Rehabilitation and Therapy Commons^™

Low Income And Stroke Rehabilitation: A Tale Of Two Clients, Sarah Bernard, Katrine Sauvé-Schenk, Mary Egan

The Open Journal of Occupational Therapy

No abstract provided.

White Matter Biomarkers Associated With Motor Change In Individuals With Stroke: A Continuous Theta Burst Stimulation Study, K P Wadden, Sue Peters, M R Borich, J L Neva, K S Hayward, C S Mang, N J Snow, K E Brown, T S Woodward, S K Meehan, L A Boyd

Physical Therapy Publications

Continuous theta burst stimulation (cTBS) is a form of noninvasive repetitive brain stimulation that, when delivered over the contralesional hemisphere, can influence the excitability of the ipsilesional hemisphere in individuals with stroke. cTBS applied prior to skilled motor practice interventions may augment motor learning; however, there is a high degree of variability in individual response to this intervention. The main objective of the present study was to assess white matter biomarkers of response to cTBS paired with skilled motor practice in individuals with chronic stroke. We tested the effects of stimulation of the contralesional hemisphere at the site of the …

The Impact Of Depression On Treatment Outcomes For Patients With Aphasia Who Participate In An Intensive Comprehensive Aphasia Program (Icap), Harley B. Kincheloe

Undergraduate Theses, Professional Papers, and Capstone Artifacts

Abstract

Background: Aphasia is a multi-modal impairment resulting from left-hemisphere stroke. Aphasia is often accompanied by post-stroke depression. Acquiring aphasia and depression is seen to hinder quality of life and rehabilitative outcomes. Traditional stroke therapy often does not monitor or treat psychological difficulties such as depression. Such psychological difficulties hinder progress in recovery and may need to be addressed in therapy to ensure the best possible outcomes.

Aims: In response to the lack of psychological support for persons with aphasia, this literature review aims to explore the impact of depression on functional outcomes. Furthermore, this literature review will explore how …

Development Of A Training Program To Increase Student Clinician Competency When Communicating With People With Aphasia, Meghan Doherty, Chevie Lay

Journal of Occupational Therapy Education

The Washington University in St. Louis Stroke Clinic is a student-run free clinic (SRSC) designed to enhance student learning and provide the community with no-cost evidence-based occupational therapy services. Aphasia is a common communication impairment after stroke that affects the ability to access services and give and get information, and impacts life participation and satisfaction. Conversation partner training is an evidence-based treatment approach to improve communication with people with aphasia (PWA). The purpose of this project was to develop and evaluate the effectiveness of student clinician training about communicating with PWA using conversation partner training in the SRSC. This study …

The Tailoring Of National Guidelines For Upper Extremity Post-Stroke Rehabilitation: A Concept In Use., Salem F. Alatawi

Internet Journal of Allied Health Sciences and Practice

Background: In Saudi Arabia, national evidence-based clinical guidelines (NCG) were created based for healthcare interventions. However, clinicians appear to be slow to incorporate the evidence into practice. As a result, there exists a time-gap between the gathering and presentation of evidence for best practice and the use of that evidence by clinicians. It becomes, therefore, imperative to investigate the gap between the research evidence and clinical practice. The knowledge to action (KTA) framework is available to facilitate the implementation of research evidence. This framework incorporates the theory of tailoring, a concept that is intended to create a fit between …

Comparison Of Laryngeal Excursion In Stroke Patients With And Without Penetration/Aspiration By Videofluoroscopy Swallowing Study, Yun-Fang Lee, Yung-Chun Chi, Shih-Chung Chang

Rehabilitation Practice and Science

Objective: Post-stroke dysphagia is associated with increased morbidity and mortality in acute stroke patients due to malnutrition or aspiration. This study compares the hyolaryngeal movement during swallowing between post-stroke dysphagia patients with and without penetration/aspiration by videofluoroscopy swallowing study (VFSS). The goal was to find out possible defects in swallow mechunism for improving post-stroke dysphagia swallowing training. Method: We retrospectively collected VFSS images from stroke in-patients in a medical center in Central Taiwan from October 2015 to April 2017. The subjects were subdivided according to the VFSS results and 8-point penetration-aspiration scale (PAS) into those with penetration/aspiration (PAS ≥ 3) …

