psychiatric history; deafness and muteness. According to the will of the patients or their relatives, the patients who accepted the standardized rehabilitation program were enrolled as the treatment group (n =42), and the others as the control group (n =40). Approval was obtained from the ethical committee of the hospital. METHODS: All the patients were given routine therapies of internal medicine after admission. According to the conditions of Brunnstom recovery 6-phase evaluation, the patients in the treatment group were trained with the pre-designed comprehensive standardized rehabilitation program for corresponding period. At early period (within about 1 month after attack), the patients received rehabilitative interventions in the Department of Emergency or Department of Neurology, once a day, 45 minutes for each time, 5 times a week; At middle period (about 1–3 months after attack), the patients received rehabilitative interventions in the rehabilitation ward or center, once to twice a day, 30–45 minutes for each time, 4–5 days a week; At late period (about 3–6 months after attack), the patients received rehabilitative intervention mainly assisted by rehabilitation physician in the community, relatives and volunteers, 3–4 times a week, and they were followed in the house or outpatient department once every two weeks. MAIN OUTCOME MEASURES: The patients were evaluated blindly by the same rehabilitation physician using scale of modified Barthel index at admission and 1, 3 and 6 months after attack respectively. RESULTS: Totally 82 patients with acute stroke were enrolled, and 3 cases in the treatment group missed, including 2 cases died at 1 month after admission, and 1 case refused the follow up 10 days later, all the others were involved in the analysis of results. The scores of modified Barthel index at corresponding time points after admission in the treatment group were all obviously higher than those in the control group (P < 0.01), and the score differences were also obviously higher than those in the control group (P < 0.01). The activities of daily living at admission and 1, 3 and 6 months after admission in the treatment group were 22.50%, 46.43%, 75.95% and 89.52% of that of normal people respectively, and those in the control group were 17.09%, 25.77%, 43.38% and 55.00% respectively. The activities of daily living at admission and 1, 3 and 6 months in the treatment group were 131.66%, 180.17%, 175.08% and 162.76% of those in the control group. As compared with at admission, the percentage of the score difference to the total score at the ends of the 1st, 3rd and 6th months were 23.93%, 53.45% and 67.02% in the treatment group, while 8.67%, 25.36% and 36.98% in the control group. CONCLUSION: Standardized tertiary rehabilitation can obviously promote the activities of daily living in stroke patients with hemiplegia.     

Reliability of Longshi scale with remote assessment of smartphone video calls for stroke patients' activities of daily living

ObjectivesThe impairment of activities of daily living (ADL) has brought a heavy burden to the life of patients after stroke. Timely and accurate assessment of patients' activities of daily living is very necessary, which determines the whole process of diagnosis, rehabilitation and prognosis of patients. However, the patients with limited mobility or transportation are difficulted to gain high quality assessment services. This study aimed to explore the reliability of remote Longshi Assessment Scale of Activities of Daily Life (Longshi Scale) with smartphone video calls by comparing the consistency of remote assessment and bedside assessment, as well as the test-retest reliability of the remote assessment. The evaluation duration of these two methods was recorded and the level of satisfaction of patients was investigated.MethodsIn this prospective study, a total of 129 stroke survivors were recruited and accepted a bedside face-to-face assessment and a remote assessment by video calls. The Longshi Scale was used for both bedside and remote assessment and conducted with the inquiry between patients and evaluators. A satisfaction questionnaire was also launched.ResultsThe result of disability level evaluated from the bedside and remote assessments was highly consistent. The intraclass correlation coefficient with weighted kappa (wK) value was 0.86 (95% confidence interval, 0.80～0.92). And test-retest of the remote assessment indicated an excellent agreement beyond chance, and its correlation coefficient with wK value was 0.96 (95% confidence interval, 0.92～1.00). It took 74.44±55.3 s to complete the bedside assessment and 90.86±63.30 s to complete the remote assessment of Longshi Scale. There was no statistical significance in the assessment duration between these two methods (P = 0.056). Satisfaction surveys showed more than 85% of participants were satisfied or very satisfied with remote Longshi scale assessment.ConclusionsThe remote assessment of Longshi Scale with smartphone video calls is reliable and has high acceptance. This method can be readily implemented to evaluate the ADL of stroke patients to improve the capacity of rehabilitation and health services in remote areas.     

