Purpose—The aim of this guideline is to provide a synopsis of best clinical practices in the rehabilitative care of adults recovering from stroke. Methods—Writing group members were nominated by th...

Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association

:Rationale:Many Americans live with physical functional limitations stemming from stroke These functional limitations can be reduced by task-specific training that is repetitive, motivating, and augmented with feedback Virtual reality (VR) is reported to offer an engaging environment that

Feasibility of using the Sony PlayStation 2 gaming platform for an individual poststroke: a case report.

Background
Acquired brain injury (ABI) is the main cause of death and disability among young adults. In most cases, survivors can experience balance instability, resulting in functional impairments that are associated with diminished health-related quality of life. Traditional rehabilitation therapy may be tedious. This can reduce motivation and adherence to the treatment and thus provide a limited benefit to patients with balance disorders. We present eBaViR (easy Balance Virtual Rehabilitation), a system based on the Nintendo® Wii Balance Board® (WBB), which has been designed by clinical therapists to improve standing balance in patients with ABI through motivational and adaptative exercises. We hypothesize that eBaViR, is feasible, safe and potentially effective in enhancing standing balance.

/pdf/effectiveness-of-a-wii-balance-board-based-system-ebavir-for-2k9ud067tt.pdf

Effectiveness of a Wii balance board-based system (eBaViR) for balance rehabilitation: a pilot randomized clinical trial in patients with acquired brain injury

Objective: To investigate the frequency of somatosensory impairment in stroke patients within different somatosensory modalities and different body areas, and their recovery.Design: Prospective observational study.Setting: Two stroke rehabilitation units.Subjects: Seventy patients with a first stroke (36 men, 34 women; average age, 71, SD 10.00 years; average time since stroke onset, 15 days) were assessed on admission and two, four and six months after stroke.Interventions: Not applicable.Main measure: Nottingham Sensory Assessment.Results: Somatosensory impairment was common after stroke; 7—53% had impaired tactile sensations, 31—89% impaired stereognosis, and 34—64% impaired proprioception. When comparing somatosensory modalities within body areas the kappa values were low (kappa values <0.54). Recovery occurred over time, though not significantly in lower limb tactile sensations. Stroke severity was the main factor influencing initial somatosensory impairment, but accounted for a small amount of the v...

Somatosensory impairment after stroke: frequency of different deficits and their recovery

Background and Purpose— Shoulder pain is a well-known complication after stroke, but data on prevalence, predictors, and outcome in unselected stroke populations are limited. Methods— During a 1-ye...

Shoulder pain after stroke : A prospective population-based study

Background and Purpose. Balance disability is common after stroke, but there is little detailed information about it. The aims of this study were to investigate the frequency of balance disability; to characterize different levels of disability; and to identify demographics, stroke pathology factors, and impairments associated with balance disability.

Subjects. The subjects studied were 75 people with a first-time anterior circulation stroke; 37 subjects were men, the mean age was 71.5 years (SD=12.2), and 46 subjects (61%) had left hemiplegia.

Methods. Prospective hospital-based cross-sectional surveys were carried out in 2 British National Health Service trusts. The subjects’ stroke pathology, demographics, balance disability, function, and neurologic impairments were recorded in a single testing session 2 to 4 weeks after stroke.

Results. A total of 83% of the subjects (n=62) had a balance disability; of these, 17 (27%) could sit but not stand, 25 (40%) could stand but not step, and 20 (33%) could step and walk but still had limited balance. Subjects with the most severe balance disability had more severe strokes, impairments, and disabilities. Weakness and sensation were associated with balance disability. Subject demographics, stroke pathology, and visuospatial neglect were not associated with balance disability.

Discussion and Conclusion. Subjects with the most severe balance disability had the most severe strokes, impairments, and disabilities. Subject demographics, stroke pathology, and visuospatial neglect were not associated with balance disability. [Tyson SF, Hanley M, Chillala J, et al. Balance disability after stroke. Phys Ther . 2006;86:30–38.]