Hand Temperature And Heart Rate Variability In Stroke Patients When Using Yole Hands And Conventional Elastic Bandages During Passive Upper Limb Exercises, Mei-Yi Lee, Chun-Han Yang, Ko-Long Lin, Shih-Ming Chen, Shu-Shi Chen

Rehabilitation Practice and Science

Therapeutic exercise can mitigate sensorimotor deficit and improve motor function in the upper limbs of stroke patients. During physical rehabilitation, elastic bandages (EB) are often used to secure stroke patients' affected upper limbs to exercise equipment. However, the application of EB can reduce blood flow and lower skin temperature in patients' hands. Furthermore, reduced skin temperature can lead to autonomic nervous reactions, of which heart rate variability (HRV) is an effective indicator. This study investigates the correlation between hand temperature and HRV. Stroke patients' hand temperatures and HRVs were documented during passive upper limb exercises, and the results between the …

A Systematic Reviewarticle Of Turning Difficulties In Individuals With Stroke, Pei-Yi Chou, Shu-Chun Lee

Rehabilitation Practice and Science

Introduction: Making turn is a challenging task that is reported as one of the activities that most frequently leads to fall in stroke patients. Among community-dwelling older adults, hip fractures are eight times more likely to result from falls while making turns than from falls while walking straight. The stroke patients have asymmetric posture and movements due to hemiparesis, thus their turning performance may varied depending on the direction of the turn. Therefore, the purpose of this systematic reviewarticle was to summarize the characteristics of turning after stroke and discuss the possible neuromuscular mechanisms of turning difficulties. Methods: Searches of …

External Load On The Hemi-Paretic Lower Limb With Task-Oriented Training To Improve Gait Post Right Aca Stroke, Jacob France, Lindsey Perry

St. Augustine, Fall 2018

The purpose of this case report is to describe the treatment of a 77-year-old male post-stroke with the application of an external load to the paretic lower limb in conjunction with task-oriented training to improve gait.

Strength, balance, gait speed, and functional tasks all improved over the course of physical therapy. At the end of 2 weeks, the patient exceeded the minimal detectable change (MDC) for the TUG (2.9 sec) and achieved the minimal clinically important difference (MCID) for the FIM (22 points).^4-5 Although the MCID is not established for the Modified Ashworth Scale (MAS), the patient experienced improvements …

Predicting Gains With Visuospatial Training After Stroke Using An Eeg Measure Of Frontoparietal Circuit Function, Robert J. Zhou, Hossein M. Hondori, Maryam Khademi, Jessica M. Cassidy, Katherine M. Wu, Derek Z. Yang, Nikhita Kathuria, Fareshte R. Erani, Lucy Dodakian, Alison Mckenzie, Cristina V. Lopes, Walt Scacchi, Ramesh Srinivasan, Steven C. Cramer

Physical Therapy Faculty Articles and Research

The heterogeneity of stroke prompts the need for predictors of individual treatment response to rehabilitation therapies. We previously studied healthy subjects with EEG and identified a frontoparietal circuit in which activity predicted training-related gains in visuomotor tracking. Here we asked whether activity in this same frontoparietal circuit also predicts training-related gains in visuomotor tracking in patients with chronic hemiparetic stroke. Subjects (n = 12) underwent dense-array EEG recording at rest, then received 8 sessions of visuomotor tracking training delivered via home-based telehealth methods. Subjects showed significant training-related gains in the primary behavioral endpoint, Success Rate score on a standardized test …

