Rehabilitation and Therapy Commons^™

The Effect Of Outpatient Physiotherapy After Stroke On Cardiopulmonary Training Goals: The Current Situation In A Single Medical Center, Yichun Lu, Chiachi Huang, Chenliang Chou

Rehabilitation Practice and Science

Study background and objectives: Reduced cardiopulmonary function after stroke has drawn increasing attention. Cardiovascular function and muscle fiber composition change after stroke, leading to a decline in physical fitness. Some studies have also reported decreased maximum oxygen uptake after stroke, which would further reduce patient ability to perform daily life functions, inducing a circle of disability and reduced mobility. Cardiopulmonary rehabilitation after early or late strokes has been found to improve cardiopulmonary function; these improvements are especially noticeable in patients with lower levels of physical activity before their stroke onset. However, traditional rehabilitation programs mostly focus on recovery of limb …

Deep Vein Thrombosis In An Ambulatory Hemiparetic Stroke Patient Probably Due To Exercise-Related Repetitive Impact: A Casereport, Kun-Chang Lee, Chien-Ting Liu, Pi-Wei Wang, An-Fang Hsiao, Yi-Shiung Horng

Rehabilitation Practice and Science

Deep vein thrombosis (DVT) of the lower extremity is a multifactorial and potentially fatal complication following stroke. However, repetitive impact on the lower extremity is a relatively uncommon risk factor for DVT. We report an ambulatory hemiparetic stroke patient who, without classic DVT risk factors, developed a lower extremity DVT probably due to repetitive impact on the popliteal fossa after the inappropriate use of a seated leg flexion machine. This case can remind physiatrists and therapists of the importance of preventing patients from using non-ergonomic postures during training sessions.

Factors Associated With Nasogastric Tube Removal In Patients With Post-Stroke Dysphagia Following Acute/Subacute Stroke, Hsin-Chiao Wen, Hao-Wei Tang, Chang-Ren Peng, Kuan-Lin Chen, Ching-Min Hsiao, Chung-Che Lin

Rehabilitation Practice and Science

Purpose: Stroke is a common cause of dysphagia, and persistent post-stroke dysphagia is associated with a poor outcome and an increased mortality rate. Nasogastric tubes (NGTs) are frequently the recommended method for the safe administration of nutrition and hydration in stroke patients. However, prolonged use of NGTs can lead to complications, such as gastro-esophageal reflux and aspiration pneumonia. The purpose of this study was to determine the factors associated with NGT removal in patients with post-stroke dysphagia. Method: This was a retrospective study. We recruited patients with post-stroke dysphagia who had received feeding either partially or totally via NGT and …

Social Support Status In Informal Caregivers Of Stroke Patients, Yanyuh Lee, Yeehwa Wu, Ihsuan Chen, Kuchou Chang, Yuching Huang, Jenwen Hung

Rehabilitation Practice and Science

Objective: Informal caregivers play an important role in post-stroke care. In the present study, we aimed to investigate the social support status over an 18-month duration; the relationship between health status and social support level; and the predictors of low social support status in informal caregivers of stroke patients. Methods: We recruited eligible inpatients with first-ever ischemic stroke and their informal caregivers from a tertiary referral teaching hospital. The social support rating scale (SSRS) of the caregivers was determined at 3, 16, and 18 months after stroke onset. Beck depression inventory (BDI) as well as the physical and mental composite …

The Effects Of Chin-Tuck Position In Stroke Patient With Dysphagia Evaluated By Fiberoptic Endoscopy, Yuyu Chen, Tienwen Chen, Maohsiung Huang

Rehabilitation Practice and Science

Background and Purpose: Dysphagia is a frequent symptom after stroke. Dysphagia increases the risk of aspiration pneumonia, malnutrition, and is associated with poor prognosis. Fiberoptic endoscopic evaluation of swallowing (FEES) is a suitable method for dysphagia assessment after acute stroke. Chin-tuck position has been used in dysphagia patients to prevent aspiration during swallowing. But the combined application of these promising modalities has rarely been studied. We aimed to evaluate the effects of chin-tuck position in stroke patient with dysphagia evaluated by fiberoptic endoscopy. Methods: A total of 34 consecutive patients with first stroke were enrolled. FEES after swallowing was done …