日常生活活动能力量表在痴呆筛查中的应用

目的：以日常生活活动能力量表(ADL)评定老年人日常生活能力，分析该量表对诊断老年痴呆的意义。方法：由北京市8家医院在社区和医院调查正常人(正常组)1527名，痴呆患者(痴呆组)126例和易与痴呆混淆疾病组，如老年抑郁症、老年精神分裂症等患者84例，并作统计分析。结果：正常组ADL总分在城市和农村之间差异显著，与年龄呈正相关，与文化程度呈负相关。正常组与痴呆组ADL总分差异存在显著性。在ADL总分为22时，对痴呆区分的灵敏度和特异性兼顾最好。结论：ADL可以比较有效地区分正常人和痴呆患者，如作为筛查工具，可以适当提高ADL的分界值。ADL值得进一步研究与推广。     

Evaluation of the instrumental activities of daily living following a stroke by means of the Lawton and Brody scale

INTRODUCTION. The instrumental activities of daily living are activities that are somewhat more complex than basic activities of daily living, and being able to perform them allows a person to be independent within a community. They include housework, tasks involving mobility, managing the home and property; catching the bus; cooking meals and going shopping, among other things. AIMS. To evaluate these activities using the Lawton and Brody scale following an ischaemic stroke or intraparenchymatous haemorrhage and to analyse the factors that have an influence on the functional status at six months. PATIENTS AND METHODS. We conducted a prospective study of patients admitted to the stroke unit between September 2010 and June 2011 diagnosed with ischaemic strokes and spontaneous intraparenchymatous haemorrhages. A series of clinical and demographic variables were collected. In the follow-up visit at six months, the patients were re-evaluated by measuring their score on the Lawton and Brody scale again. RESULTS. The percentages of the Lawton and Brody scale at six months were as follows: 28.9% of patients were highly dependent, 45.4% were moderately dependent and 25.6% were dependent. There were differences according to age, severity and the type of stroke, and also depending on the presence of aphasia or hemiparesis. CONCLUSIONS. Patients who have suffered an ischaemic stroke or haemorrhage present a poorer score in instrumental activities of daily living when age is more advanced, the stroke is more severe and when aphasia or hemiparesis are present.     

Psychometric properties of an Arabic version of the fatigue severity scale in patients with stroke

Background: Post-stroke fatigue is a common symptom which needs to be assessed by a psychometrically sound tool.

Objectives: To investigate the psychometric properties of an Arabic version of the fatigue severity scale (FSS-A) in patients with stroke.

Methods: An observational, cross-sectional design was applied to 147 survivors of first-time stroke and 70 healthy participants. Internal consistency was measured by Cronbach’s α, while test-retest reliability was measured by intraclass correlation coefficients (ICCs). To assess validity, the FSS-A was correlated with the Fatigue Visual Analogue Scale (VAS-F), the Short Form 36 (SF-36) and its vitality domain (SF-36V), the stroke specific quality of life (SSQOL-A) and its energy domain (SSQOL-A-E), and the Beck Depression Inventory II (BDI-II).

Results: The FSS-A showed excellent internal consistency (Cronbach’s α = 0.934) and test-retest reliability (ICC = 0.920, 95% confidence interval (CI): 0.85–0.96). Exploratory factor analysis confirmed that the FSS-A is unidimensional. The FSS-A had high positive correlation with VAS-F, moderate positive correlation with BDI-II, high negative correlation with SSQOL-A-E and moderate negative correlations with SF-36, SF-36V, and SSQOL-A. It differentiated patients from healthy participants with a sensitivity of 78.4% and a specificity of 77.1%. The minimal detectable change with 95% CI was 1.02 (22.4%).

Conclusions: The FSS-A showed good psychometric properties suggesting its usefulness as a fatigue evaluation tool in patients diagnosed with stroke.     

