Effectiveness of a visual attention retraining program on the driving performance of clients with stroke

OBJECTIVE: To compare the effectiveness of a visual attention retraining program using the Useful Field of View (UFOV) with a traditional visuoperception treatment program on the driving performance of clients with stroke. DESIGN: Randomized controlled trial. SETTING: Rehabilitation hospital located in Quebec, Canada. PARTICIPANTS: Ninety-seven individuals referred for driving evaluation after a stroke. INTERVENTIONS: Participants were randomized to receive 20 sessions of either UFOV training of visual processing speed, divided attention, and selective attention or traditional computerized visuoperception retraining. MAIN OUTCOME MEASURES: Subjects were evaluated with an on-road driving evaluation, visuoperception tests, and the Test of Everyday Attention. An occupational therapist unaware of group assignment conducted all evaluations. RESULTS: Eighty-four participants completed the outcome evaluation. There were no significant differences between groups on any of the outcome measures. There was, however, almost a 2-fold increase (52.4% vs 28.6%) in the rate of success on the on-road driving evaluation after UFOV training for subjects with right-sided lesions. CONCLUSIONS: Rehabilitation that targets visual attention skills was not significantly more beneficial than traditional perceptual training in improving the outcome of an on-road driving evaluation. However, results suggest a potential improvement for subjects with right-sided lesions, indicating that training must target specific skills.     

Use of visual force feedback to improve digit force direction during pinch grip in persons with stroke: a pilot study

Seo NJ, Fischer HW, Bogey RA, Rymer WZ, Kamper DG. Use of visual force feedback to improve digit force direction during pinch grip in persons with stroke: a pilot study.

Objective

To investigate whether visual feedback of digit force directions for the index fingertip and thumb tip during repeated practice of grip force production can correct the digit force directions for persons with stroke during grip assessments. Following stroke, the paretic fingers generate digit forces with a higher than normal proportion of shear force to compression force during grip. This misdirected digit force may lead to finger-object slip and failure to stably grasp an object.

Design

A case series.

Setting

Laboratory.

Participants

Persons (N=11) with severe chronic hand impairment after stroke.

Interventions

Four training sessions during which participants practiced directing the index finger and thumb forces in various target directions during pinch using visual feedback.

Main Outcome Measure

Digit force direction during pinch and clinical hand function scores were measured before and immediately after the training.

Results

Study participants were able to redirect the digit force closer to the direction perpendicular to the object surface and increase their hand function scores after training. The mean ratio of the shear force to the normal force decreased from 58% to 41% (SD, 17%), the mean Box and Block Test score increased from 1.4 to 3.4 (SD, 2.0), and the mean Action Research Arm Test score increased from 10.8 to 12.1 (SD, 1.3) (P<.05 for all 3 measures).

Conclusions

Repeated practice of pinch with visual feedback of force direction improved grip force control in persons with stroke. Visual feedback of pinch forces may prove valuable as a rehabilitation paradigm for improving hand function.     

Use of ultrasound imaging by physiotherapists: a pilot study to survey use, skills and training

Objective

This study aimed to design and pilot a questionnaire to survey the use of ultrasound imaging (USI) by physiotherapists in the United Kingdom (UK), the type and content of ultrasound training physiotherapists using USI had undertaken and their perceived future training needs.

Background

The use of USI by physiotherapists is becoming increasingly common but is highly operator dependent and there are safety and professional issues regarding use in physiotherapy practice. Currently there are no specific training guidelines relating to physiotherapists using USI.

Methods

A questionnaire was developed, based on research literature and guidelines. Twelve experts in USI commented on the content and design. The electronic on-line questionnaire was piloted on groups that were likely to be users of USI.

Results

Forty-six respondents completed the questionnaire. Results indicated that USI is used predominantly for biofeedback and there are many unmet training needs. Respondents reported a mismatch between techniques for which they had received training and those that they used in practice and indicated a more structured training framework is required.

