Rehabilitation and Therapy Commons^™

Biomechanically Inspired Assistive Technology To Restore Movement Of The Upper Limbs After Stroke, Ariel Thomas

Graduate Theses, Dissertations, and Problem Reports (ETD)

A stroke often damages the neural structures responsible for movement. Stroke is a heterogeneous disease, affecting each survivor differently. There are common motor features of a stroke, but even these features vary across time as an individual proceeds through different stages of recovery. The different ways in which stroke motor impairment can present itself are often overlooked, but these differences are fundamental to the understanding of the disease and its recovery. When motor assessments are capable of acquiring information necessary to parse out a detailed profile of each stroke case, this will lead to an improved neuromechanical understanding of the …

A Systematic Reviewarticle On Discharge Destinations For Patients With Stroke, Lin-Fu Lee, Wen-Chih Lin, Willy Chou

Rehabilitation Practice and Science

Introduction: Complex and diverse factors affect the placement of patients with stroke after they are discharged from hospitals. In this study, a systematic reviewarticle of relevant literature was performed to compile related research data and explore the importance of individuals factors and the overall predictive power of multiple variables. Methods: Electronic resources from PubMed and the Cochrane Library were used along with keywords such as ＂stroke＂ and ＂discharge destination＂ to search for relevant articles published between 2005 and 2018. Only original research articles written in English were selected. Results: A total of 19 articles were selected to compile 10 factors, …

Effects Of An Anterior Ankle-Foot Orthosis On Static Standing Balance Control In Patients With Chronic Stroke Wearing The Orthosis For A Long Time, Min-Yuan Yu, Yu-Hsuan Tseng, Po-Chih Chen, Jen-Wen Hung

Rehabilitation Practice and Science

Aims: To investigate the effects of anterior ankle-foot orthosis (A-AFO) on static standing postural control in patients with chronic stroke wearing the A-AFO for a long time. Methods: We recruited patients with chronic stroke wearing an A-AFO for at least 5 months. Static standing balance control was evaluated using the Tetrax Balance System in eight positions: (1) eyes open on a solid surface [NO];(2) eyes closed on a solid surface [NC];(3) eyes open on a foam surface [PO];(4) eyes closed on a foam surface [PC];and head turned at 30° to (5) right [HR], (6) left [HL], (7) up [HB], and …

Kienböck's Disease In A Patient With Hemiparetic Stroke: A Casereport, Pao-Sheng Wu, Yen-Ting Cho

Rehabilitation Practice and Science

Kienböck's disease of the wrist is a multifactorial, progressive osteonecrosis of the lunate bone. Patients with this disease often complain of dorsal wrist pain and other wrist dysfunctions. Image studies are usually required for definite diagnosis; however, careful history taking and physical examination are also necessary. Treatment varies according to the stage of the disease; although surgery is needed in most of the cases, rehabilitation after the surgery seems helpful as well. Kienböck's disease is rarely seen in our daily practice, and even though we do recognize the disease, diagnosing it correctly in patients with comorbidities such as stroke is …

Gains Across Who Dimensions Of Function After Robot-Based Therapy In Stroke Subjects, Jennifer Wu, Lucy Dodakian, Jill See, Erin Burke Quinlan, Lisa Meng, Jeby Abraham, Ellen C. Wong, Vu Le, Alison Mckenzie, Steven C. Cramer

Physical Therapy Faculty Articles and Research

Background

Studies examining the effects of therapeutic interventions after stroke often focus on changes in loss of body function/structure (impairment). However, improvements in activities limitations and participation restriction are often higher patient priorities, and the relationship that these measures have with loss of body function/structure is unclear.

Objective

This study measured gains across WHO International Classification of Function (ICF) dimensions and examined their interrelationships.

Methods

Subjects were recruited 11 to 26 weeks after hemiparetic stroke. Over a 3-week period, subjects received 12 sessions of intensive robot-based therapy targeting the distal arm. Each subject was assessed at baseline and at 1 …

Targeted Engagement Of The Action Selection Network During Task-Oriented Arm Training After Stroke, Jill Campbell Stewart Pt,Phd, Kaci Handlery, Jessica F. Baird, Erika L. Blanck, Geetanjali Pathak, Stacy L. Fritz

Faculty Publications

Action selection (AS), or selection of an action from a set of alternatives, is an important movement preparation process that engages a frontal-parietal network. The addition of AS demands to arm training after stroke could be used to engage this motor planning process and the neural network that supports it. The purpose of this case series is to describe the feasibility and outcomes associated with task-oriented arm training aimed at engaging the AS behavioral process and the related neural network in three individuals with chronic stroke. Three participants with mild to moderate motor deficits completed 13 to 15 sessions of …

Post-Stroke Cognitive Impairments And Responsiveness To Motor Rehabilitation: A Review, Jennapher Lingo Vangilder, Andrew Hooyman, Daniel S. Peterson, Sydney Y. Schaefer

Physical Therapy Faculty Articles and Research

Purpose of Review
This review discusses the prevalence of cognitive deficits following stroke and their impact on responsiveness to therapeutic intervention within a motor learning context.

