Rehabilitation and Therapy Commons^™

The Role Of Acute Occupational Therapy In Providing Assessment And Intervention For Visual Impairments Post-Stroke, Kari Penuel

MOT Student Capstones

This project was established to explore how occupational therapy practitioners working in the acute care setting can address visual impairments post-stroke, and how these impairments effect occupational performance. Project objectives were aimed to provide occupational therapy practitioners with an increase in perceived knowledge regarding how to identify, assess, and characterize visual perceptual deficits, allowing them to use this knowledge to develop tailored interventions to address limitations with activities of daily living (ADL) performance. Goals of this project were: to highlight the importance of providing early vision assessment and intervention within the acute setting; to increase the likelihood of acute occupational …

Differential Effects Of Speech And Language Therapy And Rtms In Chronic Versus Subacute Post-Stroke Aphasia: Results Of The Northstar-Ca Trial, Anna Zumbansen, Heike Kneifel, Latifa Lazzouni, Anja Ophey, Sandra E. Black, Joyce L. Chen, Dylan Edwards, Thomas Funck, Alexander Erich Hartmann, Wolf Dieter Heiss, Franziska Hildesheim, Sylvain Lanthier, Paul Lespérance, George Mochizuki, Caroline Paquette, Elizabet Rochon, Ilona Rubi-Fessen, Jennie Valles, Susan Wortman-Jutt, Alexander Thiel

Research outputs 2022 to 2026

Background & objective: Contralesional 1-Hz repetitive transcranial magnetic stimulation (rTMS) over the right pars triangularis combined with speech-language therapy (SLT) has shown positive results on the recovery of naming in subacute (5–45 days) post-stroke aphasia. NORTHSTAR-CA is an extension of the previously reported NORTHSTAR trial to chronic aphasia (>6 months post-stroke) designed to compare the effectiveness of the same rTMS protocol in both phases. Methods: Sixty-seven patients with left middle cerebral artery infarcts (28 chronic, 39 subacute) were recruited (01-2014 to 07-2019) and randomized to receive rTMS (N = 34) or sham stimulation (N = 33) with SLT for …

Using Creative Making To Redesign Life After Stroke, Jennifer K. Fortuna

The Open Journal of Occupational Therapy

Kate Davies, a knitwear designer and author based in Scotland, provided the cover art for the Winter 2022 edition of the Open Journal of Occupational Therapy. “Balance for Better” is a blanket made from wool and mohair. The blanket consists of 30 individual squares designed and knitted by KDD & Co. employees. The colors and pattern of each square reflect the work, achievements, and legacy of the inspirational women celebrated in the blanket. At age 36, Kate suffered a near-fatal stroke that left her paralyzed on the left side of her body. Forced to give up her career as …

Visualization-Driven Time-Series Extraction From Wearable Systems Can Facilitate Differentiation Of Passive Adl Characteristics Among Stroke And Healthy Older Adults, Joby John, Rahul Soangra

Physical Therapy Faculty Articles and Research

Wearable technologies allow the measurement of unhindered activities of daily living (ADL) among patients who had a stroke in their natural settings. However, methods to extract meaningful information from large multi-day datasets are limited. This study investigated new visualization-driven time-series extraction methods for distinguishing activities from stroke and healthy adults. Fourteen stroke and fourteen healthy adults wore a wearable sensor at the L5/S1 position for three consecutive days and collected accelerometer data passively in the participant’s naturalistic environment. Data from visualization facilitated selecting information-rich time series, which resulted in classification accuracy of 97.3% using recurrent neural networks (RNNs). Individuals with …

Kinematic Analysis Of 360° Turning In Stroke Survivors Using Wearable Motion Sensors, Masoud Abdollahi, Pranav Madhav Kuber, Michael Shiraishi, Rahul Soangra, Ehsan Rashedi

Physical Therapy Faculty Articles and Research

Background: A stroke often bequeaths surviving patients with impaired neuromusculoskeletal systems subjecting them to increased risk of injury (e.g., due to falls) even during activities of daily living. The risk of injuries to such individuals can be related to alterations in their movement. Using inertial sensors to record the digital biomarkers during turning could reveal the relevant turning alterations. Objectives: In this study, movement alterations in stroke survivors (SS) were studied and compared to healthy individuals (HI) in the entire turning task due to its requirement of synergistic application of multiple bodily systems. Methods: The motion of 28 participants (14 …