Conclusions

The development and piloting of the questionnaire provides a starting point for a more extensive evaluation of how USI is being used, the training needs of physiotherapists and benefits as a biofeedback tool. Refinement is needed and replication in a larger sample. Results could assist the development of a structured formal training framework encompassing key skills.     

Compensatory stepping responses in individuals with stroke: a pilot study

Impaired postural control and a high incidence of falls are commonly observed following stroke. Compensatory stepping responses are critical to reactive balance control. We hypothesize that, following a stroke, individuals with unilateral limb dyscontrol will be faced with the unique challenge of controlling such rapid stepping reactions that may eventually be linked to the high rate of falling. The objectives of this exploratory pilot study were to investigate compensatory stepping in individuals poststroke with regard to: (1) choice of initial stepping limb (paretic or non-paretic); (2) step characteristics; and (3) differences in step characteristics when the initial step is taken with the paretic vs. the non-paretic limb. Four subjects following stroke (38-165 days post) and 11 healthy young adults were recruited. Anterior and posterior perturbations were delivered by using a weight drop system. Force plates recorded centre-of-pressure excursion prior to the onset of stepping and step timing. Of the four subjects, three only attempted to step with their non-paretic limb and one stepped with either limb. Time to foot-off was generally slow, whereas step onset time and swing time were comparable to healthy controls. Two of the four subjects executed multistep responses in every trial, and attempts to force stepping with the paretic limb were unsuccessful in three of the four subjects. Despite high clinical balance scores, these individuals with stroke demonstrated impaired compensatory stepping responses, suggesting that current clinical evaluations might not accurately reflect reactive balance control in this population.     

Problem-solving early intervention: a pilot study of stroke caregivers.

Caregivers (CGs) of stroke survivors assume their role suddenly and with little preparation. Negative emotions are common, persist over time, and are related to other negative outcomes. This pilot study, guided by a coping model, examined the efficacy and durability of a caregiver problem-solving intervention (CPSI) on CG and stroke survivor outcomes. Additional aims included assessment of feasibility issues and reliability and sensitivity of the study measures. The nonrandom sample of 15 stroke CGs was matched on depression and demographics with a comparison group. The CPSI started during acute rehabilitation and continued through 2 months after discharge. Parametric and nonparametric tests were used to assess achievement of the aims. CG depression, anxiety, preparedness, and survivor motor function improved significantly in the intervention group over time. Burden, life changes, and taking care of CG's own needs did not change significantly. CPSI group CG depression significantly improved compared with the matched group. The improvement in outcomes for the CPSI group supports further testing of the intervention with a large sample.     

Fatigue in stroke rehabilitation patients: a pilot study

Background and Purpose. Stroke is the leading cause of adult disability. Rehabilitation is a vital component of post‐stroke care with two‐thirds of survivors requiring rehabilitation. Fatigue is a common issue affecting stroke patients and is a barrier to rehabilitation causing inefficient care provision and potential limitation to patient recovery. No study to date has investigated whether the experience of fatigue is different between the two main causes of ischemic stroke: small‐vessel (SVD) and large‐vessel disease (LVD). The aim of the present study is to complete a pilot study to inform the feasibility, design, magnitude of difference in experience of fatigue, and sample size for a definitive study to evaluate differences in fatigue between these two groups of stroke patients. The experimental hypothesis is that participants with LVD experience a significantly greater level of fatigue than those with SVD as assessed by the Fatigue Severity Scale (FSS). Methods. The study used a cohort observational design. Thirteen participants were recruited over a two‐month period from King's College Hospital. Participants were visited on average at the start of the second week of rehabilitation to complete the FSS. An independent t‐test and ANCOVA were performed. For all statistical analyses, a significance level of p < 0.05 was used. Results. The study demonstrated a trend towards LVD participants reporting higher fatigue scores than SVD participants, even when controlling for age, with gender having no confounding effect. Conclusions. Fatigue is common amongst ischemic stroke rehabilitation participants with 85% of the combined sample experiencing fatigue at the start of the second week. The results demonstrate a trend towards LVD participants experiencing greater fatigue. While the results were non‐significant, the study demonstrates a feasible methodology which could help lay the groundwork for future research. Copyright © 2010 John Wiley & Sons, Ltd.     

