Physical Therapy Tests in Stroke Rehabilitation

The purpose of this chapter is to present an overview of physical therapy tests used in stroke rehabilitation. The rationale for using tests in perspective of evidence based medicine and the classification of function, introduced by the World Health Organization will also be discussed. Furthermore, the strength and weaknesses with qualitative and quantitative tests are presented and prerequisites for tests in general are discussed. Finally, three tables presenting current valid tests in stroke rehabilitation, in relation to the three levels of the ICF model, are introduced. These tables are meant to give a visual of outcomes and which aspect of care that is being evaluated by the same. Stroke rehabilitation involves a process where the physical therapists, the rehabilitation team and the patient have to discuss goals and what future directions might be considered in view of the stroke event and its consequences. This process often means change, a change from the life one lead before the stroke incidence to a life with a reduced function; this reduction can be varying in degree. The rehabilitation process also involves an evaluation of the clinical condition, planning of a treatment and evaluating the result of treatment. The 14th general meeting of the World Confederation for Physiotherapy (WCPT) defined the profession and the process as follows: “The nature of physical therapy is providing services to people and populations to develop, to maintain and to restore maximum movement and functional ability throughout the lifespan. Physical therapy includes the provision of services in circumstances where movement and function are threatened by the process of aging or that of injury or disease. Full and functional movements are at the heart of what it means to be healthy “. Furthermore: “The nature of the physical therapy process is the service only provided by, or under the direction and supervision of a physical therapist and includes assessment, diagnosis, planning, intervention and evaluation” (World Confederation for Physical Therapy, 2009). There are different ways of evaluating clinical conditions and interventions. Interviews and observation / clinical observation are two important methods (Domholdt 2000). Testing / measuring function is another method. Ideally, the assessment process involves all three; an interview, where the patient´s perceptions of the main problems are at focus, observations of performance, and tests of performance followed by a process of interpreting the information into goals, a treatment plan and continuously evaluate outcome throughout the intervention process (Wade 1992)

Functional Exercise and Physical Fitness Post Stroke: The Importance of Exercise Maintenance for Motor Control and Physical Fitness after Stroke

It is argued that all stroke patients, indifferent of disability, have the same possibility to improve with training. The aim of the study was to follow and register functional improvements in two groups with different functional capacities at baseline for a period of 36 months. Stroke patients were recruited and divided into groups related to their functional status at baseline. During the acute rehabilitation, both groups received functional task-oriented training, followed by regular self- or therapeutic driven training the first year after stroke and varied exercise patterns the following 24 months. The participants were tested on admission, and at three, six, twelve, and thirty-six months after the onset of stroke. Both groups improved functional activity up to six months which then stabilized up to twelve months to decline somewhat at thirty-six months after stroke. Change scores indicate a greater potential for rehabilitation in the MAS ≤35 in relation to group MAS >35 although the functional capacity was higher in the latter. This indicates the importance of maintaining exercise and training for all persons after stroke

Behavioural disturbances in patients with frontotemporal lobe degeneration focusing on caregiver burden at home and in nursing homes.

Aim and objective To explore the challenges faced by family caregivers of people with frontotemporal dementia and other forms of dementia affecting the frontal and temporal lobes causing behavioural disturbances through a qualitative approach with in‐depth interviews. Background Studies of different forms of dementia involving degeneration of the frontal and temporal lobes have mainly focused on the neurophysiology and physiology of the disease and on caregivers’ health. Few studies have described the challenges and burdens connected with everyday life and in relation to suitable nursing home placement that are faced by family caregivers. Method and design This study used a descriptive and explorative design. Eleven semi‐structured interviews with family caregivers of patients from special units in four nursing homes were conducted in 2014. Data were analysed based on Kvale and Brinkmann's three contexts of interpretation: self‐understanding, common sense and theoretical understanding. Checklist for qualitative studies: Standards for Reporting Qualitative Research (SRQR) http://www.equator-network.org/reporting-guidelines/srqr/ Results Two central themes were derived from the data: changes in behaviour and personality were perceived as incomprehensible, frightening and increasingly difficult to manage. Family caregivers experienced challenges in finding suitable care facilities when they were not able to continue providing home care. Due to behavioural disturbances and lack of relevant competencies among health personnel, family members were often moved between nursing homes. Conclusion Pronounced personality and behavioural disturbances such as tactlessness and aggression in a family member with dementia are experienced by caregivers as stressful and burdensome and may lead to feelings of shame and guilt. A lack of suitable care facilities adds to the stress and difficulties of the families and entails an additional and unresolved burden. Relevance to Clinical Practice The study reveals a need for more knowledge among those organising health services as well as healthcare professional dealing with this patient category to ease the burden on next of kin.publishedVersio

