Technology-supported sitting balance therapy versus usual care in the chronic stage after stroke : a pilot randomized controlled trial

Background: Technology development for sitting balance therapy and trunk rehabilitation is scarce. Hence, intensive one-to-one therapist-patient training is still required. We have developed a novel rehabilitation prototype, specifically aimed at providing sitting balance therapy. We investigated whether technology-supported sitting balance training was feasible and safe in chronic stroke patients and we determined whether clinical outcomes improved after a four-week programme, compared with usual care. Methods: In this parallel-group, assessor-blinded, randomized controlled pilot trial, we divided first-event chronic stroke participants into two groups. The experimental group received usual care plus additional therapy supported by rehabilitation technology, consisting of 12 sessions of 50 min of therapy over four weeks. The control group received usual care only. We assessed all participants twice pre-intervention and once post-intervention. Feasibility and safety were descriptively analysed. Between-group analysis evaluated the pre-to-post differences in changes in motor and functional outcomes. Results: In total, 30 participants were recruited and 29 completed the trial (experimental group: n = 14; control group: n = 15). There were no between-group differences at baseline. Therapy was evaluated as feasible by participants and therapist. There were no serious adverse events during sitting balance therapy. Changes in clinical outcomes from pre- to post-intervention demonstrated increases in the experimental than in the control group for: sitting balance and trunk function, evaluated by the Trunk Impairment Scale (mean points score (SD) 7.07 (1.69) versus 0.33 (2.35); p < 0.000); maximum gait speed, assessed with the 10 Metre Walk Test (mean gait speed 0.16 (0.16) m/s versus 0.06 (0.06) m/s; p = 0.003); and functional balance, measured using the Berg balance scale (median points score (IQR) 4.5 (5) versus 0 (4); p = 0.014). Conclusions: Technology-supported sitting balance training in persons with chronic stroke is feasible and safe. A four-week, 12-session programme on top of usual care suggests beneficial effects for trunk function, maximum gait speed and functional balance

Do trunk exercises improve trunk and upper extremity performance, post stroke? A systematic review and meta-analysis

BACKGROUND: Post-stroke trunk control is reported to be associated with trunk performance and recovery of the upper limb, but the evidence for the influence of trunk exercise on both of these is unclear.Objective: To evaluate the effect of trunk exercises on trunk performance post-stroke, and to determine if these exercises result in improved upper limb function.METHODS: A comprehensive search of the literature published between January 1990 and February 2017 was conducted using the following electronic databases; AMED, CINAHL, Cochrane Library, EMBASE, MEDLINE, PsychInfo and SPORTDiscus. Only randomized, controlled trials, published in English, evaluating the effect of trunk exercises on trunk performance and/or upper limb function post-stroke, were included.RESULTS: A total of 17 studies involving 599 participants were analysed. Meta-analysis showed that trunk exercises had large significant effect on trunk performance post-stroke. This effect varied from very large for acute stroke to medium for subacute and chronic stroke. None of the included studies had measured the effect of trunk exercise on upper limb impairment or functional activity.CONCLUSIONS: Trunk exercises improve trunk performance for people with acute, subacute and chronic stroke. As yet there is no evidence to support the effect of trunk exercise on upper limb function.<br/

Effectiveness of different types and duration of trunk training on trunk function: a systematic review and meta-analysis

status: publishe

Somatosensory impairments in the upper limb post stroke: distribution, impact of visuo-spatial neglect and association with motor function

status: accepte

Somatosensory impairments in the upper limb post stroke: distribution, impact of visuo-spatial neglect and association with motor function

status: accepte

Feasibility of delivering a trunk exercise programme post stroke using a virtual reality video game-based system: a mixed methods case series

Background: trunk control post-stroke can be affected by muscle weakness, reduced position sense and poor coordination leading to decreases in balance and functional ability ( Bohannon et al. 1995; Fujiwara et al. 2001, Langhorne et al. 2009). Virtual reality (VR) technology in stroke rehabilitation has been demonstrated to improve function and activity. The Valedo® system (Hocoma, Switzerland) comprises three lightweight sensors worn on the sternum, lumbar and sacral spine and a series of VR games. However, the feasibility of using VR to deliver post-stroke trunk exercises is unknown.Purpose: to explore the feasibility of conducting trunk rehabilitation post-stroke using a virtual reality (VR) video game-based system (Valedo® system) by investigating adherence, safety, acceptability and participation. In addition, changes in pre-post measures of trunk impairment, balance and upper and lower limb motor function were assessed.Methods: the intervention consisted of 18 sessions of VR video games trunk training program (three days/week, 45 minutes a day) over six weeks. The exercises consisted of specific upper and lower trunk exercises including lateral flexion, rotation, flexion and extension. During each session, participants practiced playing five videogames (nine minutes/game) with rest periods upon request.The feasibility of using the Valedo® system was measured by means of adherence (sessions missed/drop outs), safety (adverse events), acceptability (post intervention semi structure interview) and participation in each session (Pittsburgh Rehabilitation Participation Scale (PRPS)).Pre- and post-intervention testing included the Trunk Impairment Scale (TIS), Streamlined Wolf Motor Function Test (SWMFT), Fugl-Meyer Assessment Motor Function (FMA), Berg Balance Scale (BBS).To ensure safety, a BBS score of 45+ was required to practice exercises in a standing position. Initial TIS scores were used to tailor the exercises practiced including trunk mobilization, movement awareness and isolation.Results: two people with chronic stroke (SA and JT) participated in the intervention; SA practiced the exercises in standing (initial Berg 54/56), while JT practiced in sitting (initial Berg 44/56).Post intervention results showed adherence was excellent, no adverse events occurred, acceptability was high and the PRPS revealed very good to excellent participation; participants actively participated in all exercises with maximal effort, were excited and looked forward to subsequent therapy sessions. Both participants were positive about the intervention and would recommend it to others. Participants suggested changes to the system including changing the distracting music (SA) and increasing the challenge of the game focussed on trunk lateral flexion (JT).The clinical outcome measures for SA and JT respectively demonstrated the following improvements: TIS (7 and 6 points), SWMFT (4 and 4 points), BBS (4 and 9 points), FMA upper limb (1 and 1 point) and FMA lower limb (SA had maximal score at baseline, 5 points for JT participant).Conclusion(s): results suggest that it is feasible to utilise VR video game-based system for trunk rehabilitation post-stroke.Implications: A wider scale study is warranted, to determine feasibility and sample size for a randomised controlled trial investigating the effectiveness of trunk exercises using VR video games for improving trunk and balance ability in people with stroke

