Rehabilitation and Therapy Commons^™

Comparing The Application Of Assessment Tests On Patients With Cerebrovascular Accident: The Mini-Mental Status Examination-Chinese Test Versus The Luria-Nebraska Neuropsychological Battery-Screening Test, Tingchia Wang, Yuhsin Wu, Naiwen Guo, Maohsiung Huang, Jyonghuei Su

Rehabilitation Practice and Science

Purposes: Patients with stroke often experience neurocognitive impairment; thus, an effective screening test should be developed. The Mini-Mental Status Examination-Chinese (MMSE-C) test and the Luria-Nebraska Neuropsychological Battery-Screening (LNNB-S) test are two commonly used tests for assessing cognitive impairment. In Taiwan, few studies have been conducted on the applicability of cognitive assessment tests. In the present study, we examined the assessment effectiveness of the MMSE-C and LNNB-S and compared them regarding their assessment effectiveness for impairment in various brain regions. Methods: This study was a retrospective study. Medical records from the 2005-2014 period for patients with stroke at the rehabilitation division …

The Effect Of A Powered Ankle Foot Orthosis On Walking In A Stroke Subject: A Case Study, Ali Pourghasem, Ismail Ebrahimi Takamjani, Mohammad Taghi Karimi, Mohammad Kamali, Mohammad Jannesari, Iman Salafian

Department of Mechanical and Materials Engineering: Faculty Publications

[Purpose] Standing and walking are impaired in stroke patients. Therefore, assisted devices are required to restore their walking abilities. The ankle foot orthosis with an external powered source is a new type of orthosis. The aim of this study was to evaluate the performance of a powered ankle foot orthosis compared with unpowered orthoses in a stroke patient.

[Subjects and Methods] A single stroke subject participated in this study. The subject was fitted with three types of ankle foot orthosis (powered, posterior leg spring, and carbon ankle foot orthoses). He was asked to walk with and without the three types …

Puzzleart Therapy: Connecting The Pieces In Search Of Answers, Jennifer Fortuna

Open Journal of Occupational Therapy: Occupation and the Artist

Alli Berman has been an artist, educator, author, and lecturer for more than 25 years. Her art can be found in private, corporate, and nonprofit collections around the world. Berman is the creator of PuzzleArt, a series of small abstract paintings that combine to form a modular puzzle. When a stroke impacted Berman’s quality of life, she turned to art for answers. Engagement in a meaningful activity, such as painting, provided her motivation and strength for continued physical and psychological healing. The PuzzleArt concept evolved from a simple exercise that helped Berman to fit all of the missing pieces back …

Puzzleart Therapy: Connecting The Pieces In Search Of Answers, Jennifer Fortuna

The Open Journal of Occupational Therapy

Alli Berman, a New York based artist, provided the cover art for the Fall 2016 issue of The Open Journal of Occupational Therapy (OJOT). “Sunlight Underwater” is a 12 piece PuzzleArt painting made from acrylic on American maple that measures 22x30. The PuzzleArt concept began as a simple exercise that evolved into a therapeutic modality. When a sudden stroke impacted Berman’s well-being and quality of life, it was art that helped her to make connections during recovery.

1st Place Research Paper: The Effectiveness Of Yoga Therapy On An Adult, Post-Stroke Population: A Systematic Review, Baylor E. Hogan

Kevin and Tam Ross Undergraduate Research Prize

Objectives: The objectives of this paper are to (1) give a brief overview of stroke pathophysiology (2) outline yoga as a therapeutic strategy (3) present the current research on yoga rehabilitation for stroke (4) discuss the efficacy of yoga for chronic stroke.

Methods: Relevant terms were searched in PubMed, Web of Science, Academic OneFile, ScienceDirect, and Google Scholar electronic databases. Studies were excluded if they contained pediatric stroke, non-stroke neurological diseases, or subjects with comorbidities. Statistically significant data was extracted for the primary measures of nine trials.

Results: Four studies measured statistically significant outcomes (p<0.05). These included improvements in balance, independence, endurance, trait anxiety, fear of falling, self-efficacy, pain, strength, range of motion (ROM), activity, participation, and quality of life (QoL). Discussion: Lack of statistical significance in post-stroke depression (PSD) measures may be due to inadequate intervention length or a psychosocial cause of depression. Improvements in balance, flexibility, and strength from yoga participation permitted progress in disability and functionality. Finally, overall health-related quality of life (HRQL) is affected by the severity of mental disorders and physical disability. Yoga can have a positive effect in both domains and therefore, may improve HRQL.

Conclusion: …

Reliability Of Clinical Evaluators Of Spasticity In Patients With Stroke, Tiffany Alvino, Shiney David, Chelsea Gendvil

Dissertations, Theses, and Capstone Projects

Spasticity is characterized by hyperexcitable stretch reflexes with amplitude increases in response to velocity dependent passive movement and resistance. Spasticity is the result of abnormal function of segmental and suprasegmental neuronal circuits. The objective of this study was to determine any positive correlation between three clinical evaluators of spasticity (i.e., the pendulum test, the patellar tendon tap test (PTT), and the Modified Ashworth scale) in their reliability to assess spasticity in people post-stroke. It was hypothesized that the use of force movement sensors along with surface electromyography increases the reliability of the standardized clinical tests. The results show that all …

Effectiveness Of The Bridge/Adapt Program On Functional Skill Generalization After Acquired Brain Injury, Janice S. Li, Diana Lopez, Eugene Cheung, Angela Talamantez

Dissertations, Masters Theses, Capstones, and Culminating Projects

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

1st Place Contest Entry: The Effectiveness Of Yoga Therapy On An Adult, Post-Stroke Population: A Systematic Review, Baylor E. Hogan

Kevin and Tam Ross Undergraduate Research Prize

This is Baylor Hogan's submission for the 2016 Kevin and Tam Ross Undergraduate Research Prize, which won first place. She wrote about the effects of yoga therapy on the physical and mental wellbeing of stroke patients. You can read the final essay that came out of her research here.

