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1.
Ana Cristina R. Camargos Luci F. Teixeira-Salmela PT PhD 《Archives of physical medicine and rehabilitation》2009,90(2):314-319
Camargos AC, Rodrigues-de-Paula-Goulart F, Teixeira-Salmela LF. The effects of foot position on the performance of the sit-to-stand movement with chronic stroke subjects.
Objective
To investigate the effects of different foot positions during the sit-to-stand (STS) movements with stroke subjects.Design
Cross-sectional.Setting
Research laboratory.Participants
Twelve chronic stroke subjects (N=12).Interventions
Not applicable.Main Outcome Measures
Differential latency and electromyography (EMG) activity of the tibialis anterior, soleus, quadriceps, and hamstring muscles of the affected leg as well as the movement time, time of seat-off, weight symmetry, and rising index were obtained while the subjects performed the STS movements by using 4 different strategies: spontaneous; symmetric; asymmetric-1, with the affected foot behind; and asymmetric-2, with the unaffected foot behind.Results
Compared with the spontaneous strategy, the soleus showed the greatest differential latency in the asymmetric-2 strategy, the hamstrings had lower EMG activity in the symmetric strategy, and the movement time was greater in the asymmetric strategies.Conclusions
The asymmetric 2 strategy appeared to be the least favorable, whereas the spontaneous and the symmetric strategies appeared to be more favorable in improving the STS performance. Based on these findings, allowing the subjects to adopt the spontaneous strategy or training of the symmetric strategy could result in greater benefits for subjects with higher chronicity and higher functional levels, such as those evaluated in the present study. 相似文献2.
Kluding PM, Santos M. Effects of ankle joint mobilizations in adults poststroke: a pilot study.
Objective
To compare the effect of 2 interventions on ankle mobility, ankle kinematics, and weight-bearing symmetry during functional activities in subjects with hemiparesis after a stroke.Design
Randomized trial.Setting
Academic medical center.Participants
A convenience sample of 16 subjects with hemiparesis after stroke (mean age, 55.2y; mean time since stroke, 21.4mo).Intervention
Subjects received 8 sessions over 4 weeks of either functional task practice combined with ankle joint mobilizations, or functional task practice only.Main Outcome Measures
Changes in ankle range of motion (ROM) (not blinded), ankle kinematics during sit-to-stand (STS) and gait, and lower-extremity weight-bearing symmetry during STS and static standing.Results
The combined intervention group gained 5.7°±3.1° in passive ankle ROM compared with 0.2°±2.6° in the functional practice only group (95% confidence interval [CI], 2.5-8.6; P<.01). No significant changes in ankle kinematics or weight bearing during static standing were noted in either group. The functional practice group decreased differences in weight bearing during STS by 9.5%±6.47%, whereas the combined intervention group increased this difference by 3.37%±5.29% (95% CI, 3.26-19.46; P=.01).Conclusions
The increase in ankle motion did not improve joint kinematics and may have prevented improvement in weight-bearing symmetry. 相似文献3.
Barbic S, Brouwer B. Test position and hip strength in healthy adults and people with chronic stroke.
Objective
To determine if peak torques generated by the hip flexors and extensors are dependent on test position in healthy adults and in people with chronic stroke.Design
Cross-sectional study.Setting
Motor performance laboratory.Participants
Volunteers were 10 young (20.7±1.5y), 10 older adults (62.1±7y), and 10 stroke survivors (60.6±10y) who were an average of 5 years poststroke.Interventions
Not applicable.Main Outcome Measures
Isokinetic (60°/s) peak concentric hip flexor and extensor torques (in Nm/kg) generated in supine and standing positions.Results
Peak flexor torques measured in standing were generally higher than in supine (P=.018); a pattern evident in all groups, but significant only in stroke. An interaction between test position and group for hip extensor strength (P=.016) reflected 2 distinct patterns in which torques were highest in standing among the young subjects and highest in supine after stroke.Conclusions
Isokinetic hip flexor and extensor strength measured in standing and supine are comparable in young and older healthy people. In chronic stroke, the test position may over or underestimate maximum peak torque depending on the muscle group tested, particularly on the side ipsilateral to the lesion. These findings may have implications for predicting functional ability from strength measurements. 相似文献4.
