Longer versus shorter daily durations of electrical stimulation during task-specific practice in moderately impaired stroke

Page SJ, Levin L, Hermann V, Dunning K, Levine P. Longer versus shorter daily durations of electrical stimulation during task-specific practice in moderately impaired stroke.ObjectiveTo examine and compare efficacy of 30-, 60-, and 120-minute repetitive task-specific practice (RTP) sessions incorporating use of an electrical stimulation neuroprosthesis (ESN) on affected upper-extremity (UE) movement.DesignProspective, single-blinded, randomized controlled trial.SettingOutpatient rehabilitation hospital.ParticipantsChronic stroke subjects (N=32) exhibiting moderate, stable affected UE motor deficits.InterventionsSubjects participated in 30-, 60-, or 120-minute therapy sessions involving RTP incorporating the ESN, occurring every weekday for 8 weeks. During sessions, they wore the ESNs to enable performance of valued activities that they had identified. A fourth group participated in a 30-minute per weekday home exercise program.Main Outcome MeasuresOutcomes were evaluated using the UE section of the Fugl-Meyer Assessment of Sensorimotor Impairment (FM), the Arm Motor Ability Test (AMAT), the Action Research Arm Test (ARAT), and Box and Block (B&;B) 1 week before and 1 week after intervention.ResultsAfter intervention, subjects in the 120-minute condition were the only ones to exhibit significant score increases on the FM (P=.0007), AMAT functional ability scale (P=.002), AMAT quality of movement scale (P=.0002), and ARAT (P=.02). They also exhibited the largest changes in time to perform AMAT tasks and in B&;B score, but these changes were nonsignificant, (P=.15 and P=.10, respectively).ConclusionsOne hundred and twenty minutes a day of RTP augmented by ESN use elicits the largest and most consistent UE motor changes in moderately impaired stroke subjects.     

Combination Transcranial Direct Current Stimulation and Virtual Reality Therapy for Upper Extremity Training in Patients With Subacute Stroke

Objective

To investigate the effects of combination cathodal transcranial direct current stimulation (tDCS) and virtual reality (VR) therapy for upper extremity (UE) training in patients with subacute stroke.

Design

Pilot randomized controlled trial. Patients were randomly assigned to 1 of 3 groups: group A received cathodal tDCS, group B received VR, and group C received combination therapy (cathodal tDCS was simultaneously applied during VR therapy).

Setting

University hospital.

Participants

Patients (N=59) with impaired unilateral UE motor function after stroke.

Intervention

Fifteen sessions of treatment over a 3-week period.

Main Outcome Measures

The Modified Ashworth Scale, manual muscle test (MMT), Manual Function Test (MFT), Fugl-Meyer Scale (FMS), and Box and Block Test were used to assess UE function. To evaluate activities of daily living, the Korean-Modified Barthel Index (K-MBI) was used. All outcomes were measured before and immediately after treatment.

Results

After treatment, all groups demonstrated significant improvements in MMT, MFT, FMS, and K-MBI scores. The change in MFT and FMS scores was different between the 3 groups. Post hoc analysis revealed that the improvement of MFT and FMS scores in group C was significantly higher than those of the other 2 groups.

Conclusions

In the present pilot study, the combination of brain stimulation using tDCS and peripheral arm training using VR could facilitate a stronger beneficial effect on UE impairment than using each intervention alone. This combination therapy might be a helpful method to enhance recovery of the paretic UE in patients with stroke.     

Self-Perceived Utilization of the Paretic Arm in Chronic Stroke Requires High Upper Limb Functional Ability

Objective

To explore potential predictors of self-reported paretic arm use at baseline and after task-specific training (TST) in survivors of stroke.

Design

Data were obtained from a randomized controlled trial of somatosensory stimulation and upper limb TST in chronic stroke.

Setting

University laboratory.

Participants

Chronic (≥3mo) survivors of stroke (N=33; mean age, 62y; mean stroke duration, 38mo).

Interventions

Participants received 12 sessions of TST preceded by either active (n=16) or sham (n=17) somatosensory stimulation to all 3 peripheral nerves.