Proposing the stroke levity scale: a valid, reliable, simple, and time-saving measure of stroke severity

Background and purpose:  National Institutes of Health Stroke Scale (NIHSS) is long and complex. Our objective was to design a valid, reliable, simple, and time-saving stroke severity scale.
Methods:  About 103 and 100 consecutive stroke patients in Berlin (Germany) and Ibadan (Nigeria), respectively were evaluated using the measures listed below. The Stroke Levity Scale (SLS) was calculated as maximum power (0–5) in the dexterous hand + maximum power in the weaker lower limb + mobility score−1(if aphasia present).
Results:  It took less than 2 min to administer the SLS in contrast to 8 min for the NIHSS. The SLS showed significant correlation to the NIHSS ( ρ  = −0.79, P  < 0.0001), the modified Rankin Scale ( ρ  = −0.79, P  < 0.0001), and the health-related quality of life (QOL) in stroke patient's questionnaire ( ρ  = 0.78, P  < 0.0001). It had Cronbach's α of 0.75 (Ibadan) and 0.71 (Berlin). The κ -value for test-retest reliability was 0.77 with P  < 0.0001.
Conclusions:  The SLS is a concise, valid, and reliable stroke impairment scale that can be used routinely to monitor outcome in stroke patients. Because it is brief and simple to apply, non-neurologists can be taught to administer it in addition to QOL and disability scales for stroke survivors without significantly increasing the respondent burden.     

The outcome measures for loss of functionality in the activities of daily living of adults after stroke: a systematic review

Objective: To provide clinicians and researchers information regarding (1) the existing outcome measures to assess the loss of functionality in the activities of daily living (ADLs) of patients with stroke and (2) the presence of these assessment tools in the Italian context.

Study Design and Setting: For this Systematic Review Medline, CINAHL, and PsycINFO were searched for articles published up to 4 July 2017. Two authors independently identified eligible studies on the basis of prede?ned inclusion criteria and extracted data. Study quality and risk of bias were assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.

Results: Of 370 publications identified and screened, 46 studies fell within the inclusion criteria and were critically reviewed. The most commonly used tools were: the Frenchay Activities Index and the Functional Independence Measure.

Conclusion: This review has emphasized the need for agreement among researchers as to which tool must be studied in depth or adapted to other national contexts in order to develop universal norms and standards.     

日常生活功能量表评定阿尔茨海默病患者日常生活功能的信度与效度及其应用

目的探讨ADL在评定阿尔茨海默病患者日常生活功能中的应用。方法173例阿尔茨海默病（AD）患者应用ADL进行基线期评定,脱落16例。83例在进行为期16周盐酸美金刚治疗后进行第二次评定。74例未治疗者在4周后重复评定。逐步回归分析影响ADL分值相关因素,比较治疗组患者治疗前后ADL分值的。结果逐步回归分析显示MMSE总分、年龄和性别影响ADL总分。中度AD患者在盐酸美金刚治疗16周后ADL总分及IADL分减少。两次不同测定各单项分之间ICC值为0．84—0．96,分半信度为0．91。结论ADL总分受MMSE总分、年龄和性别的影响,盐酸美金刚能够一定程度改善中度AD患者的日常生活功能。ADL具有较好的信度。     

Rasch analysis in the development of a rating scale for assessment of mobility after stroke

The study describes the development of a rating scale for assessment of mobility after stroke. It was based on 74 first-stroke patients, 40 men and 34 women, each assessed three times during rehabilitation. Their median age was 69 years, and they represented all degrees of severity of paresis. Content, construct, criterion and convergent validity were examined, as well as the inter-rater reliability. The final rating scale has three special characteristics: 1) it reflects the regularity in the recovery of mobility after stroke; 2) the sum of item scores comprises the information contained in the 10-item subscores; 3) the score sum is independent of age, side of hemiparesis, and gender of the patient. Latent trait analysis (Rasch) was found to be an ideal model for statistical investigation of these properties.     

