Objectives: To compare the reliability, validity, and responsiveness of the motor subscale of the functional independence measure (FIM), the original 10 item Barthel index (BI), and the 5 item short form BI (BI-5) in inpatients with stroke receiving rehabilitation. Methods: 118 inpatients with stroke at a rehabilitation unit participated in the study. The patients were tested with the FIM motor subscale and original BI at admission to the rehabilitation ward and before discharge from the hospital. The distribution, internal consistency, concurrent validity, and responsiveness of each measure were examined. Results: The BI and FIM motor subscale showed acceptable distribution, high internal consistency (α coefficient ≥ 0.84), high concurrent validity (Spearman's correlation coefficient, rs ≥ 0.92, intraclass correlation coefficient (ICC) ≥ 0.83), and high responsiveness (standardised response mean ≥ 1.2, p < 0.001). The BI-5 exhibited a notable floor effect at admission but this was not found at discharge. The BI-5 showed acceptable internal consistency at admission and discharge (α coefficient ≥ 0.71). The concurrent validity of the BI-5 was poor to fair at admission (rs = 0.74, ICC ≤ 0.55) but was good at discharge (rs ≥ 0.92, ICC ≥ 0.74). It is noted that the responsiveness of the BI-5 was as high as that of the BI and the FIM motor subscale. Conclusions: The results showed that the BI and FIM motor subscale had very acceptable and similar psychometric characteristics. The BI-5 appeared to have limited discriminative ability at admission, particularly for patients with severe disability; otherwise the BI-5 had very adequate psychometric properties. These results may provide information useful in the selection of activities of daily living measures for both clinicians and researchers.

Comparison of the Psychometric Characteristics of the Functional Independence Measure, 5 Item Barthel Index, and 10 Item Barthel Index in Patients with Stroke

Stroke can lead to significant impairment of upper limb function which affects performance of activities of daily living (ADL). Functional electrical stimulation (FES) involves electrical stimulation of motor neurons such that muscle groups contract and create or augment a moment about a joint. Whilst lower limb FES was established in post-stroke rehabilitation, there is a lack of clarity on the effectiveness of upper limb FES. This systematic review aims to evaluate the effectiveness of post-stroke upper limb FES on ADL and motor outcomes. Systematic review of randomised controlled trials from MEDLINE, PsychINFO, EMBASE, CENTRAL, ISRCTN, ICTRP and ClinicalTrials.gov. Citation checking of included studies and systematic reviews. Eligibility criteria: participants > 18 years with haemorrhagic/ischaemic stroke, intervention group received upper limb FES plus standard care, control group received standard care. Outcomes were ADL (primary), functional motor ability (secondary) and other motor outcomes (tertiary). Quality assessment using GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria. Twenty studies were included. No significant benefit of FES was found for objective ADL measures reported in six studies (standardised mean difference (SMD) 0.64; 95% Confidence Interval (CI) [−0.02, 1.30]; total participants in FES group (n) = 67); combination of all ADL measures was not possible. Analysis of three studies where FES was initiated on average within 2 months post-stroke showed a significant benefit of FES on ADL (SMD 1.24; CI [0.46, 2.03]; n = 32). In three studies where FES was initiated more than 1 year after stroke, no significant ADL improvements were seen (SMD −0.10; CI [−0.59, 0.38], n = 35). Quality assessment using GRADE found very low quality evidence in all analyses due to heterogeneity, low participant numbers and lack of blinding. FES is a promising therapy which could play a part in future stroke rehabilitation. This review found a statistically significant benefit from FES applied within 2 months of stroke on the primary outcome of ADL. However, due to the very low (GRADE) quality evidence of these analyses, firm conclusions cannot be drawn about the effectiveness of FES or its optimum therapeutic window. Hence, there is a need for high quality large-scale randomised controlled trials of upper limb FES after stroke. PROSPERO: CRD42015025162
 , Date:11/08/2015

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Effectiveness of upper limb functional electrical stimulation after stroke for the improvement of activities of daily living and motor function: a systematic review and meta-analysis

