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1.
Deutscher D Horn SD Smout RJ DeJong G Putman K 《Archives of physical medicine and rehabilitation》2010,91(11):1722-1730
Deutscher D, Horn SD, Smout RJ, DeJong G, Putman K. Black-white disparities in motor function outcomes taking into account patient characteristics, nontherapy ancillaries, therapy activities, and therapy interventions.
Objective
To assess black-white differences in functional outcomes, controlling for patient characteristics, use of nontherapy ancillaries (NTAs), and use of physical (PT) and occupational therapy (OT) activities and interventions.Design
Multicenter prospective observational cohort study of poststroke rehabilitation.Setting
Six U.S. inpatient rehabilitation facilities.Participants
Patients (N=732) subdivided into case-mix subgroups (CMGs; CMGs 104-107 for moderate strokes [n=397], CMGs 108-114 for severe strokes [n=335]).Interventions
Not applicable.Main Outcome Measure
Discharge Motor FIM.Results
Taking into account patient characteristics, NTAs, and therapy activities, multivariate regressions explained (R2) 54% and 69% of variation in outcomes between patients with moderate and severe stroke, respectively. Black race was associated with lower outcomes than white race in the severe group. However, race was no longer associated with outcomes after including interventions used within PT and OT activities. Including interventions within therapy activities increased R2 to 64% and 74% for moderate and severe strokes, respectively. Some PT and OT activities were provided more to blacks than whites and vice versa. Greater intensity sometimes was associated with better and sometimes with poorer functional outcomes.Conclusions
After controlling for interventions within activities, no racial differences were found in functional outcomes at discharge despite racial differences in rehabilitation care, possibly because each racial group received a mixture of interventions that were negatively and positively associated with outcome. Clinicians should provide therapies associated with better outcomes with high and similar intensities for black and white patients poststroke. 相似文献2.
Martijn H. Niessen DirkJan H. Veeger Carel G. Meskers Peter A. Koppe Manin H. Konijnenbelt Thomas W. Janssen 《Archives of physical medicine and rehabilitation》2009,90(9):1557-1564
Niessen MH, Veeger DH, Meskers CG, Koppe PA, Konijnenbelt MH, Janssen TW. Relationship among shoulder proprioception, kinematics, and pain after stroke.
Objective
To identify a possible relationship among chronic poststroke shoulder pain (PSSP), scapular resting pose, and shoulder proprioception.Design
Case-control study.Setting
Rehabilitation center.Participants
A total of 21 inpatients with stroke and 10 healthy control subjects.Interventions
Not applicable.Main Outcome Measures
Orientations of both the contralateral and ipsilateral (ie, paretic and nonparetic) shoulders during rest in degrees, angular displacement (degrees) for threshold to detection of passive motion (TDPM) tests, and absolute error (degrees) for passive reproduction of joint position (PRJP) tests.Results
The contralateral shoulder of patients with PSSP showed more scapular lateral rotation and larger TDPM and PRJP scores than both patients without PSSP and control subjects. Additionally, the contralateral shoulder of patients with deteriorated proprioception showed more scapular lateral rotation than control subjects, whereas their ipsilateral shoulder showed more scapular lateral rotation than both control subjects and patients with good proprioception.Conclusions
A clear relation among affected shoulder kinematics, affected proprioception, and PSSP was found. In determining the risk of developing PSSP, attention should be paid to a patients shoulder proprioception and kinematics. If both are altered after stroke, this could worsen the initial pathology or cause secondary pathologies and thus initiate a vicious circle of repetitive soft tissue damage leading to chronic PSSP. Additionally, more attention should be paid to the ipsilateral (ie, nonparetic) shoulder because it could be used in determining the risk of developing PSSP in the contralateral (ie, paretic) shoulder. 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.
Jay M. Meythaler Laura Vogtle Robert C. Brunner 《Archives of physical medicine and rehabilitation》2009,90(9):1453-194
Meythaler JM, Vogtle L, Brunner RC. A preliminary assessment of the benefits of the addition of botulinum toxin A to a conventional therapy program on the function of people with longstanding stroke.