Main Outcome Measures

Demographic and clinical characteristics were entered stepwise into multiple linear regression analyses to determine the factors that best predict baseline Motor Activity Log (MAL) amount of use rating and change 3 months after TST.

Results

The Action Research Arm Test (ARAT) score predicted the amount of use at baseline (R²=.47, P<.001); in using this model, an ARAT score of 54 (maximum of 57) is required to score 2.5 on the MAL (use described as between rarely and sometimes). After TST the change in the ARAT score predicted the change in the amount of use (R²=.31, P=.001). The predictive power of the model for change at 3 months increased if the Fugl-Meyer Assessment wrist component score was added (R²=.41, P=.001).

Conclusions

Utilization of the paretic upper limb in activities of daily living requires high functional ability. The increase in self-reported arm use after TST is dependent on the change in functional ability. These results provide further guidance for rehabilitation decisions.     

Measuring upper limb capacity in patients after stroke: reliability and validity of the stroke upper limb capacity scale

Houwink A, Roorda LD, Smits W, Molenaar IW, Geurts AC. Measuring upper limb capacity in patients after stroke: reliability and validity of the Stroke Upper Limb Capacity Scale.

Objective

To investigate the interrater reliability and construct validity of the Stroke Upper Limb Capacity Scale (SULCS).

Design

Cohort study.

Setting

Inpatient department of a rehabilitation center.

Participants

Patients after stroke (N=21; mean age ± SD, 61.7±7.9y; 57% men), undergoing inpatient rehabilitation.

Interventions

Not applicable.

Main Outcome Measures

The SULCS was administered by occupational therapists (OTs) within 6 weeks after stroke (t1), 3 months after t1 by the same OT (t2), and within 1 week after t2 by another OT (t3). Interrater reliability, the repeatability between different raters, was assessed by calculating the intraclass correlation coefficient (ICC) based on the scores at t2 and t3. Construct validity, indicating agreement with hypotheses concerning the construct that is being measured, was assessed with Spearman rank correlation coefficient (ρ). The SULCS scores were cross-sectionally correlated with those of the Action Research Arm Test (ARAT) and the Rivermead Motor Assessment (RMA) at t1, and longitudinally with the respective change scores between t1 and t2.

Results

The SULCS (range, 0–10) had a high ICC (.94; 95% confidence interval, .86–.97) and strong cross-sectional correlation with both the ARAT and the RMA (ρ=.91 and ρ=.85, respectively), while the respective change scores showed a strong correlation with the ARAT (ρ=.71) and a moderate correlation with the RMA (ρ=.48).

Conclusions

The SULCS has good interrater reliability and construct validity.     

Effects of sensory cueing on voluntary arm use for patients with chronic stroke: a preliminary study

Fong KN, Lo PC, Yu YS, Cheuk CK, Tsang TH, Po AS, Chan CC. Effects of sensory cueing on voluntary arm use for patients with chronic stroke: a preliminary study.

Objective

To investigate the effect of a 2-week program of sensory cueing in which vibration induces the use of the paretic upper extremity in participants with chronic stroke in the community.

Design

A single-group longitudinal study.

Setting

Self-help organizations.

Participants

A convenience sample of 16 community residents (N=16) with chronic unilateral stroke and mild to moderate upper-extremity impairment stratified by the severity of their paretic arm function, measured by using the Functional Test for the Hemiplegic Upper Extremity (FTHUE).

Interventions

Participants engaged in repetitive upper-extremity task practice for 2 weeks while wearing an ambulatory sensory cueing device on their affected hand for 3 hours a day.

Main Outcome Measures

Evaluations were conducted on the 3 occasions of pretest (1 day before training), posttest (immediately after training), and follow-up test (2 weeks after training) by using the following behavioral measures of paretic upper-extremity performance: the Action Research Arm Test (ARAT), the Box and Block Test, the Fugl-Meyer Assessment (FMA), the FTHUE, power and pinch grips, the Motor Activity Log assessment of arm use, and kinematic data obtained from the device.

Results

Significant differences were found in ARAT and FMA scores among the pretest, posttest, and follow-up evaluations. The lower functioning group achieved a more significant increase in overall upper-extremity score than in the hand score for the FMA.