Moreau NG Li L Geaghan JP Damiano DL 《Archives of physical medicine and rehabilitation》2008,89(10):2011-2016
Moreau NG, Li L, Geaghan JP, Damiano DL. Fatigue resistance during a voluntary performance task is associated with lower levels of mobility in cerebral palsy.
Objectives
To investigate muscle fatigue of the knee flexors and extensors in people with cerebral palsy (CP) compared with those without motor disability during performance of a voluntary fatigue protocol and to investigate the relationship with functional mobility.Design
A case-control study.Setting
A biomechanics laboratory.Participants
Ambulatory subjects with CP (n=18; mean age, 17.5y) in Gross Motor Function Classification System (GMFCS) levels I, II, and III and a comparison group of age-matched subjects (n=16) without motor disability (mean age, 16.6y).Interventions
Not applicable.Main Outcome Measures
The voluntary muscle fatigue protocol consisted of concentric knee flexion and extension at 60° a second for 35 repetitions on an isokinetic dynamometer. Peak torque for each repetition was normalized by the maximum peak torque value. Muscle fatigue was calculated as the rate of decline in normalized peak torque across all repetitions, represented by the slope of the linear regression. Self-selected and fast gait velocities were measured as well as the Pediatric Outcomes Data Collection Instrument (PODCI).Results
Greater fatigability (slope) was observed in the comparison group for both knee flexors and extensors than in the group with CP. Within CP, lower knee extensor fatigue (slope) was associated with lower functioning GMFCS levels and lower levels of activity and participation as measured by the PODCI transfers and basic mobility.Conclusions
Even after adjusting for maximum peak torque, the knee flexors and extensors of participants with CP were observed to be less fatigable than age-matched peers without motor disability. The lower rate of muscle fatigue was also associated with lower functional mobility in CP. These results may be related to strength or activation differences and/or muscle property alterations. Future investigations are warranted. 相似文献5.
6.
Stephen May Ken Chance-Larsen Chris Littlewood Dave Lomas Mahmoud Saad 《Physiotherapy》2010,96(3):179-613
Background
Shoulder pain is a common clinical problem, and numerous tests are used to diagnose structural pathology.Objectives
To systematically review the reliability of physical examination procedures used in the clinical examination of patients with shoulder pain.Data sources
MEDLINE, PEDro, AMED, PsychInfo, Cochrane Library (2009) and CINAHL were searched from the earliest record on the database to June 2009.Study eligibility criteria
Reliability studies that included any patients with shoulder pain were analysed for their quality and reliability results.Study appraisal and synthesis methods
Pre-established criteria were used to judge the quality of the studies (high quality >60% methods score) and satisfactory levels of reliability (kappa or intraclass correlation coefficient ≥0.85, sensitivity analysis 0.70). A qualitative synthesis was performed based on levels of evidence.Results
Thirty-six studies were included with a mean methods score of 57%. Seventeen studies were deemed to be of high quality; high-quality studies were less likely to meet the pre-agreed level of reliability. The majority of studies indicated poor reliability for all procedures investigated.Limitations
Overall, the evidence regarding reliability was contradictory.Conclusions and implications
There is no consistent evidence that any examination procedure used in shoulder assessments has acceptable levels of reliability. Alternate methods of classification which are reliable should be used to classify patients with shoulder problems. 相似文献7.
Gary L. Shum Jack Crosbie Raymond Y. Lee 《Archives of physical medicine and rehabilitation》2009,90(1):127-1077
Shum GL, Crosbie J, Lee RY. Energy transfer across the lumbosacral and lower-extremity joints in patients with low back pain during sit-to-stand.
Objective
To examine the transfer of energy through the pelvis and the lower limb during sit-to-stand (STS) in low back pain (LBP) subjects with or without a straight-leg raise sign.Design
Cross-sectional.Setting
Biomechanics laboratory.Participants
Three groups, each of 20 subjects, participated. The first group consisted of asymptomatic subjects, and the other 2 groups of consisted of LBP subjects (duration between 7 days and 12 weeks) with and without a straight-leg raise sign.Interventions
Not applicable.Main Outcome Measures
The work done and the power of the pelvis, thigh, and leg segments during STS were determined.Results
Energy was transferred from the pelvis to the thigh segment and then to the leg segment, and this was achieved mainly by passive mechanisms. The power flow of the pelvis segment was significantly decreased in subjects with LBP. Although the power of the lower-limb segments was decreased, the total work done of these segments was increased.Conclusions
STS is a more energy-demanding and less efficient task for subjects with LBP, either with or without a positive straight-leg raise sign. Such increases in energy demand may further exacerbate back pain, and treatment should be developed to restore a more efficient energy transfer pattern. 相似文献8.