Transition to Community: a program to help clients with schizophrenia move from inpatient to community care; a pilot study

A pilot study of the Transition to Community program tested the feasibility of conducting a larger trial using the same intervention. An advanced practice psychiatric nurse interviewed hospitalized clients, contacted outpatient clinicians, and communicated with clients after discharge via prepaid cellular phones. Client compliance with medications and outpatient appointments, and the number of hospital readmission days during the 50-day period after discharge were examined. The sample size (N = 13) precluded statistically significant data; however, collective results indicated a probable difference on at least one of the variables. Modifications in methods for a multisite trial, based on this pilot project, are identified in the summary.     

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

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

Devising a checklist to evaluate the non-verbal aspects of teaching skills and delivery.

This article proposes that teachers should constantly reflect upon and evaluate their performance if they are to improve teaching skills and delivery. Interaction Analysis and a true qualitative (anthropological) approach to evaluation are critically reviewed and are considered unsuitable for a teacher wanting to self-assess performances regularly. The use of a checklist in combination with video recording of the session to be evaluated is suggested as an alternative. An example of a checklist designed to focus on non verbal skills is given together with an overview of 'ideal' teacher behaviours.     

脑卒中偏瘫肩痛患者的超声图像表现

摘要 目的：通过超声检查以及临床查体,明确脑卒中患者偏瘫肩痛（HSP）的原因,并分析超声表现与肩痛视觉模拟量表（VAS）评分之间的关系。 方法：选取56例首次发生脑卒中偏瘫的患者进行研究,根据VAS评分分为肩痛组及非肩痛组,所有患者均行双侧肩关节超声检查。临床检查包括Brunnstrom分期、Ashworth分级、肩关节半脱位及被动关节活动度（PROM）。 结果：肩痛组患者肩关节半脱位发生率较非肩痛组高（51.4% vs 23.8%）,两组比较差异有显著性意义（P＜0.05）。超声显示,肩痛组患者冈上肌病变（54.3%）和肩峰下—三角肌下滑囊（SA-SD）积液（45.7%）与非肩痛组相比差异有显著性意义（P＜0.05）。相关性分析可见冈上肌病变及肩峰下滑囊积液与偏瘫肩痛之间具有明显的相关性。 结论：肩袖损伤是脑卒中患者偏瘫后肩痛的原因之一,冈上肌损伤及肩峰下滑囊病变同肩痛的程度有关。     

The efficacy of a work-station intervention programme to improve functional ability and flexibility in ageing clients with Cerebral Palsy: a pilot study

Purpose: Health care workers associated with the long-term care of ageing clients with Cerebral Palsy have reported on the adverse effects of less active daily activity programmes with resultant decreased functional mobility. While the negative effects of ageing have been reported in these clients, programmes have not been implemented to determine whether these adverse changes can be reversed or prevented. The efficacy of a work-station intervention programme to improve functional ability and flexibility in ageing clients with cerebral palsy was investigated.

Method: A clinical intervention study using repeated measures (pre/post-intervention and at follow-up) to evaluate efficacy was undertaken. Twenty-two clients with Cerebral Palsy participated in a twice-weekly work-station programme delivered over 8 weeks. The Physical Mobility Scale items, two upper limb function measures, range limitation of hip and knee extension and gleno-humeral movement were assessed.

Results: Results showed a significant improvement that was retained at follow-up in functional but not flexibility measures.

Conclusion: The efficacy of a work-station exercise programme for ageing clients with Cerebral Palsy was demonstrated. Evidence was provided that the PMS is effective in showing level of dependency for these clients.     