Professional thinking in Individual Plan processes

This article explores the kind of critical and reflective thinking taht influences the social and health care professionals in the Individual Plan process. An inter-professional group of six healthcare and social researchers collected the data, which consisted of indepth interviews with 12 service providers who were the clients´ coordinators and one day centre leader. By focusing on reflective thinking in a critical perspective, it is concluded that coordinators are guided by different philosophical and theoretical perspectives in this process; a mixture of reasoning strategies, caring as a relational concept and a mixture of philosophical frameworks. To improve critical thinking in Individual Plan processes, coordinators need to be conscious about their way of thinking in action

Working with Individual Plans: users' perspectives on the challenges and conflicts of users' needs in health and social services

In Norway, an Individual Plan (IP) is a statutory right and a tool for cooperation between the client in need of long-term, coordinated services and the public services. This study analyses the explicit needs of users, how the various actors in the IP process met these needs, as seen from the users’ perspective, and, finally, how disability influenced the outcomes. Participants expressed physical, psychological and social needs. These needs were similar for persons with physical or psychiatric health conditions, or for persons with an innate or acquired disability. However, time elapsed since a disability had been acquired did make a difference. The municipality or district of residence, the administrative and legislative boundaries, the interpretation of those and the coordinators’ position within the hierarchy of the system all affected how well users’ needs were met, indicating the existence of tension. This tension between the external conditions or framework of services and user participation may be an explanatory factor for the slow implementation of IP

A multicenter study on transfer, walking and stair climbing in persons with stroke admitted to specialized rehabilitation

Background: Walking on even surface and stair walking capacity are prerequisites for independence, and these capacities are often referred to as primary goals in rehabilitation after stroke

Specialized stroke rehabilitation services in seven countries

Background There is a lack of defined levels of rehabilitation, indicating possibly random content and access to specialized services. Aims and/or hypothesis The aim of the study was to perform a multinational descriptive study of specialized rehabilitation in persons with stroke, to elucidate what the different centers define as prerequisites for specialized rehabilitation, and to analyze whether these descriptions map to currently applied standards or constructs of specialized rehabilitation. A secondary aim was to look for similarities and differences between therapies and services for persons with stroke in the sub-acute stage in the different institutions. Methods Descriptive data of the collaborating centers regarding structure and processes of services were recorded and compared with the British Society of Rehabilitation Medicine and Specialized Services National Definitions sets. Results Comparisons of the definitions

Clinical Study Functional Exercise and Physical Fitness Post Stroke: The Importance of Exercise Maintenance for Motor Control and Physical Fitness after Stroke

It is argued that all stroke patients, indifferent of disability, have the same possibility to improve with training. The aim of the study was to follow and register functional improvements in two groups with different functional capacities at baseline for a period of 36 months. Stroke patients were recruited and divided into groups related to their functional status at baseline. During the acute rehabilitation, both groups received functional task-oriented training, followed by regular self-or therapeutic driven training the first year after stroke and varied exercise patterns the following 24 months. The participants were tested on admission, and at three, six, twelve, and thirty-six months after the onset of stroke. Both groups improved functional activity up to six months which then stabilized up to twelve months to decline somewhat at thirty-six months after stroke. Change scores indicate a greater potential for rehabilitation in the MAS ≤35 in relation to group MAS >35 although the functional capacity was higher in the latter. This indicates the importance of maintaining exercise and training for all persons after stroke

The Norwegian General Motor Function assessment as an outcome measure for a frail elderly population: A validity study

Aim To establish the validity of the Norwegian General Motor Function (NGMF) assessment scale. Method To establish construct and criteria validity, Spearman's rank correlation coefficients were calculated for the NGMF, and age, sex, medical conditions, history of falls and to four functional tests. Content validity was evaluated by asking participating physiotherapists about the usefulness of the items in the scale. Absolute reliability was evaluated by establishing the standard error of measurement and the minimal detectable change at the 95% level of confidence for total scores of the NGMF subscales for dependence, pain and insecurity. Results Construct validity was established to medical status and medication with subscales dependence and insecurity but not to subscale pain. Criterion validity was established between the NGMF subscales dependence, pain and insecurity, and the Barthel Index, the Falls Efficacy Scale to subscales dependence and insecurity, but not with pain, and the Timed Up-and-Go test, to subscale insecurity. Neither the Chair Stand Test nor registered falls were significantly associated with any of the subscales of the NGMF. Content validity of the NGMF was perceived relevant to work in a geriatric setting and as a communication tool for a multidisciplinary team. Minimal detectable change was calculated for dependence (2.76), pain (4.9) and insecurity (6.1), respectively. Conclusion The construct, criteria and content validity of the NGMF was establishe