Neural Constraints Affect The Ability To Generate Hip Abduction Torques When Combined With Hip Extension Or Ankle Plantarflexion In Chronic Hemiparetic Stroke, Natalia Sánchez, Ana M. Acosta, Roberto López-Rosado, Julius P. A. Dewald

Physical Therapy Faculty Articles and Research

Stroke lesions interrupt descending corticofugal fibers that provide the volitional control of the upper and lower extremities. Despite the evident manifestation of movement impairments post-stroke during standing and gait, neural constraints in the ability to generate joint torque combinations in the lower extremities are not yet well determined. Twelve chronic hemiparetic participants and 8 age-matched control individuals participated in the present study. In an isometric setup, participants were instructed to combine submaximal hip extension or ankle plantarflexion torques with maximal hip abduction torques. Statistical analyses were run using linear mixed effects models. Results for the protocol combining hip extension and …

Application Of Forced Use In A Traditional Acute Hospital Setting With A 77-Year-Old Female Post Left Cva, Jimmie Parten, Anne H. Boddy

St. Augustine, Summer 2018

The purpose of this case report is to look at the positive outcomes following the application of forced use physical therapy techniques in the traditional acute hospital setting with a 77-year-old female post left CVA.

Shock And Awe: Functional Strength Training To Improve Balance And Function In A Patient Post Electrocution, Amanda K. Boone, Anne H. Boddy

St. Augustine, Summer 2018

The purpose of this case study is to study the effects of functional strength training rehabilitation in a patient post electrocution suffering from a concurrent stroke.

Motor Compensation During Lower Limb Pedaling After Stroke, Brice Thomas Cleland

Dissertations (1934 -)

Long-term motor dysfunction in the lower limb is common after stroke. One potential contributor is motor compensation, a behavior in which functions originally performed by the paretic limb are performed by the non-paretic limb. Compensation in chronic stroke may contribute to long-term motor dysfunction by limiting functional ability, impairing future recovery, and eliciting maladaptive neuroplasticity. The purpose of this dissertation was to describe the impact of compensation on motor function and brain activation during lower limb pedaling and identify elements that produce this behavior. To achieve this purpose, we evaluated muscle activation and motor performance when compensation was prevented. During …

Type-2 Diabetes Mellitus Reduces Cortical Thickness And Decreases Oxidative Metabolism In Sensorimotor Regions After Stroke., Jennifer K Ferris, Sue Peters, Katlyn E Brown, Katherine Tourigny, Lara A Boyd

Physical Therapy Publications

Individuals with type-2 diabetes mellitus experience poor motor outcomes after ischemic stroke. Recent research suggests that type-2 diabetes adversely impacts neuronal integrity and function, yet little work has considered how these neuronal changes affect sensorimotor outcomes after stroke. Here, we considered how type-2 diabetes impacted the structural and metabolic function of the sensorimotor cortex after stroke using volumetric magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS). We hypothesized that the combination of chronic stroke and type-2 diabetes would negatively impact the integrity of sensorimotor cortex as compared to individuals with chronic stroke alone. Compared to stroke alone, individuals with …

Biomarkers Of Rehabilitation Therapy Vary According To Stroke Severity, Erin Burke Quinlan, Lucy Dodakian, Jill See, Alison Mckenzie, Jill Campbell Stewart Pt,Phd, Steven C. Cramer

Faculty Publications

Biomarkers that capture treatment effects could improve the precision of clinical decision making for restorative therapies. We examined the performance of candidate structural, functional, and angiogenesis-related MRI biomarkers before and after a 3-week course of standardized robotic therapy in 18 patients with chronic stroke and hypothesized that results vary significantly according to stroke severity. Patients were 4.1 ± 1 months poststroke, with baseline arm Fugl-Meyer scores of 20–60. When all patients were examined together, no imaging measure changed over time in a manner that correlated with treatment-induced motor gains. However, when also considering the interaction with baseline motor status, treatment-induced …