Objective
To determine if botulinum toxin type A (BTX-A) combined with therapy can facilitate improved upper-extremity (UE) functional status versus therapy alone.Design
Double-blind randomized crossover trial.Setting
Tertiary care outpatient rehabilitation center.Participants
Convenience sample of 21 men and women (ages 19-80y) with stroke more than 6 months after insult who had tone greater than 3 on the Ashworth Scale for 2 joints in the involved UE.Intervention
Subjects were consecutively recruited and randomized to a double-blind crossover trial. Subjects received either BTX-A combined with a defined therapy program or placebo injection combined with a therapy program in two 12-week sessions.Main Outcome Measures
The primary functional outcome measure was the Motor Activity Log (MAL). Subjects were also assessed on physiologic measures including tone (Ashworth Scale), range of motion, and motor strength.Results
Improvements were noted in the functional status of the subjects in both arms of the study as measured by the MAL. All subjects had a significant change in functional status on MAL with therapy (P<.05). The use of BTX-A combined with therapy as compared with therapy only improved the functional status of the subjects on the MAL Quality of Movement subscale (P=.0180, t test) and showed a trend toward significance in the Amount of Use subscale (P=.0605, analysis of variance). Six weeks after treatment, the BTX-A combined with therapy decreased the Ashworth score statistically (P=.0271), but the therapy alone group decreased a similar amount at 6 weeks (P=.0117), indicating that most of the physiologic tone change could be attributed to therapy. After each 12-week period, tone had largely returned to baseline (P>.05).Conclusion
A focused therapy program showed the most improvement in function in this defined stroke population. BTX-A combined with a focused traditional therapy program slightly enhanced the functional status of stroke subjects beyond that obtained with therapy alone 12 weeks after injection. 相似文献5.
Lynne R. Sheffler Maureen T. Hennessey Jayme S. Knutson John Chae 《Archives of physical medicine and rehabilitation》2009,90(2):362-365
Sheffler LR, Hennessey MT, Knutson JS, Chae J. Neuroprosthetic effect of peroneal nerve stimulation in multiple sclerosis: a preliminary study.
Objective
To determine the neuroprosthetic effect of a peroneal nerve stimulator on tasks of functional ambulation in multiple sclerosis (MS).Design
A single point-in-time assessment of functional ambulation tasks under the conditions of no device and peroneal nerve stimulator.Setting
Outpatient academic medical center.Participants
Participants (N=11) with diagnosis of MS (>6mo), dorsiflexion weakness, and prior usage of an ankle-foot orthosis.Intervention
Surface peroneal nerve stimulator for ambulation.Main Outcome Measures
Timed 25-foot Walk portion of the MS Functional Composite; Floor, Carpet, Up and Go, Obstacle, and Stair components of the Modified Emory Functional Ambulation Profile.Results
Peroneal nerve stimulator-Stair performance was significantly enhanced (P=.05) versus no device, and statistical significance was approached for peroneal nerve stimulator-Obstacles (P=.09) versus no device. There were no significant differences between peroneal nerve stimulator and no device conditions in the remaining outcome measures.Conclusions
The neuroprosthetic effect of the peroneal nerve stimulator is modest relative to no device in the performance of specific functional tasks of ambulation in MS gait. A longitudinal, controlled trial is needed to show effectiveness. 相似文献6.
Latham NK Jette AM Ngo LH Soukup J Iezzoni LI 《Archives of physical medicine and rehabilitation》2008,89(5):807-814
Latham NK, Jette AM, Ngo LH, Soukup J, Iezzoni LI. Did the 1997 Balanced Budget Act reduce use of physical and occupational therapy services?