Recovery Of Oral Intake Function In Elderly Patients With First-Ever Acute Ischemic Stroke, Ya-Fang Hsu, Wen-Chih Lin, Ching-I Hu, Mei-Ju Ko, Chia-Yu Chang, Hing-Man Wu, Willy Chou

Rehabilitation Practice and Science

Introduction and Objective: The effects of aging on swallowing are particularly evident in elderly adults who are ill. Previous studies have reported that prolonged nasogastric tube (NGT) feeding in patients who have had a stroke increases the risk of pneumonia and mortality. However, few studies have investigated the recovery of oral intake function and the factors regarding NGT removal in patients with poststroke dysphagia. In the present study, we investigated the differences in oral intake function between elderly (age: ≥65 y) and nonelderly patients with first-ever acute ischemic stroke. Methods: In this retrospective study, we reviewarticleed the medical charts of …

Impaired Hyperemic Response To Exercise Post Stroke, Matthew J. Durand, Spencer A. Murphy, Kathleen K. Schaefer, Sandra K. Hunter, Brian D. Schmit, David D. Gutterman, Allison Hyngstrom

Exercise Science Faculty Research and Publications

Individuals with chronic stroke have reduced perfusion of the paretic lower limb at rest; however, the hyperemic response to graded muscle contractions in this patient population has not been examined. This study quantified blood flow to the paretic and non-paretic lower limbs of subjects with chronic stroke after submaximal contractions of the knee extensor muscles and correlated those measures with limb function and activity. Ten subjects with chronic stroke and ten controls had blood flow through the superficial femoral artery quantified with ultrasonography before and immediately after 10 second contractions of the knee extensor muscles at 20, 40, 60, and …

A Review Of Transcranial Magnetic Stimulation And Multimodal Neuroimaging To Characterize Post-Stroke Neuroplasticity, Angela M. Auriat, Jason L. Neva, Sue Peters, Lara A. Boyd

Physical Therapy Publications

Following stroke, the brain undergoes various stages of recovery where the central nervous system can reorganize neural circuitry (neuroplasticity) both spontaneously and with the aid of behavioral rehabilitation and non-invasive brain stimulation. Multiple neuroimaging techniques can characterize common structural and functional stroke-related deficits, and importantly, help predict recovery of function. Diffusion tensor imaging (DTI) typically reveals increased overall diffusivity throughout the brain following stroke, and is capable of indexing the extent of white matter damage. Magnetic resonance spectroscopy (MRS) provides an index of metabolic changes in surviving neural tissue after stroke, serving as a marker of brain function. The neural …

Bridge/Adapt: Transfer From Computer Remediation To Functional Skill, Eugene Cheung, Janice S. Li, Diana Lopez, Angela Talamantez

Student Research Posters

This study explored the effectiveness of the Bridge/Adapt program for generalizing increased cognition to functional skills. Three participants, identified as having significant cognitive impairments as measured by the Cognistat assessment, participated in the Bridge/Adapt program, an eight-week program that includes both remedial and compensatory components. The remedial component used was a computer-based cognitive rehabilitation program called Parrot Software. Past studies have proven computer-based cognitive rehabilitation to be effective in increasing overall cognition. The Bridge/Adapt module is the compensatory component that utilized a variety of strategies and everyday tasks to facilitate the generalization of improved cognition to functional performance. A homework …

Computer-Based Cognitive Retraining For Adults With Chronic Acquired Brain Injury: A Pilot Study, Kitsum Li, Julie Robertson, Joshua Ramos, Stephanie Gella

Kitsum Li

This study evaluated the effectiveness of a computer-based cognitive retraining (CBCR) program on improving memory and attention deficits in individuals with a chronic acquired brain injury (ABI). Twelve adults with a chronic ABI demonstrating deficits in memory and attention were recruited from a convenience sample from the community. Using a quasi-experimental one-group pretest–posttest design, a significant improvement was found in both memory and attention scores postintervention using the cognitive screening tool. This study supported the effectiveness of CBCR programs in improving cognitive deficits in memory and attention in individuals with chronic ABI. Further research is recommended to validate these findings …