Jacob J. Sosnoff Sunghoon Shin MS Robert W. Motl PhD 《Archives of physical medicine and rehabilitation》2010,91(1):93-99
Sosnoff JJ, Shin S, Motl RW. Multiple sclerosis and postural control: the role of spasticity.
Objectives
To examine the association between spasticity and postural control in subjects with multiple sclerosis (MS).Design
Cross-sectional.Setting
Motor control laboratory.Participants
Subjects with MS (n=16, 2 male) and age and sex-matched subjects (n=16) participated in the investigation. All subjects with MS had Expanded Disability Status Scale scores between 0 and 4.5 and modified Ashworth scale scores between 1 and 3.Interventions
Not applicable.Main Outcome Measures
Postural control was measured with a force platform that quantifies ground reaction forces and moments in mediolateral and anteroposterior directions. Postural control was indexed with anterior-posterior sway range, medial-lateral sway range, 95% elliptical area of the deviations of center of pressure (COP), velocity of COP sway, and the frequency at which 95% of spectral profile was contained. Participants with MS further underwent assessment of the soleus Hoffman reflex (H-reflex) as an index of spasticity.Results
Cluster analysis on H-reflex data identified groups of MS participants with high spasticity (n=7) and low spasticity (n=9). There were no differences in age, duration of MS, and disease severity between MS groups. There were no differences in anterior-posterior sway range between any of the groups. The high spasticity group had greater COP area, velocity, and mediolateral sway compared with the low spasticity and control group, and the low spasticity group had postural control values between the high spasticity and control groups.Conclusions
The pattern of results suggests that spasticity contributes to postural deficits observed in MS. 相似文献9.
Anita D. Mountain R. Lee Kirby Gail A. Eskes Cher Smith Hilary Duncan Donald A. MacLeod Kara Thompson 《Archives of physical medicine and rehabilitation》2010,91(4):596-601
Mountain AD, Kirby RL, Eskes GA, Smith C, Duncan H, MacLeod DA, Thompson K. Ability of people with stroke to learn powered wheelchair skills: a pilot study.
Objectives
Our primary objective was to test the hypothesis that people with stroke can learn to use powered wheelchairs safely and effectively. Our secondary objective was to explore the influence of visuospatial neglect on the ability to learn powered wheelchair skills.Design
Prospective, uncontrolled pilot study using within-participant comparisons.Setting
Rehabilitation center.Participants
Inpatients (N=10; 6 with visuospatial neglect), all with a primary diagnosis of stroke.Interventions
Participants received 5 wheelchair skills training sessions of up to 30 minutes each using the Wheelchair Skills Training Program (version 3.2).Main Outcome Measures
Powered wheelchair skills were tested before and after training using the Wheelchair Skills Test, Power Mobility version 3.2 (WST-P).Results
The group's total mean WST-P scores improved from 25.5% of skills passed at baseline to 71.5% posttraining (P=.002). The participants with neglect improved their WST-P scores to the same extent as the participants without neglect, although their pretraining and posttraining scores were lower. The training and testing sessions were well tolerated by the participants, and there were no serious adverse events.Conclusions
Many people with stroke, with or without visuospatial neglect, can learn to use powered wheelchairs safely and effectively with appropriate training. 相似文献10.