Effects Of Quadruped Movement In An Individual With Chronic Stroke: A Case Study, Maureen Romanow Pascal, Emily Connell, Alyssa Pratti, Kristina Russell

Student Research Poster Presentations 2022

Background/Purpose: Neuromuscular dysfunction encompasses a wide variety of conditions that impact proper muscle functioning. One common condition resulting in neuromuscular dysfunction is a cerebrovascular accident (CVA) which can disrupt sensory, motor, visual and language systems. The resulting combination of impairments can cause limitations in activity performance and restrict participation across domains. In addition, muscle weakness is widely recognized as a major contributing factor to decline in function. Literature is showing that rehabilitation programs focusing on development of core strength with emphasis on repetition, intensity and novelty are critical for recovery of motor function. The purpose of this research was to …

The Experience Of Meditation, And Its Effects On Attention, For Adults With Stroke Or Attention Deficit Hyperactivity Disorder: A Three-Part Dissertation With Qualitative And Quantitative Evidence, Cheryl Carrico

Theses and Dissertations--Rehabilitation Sciences

Impairment of attention is common after stroke; is a defining characteristic of attention deficit hyperactivity disorder (ADHD); and has been shown to correlate significantly with difficulties in daily life for individuals with these conditions. More research is needed to establish effective interventions addressing impaired attention in such cases. Meditation is not a standard-of-care intervention for this purpose but may have therapeutic potential. Meditation has been broadly defined as an activity which has self-regulation of attention as its main aim. In other words, it can be considered a training of attention. To shed light on the therapeutic potential of meditation, including …

Evaluating The Microbiome To Boost Recovery From Stroke: The Embrs Study, Tyler Hammond

Theses and Dissertations--Neuroscience

Accumulating evidence suggests that gut microbes modulate brain plasticity via the bidirectional gut-brain axis and may play a role in stroke rehabilitation. A severely imbalanced microbial community has been shown to occur following stroke, causing a systemic flood of neuro- and immunomodulatory substances due to increased gut permeability and decreased gut motility. Here we measure post-stroke increased gut dysbiosis and how it correlates with gut permeability and subsequent cognitive impairment.

We recruited 12 participants with acute stroke, 12 healthy control participants, and 18 participants who had risk factors for stroke, but had not had a stroke. We measured the gut …

Statistical Analysis Plan For The Stepped-Wedge Clinical Trial Healing Right Way - Enhancing Rehabilitation Services For Aboriginal Australians After Brain Injury, Elizabeth Armstrong, Tapan Rai, Deborah Hersh, Sandra Thompson, Juli Coffin, Natalie Ciccone, Leon Flicker, Dominique Cadilhac, Erin Godecke, Deborah Woods, Colleen Hayward, Graeme J. Hankey, Meaghan Mcallister, Judith Katzenellenbogen

Research outputs 2022 to 2026

Background: Aboriginal Australians are known to suffer high levels of acquired brain injury (stroke and traumatic brain injury) yet experience significant barriers in accessing rehabilitation services. The aim of the Healing Right Way trial is to evaluate a culturally secure intervention for Aboriginal people with newly acquired brain injury to improve their rehabilitation experience and quality of life. Following publication of the trial protocol, this paper outlines the statistical analysis plan prior to locking the database. Methods: The trial involves a stepped wedge design with four steps over 3 years. Participants were 108 adult Aboriginal Australians admitted to one of …

Poststroke Swallowing Rehabilitation And Recent Development, Shu-Fen Sun, Ping-Hsin Chang, Chien-Wei Hsu, I-Hsiu Liou

Rehabilitation Practice and Science

Dysphagia is a common poststroke complication. It is associated with aspiration, malnutrition, dehydration, and disability, and it may increase the risk of pneumonia, and even death. Early diagnosis and treatment of patients with dysphagia reduces not only the aforementioned risks, but also the length of hospitalization and overall healthcare expenditures. Patients with poststroke oropharyngeal dysphagia exhibit highly variable patterns of swallowing abnormalities, and the related symptoms remain challenging to identify clinically. Patients who have experienced stroke should be screened for dysphagia as early as possible on admission and prior to any form of oral intake. Those who fail dysphagia screening …