Concise Arm And Hand Rehabilitation Approach In Stroke (Caras): A Practical And Evidence-Based Framework For Clinical Rehabilitation Management, Johan A. Franck, Jos Halfens, Rob Smeets, Henk Seelen

The Open Journal of Occupational Therapy

The volume of information on new treatment techniques supporting the restoration of arm-hand function (AHF) and arm-hand skill performance (ASHP) in stroke survivors overwhelms therapists in everyday clinical practice when choosing the appropriate therapy. The Concise Arm and Hand Rehabilitation Approach in Stroke (CARAS) is designed for paramedical staff to structure and implement training of AHF and AHSP in stroke survivors. The CARAS is based on four constructs: (a) stratification according to the severity of arm–hand impairment (using the Utrecht Arm/Hand -Test [UAT]), (b) the individual’s rehabilitation goals and concomitant potential rehabilitation outcomes, (c) principles of self-efficacy, and (d) possibilities …

Computer-Based Cognitive Retraining For Adults With Chronic Acquired Brain Injury: A Pilot Study, Kitsum Li, Julie Robertson, Joshua Ramos, Stephanie Gella

Kitsum Li

This study evaluated the effectiveness of a computer-based cognitive retraining (CBCR) program on improving memory and attention deficits in individuals with a chronic acquired brain injury (ABI). Twelve adults with a chronic ABI demonstrating deficits in memory and attention were recruited from a convenience sample from the community. Using a quasi-experimental one-group pretest–posttest design, a significant improvement was found in both memory and attention scores postintervention using the cognitive screening tool. This study supported the effectiveness of CBCR programs in improving cognitive deficits in memory and attention in individuals with chronic ABI. Further research is recommended to validate these findings …

Computer-Based Cognitive Retraining For Adults With Chronic Acquired Brain Injury: A Pilot Study, Kitsum Li, Julie Robertson, Joshua Ramos, Stephanie Gella

Kitsum Li

This study evaluated the effectiveness of a computer-based cognitive retraining (CBCR) program on improving memory and attention deficits in individuals with a chronic acquired brain injury (ABI). Twelve adults with a chronic ABI demonstrating deficits in memory and attention were recruited from a convenience sample from the community. Using a quasi-experimental one-group pretest–posttest design, a significant improvement was found in both memory and attention scores postintervention using the cognitive screening tool. This study supported the effectiveness of CBCR programs in improving cognitive deficits in memory and attention in individuals with chronic ABI. Further research is recommended to validate these findings …

Locomotor Adaptation Is Influenced By The Interaction Between Perturbation And Baseline Asymmetry After Stroke., Christine M. Tyrell, Erin Helm, Darcy S. Reisman

Department of Physical Therapy Faculty Papers

Stroke survivors without cerebellar involvement retain the ability to adapt to the split-belt treadmill; however it has been suggested that their rate of adaptation may be slowed compared to those who are neurologically intact. Depending on limb placement, the split-belt treadmill can be configured to either exaggerate baseline asymmetry, or reduce it, which may affect the behavior of adaptation or de-adaptation. The objectives of this study were to characterize the rate and magnitude of locomotor (de)adaptation in chronic stroke survivors compared to healthy matched subjects, and to evaluate whether exaggeration or reduction of baseline asymmetry impact the responses. Seventeen stroke …

The Effects Of Color In Recognition Of Images In Multiple-Choice Displays By People With And Without Aphasia, Kristin Michelle Zenz

Theses and Dissertations

Language assessments for people with aphasia often rely on the use of images. Images are presented together with a verbal stimulus and participants are asked to choose the image that corresponds to the verbal stimulus. It is assumed that if a person chooses an incorrect image, he or she has language comprehension deficits. However, other non-linguistic factors can influence image recognition processes, such as stimulus characteristics and verbal or motoric response requirements associated with target selection. Color has been shown to facilitate image recognition in language-normal individuals and in people with aphasia. However, traditional tasks to assess the influence of …

Does Generalization Occur Following Computer-Based Cognitive Retraining?—An Exploratory Study, Kitsum Li, Jonathan Alonso, Nisha Chadha, Jennifer Pulido