Background
Chronic knee pain is a major cause of disability in the elderly. Management guidelines recommend exercise and self-management interventions as effective treatments. The authors previously described a rehabilitation programme integrating exercise and self-management [Enabling Self-management and Coping with Arthritic knee Pain through Exercise (ESCAPE-knee pain)] that produced short-term improvements in pain and physical function, but sustaining these improvements is difficult. Moreover, the programme is untried in clinical environments, where it would ultimately be delivered.Objectives
To establish the feasibility of ESCAPE-knee pain and compare its clinical effectiveness and costs with outpatient physiotherapy.Design
Pragmatic, randomised controlled trial.Setting
Outpatient physiotherapy department and community centre.Participants
Sixty-four people with chronic knee pain.Interventions
Outpatient physiotherapy compared with ESCAPE-knee pain.Outcomes
The primary outcome was physical function assessed using the Western Ontario and McMaster Universities Osteoarthritis Index. Secondary outcomes included pain, objective functional performance, anxiety, depression, exercise-related health beliefs and healthcare utilisation. All outcomes were assessed at baseline and 12 months after completing the interventions (primary endpoint). ANCOVA investigated between-group differences.Results
Both groups demonstrated similar improvements in clinical outcomes. Outpatient physiotherapy cost £130 per person and the healthcare utilisation costs of participants over 1 year were £583. The ESCAPE-knee pain programme cost £64 per person and the healthcare utilisation costs of participants over 1 year were £320.Conclusions
ESCAPE-knee pain can be delivered as a community-based integrated rehabilitation programme for people with chronic knee pain. Both ESCAPE-knee pain and outpatient physiotherapy produced sustained physical and psychosocial benefits, but ESCAPE-knee pain cost less and was more cost-effective.Clinical Trial Registration No.: ISRCTN63848242. 相似文献11.
Rumpa Boonsinsukh Lawan Panichareon Pansiri Phansuwan-Pujito 《Archives of physical medicine and rehabilitation》2009,90(6):919-436
Boonsinsukh R, Panichareon L, Phansuwan-Pujito P. Light touch cue through a cane improves pelvic stability during walking in stroke.
Objective
To examine the effect of a light touch cue provided through a cane on mediolateral (ML) pelvic stability during walking in subjects poststroke.Design
Crossover trial examining ML pelvic stability during walking using a cane with the force contact and touch contact methods.Setting
Physical therapy clinic, tertiary care center.Participants
Subacute patients (N=40) with stroke with a mean age of 59.6 years and mean stroke duration of 46.8 days. The average gait speed with a cane was .13m/s (.05-.29m/s).Intervention
Using a cane with the force contact and touch contact methods during walking.Main Outcome Measures
ML pelvic stability as measured by averaged peak-to-peak pelvic acceleration, muscle activation of bilateral tensor fascia latae (TFL), semitendinosus (ST), and vastus medialis (VM) using an electromyography system, and vertical cane force.Results
The average amount of cane force during touch contact and force contact cane use conditions was 2.3N and 49.3N, respectively. A light touch cue through a cane was required only when the paretic leg accepted the body weight, and this cue can provide ML pelvic stability (.16g of average pelvic acceleration) during walking to the same degree as the force contact method of cane use. However, significant increases in single-limb support duration with higher activations of TFL, VM, and ST muscles on the paretic leg were found during the paretic stance phase when using a cane in the touch contact fashion (P<.05).Conclusions
A light touch cue can be provided during walking through the use of a cane. This augmented somatosensory information provides lateral stability during walking for subjects with stroke by facilitating the activations of weight-bearing muscles on the paretic leg during the stance phase. 相似文献12.
Sally D. Lark Sowjanya Pasupuleti MSc 《Archives of physical medicine and rehabilitation》2009,90(3):470-474
Lark SD, Pasupuleti S. Validity of a functional dynamic walking test for the elderly.
Objective
To determine the validity of a safe, quick, and simple method of measuring dynamic balance in the elderly during gait called the parallel walk test.Design
Control study.Setting
Outpatient clinic, community.Participants
Twenty-seven elderly fallers (age 82±6y) registered at a falls clinic and 34 elderly nonfallers (age 76±7y) were recruited to this study based on Mini Mental State Examination and Barthel Index scores.Interventions
Subjects were timed as they walked 6m between 2 parallel lines on the floor at 3 different widths (20, 30.5, 38cm) in their own footwear. They were scored for foot placement on the line (1 point) or outside the lines (2 points). Participants also performed a timed 6-m tandem walk test, a 30-second tandem stance, and a 30-second parallel stance.Main Outcome Measures
Scores and time to complete the parallel walk test and tandem walk test along with the time of standing for tandem and parallel stance. Validity coefficients were calculated for the sensitivity and specificity of the parallel walk test.Results
All subjects completed the parallel walk test, but few attempted and completed the tandem walk test. The fallers had significantly greater scores at 20 and 30.5cm and took significantly longer to complete the 6m at all widths. The 20-cm width was most discriminatory. The parallel walk test showed a significant correlation with the tandem stance.Conclusions
All subjects attempted and completed the parallel walk test but not the tandem walk test. The time to completion and scoring accurately measures dynamic balance during gait in elderly fallers. The parallel walk test could be a useful tool in the clinical setting for assessing balance in gait pre- and postintervention. 相似文献13.