Objective
To investigate whether use of physical therapy (PT) and occupational therapy (OT) services decreased after the passage of the 1997 Balanced Budget Act (BBA).Design
Data from the nationally representative Medicare Current Beneficiary Survey (MCBS) were merged with Medicare claims data. We conducted cross-sectional analyses of data from 1995 (n=7978), 1999 (n=7863), and 2001 (n=7973). All analyses used MCBS sampling weights to provide estimates that can be generalized to the Medicare population with 5 common conditions.Settings
Skilled nursing facilities (SNFs), home health agencies, inpatient rehabilitation facilities (IRFs), and outpatient rehabilitation settings.Participants
Medicare beneficiaries who participated in the MCBS survey in each of the study years and had 1 or more of the following conditions: acute stroke, acute myocardial infarction, chronic obstructive pulmonary disease, arthritis or degenerative joint disease, or mobility problems.Interventions
Not applicable.Main Outcome Measures
Percentage of persons meeting our inclusion criteria who received PT or OT in each setting, and total units of PT and OT received in each setting.Results
Multivariable logistic regression revealed no statistically significant differences in the proportion of people who met our inclusion criteria who used PT or OT from home health agencies across the 3 time points. For SNFs, an increase in the odds of receiving PT was statistically significant from 1995 to 1999 (odds ratio [OR]=1.42; 95% confidence interval [CI], 1.19−1.69) and 1995 to 2001 (OR=1.69; 95% CI, 1.39−2.05). For IRF and outpatient settings, a significant increase was observed between 1995 and 2001 (OR=1.71, OR=1.27, respectively). For OT, a statistically significant increase was observed for IRF and outpatient rehabilitation settings from 1995 to 2001. For SNF, the increase was statistically significant from 1995 to 1999 and 1995 to 2001. Mean total PT and OT units received also increased across all settings from 1995 to 2001 except for IRFs.Conclusions
Despite BBA mandates restricting postacute care expenditures, this nationally representative study showed no decreases in the percentage of Medicare beneficiaries with 5 common diagnoses receiving PT and/or OT across all settings and no decreases in units of PT and/or OT services received between 1995 and 2001 except for those in IRFs. This study suggests that the delivery of PT and OT services did not decline among persons with conditions for which rehabilitation services are often clinically indicated. 相似文献7.
Dina Brooks Lori Davis Nada Vujovic-Zotovic Chris Boulias Farooq Ismail Denyse Richardson Roger S. Goldstein 《Archives of physical medicine and rehabilitation》2010,91(4):659-662
Brooks D, Davis L, Vujovic-Zotovic N, Boulias C, Ismail F, Richardson D, Goldstein RS. Sleep-disordered breathing in patients enrolled in an inpatient stroke rehabilitation program.
Objective
To report the prevalence of sleep-disordered breathing in an inpatient stroke rehabilitation unit and to explore correlations with functional status and health-related quality of life.Design
Cross-sectional study.Setting
Rehabilitation center.Participants
Consecutive patients (N=45; mean age, 67±12y) (28 men) enrolled in inpatient rehabilitation after ischemic (84%) or hemorrhagic stroke (16%).Interventions
Not applicable.Main Outcome Measures
Overnight respiratory polysomnography was performed on all subjects. Interviewer-administered scales of sleepiness (Epworth Sleepiness Scale) and functional status (FIM, Barthel Index) were completed. Health-related quality of life was assessed by using a general questionnaire (Medical Outcomes Study 36-Item Short-Form Health Survey [SF-36]).Results
Of the 45 subjects tested, only 4 (9%) had an apnea-hypopnea index of less than 10 per hour. The mean apnea-hypopnea index was 32.2 (19.4) per hour; most events were obstructive. There was no relationship between the respiratory index and the components of SF-36 (P values>.2).Conclusions
There was a dramatically high prevalence of respiratory events in patients after stroke enrolled in an inpatient stroke rehabilitation unit. The awareness of this will influence patient evaluation and management. 相似文献8.
Treger I Aidinof L Lutsky L Kalichman L 《Archives of physical medicine and rehabilitation》2010,91(11):1737-1740
Treger I, Aidinof L, Lutsky L, Kalichman L. Mean flow velocity in the middle cerebral artery is associated with rehabilitation success in ischemic stroke patients.
Objective
To evaluate the association between mean flow velocity (MFV) in the middle cerebral artery (MCA) measured by using transcranial Doppler (TCD) and functional and neurologic impairment change during rehabilitation after acute stroke.Design
Cross-sectional observational study.Setting
Acute neurologic rehabilitation department.Participants
Consecutive patients (N=67; 53 men, 14 women; mean ± SD age, 61.54±8.92y) referred to the rehabilitation center during the first 6 months of 2006 for a first ischemic stroke in the MCA area.Interventions
Not applicable.Main Outcome Measures
All subjects were evaluated on admission and at discharge by using the National Institutes of Health Stroke Scale (NIHSS) and the FIM. TCD measurements of MFV of the ipsilateral and contralateral MCA were performed on admission (during the first 20 days after stroke) and a few days before discharge.Results
Contralateral MFV at admission was associated significantly with all indexes of functional rehabilitation success (FIM score at discharge [β=.169; P=.010], change in FIM score [β=.554; P=.010], relative improvement in FIM score [β=.783; P=.003]). No significant association was found between indexes of NIHSS change and ipsilateral or contralateral MFV.Conclusions
Ipsilateral or contralateral MFV measured at admission did not change during the 2-month rehabilitation period. Our data showed a significant association between blood flow velocity in the contralateral MCA and functional rehabilitation parameters of patients after first ischemic stroke in the MCA area. 相似文献9.