Essen卒中风险评估量表对脑梗死患者颅内动脉狭窄的预测价值

目的探讨Essen卒中风险评估量表(ESRS)对脑梗死患者颅内动脉狭窄的预测价值。方法选取157例中国缺血性卒中亚型(CISS)分型为大动脉粥样硬化性和穿支动脉病的急性脑梗死患者。根据ESRS评分,将患者分为低危组、高危组及极高危组。对患者行颅内血管检查(CTA/MRA)评估血管狭窄情况。结果根据ESRS评分,将患者分为低危组68例、高危组72例、极高危组17例。随着ESRS等级上升,颅内动脉狭窄及颈部动脉狭窄比率均随之升高。三组间颅内动脉狭窄及颈部动脉狭窄比率差异有统计学意义(χ²=23.599,χ²=42.087;均P<0.001)。颅内血管狭窄程度与ESRS评分具有相关性(r=0.367,P<0.001);ESRS等级越高,颅内血管狭窄程度越重。ESRS评分≥3分预测颅内动脉狭窄的ROC曲线下面积为0.676(0.588～0.673)(P<0.001),敏感度为70.1%,特异度为65.0%。结论 ESRS评分与动脉硬化性脑梗死颅内动脉狭窄程度正相关。ESRS评分≥3分可能成为筛查颅内动脉狭窄的提示性指标。     

Intra-rater reliability of the modified Tardieu scale to quantify spasticity in elbow flexors and ankle plantar flexors in adult stroke subjects

Objectives:

The purpose of this study was to investigate Iintra-rater reliability of the Modified Tardieu Scale (MTS) in elbow flexors and ankle plantar flexors in adult subjects with stroke.

Materials and Methods:

A total of 91 subjects with stroke participated in this test-retest study. Intra-rater reliability of the MTS was investigated by a qualified and trained physiotherapist for elbow flexors and ankle plantar flexors in two sessions. A rater was one who performed the procedure and an observer only records the angles so that the rater was blinded to findings. Outcome measures in this study were measurable components of MTS, which are angle of muscle reaction (R1), passive range of motion (R2), dynamic component (R2-R1), and quality of muscle reaction (grade 0 – 4) termed as MTS score.

Results:

Intra-rater reliability of MTS was very good for R1, R2, R2-R1, and MTS score (ICC > 0.85, P<0.0001) across two sessions in elbow flexors and ankle plantar flexors.

Conclusion:

MTS is a reliable clinical tool for measurement of spasticity in the elbow flexors and ankle plantar flexors in adult subjects with stroke.     

The relationship between objective balance,perceived sense of balance,and fear of falling in stroke patients

Objective: The objective of our study was to investigate the relationship between objective balance, fear of falling, and perceived sense of balance (PSB) in stroke patients.

Methods: Seventy patients aged 18–65 years with chronically developed hemiplegia or hemiparesis were enrolled in the study. Patients’ objective balance scores, fear of falling, and PSB were obtained using the berg balance scale (BBS), the falls efficacy scale (FES), and a visual analog scale, respectively. The Standard Mini-Mental Examination was performed to exclude patients with mental disorders from the study.

Results: There was a moderate negative correlation between PSB and BBS scores (p = 0.001, ρ = ?0.588); a strong negative correlation between BBS and FES scores (p = 0.001, ρ = ?0.808); and a strong positive correlation between PSB and FES scores (p = 0.001, ρ = 0.714). We found that BBS scores had negative correlation with PBS scores in left hemiplegic patients while there was no any relationship between BBS and PBS scores in right hemiplegic patients.

Conclusion: PSB assessment, besides the BBS, should be considered among the routine assessment methods that enable the rehabilitation team to be aware of patients’ balance capacities.     