Conclusion

A combination of sensory cueing and movement-based strategies is useful and feasible in improving paretic upper-extremity performance in participants with chronic stroke; however, additional studies with a larger sample size and longer treatment period in a randomized controlled trial would be beneficial.     

Criterion validity of the StepWatch Activity Monitor as a measure of walking activity in patients after stroke

Mudge S, Stott NS, Walt SE. Criterion validity of the StepWatch Activity Monitor as a measure of walking activity in patients after stroke.

Objectives

To test the validity of the StepWatch Activity Monitor (SAM) in subjects with stroke against 2 criterion standards, 3-dimensional gait analysis (3-DGA) and footswitches in a variety of indoor and outdoor walking conditions, including different speeds and different terrains, and to test the accuracy of the SAM when worn on the paretic limb.

Design

Criterion standard validation study.

Setting

Gait laboratory and outside course.

Participants

Twenty-five participants with physical disability after stroke.

Interventions

Not applicable.

Main Outcome Measures

The total step count measured simultaneously by SAM and either 3-DGA or footswitches for both paretic and nonparetic limbs.

Results

The total step count measured by the SAM and 3-DGA was highly correlated (nonparetic limb, r=.959; paretic limb, r=.896). The 95% limits of agreement (LOA) (derived from Bland-Altman analysis) between the SAM and 3-DGA were within ±10 steps for SAMs worn on either the nonparetic or paretic limb. The total step count measured simultaneously by the SAM and footswitches was also highly correlated for each limb (nonparetic, r=.999; paretic, r=.963). The 95% LOA between the SAM and footswitches were ±9 steps on the nonparetic limb but higher at ±57 steps on the paretic limb. Further analysis showed that the measurement differences occurred during the outdoor component of the combined walk. The 95% LOA between footswitches on both limbs were not more than ±9 steps for walking, suggesting that the error was accounted for by the SAM on the paretic limb, which both over- and underread the total step count in the outdoor walking conditions.

Conclusions

Criterion validity of the SAM to measure steps in both clinical and natural environments has been established when used on the nonparetic limb. However, more errors are apparent when the SAM is worn on the paretic limb while walking over a variety of outdoor terrains. Validation is recommended before use in patients with neurologic conditions affecting bilateral legs because there may be more error, particularly in outdoor activities.     

Effects of mobilization and tactile stimulation on recovery of the hemiplegic upper limb: a series of replicated single-system studies

Hunter SM, Crome P, Sim J, Pomeroy VM. Effects of mobilization and tactile stimulation on recovery of the hemiplegic upper limb: a series of replicated single-system studies.

Objective

To explore the effects on motor function and impairment of mobilization and tactile stimulation for the paretic arm and hand after stroke.

Design

Replicated single-system series, ABA design.

Setting

The stroke rehabilitation ward of a community hospital in the United Kingdom.

Participants

Consecutive sample, men and women (N=6) with stroke (left or right), within 3 months of onset.

Intervention

Sixty minutes of daily mobilization and tactile stimulation to the paretic arm and hand for 6 weeks in addition to the usual rehabilitation program.

Main Outcome Measures

Focal disability (Action Research Arm Test [ARAT]) and motor impairment (Motricity Index arm section).

Results

All participants showed visual change in 1 or more of trend, level, or slope between baseline and intervention phases for both the ARAT and the Motricity Index. The visual analysis was confirmed through statistical testing (c statistic and/or Mann-Whitney U test) for 5 of 6 participants (statistical analysis was precluded for 1 participant). No further improvements were made on intervention withdrawal.

Conclusions

This study shows proof of concept for using mobilization and tactile stimulation to improve motor recovery after severe paresis, justifying conducting dose-finding studies as a precursor to multicenter phase III clinical trials.     

Mirror Therapy Enhances Motor Performance in the Paretic Upper Limb After Stroke: A Pilot Randomized Controlled Trial

Objective

To investigate the effectiveness of mirror therapy (MT) combined with bilateral arm training and graded activities to improve motor performance in the paretic upper limb after stroke.

