Rehabilitation and Therapy Commons^™

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 …

The Relationship Of Plantar Sensation With Standing Balance And Gait Post-Stroke, Stephen Parsons

Electronic Thesis and Dissertation Repository

Gait and balance dysfunction after stroke limit independence and quality of life. Numerous contributing factors have been investigated but the role of sensation deficits has received little attention. This thesis investigated the relationship between plantar cutaneous sensation and 1) standing balance, 2) gait, and 3) use of vision to compensate for sensory loss with a secondary analysis of data from individuals with subacute stroke. Associations between standing balance, gait and sensation were investigated with Spearman correlations. Individuals classified as impaired or intact sensation were compared on gait and standing balance measures. This thesis found plantar sensation is related to standing …

Interrater Reliability Of The Wolf Motor Function Test–Functional Ability Scale: Why It Matters, Susan V. Duff, Jiaxue He, Monica A. Nelsen, Christianne J. Lane, Veronica T. Rowe, Steve L. Wolf, Alexander W. Dromerick, Carolee J. Winstein

Physical Therapy Faculty Articles and Research

Background. One important objective for clinical trialists in rehabilitation is determining efficacy of interventions to enhance motor behavior. In part, limitation in the precision of measurement presents a challenge. The few valid, low-cost observational tools available to assess motor behavior cannot escape the variability inherent in test administration and scoring. This is especially true when there are multiple evaluators and raters, as in the case of multisite randomized controlled trials (RCTs). One way to enhance reliability and reduce variability is to implement rigorous quality control (QC) procedures. Objective. This article describes a systematic QC process used to refine …

Home-Based Constraint Induced Movement Therapy Poststroke, Stephen Isbel, Christine Chapparo, David Mcconnell, Judy Ranka

The Open Journal of Occupational Therapy

Background: This study examined the efficacy of a home-based Constraint Induced Movement Therapy (CI Therapy) protocol with eight poststroke survivors.

Method: Eight ABA, single case experiments were conducted in the homes of poststroke survivors. The intervention comprised restraint of the intact upper limb in a mitt for 21 days combined with a home-based and self-directed daily activity regime. Motor changes were measured using The Wolf Motor Function Test (WMFT) and the Motor Activity Log (MAL).

Results: Grouped results showed statistically and clinically significant differences on the WMFT (WMFT [timed items]): Mean 7.28 seconds, SEM 1.41, 95% CI 4.40 – 10.18, …

“I Think Relax, Relax And It Flows A Lot Easier”: Exploring Client-Generated Relax Strategies, Dianne Cirone, Sara E. Mcewen

The Open Journal of Occupational Therapy

Background. Some adult stroke survivors participating in Cognitive Orientation to daily Occupational Performance (CO-OP) treatment programs self-generated relax strategies that have not been explored in previous CO-OP publications. The objective of this study was to describe the process by which adults with stroke used relax strategies and to explore the outcomes associated with their use.

Methods. Secondary analysis of transcripts of intervention sessions from five participants was conducted.

Results. All five participants applied relax strategies after initially observing a breakdown in performance that was attributed to increased fatigue or tension. The relax strategies used by the participants during their occupations …

A Multiple Degree Of Freedom Lower Extremity Isometric Device To Simultaneously Quantify Hip, Knee, And Ankle Torques, Natalia Sánchez, Ana Maria Acosta, Arno H. A. Stienen, Julius P. A. Dewald

Physical Therapy Faculty Articles and Research

Characterization of the joint torque coupling strategies used in the lower extremity to generate maximal and submaximal levels of torque at either the hip, knee, or ankle is lacking. Currently, there are no available isometric devices that quantify all concurrent joint torques in the hip, knee, and ankle of a single leg during maximum voluntary torque generation. Thus, joint-torque coupling strategies in the hip, knee, and concurrent torques at ankle and/or coupling patterns at the hip and knee driven by the ankle have yet to be quantified. This manuscript describes the design, implementation, and validation of a multiple degree of …

Sensory Electrical Stimulation Improves Foot Placement During Targeted Stepping Post-Stroke, Eric R. Walker, Allison Hyngstrom, Brian D. Schmit