Jonsdottir J, Cattaneo D. Reliability and validity of the Dynamic Gait Index in persons with chronic stroke.
Objective
To establish the test-retest and interrater reliability as well as the concurrent construct validity of the Dynamic Gait Index (DGI) as a measure for dynamic balance in people with chronic stroke.Design
Cohort study.Setting
Day hospital and ambulatory care at a rehabilitation center.Participants
A consecutive sample of 25 participants, at least 3 months poststroke and able to walk at least 10m with or without a walking aid, participated in the study. Two independent raters rated performances on the DGI.Interventions
Not applicable.Main Outcome Measures
The DGI was administered in 2 testing sessions 3 days apart. In the second session, the participants were rated by 2 raters. Intraclass correlation coefficients (ICCs), model 2,1, and the Bland and Altman method were used to analyze total scores and item scores. Concurrent construct validity was tested by correlating results to the Berg Balance Scale, the timed walking test, the Timed Up & Go test, and the Activities-specific Balance Confidence Scale.Results
ICCs for test-retest and interrater reliability of total scores were good (.96, .96, respectively) whereas reliability for single item scores was moderate to good (range, .55−.93). The hypotheses for concurrent construct validity were confirmed with all measures (range, .68−.83).Conclusions
The DGI showed high reliability and showed evidence of concurrent validity with other balance and mobility scales. It is a useful clinical tool for evaluating dynamic balance in ambulatory people with chronic stroke. 相似文献14.
McCain KJ Pollo FE Baum BS Coleman SC Baker S Smith PS 《Archives of physical medicine and rehabilitation》2008,89(4):684-691
McCain KJ, Pollo FE, Baum BS, Coleman SC, Baker S, Smith PS. Locomotor treadmill training with partial body-weight support before overground gait in adults with acute stroke: a pilot study.
Objective
To investigate the impact of locomotor treadmill training with partial body-weight support (BWS) before the initiation of overground gait for adults less than 6 weeks poststroke.Design
Parallel group, posttest only.Setting
Inpatient rehabilitation center.Participants
Adults after first stroke admitted to an inpatient rehabilitation unit: treadmill group (n=7) and comparison group (n=7).Interventions
Locomotor treadmill training with partial BWS or traditional gait training methods.Main Outcome Measures
Gait kinematics, symmetry, velocity, and endurance at least 6 months postinsult.Results
Data from 3-dimensional gait analysis and 6-minute walk test (6MWT) supported improved gait for adults postacute stroke who practiced gait on a treadmill before walking over ground. Gait analysis showed increased knee flexion during swing and absence of knee hyperextension in stance for the treadmill group. In addition, more normal ankle kinematics at initial contact and terminal stance were observed in the treadmill group. Improved gait symmetry in the treadmill group was confirmed by measures of single support time, hip flexion at initial contact, maximum knee flexion, and maximum knee extension during stance. The treadmill group also walked further and faster in the 6MWT than the comparison group.Conclusions
Application of locomotor treadmill training with partial BWS before overground gait training may be more effective in establishing symmetric and efficient gait in adults postacute stroke than traditional gait training methods in acute rehabilitation. 相似文献15.
Yeh C-Y, Tsai K-H, Su F-C, Lo H-C. Effect of a bout of leg cycling with electrical stimulation on reduction of hypertonia in patients with stroke.