Design

Randomized, controlled, assessor-blinded study.

Setting

Inpatient stroke rehabilitation center of a tertiary care teaching hospital.

Participants

Patients with first-time ischemic or hemorrhagic stroke (N=20), confined to the territory of the middle cerebral artery, occurring <6 months before the commencement of the study.

Intervention

The MT and control group participants underwent a patient-specific multidisciplinary rehabilitation program including conventional occupational therapy, physical therapy, and speech therapy for 5 d/wk, 6 h/d, over 3 weeks. The participants in the MT group received 1 hour of MT in addition to the conventional stroke rehabilitation.

Main Outcome Measures

The Upper Extremity Fugl-Meyer Assessment for motor recovery, Brunnstrom stages of motor recovery for the arm and hand, Box and Block Test for gross manual hand dexterity, and modified Ashworth scale to assess the spasticity.

Results

After 3 weeks of MT, mean change scores were significantly greater in the MT group than in the control group for the Fugl-Meyer Assessment (P=.008), Brunnstrom stages of motor recovery for the arm (P=.003) and hand (P=.003), and the Box and Block Test (P=.022). No significant difference was found between the groups for modified Ashworth scale (P=.647).

Conclusions

MT when combined with bilateral arm training and graded activities was effective in improving motor performance of the paretic upper limb after stroke compared with conventional therapy without MT.     

Pilot Randomized Controlled Trial of Self-Regulation in Promoting Function in Acute Poststroke Patients

Objective

To test the efficacy of self-regulation (SR) for promoting task performance and motor and cognitive functions.

Design

Pilot randomized controlled trial.

Setting

Rehabilitation unit.

Participants

Inpatients with acute poststroke (N=44) after a cerebral infarction aged ≥60 years.

Interventions

Patients were randomly assigned to the SR (n=24) or functional rehabilitation (control; n=20) intervention. The SR intervention consisted of 1 week of therapist-supervised practices of daily tasks using SR of one's own performance (five 1-h sessions). Patients in the control intervention practiced the same daily tasks with a therapist's demonstration and guidance.

Main Outcome Measures

Performance of tasks, including household and monetary transaction tasks; FIM; Fugl-Meyer Assessment (FMA); and Color Trails Test (CTT).

Results

The SR group showed significant improvement in all tasks (median difference, 1–2; effect size [r]=.74–.89) versus none (median difference, 0–0.5) in the control group. Results of the FIM (P<.001, r=.87 in the motor subscale; P<.001, r=.49 in the cognitive subscale), FMA (P<.001, r=.84 for upper extremity motor function and r=.63 for lower extremity motor function), and CTT (P=.002, r=.72) of the SR group improved. The SR group outperformed their control counterparts in 4 of the 5 tasks (median difference, 1; r=.30–.52) and in the FIM motor subscale (P=.002, r=.47), but not in the cognitive subscale and motor and cognitive functions.

Conclusions

SR appears useful for improving task performance that demands both motor and cognitive abilities by promoting information processing and active learning.     

Does treadmill exercise improve performance of cognitive or upper-extremity tasks in people with chronic stroke? A randomized cross-over trial

Ploughman M, McCarthy J, Bossé M, Sullivan HJ, Corbett D. Does treadmill exercise improve performance of cognitive or upper-extremity tasks in people with chronic stroke? A randomized cross-over trial.

Objective

To determine whether acute exercise, using a body-weight-supported treadmill, improves performance on subsequent cognitive tests or an upper-extremity task in people with stroke.

Design

The study was a within-subject, cross-over design in which 21 subjects received, randomly, 2 different testing sequences separated by an interval of 7 to 10 days.

Setting

Outpatient department of a rehabilitation hospital.

Participants

Of 72 potential participants in the convenience sample, 21 people with chronic stroke completed the study. They were 0.5 to 5 years after only 1 documented stroke, were able to walk with or without a cane, were able to grasp with the affected hand, and scored more than 24 on the Mini-Mental State Examination.

Interventions

One session of body-weight-supported treadmill walking for 20 minutes at 70% of estimated heart rate reserve or level 13 on the Borg rating of perceived exertion scale. The control condition consisted of a 20-minute review of a home exercise program with a physiotherapist.