Recent Findings
Clinical and experimental studies have established that post-stroke cognitive and motor deficits may impede ambulation, augment fall risk, and influence the efficacy of interventions. Recent research suggests the presence of cognitive deficits may play a larger role in motor recovery than previously understood.

Summary
Considering that cognitive impairments affect motor relearning, post-stroke motor rehabilitation therapies may benefit from formal neuropsychological testing. For example, early work suggests that in neurotypical adults, cognitive function …

Group Therapy Versus Individual Therapy For Older Adults With A Cerebrovascular Accident, Montana R. Bawcum, Jessica Sorrell, Kaleigh Stevens, Caitlyn Strietelmeier, Madeline Young

Master of Occupational Therapy Student Critically Appraised Topics

The purpose of our critically appraised topic is to synthesize the best current evidence regarding the feasibility of group occupational therapy and outcomes related to ADL performance. The final portfolio contains a total of five research articles. Study designs include two pre-post single group designs, two case studies, and one non randomized pilot trial with a control group. All studies related directly to the PICO question and were used to determine best evidence for the feasibility of group therapy of the older adult population in a rehabilitation setting.

The Effects Of Somatosensory Input On Gait In Individuals Post-Stroke, Victor Hung, Amanda Reilly, Rachel Wood, Nikita Yuskov

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background and Purpose: Stroke is a leading cause of disability that results in various neurological deficits, one of which is hemiplegia. This deficit alters the gait cycle, resulting in decreased propulsion force by plantar flexor muscles, decreased activation of dorsiflexor (DF) muscles, and increased coactivation of antagonistic ankle muscles. Stroke also leads to altered somatosensory input which results in decreased balance and gait speed, ultimately increasing fall risk. Therapies targeting increased somatosensory input have been shown to be beneficial in stroke as well as other neurological populations. However, no known studies have investigated the acute effects of local vibration to …

Are All Instrumental Activities Of Daily Living Equal? A Pilot Study On The Performances Of Adults With Acquired Brain Injury, Crystal Lee, Samantha Schauer, Amy Tam, Yareli Vargas

Occupational Therapy | MSOT Capstone Projects

Aim: To determine if a relationship exists among performances of different instrumental activities of daily living (IADLs) in adults with acquired brain injury (ABI).

Methods: A two-group correlational design was used to examine the relationship among performances in cooking, medication management, and financial management in nine adults with ABI who returned to driving and nine adults with ABI who did not return to driving. The Executive Function Performance Test (EFPT) measured initiation, organization, sequencing, judgment and safety, and completion.

The Effects Of Bilingualism In Post-Stroke Aphasia Patients: Clinical Implications Within The United States, Kristen Bennett

Undergraduate Honors Theses

The consistent increase of cultural diversity and immigration within the United States over the last fifty years has contributed to a societal shift towards a growing bilingual population. The growth of this population has generated a need to evaluate current assessment and treatment plans for bilingual post-stroke aphasia patients within the United States to ensure that these individuals are receiving effective healthcare. This study aims to investigate the current knowledge gap surrounding appropriate methods of assessing and treating bilingual post-stroke aphasia patients within the United States and suggest potential approaches based on existing research. In order to synthesize information regarding …

Assessing Unmet Needs Of Caregivers After Stroke: Occupational Therapist Practices And Perspectives, Deborah R. Clymer, Hadley A. Fields, Kathy Kniepmann

The Open Journal of Occupational Therapy

Background: Family caregivers of stroke survivors often feel unprepared and overwhelmed post discharge with numerous unmet needs. Occupational therapists can play an integral role in addressing family caregivers’ needs. Limited research exists on assessment practices of occupational therapists in identifying caregivers’ needs poststroke. This study explores the practices and perspectives of occupational therapists in assessing unmet caregivers’ needs.