Toby B. Cumming Prudence Plummer-D'Amato Thomas Linden Julie Bernhardt 《Archives of physical medicine and rehabilitation》2009,90(11):1931-1936
Cumming TB, Plummer-D'Amato P, Linden T, Bernhardt J. Hemispatial neglect and rehabilitation in acute stroke.
Objectives
To compare 2 methods for determining neglect in patients within 2 days of stroke, and to investigate whether early neglect was related to rehabilitation practice, and whether this relationship was affected by an early, intensive mobilization intervention.Design
Data were collected from patients participating in a phase II randomized controlled trial of early rehabilitation after stroke.Setting
Acute hospital stroke unit.Participants
Stroke patients (N=71).Intervention
The 2 arms of the trial were very early mobilization (VEM) and standard care (SC).Main Outcome Measures
Neglect was assessed using the Star Cancellation Test and the National Institutes of Health Stroke Scale (NIHSS) inattention item within 48 hours of stroke onset, and therapy details were recorded during the hospital stay.Results
Assessing neglect so acutely after stroke was difficult: 29 of the 71 patients were unable to complete the Star Cancellation Test, and agreement between this test and the NIHSS measure was only .42. Presence of neglect did not preclude early mobilization. SC group patients with neglect had longer hospital stays (median, 11d) than those without neglect (median, 4d); there was no difference in length of stay between patients with and without neglect in the VEM group (median, 6d in both).Conclusion
Early mobilization of patients with neglect was feasible and may contribute to a shorter acute hospital stay. 相似文献10.
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11.
Yang YR Wang RY Chen YC Kao MJ 《Archives of physical medicine and rehabilitation》2007,88(10):1236-1240
Yang YR, Wang RY, Chen YC, Kao MJ. Dual-task exercise improves walking ability in chronic stroke: a randomized controlled trial.
Objective
To examine the effectiveness of a dual-task-based exercise program on walking ability in subjects with chronic stroke.Design
Single-blind randomized controlled trial.Setting
General community.Participants
Twenty-five subjects with chronic stroke who were at least limited community ambulatory subjects (a minimum gait velocity, 58cm/s).Interventions
Participants were randomized into a control group (n=12) or experimental group (n=13). Subjects in the control group did not receive any rehabilitation training. Subjects in the experimental group underwent a 4-week ball exercise program.Main Outcome Measures
Gait performance was measured under single task (preferred walking) and tray-carrying task. Gait parameters of interest were walking speed, cadence, stride time, stride length, and temporal symmetry index.Results
The experimental group showed significant improvement in all selected gait measures except for temporal symmetry index under both task conditions. In the control group, there were no significant changes over the 4-week period for all selected measures. There was a significant difference between groups for all selected gait variables except for temporal symmetry index under both task conditions.Conclusions
The dual-task-based exercise program is feasible and beneficial for improving walking ability in subjects with chronic stroke. 相似文献12.
Steele BG Belza B Cain KC Coppersmith J Lakshminarayan S Howard J Haselkorn JK 《Archives of physical medicine and rehabilitation》2008,89(3):404-412
Steele BG, Belza B, Cain KC, Coppersmith J, Lakshminarayan S, Howard J, Haselkorn JK. A randomized clinical trial of an activity and exercise adherence intervention in chronic pulmonary disease.