早期康复治疗对急性脑卒中患者运动功能和生活能力的影响

目的探讨早期康复治疗对脑卒中患者运动功能和日常生活活动能力(ADL)的影响。方法将50例脑卒中偏瘫患者随机分成康复组(25例)和对照组(25例)进行临床对照研究,两组均进行常规神经内科药物治疗,康复组加以运动疗法,每例患者入组时、治疗第30d分别用Fugl-Meyer运动功能(FMA)量表测试运动功能和改良Barthel指数量表(MBI)测试ADL。结果MBI值:康复组治疗前、后分别为:20.68±8.98、72.36±17.39,对照组治疗前后分别为:21.24±12.59、51.29±18.52。FMA值:康复组治疗前、后分别为33.84±12.63、68.46±20.45,对照组治疗前、后分别为32.13±11.26、44.25±18.86。康复组和治疗组组间及组内比较差异具有显著统计学意义。结论康复治疗对偏瘫患者运动功能和日常生活活动能力具有良好的促进作用。可明显降低患者的依赖程度,提高其生活质量。     

The effects of Nintendo WiiTM-based balance and upper extremity training on activities of daily living and quality of life in patients with sub-acute stroke: a randomized controlled study

Objective: The aim of this study was to investigate the effects of Nintendo Wii^TM-based balance and upper extremity training on activities of daily living and quality of life in patients with subacute stroke. Methods: 42 adults with stroke (mean age (SD) = 58.04 (16.56) years and mean time since stroke (SD) = (55.2 ± 22.02 days (～8 weeks)) were included in the study. Participants were enrolled from the rehabilitation department of a medical center (a single inpatient rehabilitation facility). Participants were randomly assigned to Nintendo Wii group (n = 20) or Bobath neurodevelopmental treatment (NDT) (n = 22). The treatments were applied for 10 weeks (45–60 minutes/day, 3 days/week) for both of two groups. Nintendo Wii group used five games selected from the Wii sports and Wii Fit packages for upper limb and balance training, respectively. The patients in Bobath NDT group were applied a therapy program included upper extremity activites, strength, balance gait and functional training. The functional independence in daily life activities and health-related quality of life was assessed with Functional Independence Measure (FIM) and Nottingham Health Profile (NHP), respectively. Participant's treatment satisfaction was recorded by using Visual Analogue Scale. A second evaluation (FIM and NHP) occurred after 10 weeks at the end of rehabilitative treatment (post-training). Treatment satisfaction was measured after 10 sessions. Results: There were significant difference between FIM and NHP values in NDT and Nintendo Wii group (p < 0.05). However, a significant difference was not found between the groups with regard to FIM and NHP (p > 0.05). The patients in Nintendo Wii group were detected to be better satisfied from the therapy (p < 0.05). A significant difference was found between subparameters and total FIM score, all subparameters and total NHP score in both groups (p < 0.05). Conclusion: These findings suggested that the Nintendo Wii training was as effective as Bobath NDT on daily living functions and quality of life in subacute stroke patients.     

A study of the relationship between participation in common leisure activities and seizure occurrence

OBJECTIVE: To investigate whether participation in a structured programme of fairly intensive leisure activities increased seizure occurrence. MATERIAL AND METHODS: 212 adults with medically-intractable epilepsy were closely monitored for seizure occurrence during an "activities day", i.e. a day consisting of various structured sessions of leisure pursuits (video game play, reading, word puzzles, television, physical exercise), and during other days of relative rest, whilst undergoing prolonged video EEG monitoring. RESULTS: The relative risk of seizures did not differ significantly during activities days [0.71 (95% CL: 0.38 to 1.33)] compared with days of relative rest. CONCLUSIONS: These findings fail to provide empirical support for the hypothesis that cognitive exertion has an adverse effect on seizure control.     

Prevalence of spasticity following stroke and its impact on quality of life with emphasis on disability in activities of daily living. Systematic review

Spasticity is characterized by a velocity-dependent increase in muscle tone related to disturbed sensory-motor control of muscle tone following upper motor neuron damage. Spasticity and its clinical implications are still poorly described. There is no consensus concerning the number of patients developing spasticity or the relationship between spasticity and motor disabilities after stroke. Surprisingly, only a few studies have addressed the prevalence of spasticity following stroke. The present paper aims to review recent studies on prevalence of spasticity, its risk factors and on quality of life with emphasis on disability in activities of daily living and to relate collected data to situation in Poland.