In-Home Delivery Of Constraint-Induced Movement Therapy Via Virtual Reality Gaming, Alexandra L. Borstad, Roger Crawfis, Kala Phillips, Linda Pax Lowes, David Maung, Ryan Mcpherson, Amelia Siles, Lise Worthen-Chaudhari, Lynne V. Gauthier

Journal of Patient-Centered Research and Reviews

Purpose: People with chronic hemiparesis are frequently dissatisfied with the recovery of their hand and arm, yet many lack access to effective treatments. Constraint-induced movement therapy (CI therapy) effectively increases arm function and spontaneous use in persons with chronic hemiparesis. The purpose of this study was to determine the feasibility and measure safety and outcomes of an in-home model of delivering CI therapy using a custom, avatar-based virtual reality game.

Methods: Seventeen individuals with chronic hemiparesis participated in this pretest/posttest quasi-experimental design study. The 10-day intervention had three components: 1) high-repetition motor practice using virtual reality gaming; 2) constraint of …

Selection Of Post-Acute Care For Stroke Patients, Kathryn M. Gulfo, Glen Gillen, Lauri Bishop, Clare C. Bassile, Randy B. Kolodny, Joel Stein

The Open Journal of Occupational Therapy

Background: Significant variation exists in post-acute care for stroke survivors. This study examines referral practices of occupational and physical therapists for patients after acute stroke.

Method: Occupational therapists (OTs) and physical therapists (PTs) were surveyed either electronically or in person at a national conference. The respondents selected the most appropriate referral for each of five case vignettes. The referral choices included Inpatient Rehabilitation Facility (IRF), Skilled Nursing Facility (SNF), Long-Term Acute Care Hospital (LTACH), home with home services, or home with outpatient services. Demographic data included practice location, setting, and duration. The respondents were also asked to rate …

Thrombolysis And Early Speech And Language Recovery After Stroke, Sarah E. Campbell

Theses and Dissertations--Rehabilitation Sciences

Speech and language impairments after left hemisphere stroke are life altering. Neuroprotective interventions, such as tissue plasminogen activator, or tPA, are utilized to diminish the impact of the stroke on functional ability.

The purpose of this study was to examine speech and language recovery in the first three months after stroke in individuals with aphasia and to further investigate any differences between individuals who did and individuals who did not receive tPA, using objective speech and language measures.

Twenty-six individuals, thirteen of whom received tPA and thirteen who did not, suffering from first-ever left hemisphere stroke with resulting aphasia were …

A Correlation Study Between Activity Items Of Touch Screen System For Upper Extremity Training And Functional Performance In Upper Limb Among Patients With Stroke, Shu-Yu Yang, Pei-Chi Hsiao, Yu-Sheng Yang, Chi-Min Yang, Jyh-Jong Chang, Ying-Chun Chou

Rehabilitation Practice and Science

Because of progress made in human-machine interfaces, touchscreens increasingly play a key role in daily living. A task-oriented concept combined with a computerized touchscreen training system was developed and used to facilitate upper limb rehabilitation after stroke. However, the reliability and validity of the activity items within the system required further verification. Therefore, the aims of this study were 1) to examine the reliability of scores for the activity items when patients with stroke used this device and 2) to verify criterion-related validity by analyzing the relationship between scores from this device and other standard upper limb functional assessments. Thirty …

Comparison Of Conventional Elastic Bandages And Novel Hand Gloves By Measuring Changes In Stroke Patients' Hand Temperature During Passive Upper Limb Exercises, Mei-Yi Lee, Chan-Yu Taso, Ka-Hei Lao, Shu-Shi Chen

Rehabilitation Practice and Science

Elastic bandages are often used to secure stroke patients' affected upper limbs to exercise equipment during physical rehabilitation. However, the application of elastic bandages can cause soft tissue injuries in patients' extremities. Therefore, our research team developed novel medical hand gloves, called ＂Yole Hands,＂ to safely secure stroke patients' affected hands to exercise equipment. This study compared conventional elastic bandages with Yole Hands by measuring changes in stroke patients' hand temperature during passive upper limb exercises. This study recruited 18 stroke patients aged 63.1 ± 13.4 years from a rehabilitation clinic. A thermograph (midi LOGGER GL220, Graphtec) was used to …