Objectives
To evaluate the effectiveness of an exercise adherence intervention to maintain daily activity, adherence to exercise, and exercise capacity over 1 year after completion of an outpatient pulmonary rehabilitation program.Design
A 2-group, experimental design was used with randomization into intervention and usual care groups.Setting
Outpatient pulmonary rehabilitation program in a university-affiliated medical center.Participants
One hundred six subjects (98 men; 98 with chronic obstructive pulmonary disease) with a mean age of 67 years and chronic lung disease.Intervention
Twelve-week adherence intervention (weekly phone calls and home visit) including counseling on establishing, monitoring, and problem-solving in maintaining a home exercise program.Main Outcome Measures
Primary outcomes included daily activity (accelerometer), exercise adherence (exercise diary), and exercise capacity (six-minute walk test). All measures were performed at baseline, after the pulmonary rehabilitation program (8wk), after the adherence intervention (20wk), and at 1 year.Results
A rank-based analysis of covariance showed less decline at 20 weeks in exercise adherence (intervention mean, +3min; control mean, −13min; P=.015) and exercise capacity (intervention mean, −10.7m; control mean, −35.4m; P=.023). There were no differences in daily activity at 20 weeks or any differences in any primary variable at 1 year.Conclusions
The intervention enhanced exercise adherence and exercise capacity in the short term but produced no long-term benefit. These findings are in part attributed to the disappointing measurement characteristics of the accelerometer used to measure daily activity. The intervention was acceptable to participants. Further study is needed to fashion interventions that have more persistent benefit. 相似文献13.
Berlowitz DR Hoenig H Cowper DC Duncan PW Vogel WB 《Archives of physical medicine and rehabilitation》2008,89(10):1903-1906
Berlowitz DR, Hoenig H, Cowper DC, Duncan PW, Vogel WB. Impact of comorbidities on stroke rehabilitation outcomes: does the method matter?
Objectives
To examine the impact of comorbidities in predicting stroke rehabilitation outcomes and to examine differences among 3 commonly used comorbidity measures—the Charlson Index, adjusted clinical groups (ACGs), and diagnosis cost groups (DCGs)—in how well they predict these outcomes.Design
Inception cohort of patients followed for 6 months.Setting
Department of Veterans Affairs (VA) hospitals.Participants
A total of 2402 patients beginning stroke rehabilitation at a VA facility in 2001 and included in the Integrated Stroke Outcomes Database.Interventions
Not applicable.Main Outcome Measures
Three outcomes were evaluated: 6-month mortality, 6-month rehospitalization, and change in FIM score.Results
During 6 months of follow-up, 27.6% of patients were rehospitalized and 8.6% died. The mean FIM score increased an average of 20 points during rehabilitation. Addition of comorbidities to the age and sex models improved their performance in predicting these outcomes based on changes in c statistics for logistic and R2 values for linear regression models. While ACG and DCG models performed similarly, the best models, based on DCGs, had a c statistic of .74 for 6-month mortality and .63 for 6-month rehospitalization, and an R2 of .111 for change in FIM score.Conclusions
Comorbidities are important predictors of stroke rehabilitation outcomes. How they are classified has important implications for models that may be used in assessing quality of care. 相似文献14.
Tricia J. Hubbard Charlie Hicks-Little Mitchell Cordova 《Archives of physical medicine and rehabilitation》2009,90(7):1136-1726
Hubbard TJ, Hicks-Little C, Cordova M. Mechanical and sensorimotor implications with ankle osteoarthritis.
Objective
To understand the mechanical and sensorimotor adaptations that may occur with ankle osteoarthritis (OA).Design
Case-control.Setting
Biodynamics research laboratory.Participants
Subjects with ankle OA (n=8; 4 males, 4 females) were matched to healthy controls (n=8; 4 males, 4 females).Interventions
Not applicable.Main Outcome Measures
Mechanical joint stability was assessed with an instrumented ankle arthrometer. Static balance was measured using a force platform during a double-legged stance. Isometric ankle/foot complex strength in the sagittal and frontal plane was assessed with a handheld dynamometer. Last, subjective level of function was assessed using the foot and ankle disability index.Results
There were significant group × side interactions for anterior displacement, inversion rotation, eversion rotation, ankle isometric strength, and the foot and ankle disability index (P<.05). The affected ankle of the OA group demonstrated significantly more mechanical stiffness, more impairments in ankle/foot isometric strength, and less subjective level of function than the matched controls. Additionally, the ankle OA group exhibited significantly more center of pressure displacement, total velocity, and medial-lateral velocity (P<.05).Conclusions
These limitations observed in joint laxity, postural control, muscle strength, and perceived function provide evidence that patients with ankle OA display a number of characteristics that affect joint stability and overall function. These identified impairments necessitate the need for rehabilitation and exercise programs to be developed to help improve joint stability and function in patients with ankle OA. 相似文献15.
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.