The aim of this study was to determine whether non-invasive brain stimulation (NIBS) techniques improve fine motor performance in stroke. We searched PubMed, EMBASE, Web of Science, SciELO and OpenGrey for randomized clinical trials on NIBS for fine motor performance in stroke patients and healthy participants. We computed Hedges' g for active and sham groups, pooled data as random-effects models and performed sensitivity analysis on chronicity, montage, frequency of stimulation and risk of bias. Twenty-nine studies (351 patients and 152 healthy subjects) were reviewed. Effect sizes in stroke populations for transcranial direct current stimulation and repeated transcranial magnetic stimulation were 0.31 [95% confidence interval (CI), 0.08-0.55; P = 0.010; Tau2 , 0.09; I2 , 34%; Q, 18.23; P = 0.110] and 0.46 (95% CI, 0.00-0.92; P = 0.05; Tau2 , 0.38; I2 , 67%; Q, 30.45; P = 0.007). The effect size of non-dominant healthy hemisphere transcranial direct current stimulation on non-dominant hand function was 1.25 (95% CI, 0.09-2.41; P = 0.04; Tau2 , 1.26; I2 , 93%; Q, 40.27; P < 0.001). Our results show that NIBS is associated with gains in fine motor performance in chronic stroke patients and healthy subjects. This supports the effects of NIBS on motor learning and encourages investigation to optimize their effects in clinical and research settings.

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Non-invasive brain stimulation for fine motor improvement after stroke: a meta-analysis.

Introduction It remains unclear whether patients presenting with large vessel occlusion strokes and mild symptoms benefit from thrombectomy. Objective To compare outcomes of endovascular therapy versus medical management in patients with large vessel occlusion strokes and National Institute of Health Stroke Scale (NIHSS) score ≤5. Methods This was a retrospective analysis combining two large prospectively collected datasets including patients with (1) admission NIHSS score ≤5, (2) premorbid modified Rankin Scale (mRS) score 0–2, and (3) middle cerebral-M1/M2, intracranial carotid, anterior cerebral or basilar artery occlusions. Groups receiving (1) endovascular treatment and (2) medical management were compared. The primary and secondary outcome measures were NIHSS shift (discharge NIHSS minus admission NIHSS) and the rates of mRS 0–2 at discharge and 3–6 months, respectively. Univariate, multivariate, and matched analyses were performed. Results Eighty-eight patients received medical management and 30 thrombectomy. Multivariable analysis indicated thrombectomy was the only predictor of favorable NIHSS shift (β −3.7, 95% CI −6.0 to −1.5, p=0.02), as well as independence at discharge (β −21.995% CI −41.4to −20.8, p Conclusion In patients presenting with minimal stroke symptoms (NIHSS score ≤5) and large vessel occlusion strokes, mechanical thrombectomy appears to be associated with a favorable shift of NIHSS at discharge, as well as higher rates of independence at discharge and long-term follow-up. Confirmatory prospective studies are warranted.

https://jnis.bmj.com/content/neurintsurg/10/4/325.full.pdf

Thrombectomy versus medical management for large vessel occlusion strokes with minimal symptoms: an analysis from STOPStroke and GESTOR cohorts

Background and purpose After stroke, only 12% of survivors obtain complete upper limb (UL) functional recovery, while in 30% to 60% UL deficits persist. Despite the complexity of the UL, prior robot-mediated therapy research has used only one robot in comparisons to conventional therapy. We evaluated the efficacy of robotic UL treatment using a set of 4 devices, compared with conventional therapy. Methods In a multicenter, randomized controlled trial, 247 subjects with subacute stroke were assigned either to robotic (using a set of 4 devices) or to conventional treatment, each consisting of 30 sessions. Subjects were evaluated before and after treatment, with follow-up assessment after 3 months. The primary outcome measure was change from baseline in the Fugl-Meyer Assessment (FMA) score. Secondary outcome measures were selected to assess motor function, activities, and participation. Results One hundred ninety subjects completed the posttreatment assessment, with a subset (n = 122) returning for follow-up evaluation. Mean FMA score improvement in the robotic group was 8.50 (confidence interval: 6.82 to 10.17), versus 8.57 (confidence interval: 6.97 to 10.18) in the conventional group, with no significant between-groups difference (adjusted mean difference -0.08, P = 0.948). Both groups also had similar change in secondary measures, except for the Motricity Index, with better results for the robotic group (adjusted mean difference 4.42, P = 0.037). At follow-up, subjects continued to improve with no between-groups differences. Discussion and conclusions Robotic treatment using a set of 4 devices significantly improved UL motor function, activities, and participation in subjects with subacute stroke to the same extent as a similar amount of conventional therapy. Video Abstract is available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A291).

