Sensorimotor impairments of paretic upper limb correlates with activities of daily living in subjects with chronic stroke

The  main objective  of  this  study  was  to  investigate  the correlations  between sensorimotor  impairments  of  paretic  upper  limb  and the  hand  functions of  activities of daily  living  (ADLs)  scores  in  persons  with chronic stroke.This is a cross-sectional  study  with  19  chronic  stroke  survivors.  Hand function was measured by the Jebsen-Taylor Hand Function Test (JTHFT). Impairments in upper extremity motor function were measured by upper limb items  of  Fugl-Meyer  Assessment  (FMA-UE).  Forearm  muscles  strength, handgrip  and  pinch  grip  power  were  assessed  using  handheld  dynamo-meters. Tactile sensation threshold was measured by monofilaments.Significant differences were found between the affected and unaffected side in the total JTHFT scores, forearm muscle strength, handgrip and pinch grip (p≤0.017), but not the tactile sensa-tion threshold.  The total JTHFT scores were found to be correlated with total score of FMA-UE (rs = -0.789), hand-grip  power  (rs = -0.588) and pinch grip power (rs = -0.657) on the affected side, but not the tactile sensation. The total JTHFT scores were correlated with FMA-UE scores, handgrip and pinch grip of the affected side.  This is the first study in documenting the correlation between the sensorimotor impairments and JTHFT scores in persons with  chronic stroke. Our findings highlights the importance of including upper limb and grip strength training in stroke rehabilitation program in order to improve hand functions in activities of daily living in patients with chronic stroke

Reliability and convergent validity of the five-step test in people with chronic stroke

Objectives: (i) To estimate the intra-rater, inter-rater and test-retest reliabilities of the Five-Step Test (FST), as well as the minimum detectable change in FST completion times in people with stroke. (ii) To estimate the convergent validity of the FST with other measures of stroke-specific impairments. (iii) To identify the best cut-off times for distinguishing FST performance in people with stroke from that of healthy older adults. Design: A cross-sectional study. Setting: University-based rehabilitation centre. Participants: Forty-eight people with stroke and 39 healthy controls. Interventions: None. Main outcome measures: The FST, along with (for the stroke survivors only) scores on the Fugl-Meyer Lower Extremity Assessment (FMA-LE), the Berg Balance Scale (BBS), Limits of Stability (LOS) tests, and Activities-specific Balance Confidence (ABC) scale were tested. Results: The FST showed excellent intra-rater (intra-class correlation coefficient; ICC = 0.866–0.905), inter-rater (ICC = 0.998), and test-retest (ICC = 0.838–0.842) reliabilities. A minimum detectable change of 9.16 s was found for the FST in people with stroke. The FST correlated significantly with the FMA-LE, BBS, and LOS results in the forward and sideways directions (r = –0.411 to –0.716, p < 0.004). The FST completion time of 13.35 s was shown to discriminate reliably between people with stroke and healthy older adults. Conclusion: The FST is a reliable, easy-to-administer clinical test for assessing stroke survivors’ ability to negotiate steps and stairs

The effects of an activity-based lifestyle intervention on moderate sleep complaints among older adults: study protocol for a randomized controlled trial