Method: A cross-sectional, mixed methods research design was used to electronically survey 15 occupational therapists. Part 1 of the survey explored participant methods for identifying caregivers’ needs and their views on using formal caregiver assessment tools. Part 2 gathered participant perspectives on …

The Effects Of Virtual Rehabilitation Therapy On Multiple Sclerosis, Mary Price

Honors Projects

In this review article, the effect of virtual rehabilitation therapy on multiple sclerosis, a neurodegenerative disorder, is explored. Multiple sclerosis is characterized by damaged nerves that result in incomplete signal processing between the brain and the spinal cord. The symptoms of this condition can include vision loss, decreased coordination, pain, fatigue, and deteriorating motor output. The severity of the symptoms and the rate of progression of multiple sclerosis can vary from person to person; some individuals live the majority of their lives with mild symptoms while others become bedridden and immobile. There is no cure for this disease, however implementation …

The Impact Of Education On The Attitudes Of Staff Of A Rehabilitation Hospital, Kathryn Voreis, Kathryn G. Voreis

Electronic Theses and Dissertations

Stroke, also known as CVA or cerebrovascular accident, is a major chronic disease worldwide. In the United States, it is the leading cause of disability, costing a billion dollars each year (CDC, 2017). Typically, Western medicine is used for the treatment of stroke in the United States. An approach that has potential to improve general health outcomes, movement, mobility, aphasia, and quality of life includes acupuncture along with the standard therapies. The purpose of this quantitative research was to determine if the staff of a rehabilitation hospital would have a change in attitude after an educational program on acupuncture. The …

Age And Functional Outcomes Post-Neurologic Insult In Patients Attending Inpatient Rehabilitation, Jonathan Bowman Spt, Elena Crooks Pt, Dpt, Phd, Doug Weeks Phd, Kimberly Honn Phd

2020 Symposium Posters

Introduction

Neurologic insults such as strokes and traumatic brain injuries (TBI) affect over 1 million Americans every year. The lack of current knowledge informing accurate prognoses causes victims and their loved ones distress, and is a focus of much research. The purpose of this study was to determine whether patient age at time of insult could predict change in functional outcomes during inpatient rehabilitation.

Methods

Subjects were patients of an inpatient rehabilitation facility (IRF) post-stroke or TBI. The Functional Independence Measure (FIM) assessed functional independence and cognitive status at admission and discharge from the IRF. The Montebello Rehabilitation Factor Score …

An Exploration Of Quality Of Life Contributors For Stroke Survivors: Potential Implications For Service Delivery Within The Community Rehabilitation Context, Gaylea Fritsch, Sarah Patterson, Anita Blight, Renaye Daniells

Internet Journal of Allied Health Sciences and Practice

Purpose: Community rehabilitation services typically assist stroke survivors with function, participation, and quality of life. Many factors have been found to influence the overall quality of life including self-identity, control, social supports, personality, and participation in valued activities. This review explored the possible contributing quality of life factors for stroke survivors within a community rehabilitation context to assist with further development of service delivery within this clinical area. Method: A purposive sample of clients with stroke (n=20) was selected based on their overall quality of life change during their rehabilitation program as measured on the World Health Organisation Quality of …

A Phenomenological Study Of The Impact Of Stroke On Marriage: Life Satisfaction And Occupational Performance In Daily Life, Melissa Arwood

Online Theses and Dissertations

Introduction: Following a stroke, an individual may experience physical, cognitive, and emotional changes. For individuals in a marital relationship, the spouse’s life is also impacted post-stroke. The majority of current literature regarding the impact of stroke on marriage focuses on one spouse. This study sought to address this gap by exploring the impact of stroke on the marital dyad.

Method: A qualitative, phenomenological approach was used for this study. Semi-structured phone interviews were conducted. The interviews were transcribed verbatim and analyzed using Colaizzi’s method as explained by Shosha (2012).

Findings: Four couples, eight participants were included in this study. One …

Determinants Of Stroke Inpatient Charge In Chronic Rehabilitation Wards Of A Community Hospital In Taiwan, Allen C.L. Hsu, Miao-Ming Chen, Chih-Kuang Chen

Rehabilitation Practice and Science

Stroke is a disease with severe consequences which impose a considerable socio-economic burden on patients and society. In developed countries, stroke patients alone generate about 3-4% of the direct costs within the healthcare system. The costs of rehabilitation and long-term care of disabled stroke survivors are expected to rise even further because of the increasing number of the aging population and declining stroke case-fatality rates. The aims of the paper are to evaluate the factors that may influence costs of stroke patients in chronic rehabilitation wards for better management of medical resources. This study was conducted at a local general …

A Focal Survey Of Medical Professionals' Conceptions Of Gastrostomy In Patients With Dysphagia After Stroke In Taiwan, Sheng-Hao Cheng, Yi-Ching Chen, Ming-Yen Hsiao, Tyng-Guey Wang