Physical Therapy Faculty Research and Publications

Proper foot placement is vital for maintaining balance during walking, requiring the integration of multiple sensory signals with motor commands. Disruption of brain structures post-stroke likely alters the processing of sensory information by motor centers, interfering with precision control of foot placement and walking function for stroke survivors. In this study, we examined whether somatosensory stimulation, which improves functional movements of the paretic hand, could be used to improve foot placement of the paretic limb. Foot placement was evaluated before, during, and after application of somatosensory electrical stimulation to the paretic foot during a targeted stepping task. Starting from standing, …

The Stroke-Related Effects Of Hip Flexion Fatigue On Over Ground Walking, Megan M. Rybar, Eric R. Walker, Henry Kuhnen, Daniel R. Ouellette, Reivian Berrios, Sandra K. Hunter, Allison Hyngstrom

Exercise Science Faculty Research and Publications

Individuals post stroke often rely more on hip flexors for limb advancement during walking due to distal weakness but the effects of muscle fatigue in this group is not known. The purpose of this study was to quantify how stroke affects the influence of hip flexor fatigue on over ground walking kinematics and performance and muscle activation. Ten individuals with chronic stroke and 10 without stroke (controls) participated in the study. Maximal walking speed, walking distance, muscle electromyograms (EMG), and lower extremity joint kinematics were compared before and after dynamic, submaximal fatiguing contractions of the hip flexors (30% maximal load) …

Anomia Treatment Platform As Behavioral Engine For Use In Research On Physiological Adjuvants To Neurorehabilitation, Diane Kendall, Anastasia Raymer, Miranda Rose, Joellen Gilbert, Leslie J. Gonzalez Rothi

Communication Disorders & Special Education Faculty Publications

The purpose of this study was to create a "behavioral treatment engine" for future use in research on physiological adjuvants in aphasia rehabilitation. We chose the behavioral target anomia, which is a feature displayed by many persons who have aphasia. Further, we wished to saturate the treatment approach with many strategies and cues that have been empirically reported to have a positive influence on aphasia outcome, with the goal being to optimize the potential for positive response in most participants. A single-subject multiple baseline design with replication across eight participants was employed. Four men and four women, with an average …

Speech And Swallowing Rehabilitation In The Home: A Comparison Of Two Service Delivery Models For Stroke Survivors, Katy J. E. Stewart

Theses: Doctorates and Masters

Background and Aims

Speech and swallowing difficulties are common sequelae for people who have suffered a stroke. Recently, there has been an increase in early discharge, community rehabilitation and the use of therapy assistants to support health professionals in stroke rehabilitation. However, the impact of these factors on communication and swallowing outcomes remains under researched. This research explored Rehabilitation in the Home (RITH) Speech Pathology (SP) services for stroke survivors with dysarthria and dysphagia. More specifically, this research investigated whether traditional speech pathology interventions, supplemented with a home practice program are effective, as well as compare usual treatment to that …

Minimal Detectable Change And Responsiveness Of The 5-Item Barthel Index In Patients With Stroke, Wen-Shian Lu, Ya-Chen Lee, Fuh-Chour Twu, Ching-Lin Hsieh

Rehabilitation Practice and Science

Background and Purpose: A concise measurement tool can be easily accepted by clinicians. The 5-item Barthel Index (BI-5) has only 5 items and thus the potential to be used routinely in clinical settings. However, the minimal detectable change (MDC) and responsiveness of the BI-5 have not been verified sufficiently, limiting the interpretability of the change scores of the BI-5. The purposes of this study were to investigate the MDC and responsiveness of the BI-5 in patients with stroke and to compare the MDC and responsiveness of the BI-5 to those of the original BI.Methods: This study used secondary data analysis. …

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

Collected Faculty and Staff Scholarship

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 …

Changes In Hemodynamic Responses In Chronic Stroke Survivors Do Not Affect Fmri Signal Detection In A Block Experimental Design, Nutta-On Promjunyakul, Brian D. Schmit, Sheila Schindler-Ivens

Physical Therapy Faculty Research and Publications

The use of canonical functions to model BOLD-fMRI data in people post-stroke may lead to inaccurate descriptions of task-related brain activity. The purpose of this study was to determine whether the spatiotemporal profile of hemodynamic responses (HDRs) obtained from stroke survivors during an event-related experiment could be used to develop individualized HDR functions that would enhance BOLD-fMRI signal detection in block experiments. Our long term goal was to use this information to develop individualized HDR functions for stroke survivors that could be used to analyze brain activity associated with locomotor-like movements. We also aimed to examine the reproducibility of HDRs …