A Home-Based Telerehabilitation Program For Patients With Stroke, Lucy Dodakian, Alison Mckenzie, Vu Le, Jill See, Kristin Pearson-Fuhrhop, Erin Burke Quinlan, Robert J. Zhou, Renee Augsberger, Xuan A. Tran, Nizan Friedman, David J. Reinkensmeyer, Steven C. Cramer

Physical Therapy Faculty Articles and Research

Background. Although rehabilitation therapy is commonly provided after stroke, many patients do not derive maximal benefit because of access, cost, and compliance. A telerehabilitation-based program may overcome these barriers. We designed, then evaluated a home-based telerehabilitation system in patients with chronic hemiparetic stroke. Methods. Patients were 3 to 24 months poststroke with stable arm motor deficits. Each received 28 days of telerehabilitation using a system delivered to their home. Each day consisted of 1 structured hour focused on individualized exercises and games, stroke education, and an hour of free play. Results. Enrollees (n = 12) had baseline …

Lower Extremity Motor Impairments In Ambulatory Chronic Hemiparetic Stroke: Evidence For Lower Extremity Weakness And Abnormal Muscle And Joint Torque Coupling Patterns, Natalia Sánchez, Ana Maria Acosta, Roberto Lopez-Rosado, Arno H. A. Stienen, Julius P. A. Dewald

Physical Therapy Faculty Articles and Research

Although global movement abnormalities in the lower extremity poststroke have been studied, the expression of specific motor impairments such as weakness and abnormal muscle and joint torque coupling patterns have received less attention. We characterized changes in strength, muscle coactivation and associated joint torque couples in the paretic and nonparetic extremity of 15 participants with chronic poststroke hemiparesis (age 59.6 ± 15.2 years) compared with 8 age-matched controls. Participants performed isometric maximum torques in hip abduction, adduction, flexion and extension, knee flexion and extension, ankle dorsi- and plantarflexion and submaximal torques in hip extension and ankle plantarflexion. Surface electromyograms (EMGs) …

Video Game Rehabilitation For Outpatient Stroke (Vigorous): Protocol For A Multi-Center Comparative Effectiveness Trial Of In-Home Gamified Constraint-Induced Movement Therapy For Rehabilitation Of Chronic Upper Extremity Hemiparesis., Lynne V Gauthier, Chelsea Kane, Alexandra Borstad, Nancy Strahl, Gitendra Uswatte, Edward Taub, David Morris, Alli Hall, Melissa Arakelian, Victor Mark

Articles, Abstracts, and Reports

BACKGROUND: Constraint-Induced Movement therapy (CI therapy) is shown to reduce disability, increase use of the more affected arm/hand, and promote brain plasticity for individuals with upper extremity hemiparesis post-stroke. Randomized controlled trials consistently demonstrate that CI therapy is superior to other rehabilitation paradigms, yet it is available to only a small minority of the estimated 1.2 million chronic stroke survivors with upper extremity disability. The current study aims to establish the comparative effectiveness of a novel, patient-centered approach to rehabilitation utilizing newly developed, inexpensive, and commercially available gaming technology to disseminate CI therapy to underserved individuals. Video game delivery of …

Care Coordination For Community Transitions For Individuals Post-Stroke Returning To Low-Resource Rural Communities, Patrick H. Kitzman, Keisha Hudson, Violet Sylvia, Frances Feltner, Johnnie Lovins