Objective
To evaluate whether leg cycling training in subjects with chronic stroke can improve cycling performance, aerobic capacity, muscle strength, and functional performance and to determine if electric stimulation (ES) to the contralateral (paretic) leg during cycling has additional effects over cycling without ES.Design
A randomized controlled trial, with a partial double-blind design.Setting
A rehabilitation center.Participants
Twelve stroke patients (range, 18-70y), more than 5 months poststroke, with lower-extremity hemiparesis.Intervention
Subjects were randomly assigned to groups that performed cycling exercise, one with ES evoking muscle contractions and a control group with ES not evoking muscle contractions. Subjects, blinded for group assignment, trained twice a week for 6 weeks.Main Outcome Measures
Changes in aerobic capacity and maximal power output, functional performance, and lower-limb muscle strength.Results
Aerobic capacity and maximal power output significantly increased by 13.8%±19.1% and 38.1%±19.8%, but muscle strength was not significantly enhanced after training. Functional performance improved (ie, scores on the Berg Balance Scale increased by 6.9%±5.8% (P=.000) and the six-minute walk test improved by 14.5%±14.1% (P=.035). There was no significant effect on the Rivermead Mobility Index (P=.165). Training-induced changes were not significantly different between the 2 groups. Changes in cycling performance and aerobic capacity were not significantly related to changes in functional performance.Conclusions
This study showed that a short cycling training program on a semirecumbent cycle ergometer can markedly improve cycling performance, aerobic capacity, and functional performance of people with chronic stroke. The use of ES had no additional effects in this specific group of subjects with chronic stroke. 相似文献16.
Aquilani R Verri M Iadarola P Arcidiaco P Boschi F Dossena M Sessarego P Scocchi M Arrigoni N Pastoris O 《Archives of physical medicine and rehabilitation》2004,85(5):779-784
Aquilani R, Verri M, Iadarola P, Arcidiaco P, Boschi F, Dossena M, Sessarego P, Scocchi M, Arrigoni N, Pastoris O. Plasma precursors of brain catecholaminergic and serotonergic neurotransmitters in rehabilitation patients with ischemic stroke. Arch Phys Med Rehabil 2004;85:779-84.
Objective
To determine levels of plasma amino acid tyrosine and tryptophan, precursors of brain catecholamine and serotonin neurotransmitters, respectively, in rehabilitative patients with ischemic stroke.Design
Controlled, pre-post analysis, consecutive sample.Setting
Rehabilitation center.Participants
Twenty men with ischemic stroke (age, 68±11.3y) consecutively admitted into rehabilitation 15±10 days (range, 7-28d) after an acute cerebrovascular insult; 15 healthy sedentary subjects (controls 1); and 13 healthy hypoactive individuals who had recently had knee arthroplasty (controls 2). Both control groups were matched to stroke subjects for age, gender, and body weight.Interventions
At 8:00 am, after overnight fasting, venous blood samples were drawn from patients to determine plasma tyrosine and tryptophan levels. A nutritional evaluation, including nitrogen balance, was made. The same procedures were repeated after 45 days of rehabilitation. Amino acid data were compared with those obtained from the controls.Main outcome measure
Plasma concentrations of amino acids.Results
Patients with ischemic stroke, on admission, had lower plasma tyrosine concentration than did both controls 1 (P<.0005) and controls 2 (P<.001), but a similar tryptophan level. The plasma content of tyrosine was similar between the 2 control groups. After 45 days of rehabilitation, the stroke patients’ tyrosine and tryptophan levels remained virtually unchanged, as did nutritional parameters. Nutritional intakes were adequate to meet body needs but insufficient to correct plasma tyrosine.Conclusions
Patients experiencing a recent stroke may have low plasma tyrosine levels and, therefore, reduced brain catecholamine formation. It is possible that an imbalance of brain neurotransmitters may occur. 相似文献17.
Bensoussan L Viton JM Schieppati M Collado H Milhe de Bovis V Mesure S Delarque A 《Archives of physical medicine and rehabilitation》2007,88(8):1009-1015
Bensoussan L, Viton J-M, Schieppati M, Collado H, Milhe de Bovis V, Mesure S, Delarque A. Changes in postural control in hemiplegic patients after stroke performing a dual task.