Therapeutic Efficacy Of Dynamic Hand Splints In Spastic Hemiparetic Hands: A Randomized Controlled Single-Blind Trial, Yi-Ching Huang, Shih-Che Lin, Kai-Hua Chen, Chien-Min Chen, Chia-Hao Chang, Chu-Hsu Lin

Rehabilitation Practice and Science

Background: It is usually challenging to treat patients following stroke or brain injury with spastic hemiparetic upper limbs. Dynamic hand splints have been used to manage this issue for years, but evidence of their efficacy is still lacking. Objective: To investigate the treatment efficacy of dynamic hand splinting in spastic hemiparetic patients. Methods: In this randomized controlled single-blind clinical trial, patients with spastic hemiparesis lasting more than half a year after a stroke or brain injury were enrolled. They were randomly divided into a splint group and a control group, and received 1 month of task-oriented training with or without …

The Effectiveness Of Occupation-Based Virtual Reality Intervention On Upper Extremity Functional Improvement In Post-Stroke Individuals: A Systematic Review, Darcy Bowman, Tiffani Suhm, Ann Marie Brown, Aubrey Barrett, Hannah Reilley

Student Journal of Occupational Therapy

Purpose: Virtual reality (VR)-based therapy is an emerging practice in the clinical setting and still requires research documenting its efficacy. This review analyzed the effectiveness of VR-based therapy on upper extremity (UE) motor recovery in individuals with chronic stroke by analyzing multiple randomized controlled trials.

Methods: Search limits for this review consisted of articles published between January 2010 and January 2020 and available in English. Search keywords were based on language in individual databases (e.g. stroke or cerebrovascular accident, upper extremity, occupational therapy). Articles were limited to include only randomized control trials consisting of adult patients (18+) with …

Different Biomechanical Variables Explain Within-Subjects Versus Between-Subjects Variance In Step Length Asymmetry Post-Stroke, Natalia Sánchez, Nicolas Schweighofer, James M. Finley

Physical Therapy Faculty Articles and Research

Step length asymmetry (SLA) is common in most stroke survivors. Several studies have shown that factors such as paretic propulsion can explain between-subjects differences in SLA. However, whether the factors that account for between-subjects variance in SLA are consistent with those that account for within subjects, stride-by-stride variance in SLA has not been determined. SLA direction is heterogeneous, and different impairments likely contribute to differences in SLA direction. Here, we identified common predictors between-subjects that explain within-subjects variance in SLA using sparse partial least squares regression (sPLSR). We determined whether the SLA predictors differ based on SLA direction and whether …

Development And Feasibility Of A Modified Fugl-Meyer Lower Extremity Assessment For Telerehabilitation: A Pilot Study., Sue Peters, Marcela Botero, Allison Evers, Brianna Fong, Botond Jakab, Emily Petter, Janice J Eng

Physical Therapy Publications

BACKGROUND: The majority of stroke survivors experience motor impairment which benefits from rehabilitation treatment. Telerehabilitation, remote delivery of rehabilitation services, is a possible solution providing access to rehabilitation for stroke survivors living in rural areas or in situations like the COVID-19 pandemic where face-to-face treatment may be risky. However, valid and reliable motor impairment measures have not yet been established over a telerehabilitation platform. The Fugl-Meyer (FM) lower extremity assessment is widely used clinically and in research. Thus, the aim was to develop a modified FM for telerehabilitation (FM-tele) and assess the feasibility and preliminary agreement of FM-tele scores with …

The Time For Translation Of Mobile Brain And Body Imaging To People With Stroke Is Now, Brian Greeley, Grant Hanada, Lara A Boyd, Sue Peters

Physical Therapy Publications

No abstract provided.