Upper Limb Robotic Rehabilitation After Stroke: A Multicenter, Randomized Clinical Trial.

The aim of this study is to compare the time-course changes in neurologic impairments (trunk control, motor function, sensory, and cognition) and recovery in functional impairments (activity of daily livings and gait) simultaneously from initiating rehabilitation to 6 months after stroke. Consecutive stroke patients were recruited from the department of nervous surgery, and transferred into the department of rehabilitation medicine and continued on treatment during the acute stage. Outcome measures were examined at the initial rehabilitation baseline, 1, 2, and 4 weeks after rehabilitation treatment, and 3, 4, 5, and 6 months after stroke. Patients were assessed using the Trunk Impairment Scale, the Fugl-Meyer Motor and Sensory Assessments for the upper and lower limbs, Mini-Mental State Examination, Functional Ambulation Category, and Modified Barthel Index. Twenty consecutive patients were analyzed in the study with complete assessments. The recovery was relatively rapid during the 4 weeks after treatment (P value ranges from <0.001 to <0.007) and then to a lesser extent decelerated between 3 and 6 months after stroke (P value between <0.001 and 0.080). Statistical comparison by repeated measures analysis showed a significant interaction between time points and measures of all recovery variables (P<0.001). Significant differences in level of impairments and functional recovery were found at the different time points. In comparison with the lower leg and trunk control, the upper arm showed less recovery, with a significant difference. All variables except for leg motor function improved continuously over 6 months after stroke. Nevertheless, this study confirms the importance of the period within 3 months for recovery after stroke, during which most of the recovery occurred, ranging from 48 to 91%. Therefore, intensive treatment targeting motor and sensory functions early after stroke may be beneficial for recovery of impairments and functional performance.

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Six-month functional recovery of stroke patients: a multi-time-point study.

OBJECTIVE This study aimed to investigate the effects of dual-task gait training using a treadmill on gait ability, dual-task interference, and fall efficacy in people with stroke. METHODS Patients with chronic stroke (N = 34) were recruited and randomly allocated to the experimental or control group. Both groups underwent gait training on a treadmill and a cognitive task. In the experimental group, gait training was conducted in conjunction with the cognitive task, whereas in the control group, the training and the cognitive task were conducted separately. Each intervention was provided for 60 minutes, twice a week, for a period of 6 weeks for both groups. The primary outcomes were as follows: gait parameters (speed, stride, variability, and cadence) under single-task and dual-task conditions, correct response rate (CRR) under single-task and dual-task conditions, and dual-task cost (DTC) in gait parameters and CRR. The secondary outcome was the Fall Efficacy Scale. RESULTS Dual-task gait training using a treadmill improved all gait parameters in the dual-task condition, speed, stride, and variability in the single-task condition, and CRR in both conditions. A difference between the groups was observed in speed, stride, and variability in the dual-task condition. Furthermore, dual-task gait training on a treadmill improved DTC in speed, variability, and cadence along with that in CRR, indicating true improvement of DTC, which led to significant improvement in DTC in speed and variability compared with single-task training. CONCLUSIONS Dual-task gait treadmill training was more effective in improving gait ability in dual-task training and dual-task interference than single-task training involving gait and cognitive task separately in people with chronic stroke.

Effects of Dual-Task Gait Treadmill Training on Gait Ability, Dual-Task Interference, and Fall Efficacy in People With Stroke: A Randomized Controlled Trial.