Objective
To determine the effects of an attentional task on hemiplegic patients’ postural control performances.Design
Retrospective study.Setting
Department of physical and rehabilitation medicine at a university hospital.Participants
Twenty-three hemiplegic patients and 23 healthy age- and sex-matched control subjects.Interventions
Not applicable.Main Outcome Measures
Sway area and sway path of the center of pressure were measured during 30 seconds in standing subjects and patients under 3 conditions: eyes open (EO), EO while performing a simple arithmetic task (EO-AT), and eyes closed (EC).Results
In the hemiplegic patients, the body sway area increased significantly with EC (P<.001) and during the EO-AT task (P<.017) in comparison with EO. Sway area with EO-AT remained, however, significantly smaller than with EC (P<.014). In the healthy subjects, the body sway did not differ significantly between the EO-AT and EO tasks (P<.42). The increase observed in the sway area and path in the hemiplegic population during the EO-AT task correlated significantly with age.Conclusions
The postural performances of hemiplegic patients decreased during both the arithmetic task and the EC task. The cognitive task had no effect on healthy subjects’ postural performances. This study is the first to show the combined effects of age and dual task on the postural performances of hemiplegic subjects. 相似文献18.
Woan Shin Tan Bee Hoon Heng Karen Sui-Geok Chua Kay Fei Chan 《Archives of physical medicine and rehabilitation》2009,90(7):1202-1066
Tan WS, Heng BH, Chua KS, Chan KF. Factors predicting inpatient rehabilitation length of stay of acute stroke patients in Singapore.
Objective
To determine the predictors of hospital length of stay (LOS) of stroke patients at the point of admission.Design
A retrospective cohort study.Setting
An acute hospital rehabilitation center in Singapore.Participants
Stroke patients (N=491) admitted between March 2005 and December 2006.Interventions
None.Main Outcome Measures
Rehabilitation LOS was calculated as the total number of rehabilitation days before discharge. We measured the functional status of patients by using the Functional Independence Measure (FIM).Results
The median LOS was 29 days (mean = 30.8d). Independent clinical and sociodemographic characteristics found to significantly predict rehabilitation LOS were FIM motor score at admission, the presence of more than 3 comorbid conditions at admission, living with nonimmediate relatives before admission, and the hospital subsidy status of the patient. In particular, the admission FIM motor score explained 43% of the variation in LOS and decreased the LOS by approximately 1.1 days for each 1-point increase in score.Conclusion
Patients' socioeconomic status and family structure was found to influence LOS and should be considered in allocating resources and determining treatment need. The extent of motor function of patients at admission is an important factor influencing rehabilitation LOS and is a useful tool for facilitating rehabilitation resource planning for stroke patients. 相似文献19.
Kelli G. Sharp Robert Gramer Laine Butler Steven C. Cramer Erinn Hade Stephen J. Page 《Archives of physical medicine and rehabilitation》2014
Objective
To compare the efficacy of a regimen combining mental practice (MP) with overground training (OT) with the efficacy of a regimen consisting of OT only on gait velocity and lower extremity motor outcomes in individuals with chronic (>12mo postinjury), incomplete spinal cord injury (SCI).Design
Randomized, controlled, single-blinded study.Setting
Outpatient rehabilitation laboratories.Participants
Subjects with chronic, incomplete SCI (N=18).Interventions
Subjects were randomly assigned to receive (1) OT only, occurring 3d/wk for 8 weeks; or (2) OT augmented by MP (MP + OT), during which randomly assigned subjects listened to an MP audio recording directly after OT sessions.Main Outcome Measures
Subjects were administered a test of gait velocity as well as the Tinetti Performance Oriented Mobility Assessment, Spinal Cord Injury Independence Measure, and Satisfaction With Life Scale on 2 occasions before intervention, 1 week after intervention, and 12 weeks after intervention.Results
A significant increase in gait velocity was exhibited across subjects at both 1 week posttherapy (P=.005) and at 12 weeks posttherapy (P=.006). However, no differences were seen in intervention response at either 1 or 12 weeks postintervention among subjects in the MP + OT group versus the OT-only group.Conclusions
OT was associated with significant gains in gait velocity, and these gains were not augmented by further addition of MP. 相似文献20.
Bürge E Kupper D Finckh A Ryerson S Schnider A Leemann B 《Archives of physical medicine and rehabilitation》2008,89(10):1857-1862
Bürge E, Kupper D, Finckh A, Ryerson S, Schnider A, Leemann B. Neutral functional realignment orthosis prevents hand pain in patients with subacute stroke: a randomized trial.