Using Biofeedback To Reduce Spatiotemporal Asymmetry Impairs Dynamic Balance In People Post-Stroke, Sungwoo Park, Chang Liu, Natalia Sánchez, Julie K. Tilson, Sara J. Mulroy, James M. Finley

Physical Therapy Faculty Articles and Research

Background. People poststroke often walk with a spatiotemporally asymmetric gait, due in part to sensorimotor impairments in the paretic lower extremity. Although reducing asymmetry is a common objective of rehabilitation, the effects of improving symmetry on balance are yet to be determined. Objective. We established the concurrent validity of whole-body angular momentum as a measure of balance, and we determined if reducing step length asymmetry would improve balance by decreasing whole-body angular momentum. Methods. We performed clinical balance assessments and measured wholebody angular momentum during walking using a full-body marker set in a sample of 36 people with …

Supporting Caregivers And Survivors Of Stroke In Their Journey Through Stroke Recovery Via Telehealth Services, Keri Kamphoff

Occupational Therapy Capstone Presentations

Supporting Caregivers and Survivors of Stroke in their Journey through Stroke Recovery via Telehealth Services

Background: Strokes are a prevalent condition around the world that cause chronic functional deficits. Survivors of stroke and their caregivers in the community report limited social participation, decreased involvement in favored occupations, worse health outcomes, and increased rates of anxiety and stress. Occupational therapists have the skills to provide education and support for this population through community programs using telehealth.

Methodology: This project was completed at the American Stroke Foundation (ASF), which was operating virtually due to the COVID-19 pandemic. Webinars, caregiver support groups, daily …

Lost In Translation: Simple Steps In Experimental Design Of Neurorehabilitation-Based Research Interventions To Promote Motor Recovery Post-Stroke, Natalia Sánchez, Carolee J. Winstein

Physical Therapy Faculty Articles and Research

Stroke continues to be a leading cause of disability. Basic neurorehabilitation research is necessary to inform the neuropathophysiology of impaired motor control, and to develop targeted interventions with potential to remediate disability post-stroke. Despite knowledge gained from basic research studies, the effectiveness of researchbased interventions for reducing motor impairment has been no greater than standard of practice interventions. In this perspective, we offer suggestions for overcoming translational barriers integral to experimental design, to augment traditional protocols, and re-route the rehabilitation trajectory toward recovery and away from compensation. First, we suggest that researchers consider modifying task practice schedules to focus on …

A Qualitative Study Investigating Stroke Survivors’ Perceptions Of Their Psychosocial Needs Being Met During Rehabilitation, Robin A. Wenzel, Emily A. Zgoda, Mia C. St. Clair, Lisa J. Knecht-Sabres

The Open Journal of Occupational Therapy

Background: Depression and anxiety can negatively impact one’s recovery, outcomes, and quality of life. Even though therapists consider the mental health needs of their clients to be a priority, they are dissatisfied with their ability to completely address these needs. The purpose of this study was to examine the client’s perspective regarding the extent to which health care professionals addressed their psychosocial needs after a stroke.

Method: A phenomenological research design was used to collect data from six participants. Interviews and focus group were audiotaped, transcribed verbatim, and thematically analyzed. Member checks, peer-review, multiple coders, triangulation, and expert …

Reducing Stroke Readmission Through The Implementation Of Telehealth, Leilani Hermosura

Student Scholarly Projects

Practice Problem: Readmission occurs frequently among patients with stroke and because of this, the Centers for Medicare and Medicaid Services (CMS) have imposed programs to reduce 30-day readmissions among hospitals. The health care system must respond with transition of care, especially during the period of recent stroke to improve patient outcomes.

PICOT: The PICOT question that guided this project was among patients with a recent diagnosis of stroke (P), what is the effect of a telehealth appointment with a nurse practitioner (NP) for post discharge follow-up (I), compared to a standard face-to-face clinic appointment (C), on 30-day readmissions rates (O), …

Comparison Of 360° Turn Cycles Among Individuals After Stroke And Healthy Older Adults, Rahul Soangra, Vennila Krishnan, Joby John, Ehsan Rashedi, Alison Mckenzie