Balance disability after stroke

Objective: To characterize the nature of sensory impairments
after stroke, identify associated factors, and assess the relationships
between sensory impairment, disability, and recovery.
Methods: Prospective cross-sectional survey of 102 people with
hemiparesis following their first stroke. Tactile and proprioceptive
sensation in the affected arm and leg were measured using
the Rivermead Assessment of Somatosensory Perception 2-4
weeks post-stroke. Demographics, stroke pathology, weakness,
neglect, disability, and recovery were documented. Results:
Tactile impairment was more common than proprioceptive (p <
.000), impairment of discrimination was more common than
detection (p < .000), and tactile sensation was more severely
impaired in the leg than the arm (p < .000). No difference in
proprioception between the arm and leg (p = .703) or between
proximal and distal joints (p = .589, p = .705) was found. The
degree of weakness and the degree of stroke severity were significantly
associated with sensory impairment; demographics,
stroke side and type, and neglect were not associated.All the sensory
modalities were significantly related to independence,
mobility, and recovery (r = 0.287 [p < .011] to r = 0.533 [p <
.000]). Conclusion: Sensory impairments of all modalities are
common after stroke, although tactile impairment is more frequent
than proprioceptive loss, especially in the leg. They are
associated with the degree of weakness and the degree of stroke
severity but not demographics, stroke pathology, or neglect, and
they are related to mobility, independence in activities of daily
living (ADL), and recovery.

/pdf/sensory-loss-in-hospital-admitted-people-with-stroke-48baqj5y9u.pdf

Sensory loss in hospital-admitted people with stroke: characteristics, associated factors, and relationship with function.

Objective. To examine the influence of balance disability on function and the recovery of function after stroke and consequently to assess the predictive validity of the Brunel Balance Assessment (BBA). Methods. Cross-sectional study of 102 patients admitted consecutively to 6 National Health Service hospitals with weakness 2 to 4 weeks after their first anterior circulation stroke; 75 of whom completed follow-up assessment at 3 months. The BBA was assessed during admission and compared to the Barthel Index and Rivermead Mobility Index at 3 months. Results. Balance disability was the strongest predictor of function (in terms of activities of daily living [ADLs] and mobility disability) in the acute stages. Weakness was also an independent predictor. Recovery of ADLs was independently predicted by balance disability, weakness, age, and premorbid disability, whereas recovery of mobility disability was predicted by balance and age alone. At 3 months, a minority of people with limited sitting balance (0%-22%) and standing balance (25%-50%) recovered independent functional mobility. Most people who could walk initially recovered independent functional mobility (66%-84%), but 16% suffered a decline in their mobility and 44% had enduring limitations in everyday mobility activities. Conclusion. Initial balance disability is a strong predictor of function and recovery after stroke. These results demonstrate the predictive validity of the BBA.

https://journals.sagepub.com/doi/pdf/10.1177/1545968306296966

The relationship between balance, disability, and recovery after stroke: predictive validity of the Brunel Balance Assessment.

Objective. To assess the distribution of weakness in the upper and lower limbs post-stroke and the factors associated with weakness. Method. The design was a prospective cross-sectional survey. A consecutive sample of 75 patients (37 (49%) men, mean age 71.5 (SD 12.2) years, 46 (61%) left hemiplegics) with a first-time anterior-circulation stroke, tested 2‐4 weeks poststroke, were recruited from two NHS trusts. Main outcome measures. Weakness (Motricity Index, MI). Results. Mean MI score was 58.5 (SD 39.6) and 69.1 (SD 33.6) for the upper and lower limb (p50.001), but examination of individual data indicated 36 (48%) had no/ negligible difference (0 þ/7 9 points) in MI score between the limbs. When there was a difference, the lower limb was more frequently the stronger. There was no significant difference between the proximal and distal joints in either limb (p50.217 and 0.410). Severity of weakness was not associated with the subjects’ demographics or stroke pathology, but was associated with neglect and sensation. Conclusions. Although group analysis showed that the leg was significantly stronger than the arm, individual analysis showed that most participants had a similar degree of weakness in both limbs. When there was a difference, the lower limb was more frequently the stronger. Proximal joints were not more severely affected than distal joints. Patient demographics and stroke pathology factors were not associated with weakness, but stroke-related impairments were.

Jay Chillala

Papers

Balance disability after stroke

Sensory loss in hospital-admitted people with stroke: characteristics, associated factors, and relationship with function.

The relationship between balance, disability, and recovery after stroke: predictive validity of the Brunel Balance Assessment.

Distribution of weakness in the upper and lower limbs post-stroke

Quality of medical care in British care homes.