Collected Faculty and Staff Scholarship

Computer-based cognitive retraining (CBCR) intervention has gained great popularity in recent years. This study aimed to investigate the occurrence of skill generalization to daily living task for individuals with acquired brain injury (ABI) after completion of eight modules of a commercially available CBCR program, the Parrot Software. The study investigated changes in individuals’ global cognition as measured by the Montreal Cognitive Assessment, and changes in individuals’ performance during a medication-box sorting task, a novel instrumental activity of daily living. The medication-box sorting task resembled real life medication management with daily prescribed and over-the-counter medications. Twelve individuals with ABI from a …

Connectivity Measures Are Robust Biomarkers Of Cortical Function And Plasticity After Stroke, Jennifer Wu, Erin Burke Quinlan, Lucy Dodakian, Alison Mckenzie, Nikhita Kathuria, Robert J. Zhou, Renee Augsburger, Jill See, Vu H. Lee, Ramesh Srinivasan, Steven C. Cramer

Physical Therapy Faculty Articles and Research

Valid biomarkers of motor system function after stroke could improve clinical decision-making. Electroencephalography-based measures are safe, inexpensive, and accessible in complex medical settings and so are attractive candidates. This study examined specific electroencephalography cortical connectivity measures as biomarkers by assessing their relationship with motor deficits across 28 days of intensive therapy. Resting-state connectivity measures were acquired four times using dense array (256 leads) electroencephalography in 12 hemiparetic patients (7.3 ± 4.0 months post-stroke, age 26–75 years, six male/six female) across 28 days of intensive therapy targeting arm motor deficits. Structural magnetic resonance imaging measured corticospinal tract injury and infarct volume. …

A Manual For Occupational Therapy Student-Run Wellness Program Targeting Persons With Chronic Stroke, Jennifer Hoeniges, Julie Fry

School of Occupational Therapy Master's Theses (2010-2015)

It is not uncommon for stroke survivors to encounter a number of mental and physical barriers that impede on their ability to engage in everyday occupations. In order for these individuals to successfully live a meaningful lifestyle, it is necessary that they be educated on how to use their resources and re-integrate themselves back into the community. Participation in group interventions aimed at increasing self-management skills has been effective for persons with other chronic diseases and show potential to increase overall wellness and participation for those living with chronic stroke. A manual was created to educate occupational therapy students on …

Fret: Validity Of A Fall Risk Evaluation Tool For Individuals With Acquired Brain Injuries, Desiree Shaver, Colon Mikaela, Irene Leung, Melanie Shea

Dissertations, Masters Theses, Capstones, and Culminating Projects

Objective: The purpose of this study is to evaluate the predictive validity of the Fall Risk Evaluation Tool (FRET) for individuals with acquired brain injuries (ABIs).

Methods: Ten participants were included for the study. Inclusion criteria for participants included: age 18 and older, English speaking, 6-months post ABI, ambulatory with or without an assistive device, and uses a wheelchair less than 25% of the day. Exclusion criteria for participants included: global confusion and degenerative neurological conditions. Following the administration of the FRET, participants recorded falls that occurred over the following 3-month study period.

Results: Data was analyzed using the Pearson’s …

Outcomes After A Comprehensive Inpatient Rehabilitation Treatment Program For A Patient With A Right Pontine Stroke: A Case Report, Traci Rzeszutko

All Capstone Projects

Background/Purpose: A stroke occurs as a result of decreased blood flow to the brain and can cause serious limitations in mobility, balance, coordination, and strength resulting in functional limitations. The purpose of this case study is to examine the effects of a comprehensive acute inpatient rehabilitation program focusing on gait, balance, lower extremity strengthening, neuromuscular control, bed mobility, coordination, and stair training on a 67-year-old male after a right pontine stroke with a medical history that includes a right stroke eight years ago.