Causes Of Post Stroke Falls Along The Care Continuum: Implications For Improving Patient Safety, Mona Madady

Electronic Thesis and Dissertation Repository

In Western countries stroke is responsible for 10-12% of all deaths. In 2000, strokes cost $3.6 billion for the Canadian healthcare system and lost productivity due to premature death and long-term disability. Falls are a frequent occurrence at all stages of post-stroke recovery and can have significant negative impacts. While information about the incidence and risk factors of falling among stroke survivors is available, considerably less is known about the specific factors contributing to falls and the circumstances surrounding these adverse events. The purpose of this project was to identify similarities between systemic factors of falls in stroke survivors across …

Kinematic And Kinetic Comparisons Of Arm And Hand Reaching Movements With Mild And Moderate Gravity-Supported, Computer-Enhanced Armeo®Spring: A Case Study, Qussai M. Obiedat

Theses and Dissertations

Background: Stroke has been recognized as a leading cause of serious long-term disability in the United States (U.S.) with 795,000 people experience a new or recurrent stroke each year (Roger et al., 2011). The most apparent defect after stroke is motor impairments (Masiero, Armani, & Rosati, 2011). Statistically, half of stroke survivors suffer from upper extremity hemiparesis and approximately one quarter become dependent in activities of daily living (Sanchez et al., 2006). There is strong evidence that intensity and task specificity are the main drivers in an effective treatment program after stroke. In addition, this training should be repetitive, functional, …

Intensive Goal-Directed Treatments In Enriched Environments Augments Patient Outcomes Post-Stroke, Blake A. Kandah, Michael A. Klonowski, Ryan M. Pelo, Nicole M. Williams, Raquel V. Santiago, Christopher K. Thompson, Kristan A. Leech, Carey L. Holleran, Abigail L. Leddy, T. George Hornby

GW Research Days 2013

Objective: Previous research indicates that patients post-stroke, average 400-800 steps within physical therapy sessions and demonstrate heart rate values of 24-35% of HR Max. This dosage and intensity is inadequate to promote neuroplastic changes and maximize recovery. The goal of this study was to quantify and examine the amount of high-intensity stepping practice that was delivered within an Acute Inpatient Rehabilitation (AIR) setting for individuals with sub-acute stroke.

Methods: 14 patients with a diagnosis of sub-acute stroke were admitted to AIR. Standardized outcomes included the 6-Minute Walk Test (6MWT), 10-Meter Walk Test (10MWT), the Berg Balance Scale (BBS) and the …

A Pilot Study To Measure Upper Extremity H-Reflexes Following Neuromuscular Electrical Stimulation Therapy After Stroke, Ann M. Stowe, L. Hughes-Zahner, V. K. Barnes, L. L. Herbelin, Sheila M. Schindler-Ivens, B. M. Quaney

Physical Therapy Faculty Research and Publications

Upper extremity (UE) hemiparesis persists after stroke, limiting hand function. Neuromuscular electrical stimulation (NMES) is an effective intervention to improve UE recovery, although the underlying mechanisms are not fully understood. Our objective was to establish a reliable protocol to measure UE agonist–antagonist forearm monosynaptic reflexes in a pilot study to determine if NMES improves wrist function after stroke. We established the between-day reliability of the H-reflex in the extensor carpi radialis longus (ECRL) and flexor carpi radialis (FCR) musculature for individuals with prior stroke (n = 18). The same-day generation of ECRL/FCR H-reflex recruitment curves was well tolerated, regardless of …

Usefulness Of The Mms And S5 For Assessing Medication Management Capacity For Clients Post-Stroke, Jessica Jean Bolduc

Occupational Therapy Program Student Theses, Dissertations and Capstones

Occupational therapists need a means to efficiently and accurately screen a client’s medication management capacity, especially for clients post-stroke. Most therapists are not aware of, nor do they utilize specific assessments for medication management capacity, partly due to lack of thorough assessments. The purpose of this study was to compare the scores of the ManageMed Screen (MMS), the Screening for Self-Medication Safety Post Stroke (S5), and the Montreal Assessment of Cognition (MoCA) on a population of rehabilitation clients post-stroke to evaluate consistency of scores and determine their usefulness in clinical practice. All screens were designed for use in occupational therapy; …

Is Electrical Muscle Stimulation Effective In The Progression Of Oral Feeding, For Patients With Dysphagia, Caused By A Stroke?, Kristen Iaconelli

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether or not electrical muscle stimulation is effective in the progression of oral feeding, for patients with dysphagia, caused by a stroke.

