Functional Strength Training and Movement Performance Therapy for upper limb recovery early post-stroke – efficacy, neural correlates, predictive markers and cost-effectiveness: FAST-INdiCATE trial

BackgroundVariation in physiological deficits underlying upper limb paresis after stroke could influence how people recover and to which physical therapy they best respond.ObjectivesTo determine whether functional strength training (FST) improves upper limb recovery more than movement performance therapy (MPT). To identify: (a) neural correlates of response and (b) whether pre-intervention neural characteristics predict response.DesignExplanatory investigations within a randomised, controlled, observer-blind, and multicentre trial. Randomisation was computer-generated and concealed by an independent facility until baseline measures were completed. Primary time point was outcome, after the 6-week intervention phase. Follow-up was at 6 months after stroke.ParticipantsWith some voluntary muscle contraction in the paretic upper limb, not full dexterity, when recruited up to 60 days after an anterior cerebral circulation territory stroke.InterventionsConventional physical therapy (CPT) plus either MPT or FST for up to 90 min-a-day, 5 days-a-week for 6 weeks. FST was “hands-off” progressive resistive exercise cemented into functional task training. MPT was “hands-on” sensory/facilitation techniques for smooth and accurate movement.OutcomesThe primary efficacy measure was the Action Research Arm Test (ARAT). Neural measures: fractional anisotropy (FA) corpus callosum midline; asymmetry of corticospinal tracts FA; and resting motor threshold (RMT) of motor-evoked potentials.AnalysisCovariance models tested ARAT change from baseline. At outcome: correlation coefficients assessed relationship between change in ARAT and neural measures; an interaction term assessed whether baseline neural characteristics predicted response.Results288 Participants had: mean age of 72.2 (SD 12.5) years and mean ARAT 25.5 (18.2). For 240 participants with ARAT at baseline and outcome the mean change was 9.70 (11.72) for FST + CPT and 7.90 (9.18) for MPT + CPT, which did not differ statistically (p = 0.298). Correlations between ARAT change scores and baseline neural values were between 0.199, p = 0.320 for MPT + CPT RMT (n = 27) and −0.147, p = 0.385 for asymmetry of corticospinal tracts FA (n = 37). Interaction effects between neural values and ARAT change between baseline and outcome were not statistically significant.ConclusionsThere was no significant difference in upper limb improvement between FST and MPT. Baseline neural measures did not correlate with upper limb recovery or predict therapy response.Trial registrationCurrent Controlled Trials: ISRCT 19090862, http://www.controlled-trials.co

Sensory Integration for Postural Control during Stance on Compliant Surfaces

Thesis (Ph.D.)--University of Washington, 2014Background. Both Sides Up (BOSU) balls are often used in sports rehabilitation as a form of `somatosensory training'. Memory foam is often used in neurologic rehabilitation as a method of disrupting the somatosensory systems' contributions to balance in order to enhance dependence on vision and vestibular input. Objectives. The purposes of this study were to quantify how much young adults depended on vision (via response to moving dots projected on a screen) and on somatosensory cues (via their response to bilateral brief Achilles tendon vibration) when standing on different surfaces. Methods. The responses of 30 healthy young adults (HEALTHY) were compared to the responses of 10 young adults with history of repeated ankle sprains (SPRAIN) when participants were standing on a firm surface, memory foam and a BOSU ball. The primary measures of visual dependence were: the ratio of body-sway amplitude at the visual frequency over all other sway peaks (Visual Amplitude Fraction [VAF]), and the estimated frequency of the peak of body-sway (EFP) amplitude. To quantify response to vibration we used traditional (Center of Pressure excursion) and nonlinear measures (Complexity Index). Results. In both groups, VAFs were significantly higher on the BOSU compared to floor or foam (P<0.001). The difference for EFP was significant (P<0.001) with clear matching of the stimulation frequency only on the BOSU. The excursion response to vibration was significantly different between the surfaces (P<0.001).We observed an increase in excursion when vibration was introduced on the floor, a smaller increase on the foam and a decrease on the BOSU. An increase in Complexity Index with vibration differed significantly between surfaces (P<0.001) and was larger on the foam and BOSU compared to floor. SPRAIN showed similar trends with overall decreased response to vibration compared to HEALTHY. Limitations. Our SPRAIN sample was small and heterogeneous. Training effects were not measured. Conclusions. Young adults with and without a history of ankle sprains strongly responded to the visual stimuli and appeared to use cues from vibration to stabilize themselves when standing on BOSU. The findings suggest that visual dependence increases and somatosensory integration decreases in stance on challenging compliant surfaces

Psychosocial factors associated with bulimia nervosa during pregnancy: An internal validation study

Objective The aim of this paper was to internally validate previously reported relations (Knoph Berg et al., Aust N Z J Psychiatry, 42, 396–404, 2008) between psychosocial factors and bulimia nervosa (BN) outcomes during pregnancy. Method This study is based on the Norwegian Mother and Child Cohort Study (MoBa) conducted by the Norwegian Institute of Public Health. Participants were women enrolled during pregnancy (N?=?69,030). Internal validity was evaluated by way of bootstrapped parameter estimates using the overall sample and a split sample calibration approach. Results Bootstrap bias estimates were below the problematic threshold, and extend earlier findings (Knoph Berg et al., Aust N Z J Psychiatry, 42, 396–404, 2008) by providing support for the validity of the models at the population level of all pregnant women in Norway. Bootstrap risk ratios indicated that prevalence, incidence, and remission of BN during pregnancy were significantly associated with psychosocial factors. The split sample procedure showed that the models developed on the training sample did not predict risks in the validation sample. Discussion This study characterizes associations between psychosocial exposures and BN outcomes among pregnant women in Norway. Women with lifetime and current self-reported psychosocial adversities were at a much higher risk for BN during pregnancy. Psychosocial factors were associated with BN remission during pregnancy, inviting the prospect of enhancing therapeutic interventions. We consider the findings in the context of reproducibility in science. © 2014 Wiley Periodicals, Inc. (Int J Eat Disord 2015; 48:654–662