Physical Therapy Faculty Publications

High rates of hospital readmissions have been shown within 12 months post-discharge from inpatient rehabilitation following stroke. Multiple studies coupled with our previous work indicate a need for care support for stroke survivors’ transitions to the community. The Kentucky Care Coordination for Community Transitions (KC³T) program was developed to provide access to medical, social, and environmental services to support community transitions for individuals with neurological conditions and their caregivers living in Kentucky. This program assessment was conducted to determine the effectiveness of using a specially trained community health worker to support community transitions. Thirty acute stroke survivors were …

Vrshape: A Virtual Reality Tool For Shaping Movement Compensation, Matthew Hale Foreman

Arts & Sciences Graduate Student Theses and Dissertations

The majority of persons living with chronic stroke experience some form of upper extremity motor impairment that affects their functional movement, performance of meaningful activities, and participation in the flow of daily life. Stroke survivors often compensate for these impairments by adapting their movement patterns to incorporate additional degrees of freedom at new joints and body segments. One of the most common compensatory movements is the recruitment of excessive trunk flexion when reaching with the affected upper extremity. Long-term use of these compensations may lead to suboptimal motor recovery and chronic pain or injury due to overuse. Rehabilitation focuses on …

Role Of Corpus Callosum Integrity In Arm Function Differs Based On Motor Severity After Stroke, Jill Campbell Stewart, Pritha Dewanjee, George Tran, Erin Burke Quinlan, Lucy Dodakian, Alison Mckenzie, Jill See, Steven C. Cramer

Physical Therapy Faculty Articles and Research

While the corpus callosum (CC) is important to normal sensorimotor function, its role in motor function after stroke is less well understood. This study examined the relationship between structural integrity of the motor and sensory sections of the CC, as reflected by fractional anisotropy (FA), and motor function in individuals with a range of motor impairment level due to stroke. Fifty-five individuals with chronic stroke (Fugl-Meyer motor score range 14 to 61) and 18 healthy controls underwent diffusion tensor imaging and a set of motor behavior tests. Mean FA from the motor and sensory regions of the CC and from …

Safety And Improvement Of Movement Function After Stroke With Atomoxetine: A Pilot Randomized Trial, Andrea Ward, Cheryl Carrico, Elizabeth Powell, Philip M. Westgate, Laurie Nichols, Anne Fleischer, Lumy Sawaki

Physical Medicine and Rehabilitation Faculty Publications

Background: Intensive, task-oriented motor training has been associated with neuroplastic reorganization and improved upper extremity movement function after stroke. However, to optimize such training for people with moderate-to-severe movement impairment, pharmacological modulation of neuroplasticity may be needed as an adjuvant intervention.

Objective: Evaluate safety, as well as improvement in movement function, associated with motor training paired with a drug to upregulate neuroplasticity after stroke.

Methods: In this double-blind, randomized, placebo-controlled study, 12 subjects with chronic stroke received either atomoxetine or placebo paired with motor training. Safety was assessed using vital signs. Upper extremity movement function was assessed using Fugl-Meyer Assessment, …

Interhemispheric Pathways Are Important For Motor Outcome In Individuals With Chronic And Severe Upper Limb Impairment Post Stroke, Kathryn S. Hayward, Jason L. Neva, Cameron S. Mang, Sue Peters, Katie P. Wadden, Jennifer K. Ferris, Lara A. Boyd

Physical Therapy Publications

Background: Severity of arm impairment alone does not explain motor outcomes in people with severe impairment post stroke.

Objective: Define the contribution of brain biomarkers to upper limb motor outcomes in people with severe arm impairment post stroke.

Methods: Paretic arm impairment (Fugl-Meyer upper limb, FM-UL) and function (Wolf Motor Function Test rate, WMFT-rate) were measured in 15 individuals with severe (FM-UL ≤ 30/66) and 14 with mild-moderate (FM-UL > 40/66) impairment. Transcranial magnetic stimulation and diffusion weight imaging indexed structure and function of the corticospinal tract and corpus callosum. Separate models of the relationship between possible biomarkers and motor outcomes …

Clinician's Commentary On Patterson Et Al., Sue Peters

Physical Therapy Publications

No abstract provided.