Main Outcome Measures

Cognitive tests included Trail Making Tests Parts A and B, Symbol Digit Substitution Test, and Paced Auditory Serial Addition Test. The Action Research Arm Test (ARAT) measured hemiplegic upper-extremity motor skill.

Results

Treadmill exercise improved movement of the hemiplegic upper extremity (P=.04) but not cognitive performance. The improvement in the ARAT occurred without a change in strength (measured by grip strength) and was negatively correlated with maximum treadmill speed (R²=.20; P=.04).

Conclusions

These findings suggest that acute treadmill exercise improves subsequent skilled movement of the hemiplegic upper extremity that seems unrelated to attention, visuomotor processing, or strength. The etiology and duration of this enhancing effect are worth further study. The existence of an exercise-cognition relationship in people with stroke is an intriguing area of future research.     

Pragmatic lifestyle intervention in patients recovering from colon cancer: a randomized controlled pilot study

Bourke L, Thompson G, Gibson DJ, Daley A, Crank H, Adam I, Shorthouse A, Saxton J. Pragmatic lifestyle intervention in patients recovering from colon cancer: a randomized controlled pilot study.

Objective

To investigate the feasibility of a pragmatic lifestyle intervention in patients who had recently completed surgery and chemotherapy for colon cancer and to obtain preliminary data of its impact on important health outcomes.

Design

A prospective, randomized, controlled pilot trial.

Setting

University rehabilitation facility.

Participants

Eighteen (N=18) colon cancer survivors (mean age=69y; range, 52–80y), Dukes stage A to C.

Interventions

Participants were randomized 6 to 24 months postoperatively to either a 12-week program of combined exercise and dietary advice or standard treatment.

Main Outcome Measures

Exercise and dietary behavior, fatigue, health-related quality of life (QOL), aerobic exercise tolerance, functional capacity, muscle strength, and anthropometery were assessed at baseline and immediately after the intervention.

Results

Adherences to supervised and independent exercise during the intervention were 90% and 94%, respectively, and there was low attrition (6%). The lifestyle intervention elicited improvements in exercise behavior (P=.068), fatigue (P=.005), aerobic exercise tolerance (P=.010), chair sit-to-stand performance (P=.003), and waist-to-hip ratio (P=.002). A positive change in dietary fiber intake (P=.044) was also observed in the intervention group. No change in QOL was observed (P=.795).

Conclusions

These preliminary results suggest that a pragmatic lifestyle intervention implemented 6 to 24 months after primary treatment for colon cancer was feasible. We observed a significant impact on dietary behavior, fatigue, aerobic exercise tolerance, functional capacity, and waist-to-hip ratio. These findings need to be confirmed with a larger-scale definitive randomized controlled trial.     

Normalized muscle strength, aerobic capacity, and walking performance in chronic stroke: a population-based study on the potential for endurance and resistance training

Severinsen K, Jakobsen JK, Overgaard K, Andersen H. Normalized muscle strength, aerobic capacity, and walking performance in chronic stroke: a population-based study on the potential for endurance and resistance training.

Objectives

To assess muscle strength, aerobic capacity, and walking performance compared with normative values in chronic hemiparetic stroke patients and, thereby, to investigate the potential for endurance and resistance training. Second, to study the relations between muscle strength, aerobic capacity, and walking performance using normalized test values.

Design

Population-based, cross-sectional study.

Setting

University hospital, outpatient clinic.

Participants

Patients (N=48) aged 50 to 80 years with reduced muscle strength and walking capacity due to an ischemic stroke 6 to 36 months prior to recruitment.

Interventions

None.

Main Outcome Measures

Peak oxygen consumption (Vo₂peak) and isometric knee extensor muscle strength at the paretic knee were expressed as absolute and normalized values using normative data. The six-minute walk test (6MWT) and the habitual ten-meter walk test (10MWT) were secondary parameters.

