Rehab Centers: Differential Trajectory of Functional Recovery and Determinants for First Time Stroke Survivors by Using a LCGA Approach: A Hospital Based Analysis Over a 1-Year Period.
Differential trajectory of functional recovery and determinants for first time stroke survivors by using a LCGA approach: a hospital based analysis over a 1-year period.
Filed under: Rehab Centers
Eur J Phys Rehabil Med. 2012 Nov 21;
Huang HC, Chang CH, Lee TH, Chang YJ, Ryu SJ, Chang TY, Huang KL, Liu CH, Chang HJ
BACKGROUND: Functional outcome and the risk factors for stroke survivors have explored in previous study. However, a comprehensive understanding of the patterns and critical risk factors of functional recovery is limited. AIM:To explore the trajectory groups and determinants of functional recovery for ischemic stroke patients during 1 year after stroke. DESIGN: Longitudinal study. SETTING:Inpatient. POPULATION. First-time stroke patients. METHOD: A total of 367 first-time ischemic stroke patients from the Stroke Registry in the Chang Gung Hospital (SRICH) database were analyzed in this study. Study variables comprised demographic and disease characteristics, laboratory data, and functional outcome. The Latent Class Growth Analysis (LCGA) was used to identify various trajectory clusters and multinomial logistic regression was used to identify the predictors of functional recovery. RESULTS:Five trajectory clusters of functional recovery were identified using the Barthel Index. Among five clusters of functional recovery, nearly 18% of firstever ischemic stroke patients maintained functional dependence, whereas 82% of stroke patients demonstrated functional recovery; and the significant recovery time totaled three months after the stroke. Determinants for various trajectory clusters of functional recovery were body mass index and serum albumin level, especially a higher serum albumin concentration predicted a more favorable functional recovery. CONCLUSION: Our findings suggest that diverse functional recovery clusters persisted and serum albumin concentration at admission was a critical assessment factor. CLINICAL REHABILITATION: Such information could be useful for identifying the different rehabilitation needs of varying trajectory groups and for effectively improving functional ability among the ischemic stroke population.
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Effect of supervision on ultrasonographic measurements. A blinded randomized cross-over study.
Filed under: Rehab Centers
Eur J Phys Rehabil Med. 2012 Nov 21;
Ozçakar L, Kara M, Tekin L, Karanfil Y, Esen E, Utku B, Can Güven S, Ca?layan G, Youssefi A, Pitruzzella M, Ciocchetti E, Açikel C
BACKGROUND: Musculoskeletal ultrasound is becoming an increasingly popular clinical tool in the hands of physiatrists. Herewith, although the role of direct supervision (by an expert) is universally recognized as the core element for appropriate ultrasound training, to our best notice, its impact on ultrasonographic measurements has not been studied quantitatively in the hitherto literature. AIM:To quantify the effect of supervision in the early period of musculoskeletal ultrasound training by using three different tissues (muscle-cartilage-tendon) as models. DESIGN: A blinded randomized cross-over study. SETTING. Physical Medicine and Rehabilitation Department of a University Hospital. POPULATION: A total of 9 sonographers (8 novice and 1 expert) were involved whereby the novice sonographers were randomly divided into two groups; Group A (N.=4) and Group B (N.=4). METHODS:All sonographers performed three thickness measurements; medial head of the gastrocnemius muscle, patellar tendon and femoral cartilage on the left lower limb of the same subject. The expert supervised Group A in the first half of the study (9 days), and Group B in the second half (9 days). Throughout the study period, all the participants were blinded to the data. Relative effectiveness, expert effect, order effect, treatment-period effect were studied for cross-over variance analysis. RESULTS: For all the three sites, measurements under the supervision of the expert were significantly different than those without him -p values pertaining to relative effectiveness, expert effect were 0.014, 0.013 for femoral cartilage; <0.001, <0.001 for gastrocnemius and <0.001, <0.001 for patellar tendon, respectively). For gastrocnemius muscle measurements, studying with the expert in the second half of the study (vs in the first half) was better concerning the precision of the measurements (order effect P<0.001). CONCLUSION: Supervision during measurements of novice sonographers is crucial and their data should otherwise be interpreted attentively. HubMed – rehab
Motor strategies and bilateral transfer in sensorimotor learning of patients with subacute stroke and healthy subjects. A randomized controlled trial.
Filed under: Rehab Centers
Eur J Phys Rehabil Med. 2012 Nov 21;
Iosa M, Morone G, Ragaglini MR, Fusco A, Paolucci S
BACKGROUND: Bilateral transfer, i.e. the capacity to transfer from one to the other hand a learned motor skill, may help the recovery of upper limb functions after stroke. AIM:To investigate the motor strategies at the basis of sensorimotor learning involved in bilateral transfer. DESIGN: Randomized controlled trial. SSETTING: Neurorehabilitation Hospital. POPULATION: Eighty right-handed participants (65±13 years old): 40 patients with subacute stroke, 40 control healthy subjects. METHODS: Subjects performed the 9 hole-peg-test twice in an order defined by random allocation: first with low and then with high skilled hand (LS-HS) or the reverse (HS-LS). Time spent to complete the test and filling sequence were recorded, together with maximum pinch force (assessed using a dynamometer), upper limb functioning (Motricity Index), spasticity (modified Ashworth Scale), limb dominance (Edinburgh Handeness Inventory). RESULTS: As expected, in patients, the performance was found related to the residual pinch force (P<0.001), upper limb motricity (P=0.006) and side of hemiparesis (P=0.016). The performances of all subjects improved more in HS-LS than in LS-HS subgroups (P=0.043). The strategy adopted in the first trial influenced the velocity in the second one (P=0.030). CONCLUSION:Bilateral transfer was observed from high to low skilled hand. Learning was not due to a mere sequence repetition, but on a strategy chosen on the basis of the previous performance. CLINICAL REHABILITATION IMPACTThe affected hand of patients with subacute stroke may benefit from sensorimotor learning occurred with the un-affected hand. HubMed – rehab
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