Rehabilitation Practice and Science

Background and aims: People with dysphagia may require long-term tube feeding to maintain adequate nutrition. In Taiwan, nasogastric (NG) tubes are more commonly used than gastrostomy tubes. This practice is inconsistent with international treatment guidelines. Medical professionals' attitudes toward treatment may influence patients' decisions. Therefore, we designed a questionnaire to assess whether medical professionals' conceptions of gastrostomy are consistent with current international treatment principles. Methods: We used an online questionnaire hosted on ＂Google Forms＂ to collect medical professionals' conceptions of gastrostomy. Societies related to dysphagia distributed copies of the questionnaire to their members. The professionals included specialists (physiatrists, otolaryngologists, oral …

Is Vertical Orientation Ability And Visual Feedback Training Strategy Useful For Pusher Syndrome After Stroke: A System Reviewarticle, Chien-Hsun Lee

Rehabilitation Practice and Science

Stroke patients with pusher syndrome (PS) have a longer recovery time than those without this disorder. This special syndrome causes difficulty in maintaining balance when sitting or standing, with sufferers ＂pushing and leaning＂ automatically to hemi-side. PS patients may also have cognition impairment, hemi-neglect, or aphasia. Alleviating all these factors requires extensive training for therapists, however, few undergo such training. Wang et. al. published a reviewarticle article in Taiwan Journal of Physical Medicine and Rehabilitation in 2005, and the conclusions drawn were: 1) PS patients have abnormal subjective posture and vertical orientation ability; 2) training strategies that use visual feedback …

Case Study: Efficacy Of Physical Therapy On A Patient With Cva In Normalizing Gait And Shoulder Mechanics, Jane Mongkolvipakul, Amanda Orr, Queenie Lim, Rajbir Basati, Faris Alshammari

San Marcos, Fall 2019

Background & Purpose: Cerebrovascular Accident (CVA) is known as Stroke. It is a damage to the brain due to an interruption of blood supply. Two main types of stroke are ischemic stroke and hemorrhagic stroke. Ischemic stroke, the most common type of stroke, is due to a blocked artery and a hemorrhagic stroke is due to a leak or burst of a blood vessel. Signs and symptoms of stroke are presented contralaterally. The purpose of this case report is to demonstrate the use of PT interventions to improve shoulder function and gait mechanics in a post CVA patient.

Case …

Functional Mobility In A Patient With Antiphospholipid Antibody Syndrome Following A Femoral Neck Fracture Surgical Repair: A Case Report, Mckenna Young

Case Report Papers

Background and Purpose: The main focus of chronic disease in healthcare has typically been about treatment of the disease itself, with little attention given to secondary injuries that result from the chronic disease process. As these individuals age, the risk of secondary injuries increases. This is costly and adds to the caregiver burden. The purpose of this case report was to investigate a comprehensive physical therapy (PT) program focused on rehabilitation for a female with chronic disease who sustained a femoral fracture following her most recent fall. Case Description: A 42-year-old female presented to outpatient PT following a right femoral …

Tissue Plasminogen Activator Effects On Stroke And Physical Therapy Outcomes In Acute Care: A Case Report, Lindsey Leboeuf

Case Report Papers

Background and Purpose: An ischemic stroke occurs when blood flow to an area of the brain is restricted and can cause numbness or weakness on one side of the body, facial droop, trouble speaking, and trouble walking. Patients who seek medical attention for symptoms within three hours of their onset can be eligible to receive tissue plasminogen activator (tPA). These patients often have less resultant disability than their counterparts who did not receive the drug. The purpose of this case reports is to display the positive effects of tPA and physical rehabilitation following a stroke in the acute care setting. …

Use Of Standardized Assessments And Online Resources In Stroke Rehabilitation, Susan H. Lin, Pamela R. Bosch, Veronica T. Rowe, Susan E. Fasoli, Jeanne Langan

The Open Journal of Occupational Therapy

Background: The extent to which movement-related standardized assessments and online resources are used in stroke rehabilitation is unclear in the United States.

Method: The researchers used a cross-sectional descriptive survey that examined (a) therapists use of movement-related standardized assessments, (b) factors influencing learning of new assessments, and (c) use of frequency of online resources by occupational therapists and physical therapists in the United States.