Objectives
To evaluate whether a bout of leg cycling in patients with stroke reduces muscle tone and to determine whether neuromuscular functional electrical stimulation (FES) to the affected leg during cycling is more effective than cycling without FES.Design
Within-subject comparison.Setting
University hospital.Participants
Patients with stroke (N=16; age range, 42-72y; <8wk poststroke) with hypertonia in the affected leg.Interventions
Subjects' affected leg (1) performed cycling exercise with the assistance of FES (assisted-cycling session) and (2) performed cycling exercise without the assistance of FES (nonassisted-cycling session). Subjects sat in a specially designed wheelchair positioned on a resistance-free roller for each 20-minute session.Main Outcome Measures
Changes in muscle tone pre- and posttest session were compared by using the Modified Ashworth Scale and the pendulum test (relaxation index and peak velocity).Results
Modified Ashworth Scale scores were significantly lower (P<.05) and relaxation index and peak velocity values were significantly higher (P<.05) after both sessions. Changes in Modified Ashworth Scale scores, relaxation index, and peak velocity values showed a significant (P<.05) difference between the 2 sessions, and assisted cycling reduced hypertonia more than nonassisted cycling.Conclusions
The hypertonia of patients with stroke showed a significant decrease immediately after a bout of leg-cycling exercise. FES-assisted leg cycling was better than nonassisted cycling for reducing hypertonia. 相似文献16.
Fan Gao Thomas H. Grant Elliot J. Roth Li-Qun Zhang 《Archives of physical medicine and rehabilitation》2009,90(5):819-2500
Gao F, Grant TH, Roth EJ, Zhang L-Q. Changes in passive mechanical properties of the gastrocnemius muscle at the muscle fascicle and joint levels in stroke survivors.
Objectives
To investigate the ankle joint-level and muscle fascicle-level changes and their correlations in stroke survivors with spasticity, contracture, and/or muscle weakness at the ankle.Design
To investigate the fascicular changes of the medial gastrocnemius muscle using ultrasonography and the biomechanical changes at the ankle joint across 0°, 30°, 60°, and 90° knee flexion in a case-control manner.Setting
Research laboratory in a rehabilitation hospital.Participants
Stroke survivors (n=10) with ankle spasticity/contracture and healthy control subjects (n=10).Interventions
Not applicable.Main Outcome Measurements
At the muscle fascicle level, medial gastrocnemius muscle architecture including the fascicular length, pennation angle, and thickness were evaluated in vivo with the knee and ankle flexion changed systematically. At the joint level, the ankle range of motion (ROM) and stiffness were determined across the range of 0° to 90° knee flexion.Results
At comparable joint positions, stroke survivors showed reduced muscle fascicle length, especially in ankle dorsiflexion (P≤.048) and smaller pennation angle, especially for more extended knee positions (P≤.049) than those of healthy control subjects. At comparable passive gastrocnemius force, stroke survivors showed higher fascicular stiffness (P≤.044) and shorter fascicle length (P≤.025) than controls. The fascicle-level changes of decreased muscle fascicle length and pennation angle and increased medial gastrocnemius fascicle stiffness in stroke were correlated with the joint level changes of increased joint stiffness and decreased ROM (P<.05).Conclusions
This study evaluated specific muscle fascicular changes as mechanisms underlying spasticity, contracture, and joint-level impairments, which may help improve stroke rehabilitation and outcome evaluation. 相似文献17.
Blennerhassett JM Jayalath VM 《Archives of physical medicine and rehabilitation》2008,89(11):2156-2161
Blennerhassett JM, Jayalath VM. The Four Square Step Test is a feasible and valid clinical test of dynamic standing balance for use in ambulant people poststroke.
Objective
To examine if the Four Square Step Test (FSST), a previously reported clinical test of dynamic standing balance, which involves stepping over obstacles and turning, was a feasible and valid test, and sensitive to change during stroke rehabilitation.Design
Prospective observational cohort study over a 4-week duration.Setting
Rehabilitation hospital.Participants
People with stroke (N=37) who could walk at least 50m with minimal assistance were recruited consecutively when attending physical therapy during rehabilitation.Interventions
Not applicable.Main Outcome Measures
Dynamic standing balance was examined at 2 weekly intervals using 2 clinical tests: the FSST and the Step Test. Falls events were monitored using a falls diary and by an audit of medical histories.Results
Strong agreement was observed between performance scores for the FSST and Step Test obtained within the same testing session (intraclass correlation coefficient3,k, .94-.99). A moderate to strong inverse relationship (Spearman ρ=−.73 to −.86) was observed between the FSST and Step Test scores at each assessment. Scores from both tests revealed significant improvements in dynamic balance across the 4-week period (P<.001-.010). Five of the participants reported falls during the study. These 5 people had low scores for both clinical tests and difficulty clearing their foot when stepping over objects in the FSST.Conclusions
The FSST is a feasible and valid test of dynamic standing balance that is sensitive to change during stroke rehabilitation. 相似文献18.