Case Description: The subject was a 67-year-old male with a diagnosis of right pontine stroke. The subject …

Treatment Of A 92 Year Old Female Deconditioned After Hospitalization Secondary To A Hemorrhagic Stroke: A Case Report, Paul A. Naujokas

All Capstone Projects

Background and Purpose: Research suggests that older adults are more likely to be hospitalized and to be at risk for hospital-associated deconditioning after successful treatment of their medical condition.This case report demonstrates that a walking program with progressive resistive exercises (PREs) helped one 92 year old female patient, suffering from hospital associated deconditioning, improve her strength, cardiovascular endurance, and functional abilities, including sit-stand transfers, ambulation with the least resistive assistive device (LRAD) and stair climbing. These improvements allowed the patient to return to her prior level of functioning, living independently in her 2nd story apartment with assistance as needed from …

Characterizing Knee Loading Patterns In People Post-Stroke, Stephanie Marrocco

Electronic Thesis and Dissertation Repository

Post-stroke temporal gait asymmetry (TGA) could cause excess loading of the non-paretic leg which may cause musculoskeletal (MSK) issues in the knee. This thesis investigated knee loading during gait and its relationship to TGA post-stroke. Methods: Gait analysis was conducted in nine people post-stroke. Gait was classified as symmetric (TGS) or asymmetric and external knee adduction (KAM) and flexion moments (KFM) were calculated. Participants were compared to healthy older adults (n=109) on KAM and KFM. The proportion of individuals with increased loading was compared between the TGS and TGA groups. Results: Six and four participants exhibited increased loading …

Mirror Therapy For The Lower-Extremities Post-Stroke, Lucas David Crosby

Electronic Thesis and Dissertation Repository

Despite extensive rehabilitation post-stroke gait remains slow, variable and asymmetric. There is a need for simple interventions to improve lower-extremity motor control and walking ability. Mirror therapy is a promising intervention though little attention has focused on its use on the lower-extremities post-stroke. This thesis investigates the feasibility and potential effects of a bilateral lower-extremity mirror therapy intervention (LE-MT) post-stroke. A case series involving three participants, who performed twelve 30 minute sessions of LE-MT over four weeks, is presented. Session duration and number of repetitions completed improved over the course of the intervention indicating LE-MT post-stroke is feasible. Some cases …

Stroke-Related Effects On Maximal Dynamic Hip Flexor Fatigability And Functional Implications, Henry Kuhnen, Megan M. Rybar, Tanya Onushko, Ryan E. Doyel, Sandra K. Hunter, Brian D. Schmit, Allison Hyngstrom

Exercise Science Faculty Research and Publications

Introduction: Stroke-related changes in maximal dynamic hip flexor muscle fatigability may be more relevant functionally than isometric hip flexor fatigability. Methods: Ten chronic stroke survivors performed 5 sets of 30 hip flexion maximal dynamic voluntary contractions (MDVC). A maximal isometric voluntary contraction (MIVC) was performed before and after completion of the dynamic contractions. Both the paretic and nonparetic legs were tested. Results: Reduction in hip flexion MDVC torque in the paretic leg (44.7%) was larger than the nonparetic leg (31.7%). The paretic leg had a larger reduction in rectus femoris EMG (28.9%) between the first and last …

Relieving Post-Stroke Fatigue Using A Group-Based Educational Training Approach, Catherine E. Emery

Theses and Dissertations

Post-stroke fatigue is a common problem that may limit participation in everyday activities. Emerging evidence suggests that group-based training in fatigue management may be an efficient means of reducing the effects of post-stroke fatigue. This mixed methods, quasi-experimental study proposed to determine whether a group-based educational program could be successful in relieving post-stroke fatigue and improving participation in daily activities. A convenience sample of stroke survivors (n=20) from retirement communities in southeastern PA were invited to participate in the research. Participants were screened for depression, motor and cognitive recovery, and sleep quality. Fatigue was measured using the Fatigue Severity Scale …

Choice Of Human–Computer Interaction Mode In Stroke Rehabilitation, Hossein Mousavi Hondori, Maryam Khademi, Lucy Dodakian, Alison Mackenzie, Cristina V. Lopes, Steven C. Cramer

Physical Therapy Faculty Articles and Research

Background and Objective. Advances in technology are providing new forms of human–computer interaction. The current study examined one form of human–computer interaction, augmented reality (AR), whereby subjects train in the real-world workspace with virtual objects projected by the computer. Motor performances were compared with those obtained while subjects used a traditional human–computer interaction, that is, a personal computer (PC) with a mouse. Methods. Patients used goal-directed arm movements to play AR and PC versions of the Fruit Ninja video game. The 2 versions required the same arm movements to control the game but had different cognitive demands. With …