Results

Peak Vo₂ was 77% (95% confidence interval [CI], 71–84) of the expected value, and the strength of the paretic knee was 71% (95% CI, 64–78), whereas walking speed (10MWT) was 59% (95% CI, 52–66) and walking distance (6MWT) was 59% (95% CI, 52–67). The normalized Vo₂peak correlated to the normalized 6MWT (r=.58; P<.001) and normalized 10MWT (r=.53; P<.001). Normalized strength of the paretic knee correlated to normalized 6MWT (r=.40; P<.01) and normalized 10MWT (r=.31; P<.05).

Conclusions

Lower extremity muscle strength and aerobic capacity are related to walking performance, which suggests a potential for endurance and resistance training in rehabilitation of walking performance in chronic hemiparesis after stroke. Correction for the influence of age, weight, and height providing normalized values improves the interpretation of severity of impairments and enables comparisons between patients.     

Clinical implications of using the arm motor ability test in stroke rehabilitation

O'Dell MW, Kim G, Finnen LR, Polistena C. Clinical implications of using the Arm Motor Ability Test in stroke rehabilitation.

Objectives

To identify all published studies using the Arm Motor Ability Test (AMAT), a standardized, laboratory-based measure for selected upper extremity activities of daily living (ADLs); and to summarize its current uses and provide recommendations for its future use.

Data Sources

An Ovid online search was performed using the terms “Arm Motor Ability Test” and “AMAT.” The reference lists of all articles obtained were reviewed for additional studies not appearing in the literature search. In addition, the original manual for the use and administration of the AMAT was reviewed.

Study Selection

All studies examining the psychometric properties of the AMAT or using the AMAT as an outcome measure were identified. Articles simply mentioning the AMAT without providing data and case reports or abstracts (other than those addressing a specific aspect of the scale of interest) were excluded.

Data Extraction

Studies were reviewed by the primary author. No formal system of quality review was used.

Data Synthesis

The AMAT has been used as an outcome measure in stroke rehabilitation research examining upper extremity robotics, functional electrical stimulation, and cortical stimulation. The most recent version contains 10 ADL tasks, each of which is composed of 1 to 3 subtasks. Of the 3 domains originally proposed, only the “functional ability” domain is routinely assessed. Psychometric studies have demonstrated good reliability and at least reasonable construct validity. The instrument's sensitivity to change over time is less well established, and no recommendation can be made regarding a minimal clinically important difference.

Conclusions

We recommend that the 10-item version of the AMAT and assessment of only the functional ability domain be adopted as standard going forward. Further research should include examination of sensitivity over time, minimal clinically important change, reliability and validity in the mid and lower range of scores, and in neurologic diagnoses other than stroke.     

Discrimination of Real and Sham Acupuncture Needles Using the Park Sham Device: A Preliminary Study

Tan C-W, Christie L, St-Georges V, Telford N. Discrimination of real and sham acupuncture needles using the Park sham device: a preliminary study.

Objective

To evaluate the blinding effectiveness of the Park sham acupuncture device using participants' ability to discriminate between the real and sham acupuncture needles.

Design

The design was a yes-no experiment. Judgments were made on whether the real or sham acupuncture needle was administered.

Setting

University laboratory.

Participants

Healthy, acupuncture-naive university students and staff (N=20; median age, 22y; range, 18–48y) recruited through convenience sampling.

Interventions

Participants made yes-no judgments on whether the real or sham needle was administered to 8 acupoints (4 traditional and 4 nontraditional) along the Pericardium meridian (Pericardium 3 to Pericardium 6) on the dominant forearm.

Main Outcome Measures

The accuracy index, d′, of participants' ability to discriminate between the real and sham needles (discriminability) was computed for the traditional alone, the nontraditional alone, and a combination of both types of acupoints.

Results

The participants' d′ between the real and sham needles was not statistically significant from d′ equal to 0 for the combined traditional and nontraditional acupoints comparison and the nontraditional acupoints alone comparison (combined, t₁₉=1.20, P=.25; nontraditional, t₁₉=.16, P=.87). However, the participants' d′ was statistically significant from d′ equal to 0 for the traditional acupoints comparison (t₁₉=2.096, P=.049).