STUDY DESIGN: Review of 3 randomized controlled trials, published between 2008-2009.

DATA SOURCES: All 3 randomized controlled trials were found using the Cochrane database.

OUTCOMES MEASURED: All 3 studies measured subjective swallowing function pre- and post-treatment, however, each trial differed in the way they measured this. Permsirivanich et al used a functional oral intake scale (FOIS), or a 7-point scale reflecting the patient’s report of …

Functional Implications Of Impaired Control Of Submaximal Hip Flexion Following Stroke, Allison S. Hyngstrom, Sandra K. Hunter

Exercise Science Faculty Research and Publications

Introduction: We quantified sub-maximal torque regulation during low to moderate intensity isometric hip flexion contractions in individuals with stroke and the associations with leg function. Methods: 10 participants with chronic stroke and 10 controls performed isometric hip flexion contractions at 5%, 10%, 15%, 20%, and 40% of maximal voluntary contraction (MVC) in paretic, non-paretic, and control legs. Results: Participants with stroke had larger torque fluctuations (coefficient of variation, CV), for both the paretic and non-paretic legs, than controls (Pr² =0.45) and Berg Balance Score (r²=0.38). At 5% MVC, there were larger torque fluctuations in the …

Ability And Skill Retraining With Task-Oriented Intervention To Improve Functional Independence In Persons With Stroke, Trista Thacker

Online Theses and Dissertations

The purpose of the study was to examine the difference that ability and skill retraining used with task-oriented intervention can make on functional independence (as measured by FIM subscales) in persons with stroke. The findings of this study can contribute to the body of literature to support occupational therapy. Review of related literature includes background support for the use of FIM with the stroke population through analysis of the psychometric properties of the instrument. Also, the review of related literature provides support for the use of ability and skill retraining and task-oriented interventions with the stroke population. This supports the …

Developing The Rehabilitation Education For Caregivers And Patients (Recap) Model: Application To Physical Therapy In Stroke Rehabilitation, Megan M. Danzl

Theses and Dissertations--Rehabilitation Sciences

Patient and caregiver education is recognized as a critical component of stroke rehabilitation and physical therapy practice yet the informational needs of stroke survivors and caregivers are largely unmet and optimal educational interventions need to be established. The objective of this dissertation was to develop a theory and model of “Rehabilitation Education for Caregivers and Patients” (RECAP) in the context of physical therapy and stroke rehabilitation, grounded in the experiences and perceptions of stroke survivors, their caregivers, and physical therapists.

Qualitative research methods with a novel grounded theory approach were used. Potential constructs of RECAP were identified from existing research. …

Ipsilateral Hemiparesis Caused By Supratentorial Stroke: Two Casereports, Yen-Chung Chen, Ta-Sen Wei, Chih-Lin Chen

Rehabilitation Practice and Science

A common symptom that occurs after strokes is impaired contralesional motor function and contralateral limbs weakness. Such weakness of the limbs is often found in a supratentorial stroke. Two patients with ipsilateral limbs weakness after supratentorial stroke events were reported. One was a recurrent ischemic stroke in the right frontal lobe with right hemiparesis; the other was a new ischemic stroke in the right thalamus with right hemiparesis. There were few reported cases of ipsilateral hemiparesis caused by a supratentorial cerebral lesion. The mechanism of such symptoms may be related to 1. Activation and cortical reorganization within the motor areas …

Cerebral Stroke And Spinal Infarction After Coronary Artery Bypass Graft: A Casereport, Chun-Sheng Hsu, Hsiao-Wei Lin, Hsi-Hsun Su, Shu-Chuan Wu

Rehabilitation Practice and Science

Cerebral stroke and spinal cord infarction are rare complications after coronary artery bypass graft (CABG). The coexistence of them in one case is extremely rare. Cerebral microemboli generated during CABG is connected to acute ischemic stroke. Spinal cord infarction after CABG is related to hypoperfusion of the spinal cord. Except for the cardiovascular disease, the use of cardiopulmonary bypass during or after surgery is also a risk factor for both of the complications. They are not only increase the length of hospital stay but also contribute to patient's poor prognosis.We reported a 61-year-old male, with histories of hypertension, type II …