James E. Graham Cynthia M. Ripsin Anne Deutsch Yong-Fang Kuo Sam Markello Carl V. Granger Kenneth J. Ottenbacher 《Archives of physical medicine and rehabilitation》2009,90(7):1110-1116
Graham JE, Ripsin CM, Deutsch A, Kuo Y-F, Markello S, Granger CV, Ottenbacher KJ. Relationship between diabetes codes that affect Medicare reimbursement (tier comorbidities) and outcomes in stroke rehabilitation.
Objectives
To examine the extent to which diabetes codes that increase reimbursement (tier comorbidities) under the prospective payment system are related to length of stay and functional outcomes in stroke rehabilitation.Design
Secondary data analysis.Setting
Inpatient rehabilitation facilities (N=864) across the United States.Participants
Patients (N=135,097) who received medical rehabilitation for stroke in 2002-2003.Intervention
None.Main Outcome Measures
Length of stay, FIM instrument, and discharge setting. Diabetes status was assigned to 1 of 3 categories: tier (increases reimbursement), nontier (no reimbursement effect), and no diabetes.Results
Mean ± standard deviation age of the sample was 70.4±13.4 years, and 31% had diabetes (6% tier, 25% nontier). Diabetes status by age demonstrated significant (P<.05) interaction effects, which lead to the following age-specific findings. In younger stroke patients (60y), tier diabetes was associated with shorter lengths of stay compared with both groups, lower FIM discharge scores compared with both groups, and lower odds of discharge home relative to the no-diabetes group. In older stroke patients (80y), tier diabetes was associated with longer lengths of stay compared with both groups and with higher FIM discharge scores compared with the nontier group.Conclusions
The diabetes-related conditions identified as tier comorbidities under the prospective payment system are significant predictors of stroke rehabilitation outcomes, but these relationships are moderated by patient age. 相似文献19.
Haeuber E Shaughnessy M Forrester LW Coleman KL Macko RF 《Archives of physical medicine and rehabilitation》2004,85(12):1997-2001
Haeuber E, Shaughnessy M, Forrester LW, Coleman KL, Macko RF. Accelerometer monitoring of home- and community-based ambulatory activity after stroke. Arch Phys Med Rehabil 2004;85:1997-2001.
Objectives
To investigate the utility of a novel microprocessor-linked Step Watch Activity Monitor (SAM) to quantify ambulatory activity after stroke and to evaluate the validity and reliability of conventional accelerometers to measure free-living physical activity in this population.Design
Cross-sectional with repeated measures of 2 separate 48-hour recordings in 17 persons wearing an ankle-mounted SAM and Caltrac, a hip-mounted mechanical accelerometer.Setting
Home and community.Participants
Seventeen subjects with chronic hemiparetic gait after stroke.Interventions
Not applicable.Main outcome measures
The SAM derived stride counts per day and Caltrac estimated the daily caloric expenditure of physical activity.Results
SAM data revealed that stroke patients had a mean strides per day ± standard deviation of 3035±1944 and demonstrated a broad range of daily activity profiles (400-6472 strides). SAM test-retest reliability was high across separate monitoring periods (r=.96, P<.001). Although Caltrac also revealed a broad range of daily activity calories (346±217kcal/d; range, 83-1222kcal/d), reliability was poor (r=.044, P=not significant) and Caltrac accounted for only 64% of the ambulatory activity quantified by the SAM.Conclusions
Microprocessor-linked accelerometer monitoring, but not conventional accelerometers, are accurate and highly reliable for quantifying ambulatory activity levels in stroke patients. These findings support the utility of personal status monitoring of ambulatory activity as an outcomes instrument and metric in programs to increase physical activity and cardiovascular health after stroke. 相似文献20.
Janssen TW Beltman JM Elich P Koppe PA Konijnenbelt H de Haan A Gerrits KH 《Archives of physical medicine and rehabilitation》2008,89(3):463-469
Janssen TW, Beltman JM, Elich P, Koppe PA, Konijnenbelt H, de Haan A, Gerrits KH. Effects of electric stimulation-assisted cycling training in people with chronic stroke.