Feasibility of a home-based program to improve handwriting after stroke: a pilot study

Purpose: To test the feasibility of a handwriting retraining program with adults after stroke; specifically the feasibility of: (i) recruiting people with stroke to the study, (ii) delivering the handwriting retraining program and (iii) outcome measures of handwriting performance. Method: A quasi-experimental pre-test post-test design was used. A four-week, home-based handwriting retraining program was delivered by an occupational therapist using task-specific practice. Legibility, speed, pen control and self-perception of handwriting were measured at baseline and completion of the program. Legibility was scored by a blinded rater. Results: Seven adults with stroke were recruited (eligibility fraction 43% of those screened, and enrolment fraction 78% of those eligible). There were no dropouts. Although, recruitment was slow the intervention was feasible and acceptable to adults with stroke. No statistically or clinically significant changes in legibility were reported in this small sample, but a ceiling effect was evident for some outcome measures. The study was not powered to determine efficacy. Conclusions: Delivery of a four-week handwriting intervention with eight supervised sessions in the community was feasible; however, recruitment of an adequate sample size would require greater investment than the single site used in this pilot.

• Implications for Rehabilitation

• Handwriting difficulty is common following hemiparesis after stroke, however research addressing handwriting retraining for adults with stroke is lacking.

• A four-week home-based handwriting program using task-specific practice and feedback was feasible to deliver and appropriate for adults with stroke.

• Improving handwriting legibility and neatness across a range of tasks were important goals for adults with handwriting impairment.

     

Contrast-enhanced ultrasound to evaluate changes in renal cortical perfusion around cardiac surgery: a pilot study

Introduction

Contrast-enhanced ultrasound (CEUS) is a new technique that might enable portable and non-invasive organ perfusion quantification at the bedside. However, it has not yet been tested in critically ill patients. We sought to establish CEUS''s feasibility, safety, reproducibility and potential diagnostic value in the assessment of renal cortical perfusion in the peri-operative period in cardiac surgery patients.

Methods

We recruited twelve patients deemed at risk of acute kidney injury (AKI) planned for elective cardiac surgery. We performed renal CEUS with destruction-replenishment sequences before the operation, on ICU arrival and the day following the admission. Enhancement was obtained with Sonovue^® (Bracco, Milano, Italy) at an infusion rate of 1 ml/min. We collected hemodynamic parameters before, during and after contrast agent infusion. At each study time, we obtained five video sequences, which were analysed using dedicated software by two independent radiologists blinded to patient and time. The main output was a perfusion index (PI), corresponding to the ratio of relative blood volume (RBV) over mean transit time (mTT).

Results

All 36 renal CEUS studies, including 24 in the immediate post-operative period could be performed and were well tolerated. Correlation between readers for PI was excellent (R² = 0.96, P < 0.0001). Compared with baseline, there was no overall difference in median PI''s on ICU admission. However, the day after surgery, median PI''s had decreased by 50% (P < 0.01) (22% decrease in RBV (P = 0.09); 48% increase in mTT (P = 0.04), both suggestive of decreased perfusion). These differences persisted after correction for haemoglobin; vasopressors use and mean arterial pressure. Four patients developed AKI in the post-operative period.

Conclusions

CEUS appears feasible and well-tolerated in patients undergoing cardiac surgery even immediately after ICU admission. CEUS derived-parameters suggest a decrease in renal perfusion occurring within 24 hours of surgery.     

Improving medication calculation skills of practicing nurses and senior nursing students: a pilot study.

Medication administration is an essential nursing competency as calculation difficulties can lead to serious medication errors. Nurses involved in staff education need to be aware of methods to assess for computation difficulty and develop strategies for nurses to improve their computation abilities. The purposes of this quasi-experimental pilot study were to assess the medication calculation skills of nurses and nursing students and to determine the effectiveness of teaching strategies aimed at improving these skills.