Conclusions

The Park sham acupuncture device appears to be effective in blinding participants to real acupuncture intervention when it is applied to the nontraditional acupoints and when traditional and nontraditional acupoints are combined on the forearm along the pericardium meridian. However, the sham device does not appear to blind participants effectively when traditional acupoints alone are used for the same context.     

Effect of Overground Training Augmented by Mental Practice on Gait Velocity in Chronic,Incomplete Spinal Cord Injury

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.     

Self-training to improve UE function at the chronic stage post-stroke: a pilot randomized controlled trial

Background and purpose: On-going practice and use of the weaker upper extremity (UE) are important for maintaining and improving function in individuals with chronic stroke. The effectiveness of two self-training programs for UE function and daily-use was compared.

Methods: In this pilot, single-blinded clinical trial, individuals with chronic stroke were randomized to video-games or traditional self-training (1-hour/day, 6-times/week, 5 weeks). Assessments were performed pre-intervention (an average of two assessments), post-intervention, and at 4-week follow-up. The primary outcome was the functional ability of the upper extremity [The Action Research Arm Test (ARAT)]. Secondary measures were the daily use of the upper extremity [Motor Activity Log (MAL)] and manual dexterity (Box and Block Test). Repeated measures ANOVA was used to test the effectiveness and estimate effect sizes.

Results: Twenty-four of the 142 participants screened by phone were randomized to video-games [N?=?13, mean (SD) age – 59.1 (10.5)] or traditional [N?=?11, mean (SD) age – 64.9 (6.9)] self-training. Significant between-group differences were not detected. ARAT significantly improved by 13.9% and 9.6% following the video-games and traditional self-training programs (respectively), with a large effect size. MAL (quantity) also improved significantly between pre- intervention to follow-up with medium-large effect size.

Conclusions: UE functional improvement can be achieved by self-training at the chronic stage and, therefore, should be encouraged by clinicians.

• Implications for rehabilitation

• Video-games or traditional self-training programs can be used to practice repetitive UE movements without the supervision of a clinician

• Self-training of the UE is beneficial at the chronic stage post-stroke and, therefore, should be encouraged

• The type of self-training (video-games or traditional) should be suited to the client's abilities and preferences.

• The compliance of self-training using video-games during the follow-up period was higher than the traditional self-training. This is important since self-training programs for chronic stroke need to be long-term and sustainable.

     

Reducing Risk of Falling in Older People Discharged From Hospital: A Randomized Controlled Trial Comparing Seated Exercises, Weight-Bearing Exercises, and Social Visits

Vogler CM, Sherrington C, Ogle SJ, Lord SR. Reducing risk of falling in older people discharged from hospital: a randomized controlled trial comparing seated exercises, weight-bearing exercises, and social visits.

Objective

To compare the efficacy of seated exercises and weight-bearing (WB) exercises with social visits on fall risk factors in older people recently discharged from hospital.

Design

Twelve-week randomized, controlled trial.

Setting

Home-based exercises.

Participants

Subjects (N=180) aged 65 and older, recently discharged from hospital.

Interventions

Seated exercises (n=60), WB exercises (n=60), and social visits (n=60).

Main Outcome Measures

Primary outcome factors were Physiological Profile Assessment (PPA) fall risk score, and balance while standing (Coordinated Stability and Maximal Balance Range tests). Secondary outcomes included the component parts of the PPA and other physical and psychosocial measures.

Results

Subjects were tested at baseline and at completion of the intervention period. After 12 weeks of interventions, subjects in the WB exercise group had significantly better performance than the social visit group on the following: PPA score (P=.048), Coordinated Stability (P<.001), Maximal Balance Range (P=.019); body sway on floor with eyes closed (P=.017); and finger-press reaction time (P=.007) tests. The seated exercise group performed better than the social visit group in PPA score (P=.019) but for no other outcome factor. The seated exercise group had the highest rate of musculoskeletal soreness.

Conclusions

In older people recently discharged from the hospital, both exercise programs reduced fall risk score in older people. The WB exercises led to additional beneficial impacts for controlled leaning, reaction time, and caused less musculoskeletal soreness than the seated exercises.