The Adult Assisting Hand Assessment Stroke: Psychometric Properties of an Observation-Based Bimanual Upper Limb Performance Measurement

OBJECTIVE: To investigate interrater and intrarater reliability, measurement error, and convergent and discriminative validity of the Adult Assisting Hand Assessment Stroke (Ad-AHA Stroke). DESIGN: Cross-sectional observational study. SETTING: A total of 7 stroke rehabilitation centers. PARTICIPANTS: Stroke survivors (reliability sample: n=30; validity sample: N=118) were included (median age 67y; interquartile range [IQR], 59-76); median time poststroke 81 days (IQR 57-117). INTERVENTIONS: N/A. MAIN OUTCOME MEASURES: Ad-AHA Stroke, Action Research Arm Test (ARAT), upper extremity Fugl-Meyer Assessment (UE-FMA). The Ad-AHA Stroke is an observation-based instrument assessing the effectiveness of the spontaneous use of the affected hand when performing bimanual activities in adults poststroke. Reliability of Ad-AHA Stroke was examined using intraclass correlation coefficients (ICCs), Bland-Altman plots, and weighted kappa statistics for reliability on item level. SEM was calculated based on Ad-AHA units. Convergent validity was assessed by calculating Spearman rank correlation coefficients between Ad-AHA Stroke and ARA test and UE-FMA. Comparison of Ad-AHA Stroke scores between subgroups of patients according to hand dominance, neglect, and age evaluated discriminative validity. RESULTS: Intrarater and interrater agreement showed an ICC of 0.99 (95% confidence interval, 0.99-0.99), an SEM of 2.15 and 1.64 out of 100, respectively, and weighted kappa for item scores were all above 0.79. The relation between Ad-AHA and other clinical assessments was strong (ρ=0.9). Patients with neglect had significantly lower Ad-AHA scores compared to patients without neglect (P=.004). CONCLUSIONS: The Ad-AHA Stroke captures actual bimanual performance. Therefore, it provides an additional aspect of upper limb assessment with good to excellent reliability and low SEM for patients with subacute stroke. High convergent validity with the ARA test and UE-FMA and discriminative validity were supported.status: publishe

The Adult Assisting Hand Assessment Stroke: Psychometric Properties of an Observation-Based Bimanual Upper Limb Performance Measurement.

To investigate interrater and intrarater reliability, measurement error, and convergent and discriminative validity of the Adult Assisting Hand Assessment Stroke (Ad-AHA Stroke). Cross-sectional observational study. A total of 7 stroke rehabilitation centers. Stroke survivors (reliability sample: n=30; validity sample: N=118) were included (median age 67y; interquartile range [IQR], 59-76); median time poststroke 81 days (IQR 57-117). N/A. Ad-AHA Stroke, Action Research Arm Test (ARAT), upper extremity Fugl-Meyer Assessment (UE-FMA). The Ad-AHA Stroke is an observation-based instrument assessing the effectiveness of the spontaneous use of the affected hand when performing bimanual activities in adults poststroke. Reliability of Ad-AHA Stroke was examined using intraclass correlation coefficients (ICCs), Bland-Altman plots, and weighted kappa statistics for reliability on item level. SEM was calculated based on Ad-AHA units. Convergent validity was assessed by calculating Spearman rank correlation coefficients between Ad-AHA Stroke and ARA test and UE-FMA. Comparison of Ad-AHA Stroke scores between subgroups of patients according to hand dominance, neglect, and age evaluated discriminative validity. Intrarater and interrater agreement showed an ICC of 0.99 (95% confidence interval, 0.99-0.99), an SEM of 2.15 and 1.64 out of 100, respectively, and weighted kappa for item scores were all above 0.79. The relation between Ad-AHA and other clinical assessments was strong (ρ=0.9). Patients with neglect had significantly lower Ad-AHA scores compared to patients without neglect (P=.004). The Ad-AHA Stroke captures actual bimanual performance. Therefore, it provides an additional aspect of upper limb assessment with good to excellent reliability and low SEM for patients with subacute stroke. High convergent validity with the ARA test and UE-FMA and discriminative validity were supported