The assessment of posture and balance post-stroke

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University.Physiotherapy for people with stroke has been found to be beneficial but details of the most effective interventions are unclear. Further development of the evidence base for stroke physiotherapy is limited by a lack of clinical practice models, sensitive clinically based outcome measures and effective stratification techniques to characterise homogenous groups of subjects. These issues are addressed here with regard to balance and posture. These aspects were chosen because they form a cornerstone of stroke physiotherapy as they are thought essential for the rehabilitation of functional activities. A systematic review of assessment methods in the literature revealed a lack of measurement tools which met the utility criteria: reliability, validity, sensitivity to short-term change, suitability for a wide range of abilities, ease of use and suitability for different settings. This prompted the development of a new measurement tool. Firstly, a model of the clinical assessment process was developed using an adapted focus group method with neurological physiotherapists. This informed the content of a new measurement tool which combined an ordinal scale with functional performance tests- the Brunel Balance Assessment. The tool was evaluated in a series of studies involving 92 stroke patients. It was hierarchical (coefficient of reproducibility= 0.99, coefficient of scalability = 0.69), reliable (100% agreement) and valid as a measure of balance disability (r=0.58-0.97). The psychometric properties of the individual functional performance tests were also tested and found to be reliable (ICCs =0.88-1) and valid (r=0.32-0.63). Measurement error ranged 0-40% and the minimum change needed to detect true clinical change was calculated for each test. Balance disability, measured with the Brunel Balance Assessment, is heterogeneous with sitting, standing and stepping balance forming distinct levels of ability (p<0.027). Consequently, the BBA could be used to stratify people with stroke according to balance ability. Weakness, sensation and age were significant independent contributors to balance disability (r2=82.7%). Balance ability was a strong contributor to independence in ADL (p<0.0001). The findings of this thesis address the issues that have limited research into stroke physiotherapy with regard to balance disability. In relation to clinical practice, a robust measurement and stratification tool has been developed.Department of Health Studies, Brunel University and the Brunel University Research Enterpris

How to measure fatigue in neurological conditions? A systematic review of psychometric properties and clinical utility of measures used so far

Objective: To systemically review the psychometric properties and clinical utility (feasibility) of tools to measure fatigue in neurological conditions. Data sources: AMED, CINAHL, MEDLINE, Science Direct and Web of Knowledge were searched for studies of the psychometric properties of fatigue measures in adults with central nervous system disorders. Search terms were: Fatigue AND assess* OR measure* OR tool OR outcome OR index OR test OR scale AND stroke OR cerebrovascular* OR hemi* OR parkinson* OR sclerosis OR head injury OR brain injury OR motor neurone disease OR neuro* Review methods: Articles that addressed validity; reliability and ability to detect change were selected. Two authors independently selected articles and extracted data. Strength of the psychometric properties and clinical utility were assessed against predetermined thresholds. Results: A total of 25 articles were selected and 17 measurement tools identified including six versions of the Fatigue Severity Scale and five versions of the Fatigue Impact Scale. All were clinically feasible but none met all the criteria. Most were valid. Reliability and ability to detect change were infrequently evaluated, but were adequate when reported. The most thoroughly developed and psychometrically robust measures were the Neurological Fatigue Indices. Conclusion: Although many measures of fatigue in neurological conditions have published, none met all of the criteria for psychometric robustness and clinical utility but the Neurological Fatigue Indices are the best and can be used with caution </jats:sec

Reclamation from Absence? Luce Irigaray and Women in the History of Philosophy

Luce Irigaray 's work does not present an obvious resource for projects seeking to reclaim women in the history of philosophy. Indeed, many authors introduce their reclamation project with an argument against conceptions, attributed to Irigaray or “French feminists” more generally, that the feminine is the excluded other of discourse. These authors claim that if the feminine is the excluded other of discourse, then we must conclude that even if women have written philosophy they have not given voice to feminine subjectivity; therefore, reclamation is a futile project. In this essay, I argue against such conclusions. Rather, I argue, Irigaray 's work requires that philosophy be transformed through the reclamation of women 's writing. She gives us a method of reclamation for the most difficult cases: those in which we have no record of women 's writing. Irigaray offers this method through an engagement with the character of Diotima in Plato's Symposium. The method Irigaray demonstrates is reclamation as love

Service users' views of the assessment process in stroke rehabilitation

Objective: To investigate the service users’ (stroke survivors and care-givers) experiences and views of the rehabilitation assessment process. Design: Qualitative data analysis from three focus groups using a content analysis to identify the major themes. Setting: Participants were recruited from stroke support groups and community rehabilitation services in a large UK city. Subjects: Seventeen community-dwelling stroke survivors who had completed their rehabilitation within the previous year and six care-givers. Results: Five themes emerged: understanding the purpose of the assessment; repetition of assessments; feedback about assessments and progress; format of feedback and barriers to feedback. While all participants reported undergoing assessment, some felt their purpose was not always explained and resented unexplained repetitions of tests. Some participants reported a positive experience, but most wanted more information about their progress and predictions of recovery. They wanted regular, consistent, objective information presented in layman’s terms; verbally and in writing. Some carers reported difficulty accessing information particularly as a result of confidentiality policies. While some participants accepted these short-comings, others considered them due to staff’s disinterest or ineptitude, which undermined their trust in the team. Conclusions: Stroke service users require clear information about the purpose of assessments and regular, consistent, objective feedback about their progress using layman’s language both verbally and in writing. </jats:sec

Professionals' Views and Experiences of Using Rehabilitation Robotics With Stroke Survivors: A Mixed Methods Survey

From Frontiers via Jisc Publications RouterHistory: collection 2021, received 2021-09-20, accepted 2021-10-22, epub 2021-11-11Publication status: PublishedObjective: To understand the reason for low implementation of clinical and home-based rehabilitation robots and their potential. Design: Online questionnaire (November 2020 and February 2021). Subjects: A total of 100 professionals in stroke rehabilitation area were involved (Physiotherapists n = 62, Occupation therapists n = 35). Interventions: Not applicable. Main Measures: Descriptive statistics and thematic content analysis were used to analyze the responses: 1. Participants' details, 2. Professionals' views and experience of using clinical rehabilitation robots, 3. Professionals' expectation and concerns of using home-based rehabilitation robots. Results: Of 100 responses, 37 had experience of rehabilitation robots. Professionals reported that patients enjoyed using them and they increased accessibility, autonomy, and convenience especially when used at home. The main emergent themes were: “aims and objectives for rehabilitation robotics,” “requirements” (functional, software, and safety), “cost,” “patient factors” (contraindications, cautions, and concerns), and “staff issues” (concerns and benefits). The main benefits of rehabilitation robots were that they provided greater choice for therapy, increased the amount/intensity of treatment, and greater motivation to practice. Professionals perceived logistical issues (ease of use, transport, and storage), cost and limited adaptability to patients' needs to be significant barriers to tier use, whilst acknowledging they can reduce staff workload to a certain extent. Conclusion: The main reported benefit of rehabilitation robots were they increased the amount of therapy and practice after stroke. Ease of use and adaptability are the key requirements. High cost and staffing resources were the main barriers