Reducing the compensatory mechanism by restraining unnecessary trunk movements may help enhance the effectiveness of robot-assisted therapy.This study aimed to investigate the effects of robot-assisted therapy in combination with trunk restraint on upper extremity function and on daily activities in patients with acute stroke (≤ 30days of onset).Thirty-six acute stroke patients were randomly assigned to an experimental (n=18) or control (n=18) group. The experimental group performed robot-assisted therapy combined with trunk restraint, while the control group performed only robot-assisted therapy. Both groups were treated for 30 min, 5 days a week, for a total of 3 weeks. The outcome measures included the Fugl-Meyer assessment upper extremity, wolf motor function test, motor activity log, upper extremity muscle strength, and modified Barthel index.After the intervention, both groups showed significant improvements in Fugl-Meyer assessment upper extremity, wolf motor function test, motor activity log, elbow extensor muscle strength, and modified Barthel index (p < 0.05). Post-intervention, the experimental group exhibited greater changes in the Fugl-Meyer assessment upper extremity, motor activity log, and elbow extensor muscle strength (p < 0.05).Our study suggests that robot-assisted therapy in combination with trunk restraint is more effective for improving upper extremity function than only robot-assisted therapy in acute stroke patients. 

Robot-Assisted Therapy Combined with Trunk Restraint in Acute Stroke Patients: A Randomized Controlled Study.

This study aimed to identify the effect of facilitating neutral foot position on balance and gait in patients with chronic stroke. Thirty-two patients with stroke were randomly assigned to a study group (n=16) and control group (n=16). The neutral foot position was facilitated in the study group, and the control group received general physical therapy. Treatment intervention was performed for 30 min a day, 3 times a week for 6 weeks. Patient performance was evaluated on the Berg balance scale, functional reach test, timed up and go test and 10-meter walk test, as well as in terms of weight distribution ratio and limits of stability. There were significant differences in limits of stability, timed up and go, and 10-meter walk test in the study group compared with the control group (p<0.05). Additionally, significant differences were found across all items of weight distribution, limits of stability, Berg balance scale, functional reach test, timed up and go and 10-meter walk test (p<0.05) after the intervention in the study group. It was proved that facilitating a neutral position of the foot is an effective intervention method in stabilizing posture and improving functional gait in patients with chronic stroke.

https://sciencescholar.us/journal/index.php/ijhs/article/download/14193/11339

facilitation of the neutral foot position on balance and gait in patients with chronic stroke

PURPOSE: Respiratory function can be adversely affected after a cerebrovascular accident. This study aimed to determine whether inspiratory muscle training (IMT) changes the respiration and balance abilities of patients with stroke.METHODS: Twelve patients with stroke were randomly assigned to the study (n=6) and control (n=6) groups. The study and control groups received IMT and general physical therapy, respectively for 6 weeks, five times a week for 30 min/day. Inspiratory and expiratory functions and balance were measured pre- and post-evaluation.RESULTS: After IMT intervention, the weight distribution ratio (WDR) for balance ability measurement was significantly decreased (p<.05), and the maximum inspiratory pressure (MIP), maximum inspiratory flow rate (MIFR), maximum inspiratory capacity (MIC), peak expiratory flow (PEF), forced expiratory volume in 1 second (FEV1), and limits of stability (LOS) were significantly increased in the study group (p<.05). A comparison of the study and control groups revealed statistically significant differences in MIP (p<0.01), MIFR (p<.01), MIC (p<.05), PEF (p<.05), FEV1 (p<.05), WDR (p<.01), and LOS (p<.05).CONCLUSIONS: This study suggests that IMT is a useful and effective exercise intervention for patients with stroke.

Woo Nam Chang

Papers

Six-month functional recovery of stroke patients: a multi-time-point study.

Effects of Dual-Task Gait Treadmill Training on Gait Ability, Dual-Task Interference, and Fall Efficacy in People With Stroke: A Randomized Controlled Trial.

Robot-Assisted Therapy Combined with Trunk Restraint in Acute Stroke Patients: A Randomized Controlled Study.

facilitation of the neutral foot position on balance and gait in patients with chronic stroke

Effects of Inspiratory Muscle Training on Respiration and Balance in Patients with Stroke: A Pilot Randomized Controlled Trial