Results: Of 151 respondents (46.4% occupational therapists, 53.6% physical therapists), the most frequently used movement-related assessments by occupational and physical therapists were the Berg and Fugl-Meyer Assessment, respectively. More physical therapists use motor-related …

A Low-Cost Soft Robotic Hand Exoskeleton For Use In Therapy Of Limited Hand–Motor Function, Grant Rudd, Liam Daly, Vukica Jovanovic, Filip Cukov

Engineering Technology Faculty Publications

We present the design and validation of a low-cost, customizable and 3D-printed anthropomorphic soft robotic hand exoskeleton for rehabilitation of hand injuries using remotely administered physical therapy regimens. The design builds upon previous work done on cable actuated exoskeleton designs by implementing the same kinematic functionality, but with the focus shifted to ease of assembly and cost effectiveness as to allow patients and physicians to manufacture and assemble the hardware necessary to implement treatment. The exoskeleton was constructed solely from 3D-printed and widely available of-the-shelf components. Control of the actuators was realized using an Arduino microcontroller, with a custom-designed shield …

Racial And Ethnic Disparities In Stroke Outcomes: A Scoping Review Of Post-Stroke Disability Assessment Tools, Suzanne Perea Burns, Brandi M. White, Gayenell Magwood, Charles Ellis, Ayaba Logan, Joy N. Jones Buie, Robert J. Adams

Health and Clinical Sciences Faculty Publications

Purpose: To identify how post-stroke disability outcomes are assessed in studies that examine racial/ethnic disparities and to map the identified assessment content to the International Classification of Functioning, Disability, and Health (ICF) across the time course of stroke recovery.

Methods: We conducted a scoping review of the literature. Articles published between January 2001 and July 2017 were identified through Scopus, PubMed, CINAHL, and PsycINFO according to predefined inclusion and exclusion criteria.

Results: We identified 1791 articles through database and hand-searching strategies. Of the articles, 194 met inclusion criteria for full-text review, and 41 met inclusion criteria for study inclusion. The …

The Effect Of Mirror Therapy On Upper Extremity Functioning For Patients Poststroke: A Systematic Review, Caitlin Beach, Halie Finke, Abby Garrity, Amanda Norcini, Lily Postus, Kristen Tekel, Lyn Kaiser, Otd, Otr/L

Student Papers, Posters & Projects

Due to the high incidence of stroke and the detrimental impact it can have on a patient’s independence, several systematic reviews examining the effect of MT on post-stroke rehabilitation for upper extremity functioning have been conducted. However, it is necessary to provide an update to existing systematic reviews to include new clinical studies that have recently been published. Since stroke is a leading cause of disability, this study aims to determine the effectiveness of MT in post-stroke rehabilitation for upper extremity function as compared to conventional therapy.

Temporal And Functional Cortical Aspects Related To Mirror Visual Feedback During Target-Directed Movement In Healthy And Stroke Individuals, Maryam Rohafza

Dissertations

Stroke is the leading cause of disability in the United States (American Heart Association, American Stroke Association) affecting 800,000 individuals annually (i.e., one person every 45 seconds). Therapy for stroke often uses repetitive task practice, which is difficult to perform for patients due to impairment. Mirror visual feedback (MVF) based rehabilitation uses the effect of observing the mirror reflection of volitional movement of one limb, to activate visuomotor brain areas that process movement of the opposite limb. In persons with hemiplegia due to stroke, exercising the less affected limb while observing its reflection, perceived by them as the motion of …

Modulation Of Corticospinal Excitability Using Cathodal Transcranial Direct Current Stimulation To Improve Walking In Individuals With Chronic Post Stroke Hemiparesis, Neil Drobitch, Kylie Henry, Sage Lyons, James Schomig

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background and Purpose: Individuals who have experienced a pyramidal cerebrovascular accident (pCVA) often exhibit impairments to volitional control of corresponding motor tasks. Promising effects in motor response, post-application of transcranial direct current stimulation (tDCS), have been reported in studies on individuals with the ability to achieve independent gait for 20 minutes. These studies mainly examined the effects of combined tDCS with locomotor training on lower extremity function among higher functioning individuals post-stroke. The purpose of this study was to determine the effect of tDCS among individuals post-stroke who may not have independent ambulatory capabilities, focusing on motor response and less …

Neurodynamics Under Different Walking Speeds In Individuals With Chronic Post-Stroke Hemiparesis, Corey Ackley, Kiley Aki, Joshua Arias, Jassie Trinh

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background and Purpose: Stroke is the leading cause of long-term disability in adults worldwide. The ability to return to walking is often a main goal of rehabilitation in individuals with chronic post-stroke hemiparesis. To increase walking speed, non-neurologically impaired individuals produce greater ankle propulsion force at push-off with greater ankle dorsiflexion angles in swing phase with no change in ankle muscle co-contraction index in the swing phase. It remains unclear if individuals post-stroke would adopt similar neuromuscular strategies. Therefore, our aim was to examine the effect of altered walking speeds on propulsion force at push-off, ankle dorsiflexion angle during swing, …