Abstract Background Moderate sleep complaints are major gerontological issue affecting as many as 80% of older adults. More intriguing findings have indicated that moderate sleep complaints were associated with cognitive decline, functional deterioration, clinical depression, and even morbidity and mortality among older adults. The aim of this study is to evaluate the effects of an activity-based lifestyle intervention on moderate sleep complaint among community-dwelling older adults. Methods/Design This sequential quantitative–qualitative mixed method study will randomly allocate 224 individuals to receive either the 16-week group-based moderate-intensity stepping exercise or 16-week health education. The exercise group receives three 60-min stepping exercises per week, whereas the education group receives weekly educative talks on health topics other than sleep. The primary outcomes are sleep quality as measured by the Pittsburgh Sleep Quality Index (PSQI) and sleep pattern as measured by the actiwatch. Physical fitness and mood status are measured as mediating variables by using the Rockport walking test and Profile of Mood States. The qualitative part will invite 30 individuals from the exercise group who have different sleep-related treatment responses to participate in individual interviews to explore their overall perception of using stepping exercise as a lifestyle intervention to improve sleep. Mixed effects model with intention-to-treat analysis will be used for quantitative data. Inductive thematic analysis with a prior coding framework will be used for the qualitative data. Discussion By investigating the effects and the mediating mechanism of a moderate-intensity exercise program on moderate sleep complaints among older adults, this study will generate evidence of high scientific value and important public health implication. Understanding the sleep-promoting effects and acceptability of exercise informs how to apply lifestyle promotion as a public health practice to improve late-life moderate sleep complaints and forestall its progression to level of clinical severity. Trial registration Clinical Trial Registry Team, Center for Clinical Research and Biostatistics CUHK, CCRB00491 . Registered on 1 December 2015

An exploration of the use of visually appealing contexts in a pain management program

Purpose: Pleasant pictures can help to reduce stress, promote positive feelings, and even facilitate recovery from diseases. Visual stimulation is an approach of distraction that can effectively reduce pain thresholds and increase pain tolerances. The number of older adults who suffer from pain has increased due to age-related diseases. Technology is increasingly being applied to the management of acute pain. The pain situation among older people was explored in this study, and a visually appealing pain management program was designed with the participants’ experiences in mind. Methods: This was a descriptive observational study. Participants were recruited from local nursing homes. Results: A total of 165 older adults joined the study. The mean age of the participants was 85.6. More female than male participants experienced pain and the intensity of their pain was significantly greater. The results showed no significant differences in pain interferences between males and females. The participants stated that photographs of family members, homes, and natural scenery made them feel relaxed and happy, and reminded them of past happy times. They preferred to view those visually appealing pictures using digital devices (iPad/iPhone) to seeing hard copy versions. Conclusion: A digital-based pain management program using visually appealing contexts for older adults can be implemented. The patients’ experiences were collected and will be considered when developing a future program

Effects of play activities program for nursing home residents with dementia on pain and psychological well-being:Cluster randomized controlled trial

Aim: The prevalence of chronic pain among nursing home residents with dementia is high. This present study aimed to explore the effectiveness of a play activities program among nursing home residents with dementia. Methods: Each nursing home was randomly assigned to an experimental group or control group. A 1-h play activities program was offered weekly for 8 weeks to the experimental group, whereas participants in the control group read books and magazines for 15 min weekly for the 8 weeks. Outcome measures were assessed at baseline, post-intervention (at week 8) and 4 weeks after the intervention. Results: A total of 53 nursing home residents from four nursing homes were recruited. There were significant treatment effects on pain, depression and happiness level when comparing the experimental group and control group. However, there were no treatment effects on activities of daily living, social engagement, behavioral symptoms and mobility between the two groups. Conclusion: The play activities program was useful in reducing pain and improving the psychological health of nursing home residents with dementia. Geriatr Gerontol Int 2018; 18: 1485–1490

Play activities program to relieve chronic pain and enhance functional mobility and psychological well-being for frail older adults: a pilot cluster randomized controlled trial

Chronic pain is common in frail older adults. Pain can alter psychological status, causing higher levels of loneliness and depression and lower levels of happiness and life satisfaction. Pain hinders functional mobility and activities of daily living, and frail older adults consequently participate less in social activities, resulting in a deterioration of physical health and quality of life. Play activities are widely used in children, and their therapeutic effects are well established. Benefits include better communication skills, social skills, and cognitive ability.Play activities are also effective in reducing fear and anxiety for hospitalized children4 and postsurgical pain in children.5The social effects of play activities may help to reduce pain.6Older adults living in nursing homes tend to be lonelier and more socially isolated than individuals of other ages, which places them at greater risk of negative consequences of pain. The literature on play activities for older adults is scanty, but the potential beneficial effects of play activities in this age group warrant investigation. It was therefore the aim of this study to explore the therapeutic effects of play activities on the physical and psychological health of frail older adults