Stance symmetry and sway after stroke

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Visual feedback after stroke with the balance performance monitor:Two single-case studies

Research over the past decade had indicated the effectiveness of visual feedback as a method of training stance symmetry and weight-transference after stroke. This study was carried out to assess the efficacy of the Balance Performance Monitor (BPM) in providing feedback. A reversal ABAB single-case experimental design was used with two patients at different stages poststroke. Assessments of motor function and independence in functional tasks (ADL) were made, as well as the measures of stance symmetry. The results indicated large improvements in symmetry, with both patients achieving levels within the normal range after five treatments. Functional skills also improved. Although the limitations of single-case studies are recognized, such dramatic improvements suggest that the BPM is an effective method of providing feedback and that this approach to treatment enhances the effects of physiotherapy and could be used more frequently after stroke

Physiotherapy treatment for stroke patients:A survey of current practice

Current approaches to the treatment of stroke patients by senior physiotherapists in the Trent Region of the UK were surveyed. Familiarity with other approaches, the choice of assessment method, the use of standards and the use of aids and appliances were also recorded. Semi-structured interviews were conducted with a sample of the respondents and a vignette presented to gain detailed information. Altogether, 121 senior therapists were identified, of whom 91 (75%) responded. The 'Bobath' approach was the most frequently used approach, being reported by 80% of the respondents. The 'functional approach' and the 'motor learning approach' were favoured by 10 and 4%, respectively. The reason for choosing a particular approach was put down to experience gained through practice, not the use of published research results. As in previous studies in Sweden and Australia, the physiotherapists found it difficult to describe a theoretical basis for their treatment. The regular use of a published standardised assessment was rare. Reticence in the use of standardised published measures and a reluctance to provide a theoretical basis for intervention limit the development of neurological physiotherapy. Comparison of centres using different approaches was not considered possible

Towards a programme theory for fidelity in the evaluation of complex interventions.

Rationale, aims and objectives: This paper addresses the challenge of investigating fidelity in the implementation of a complex rehabilitation intervention designed to increase the level of independence in personal activities of daily living of stroke patients living in UK care homes. A programme theory of intervention fidelity was constructed to underpin a process evaluation running alongside a cluster randomized trial of the rehabilitation intervention. Methods: The programme theory has been constructed drawing on principles of realist evaluation. Using data from in-depth semi-structured interviews (n = 17) with all occupational therapists (OTs) and critical incident reports from the trial (n = 20), and drawing from frameworks for implementation, the programme theory was developed. Results: The programme theory incorporates four potential mechanisms through which fidelity within the trial can be investigated. These four programme theory areas are (1) the balancing of research and professional requirements that therapists performed in a number of areas while delivering the study interventions; (2) the OTs rapport building with care home staff; (3) the work focused on re-engineering the personal environments of care home patients; and (4) the learning about the intervention within the context of the trial and its impacts over time. Conclusions: These findings characterize the real-world nature of fidelity within intervention research, and specifically the negotiated nature of implementation within clinical settings, including individual patients' needs. This research adds to the evidence base because current frameworks for fidelity neglect the importance of learning over time of individuals and across the time span of a trial

Stepping to an Auditory Metronome Improves Weight-Bearing Symmetry in Post-Stroke Hemiparesis

Asymmetry in weight-bearing is a common feature in post-stroke hemiparesis, and is related to temporal asymmetry during walking. The aim of this study was to investigate the effect of an auditory cue for stepping in place on measures of temporal and weight-bearing asymmetry. Ten community-dwelling adults (four female) with chronic post-stroke hemiparesis performed 5 un-cued stepping trials and 5 stepping trials cued by an auditory metronome cue. A Vicon system was used to collect full body kinematic trajectories. Two force platforms were used to measure ground reaction forces. Step, swing and stance times were used to calculate temporal symmetry ratios. Weight-bearing was assessed using the vertical component of the ground reaction force, and centre of mass-centre of pressure separation at mid-stance. Weight-bearing asymmetry was significantly reduced during stepping with an auditory cue. Asymmetry values for step, swing and stance times were also significantly reduced with auditory cueing. These findings show auditory cueing, when stepping in place, produces immediate reductions in measures of temporal asymmetry and dynamic weight-bearing asymmetry

Treadmill training for individuals with multiple sclerosis: a pilot randomised trial

This pilot study investigated whether 4 weeks of aerobic treadmill training in individuals with multiple sclerosis (MS) improved mobility and reduced fatigue. Individuals with MS were recruited to this prospective, randomised controlled trial. Individuals were assessed at baseline, week 7 and 12 with a 10 metre timed walk, a 2 minute walk, the Rivermead Mobility Index, and the Fatigue Severity Scale. After a pre-assessment familiarisation session and a baseline assessment, individuals were randomly allocated to an initial intervention or delayed intervention group. Treadmill training consisted of 4 weeks of supervised aerobic exercise delivered weeks 3–6 in the immediate group and 8–11 in the delayed group. Of the initial 19 recruits, 16 individuals completed the study. There was a significant difference in walking endurance between the delayed and immediate groups at baseline (p<0.05). On reassessment in week 7, decreases in 10 metre walk time were found in both groups, which was significant in the immediate group (p<0.05). The 2 minute walk distance significantly increased in both groups (p<0.05). In the training group, reassessed at week 12 after training ceased, there was a return towards baseline scores. No significant changes in fatigue scores were found. This study showed that in individuals with MS, aerobic treadmill training is feasible and well tolerated. Walking speed and endurance increased following training with no increase in reported fatigue. Detraining occurred in the period following training. A larger randomised clinical trial is warranted.Abbreviations: APMHR, age predicted maximum heart rate; FSS, Fatigue Severity Scale; GNDS, Guy’s Neurological Disability Scale; MS, multiple sclerosis; RMI, Rivermead Mobility Index