Physical Therapy Faculty Articles and Research

Stroke survivors are at high risk of falling during turning. The kinematics of performing a 360° turn have not been fully analyzed among individuals after stroke. Quantitative differences in the parameters of turning between healthy older adults and those after stroke could provide detailed information on turning ability among these groups. The purpose of the current study was to characterize differences between healthy older adults and adults after stroke in 360° turn kinematics. Fourteen individuals with chronic stroke (mean age: 69 ± 8.4 years) and 14 healthy older adults (mean age: 74 ± 8.7 years) performed three trials of 360° …

Aquatic Therapy For Subacute Stroke Patients, Meaghan Buchanan

MOT Student Capstones

Stroke is one of the leading causes of disability in the U.S. affecting patients physically and psychologically. A stroke can lead to significant functional deficits, depending on the location of the stroke, and level of rehabilitation. Currently, no rehabilitation protocol exists for stroke patients and often patients reach a plateau during treatment, without reaching their full potential, and with continued deficits that affect functional mobility. Interventions provided in an aquatic environment can promote continued therapeutic outcomes, not possible with land-based therapy. The purpose of this paper is to showcase aquatic therapy as a viable therapeutic intervention and to provide a …

Publication Rate And Consistency Of Registered Trials Of Motor-Based Stroke Rehabilitation, Raabeae Aryan, David Jagroop, Cynthia J Danells, Gabriela Rozanski, Janelle Unger, Andrew H Huntley, Avril Mansfield

Physical Therapy Publications

OBJECTIVE: To determine the publication rate of motor-rehabilitation trials poststroke and the consistency between registry records and their corresponding main publications in trial design, primary objectives and outcomes, eligibility criteria, and sample size.

METHODS: We searched 18 clinical trial registries to identify randomized controlled trials of motor-based stroke rehabilitation registered after July 2005 and completed before April 2017. Eligible trials included adults with stroke, with at least one outcome measure related to motor function. Information in the registry records was compared with that of their main publications, if any.

RESULTS: Three hundred twenty-three trials met our eligibility criteria; we were …

A Feasibility Study Of Expanded Home-Based Telerehabilitation After Stroke, Steven C. Cramer, Lucy Dodakian, Vu Le, Alison Mckenzie, Jill See, Renee Augsburger, Robert J. Zhou, Sophia M. Raefsky, Thalia Nguyen, Benjamin Vanderschelden, Gene Wong, Daniel Bandak, Laila Nazarzai, Amar Dhand, Walt Scacchi, Jutta Heckhausen

Physical Therapy Faculty Articles and Research

Introduction: High doses of activity-based rehabilitation therapy improve outcomes after stroke, but many patients do not receive this for various reasons such as poor access, transportation difficulties, and low compliance. Home-based telerehabilitation (TR) can address these issues. The current study evaluated the feasibility of an expanded TR program.

Methods: Under the supervision of a licensed therapist, adults with stroke and limb weakness received home-based TR (1 h/day, 6 days/week) delivered using games and exercises. New features examined include extending therapy to 12 weeks duration, treating both arm and leg motor deficits, patient assessments performed with no therapist supervision, adding sensors …

Social Network Structure Is Related To Functional Improvement From Home-Based Telerehabilitation After Stroke, Archana Podury, Sophia M. Raefsky, Lucy Dodakian, Liam Mccafferty, Vu Le, Alison Mckenzie, Jill See, Robert J. Zhou, Thalia Nguyen, Benjamin Vanderschelden, Gene Wong, Laila Nazarzai, Jutta Heckhausen, Steven C. Cramer, Amar Dhand

Physical Therapy Faculty Articles and Research

Objective: Telerehabilitation (TR) is now, in the context of COVID-19, more clinically relevant than ever as a major source of outpatient care. The social network of a patient is a critical yet understudied factor in the success of TR that may influence both engagement in therapy programs and post-stroke outcomes. We designed a 12-week home-based TR program for stroke patients and evaluated which social factors might be related to motor gains and reduced depressive symptoms.

