Use of Segmental Coordination Analysis of Non-Paretic and Paretic Limbs During Obstacle Clearance in Community Dwelling Persons Post Stroke.
Use of segmental coordination analysis of non-paretic and paretic limbs during obstacle clearance in community dwelling persons post stroke.
Filed under: Rehab Centers
PM R. 2013 Feb 15;
Maclellan MJ, Richards CL, Fung J, McFadyen BJ
OBJECTIVE: To use a segment coordination analysis to identify coordination differences between the paretic and non-paretic limbs for obstacle clearance in community dwelling persons post stroke. DESIGN: Within-participant design. SETTING: Gait analysis Laboratory. PARTICIPANTS: Six community dwelling persons with a stroke (excluding cerebellar stroke). METHODS: Participants stepped over obstacles of two different heights (7.5 and 15% of leg length) leading alternately with their paretic and non-paretic limbs. MAIN OUTCOME MEASURES: Kinematic data were collected and segment elevation angles (absolute segment angular position with respect to vertical) were calculated for the thigh, shank, and foot segments. Established mathematical techniques related to the planar law of intersegmental coordination (principal component analysis to quantify covariance and temporal phase relationships among elevation angles) were then applied to compare and contrast the coordination of these segment elevation angle trajectories between paretic and non-paretic limbs. RESULTS: Segment covariance in elevation angles followed the planar law of intersegmental coordination during level walking (i.e., 3 elevation angles forming a plane and the variance explained by 2 principal components) for both paretic and non-paretic limbs. During obstacle clearance, however, relationships between covariance plane characteristics and phase differences for elevation angles of adjacent segments differed in the non-paretic limb, likely related to a need for greater limb elevation for obstacle clearance during paretic limb support or an altered foot trajectory resulting from pre-obstacle foot placement. CONCLUSIONS: The present coordination analysis suggests the preservation of basic control mechanisms in the paretic limb during obstacle clearance following stroke, but also reveals its specific motor control compensations. However, a larger study with differing levels of stroke severity must be conducted to understand how the evaluation of intersegmental coordination during walking could guide treatment of specific locomotor control deficits in stroke rehabilitation.
HubMed – rehab
A Comparison of Two Balance Measures to Predict Discharge Performance from Inpatient Stroke Rehabilitation.
Filed under: Rehab Centers
PM R. 2013 Feb 15;
O’Dell MW, Au J, Schwabe E, Batistick H, Christos PJ
OBJECTIVE: To compare admission Berg Balance Scale (BBS) and Postural Assessment Scale for Stroke (PASS) in predicting outcomes at discharge from an inpatient rehabilitation unit (IRU). We hypothesized that discharge outcomes would be better predicted by 1) the PASS compared to the BBS and 2) by the PASS changing position sub-score (PASS-CP) compared to the maintain posture sub-score (PASS-MP). DESIGN: Retrospective study analysis of admission BBS and admission PASS scores, and gait velocity (GV) at discharge, as well as selected functional independence measures (FIM) items assessed at discharge. GV was analyzed as both a continuous and categorical (GV/A=<.4, GV/B=.4-.8, and GV/C=>.8 m/sec) variable. SETTING: IRU in Academic Medical Center. PARTICIPANTS: Fifty-five subjects with stroke and a mean age of 71.5±13.8 years, admission FIM of 57.2±17.2 points, and an IRU length of stay of 17.3±9.7 days. METHODOLOGY/MAIN OUTCOME MEASURES: Admission and discharge BBS and PASS scores, gait velocity (GV) at discharge, and selected functional independence measures (FIM) items at discharge were measured. GV was analyzed both as continuous and categorical variables (GV/A=<.4, GV/B=.4-.8, and GV/C=>.8m/sec). RESULTS: The Spearman-rank correlation coefficient (r) was strong between admission BBS and PASS (r=0.90, p<.0001). Correlations between admission BBS and PASS and discharge GV were 0.32 (p=.03) and 0.28 (p=.06), respectively. Analysis of variance was significant for both balance measures when grouped by discharge gait speed category (p<.0001). Pairwise comparisons were significant between GV/A and the other two categories, but not between GV/B and GV/C. The magnitude of the observed correlation with discharge GV was greater for PASS-MP (r=0.35, p=.02) than for PASS-CP (r=0.23, p=.13). Both sub-scores were significantly associated with both toileting and transfers (r=0.43 to 0.56, all at least p?.001). CONCLUSIONS: Contrary to our hypotheses, the BBS and PASS performed equally well in our study sample and were best at predicting patients discharged in the slowest GV category. There were few differences between the PASS sub-scores. Further research should compare how well admission BBS and PASS predict gait speed, falls, and other functional parameters in the community after IRU discharge. HubMed – rehab
Sham Manual Medicine Protocol for Cervical Strain-Counterstrain Research.
Filed under: Rehab Centers
PM R. 2013 Feb 15;
Brose SW, Jennings DC, Kwok J, Stuart CL, O’Connell SM, Pauli HA, Liu B
OBJECTIVE: To describe the development of a sham manual medicine protocol. SETTING: An academic physical medicine and rehabilitation clinic. PARTICIPANTS: Twenty-six persons with cervical tender points were included in the pilot study. Exclusion criteria entailed cervical disk herniations or diskitis, cancer, current incarceration, or any condition that prevented small-range passive neck movements. Subjects were also excluded if, in the past 3 months, they had received cervical or thoracic spine surgery, osteopathic manipulation, or workers’ compensation benefits. INTERVENTIONS: The subjects were sequentially assigned to receive either sham or strain-counterstrain treatment. The subjects filled out pre- and posttreatment questionnaires. Fifteen subjects were in the sham group, and 11 were in the treatment group. MAIN OUTCOME MEASURES: Outcome measures included subject tolerance of manual medicine, change in pain level, and ability to accurately determine receipt of strain-counterstrain or sham technique. Statistical significance was set at P < .05. RESULTS: There were no adverse effects of the sham or treatment protocols. There was no statistically significant change in pain as a result of the sham manual medicine protocol (P = .222) in contrast to the strain-counterstrain group, which did have decreased pain (P = .014). The subjects were unable to determine whether they had received sham or strain-counterstrain technique (P = .850). CONCLUSION: The sham protocol developed for this study was well tolerated. The small study size and design limitations do not yet allow the sham protocol developed in this pilot study to be definitively validated as a manual medicine tool, but there are early indications that it may be useful. Larger studies that validate this sham protocol by addressing inter- and intra-rater reliability are needed, followed by studies that evaluate strain-counterstrain as a treatment modality. HubMed – rehab
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