Methods: Stroke patients (n = 13) with arm motor deficits underwent supervised home-based TR for 12 weeks with routine assessments of motor function and …

Integrating Survivors Of Stroke Into Exercise‐Based Cardiac Rehabilitation Improves Endurance And Functional Strength, Elizabeth Wherley Regan Dpt, Ph.D., Reed Handlery, Jill Campbell Stewart, Joseph Lee Pearson Ms,Drph, Sarah Wilcox Phd, Stacy L. Fritz Phd, Pt

Faculty Publications

Background

Cardiac rehabilitation (CR) is a structured exercise program prevalent in the United States for people with cardiovascular disease that has been shown to increase cardiovascular endurance and improve quality of life. Despite similar cardiovascular risk factors, stroke is not among the covered diagnoses for CR. The purpose of this study was to examine the participant impact of integrating survivors of stroke into the exercise portion of an existing hospital‐based CR program through measures of physical function and other health impacts and through qualitative evaluation of participant perception.

Methods and Results

Subacute and chronic survivors of stroke were integrated into …

Visual And Non-Visual Control Of Movement: The Role Of Proprioception In Upper Limb Function After Stroke, Nathan A. Baune

Arts & Sciences Graduate Student Theses and Dissertations

This dissertation presents a series of studies into human reach and grasp, focusing on the neural systems and behaviors of upper-limb action that underly performance under varied sensory conditions: specifically, acting with and without visual feedback of the limb and under typical or impaired proprioceptive sensation (proprioceptive decline with aging and proprioceptive deficit following stroke). Under typical conditions, a combination of visual and non-visual (e.g., proprioception) sources of information are used to guide action. In the instance of stroke survivors or elderly individuals with proprioceptive deficits/decline, there may be a necessary reliance on visual information to perform. The studies are …

Cardiovascular Effects Of Transcranial Direct Current Stimulation And Bimanual Training In Children With Cerebral Palsy, Manda L. Keller-Ross, Daniel P. Chantigian, Samuel Nemanich, Bernadette T. Gillick

Occupational Therapy Faculty Research and Publications

Purpose:

To determine the influence of combined transcranial direct current stimulation (tDCS) to the motor cortex (M1) and bimanual training on cardiovascular function in children with cerebral palsy (CP).

Methods:

Mean arterial pressure (MAP), heart rate (HR), and HR variability (HRV) were measured immediately before and after 20 minutes of cathodal tDCS to contralesional M1 and bimanual training on days 1, 6, and 10 of a 10-day trial in 8 participants (5 females, 7-19 years).

Results:

Baseline MAP and HR were similar across days (93 ± 10 mm Hg and 90 ± 10 bpm, P > .05). MAP was similar from …

Hospital Staff, Volunteers’ And Patients’ Perceptions Of Barriers And Facilitators To Communication Following Stroke In An Acute And A Rehabilitation Private Hospital Ward: A Qualitative Description Study, Sarah D'Souza, Erin Godecke, Natalie Ciccone, Deborah J. Hersh, Heidi Janssen, Elizabeth Armstrong

Research outputs 2014 to 2021

Objectives

To explore barriers and facilitators to patient communication in an acute and rehabilitation ward setting from the perspectives of hospital staff, volunteers and patients following stroke.

Design

A qualitative descriptive study as part of a larger study which aimed to develop and test a Communication Enhanced Environment model in an acute and a rehabilitation ward.

Setting

A metropolitan Australian private hospital.

Participants

Focus groups with acute and rehabilitation doctors, nurses, allied health staff and volunteers (n=51), and interviews with patients following stroke (n=7), including three with aphasia, were conducted.

Results

The key themes related to barriers and facilitators to …

An Exploration Of The Relationship Between Aphasia Therapy, Depression And Quality Of Life In Post-Stroke Patients After Rehabilitation At 12 And 26 Weeks After Stroke: A Verse Sub-Study, Alia Rashid Khan

Theses: Doctorates and Masters

Background: Depression is a common consequence of stroke, and people with aphasia (PWA) post-stroke have a higher risk of developing depression compared to stroke survivors without aphasia. However, current stroke interventions featuring aphasia therapy tend to neglect the effect of the treatment on mood. There is also a lack of evidence on the impact of stroke education and counselling on PWA in early stroke recovery. Additionally, the research on post-stroke depression often excludes or insufficiently describes PWA in study populations. The influence of direct aphasia therapy on depression in PWA is undetermined. This sub-study investigated: i) the effect of …