Baylor is a senior at Chapman University, majoring in Kinesiology. Her faculty mentor is Dr. Elizabeth DeBaets.

Use Of Occupational Performance Coaching For Stroke Survivors (Opc-Stroke) In Late Rehabilitation: A Descriptive Case Study, Danika Belliveau, Isabelle Belliveau, Aniane Camire-Raymond, Dorothy Kessler, Mary Egan

The Open Journal of Occupational Therapy

Background: Stroke is a leading cause of disability in adults. Following stroke, 60% of people report needing help with everyday activities, and 80% report having very few meaningful activities. These restrictions often continue for years. This study explored the efficacy of Occupational Performance Coaching for stroke survivors (OPC-Stroke) on the participation level of adults in the later stage of stroke rehabilitation.

Method: A descriptive case study design was used. One participant in the later stages of rehabilitation was recruited. Outcome measures for participation, goal performance and satisfaction, and emotional well-being were administered pre and postintervention to observe for direction of …

Influence Of Visual Feedback On Dynamic Balance Control In Chronic Stroke Survivors, Eric R. Walker, Allison S. Hyngstrom, Brian D. Schmit

Physical Therapy Faculty Research and Publications

Chronic stroke survivors have an increased incidence of falls during walking, suggesting changes in dynamic balance control post-stroke. Despite this increased incidence of falls during walking, balance control is often studied only in standing. The purpose of this study was to quantify deficits in dynamic balance control during walking, and to evaluate the influence of visual feedback on this control in stroke survivors. Ten individuals with chronic stroke, and ten neurologically intact individuals participated in this study. Walking performance was assessed while participants walked on an instrumented split-belt treadmill with different types of visual feedback. Dynamic balance control was quantified …

Effect Of Stance Symmetry On Perturbation-Induced Protective Stepping In Persons Poststroke And Controls, Katherine M. Martinez

Department of Physical Therapy Student Theses, Dissertations and Capstones

Problem Statement: Stepping is a common strategy after a perturbation. Stroke survivors display a predilection for stepping with non-paretic leg. Insight into induced stepping between stroke survivors and age-matched control may guide our understanding for reactive postural control training post stroke. Purpose: To investigate the difference in perturbation-induced stepping between chronic stroke survivors and age-matched controls at three phases of the stepping response: preparation, execution, and landing and association with clinical outcome measures. Procedure: Twenty-one community-dwelling chronic stroke survivors (mean age 59y/o ±13yrs) and 17 age- and gender-matched controls (mean age 54.4y/o ±17yrs) completed this study. Clinical measures of gait, …

The Lived Experience Of Informal Caregivers Of Chronic Stroke Patients, Ann Snider Wigginton

Online Theses and Dissertations

The purpose of this phenomenological study is to contribute to the literature surrounding stroke-survivor caregivers and to understand the caregivers’ perspective on leisure participation and quality of life. Four caregivers of clients with chronic stroke were recruited for the study via convenience sampling. Participants were audio-recorded during a semi-structured interview lasting 60-80 minutes. The interview guide was consistent across participants and included open-ended questions about the caregiver’s leisure participation and quality of life. Recorded data was transcribed and in-vivo coding was completed. Eight categories were developed from the identified codes and narrowed into primary meaning units: role shift, loss of …

The Experience Of Adults With Chronic Stroke Who Have Participated In Occupation-Based Or Modified Constraint Induced Interventions As A Part Of A Research Study, Ariel Wilson

Online Theses and Dissertations

There is a lack of qualitative research about the client perspective of specific chronic stroke interventions for motor recovery. The purpose of this phenomenological study was to understand the experiences of adults with chronic stroke who have participated in occupation-based (OBP) or modified constraint-induced (MCIT) interventions as a part of a research study. Four participants were recruited through convenience sampling and interviewed about their participation in research. Interviews were audio recorded, transcribed, and analyzed until themes emerged. Results showed participants engaged in the research interventions because of a desire to achieve a lost sense of ‘normalcy’ and perceptions of their …

Evaluation Of An Augmentative And Alternative Communication Intervention For Individuals With Aphasia., Michelle Lam

CMC Senior Theses

With a large population of people who suffer from aphasia, it is imperative that an effective form of therapy is utilized. The purpose of this study was to investigate the effectiveness of augmentative and alternative communication (AAC) programs in improving the communication needs and lives of people affected by aphasia. Individuals (n = 20) suffering from aphasia for 3 months or more completed therapy sessions with speech and language pathologists and the AAC program. Pre- and post-intervention evaluations were administered, consisting of communication satisfaction and success questionnaires, the Western Aphasia Battery (WAB), and probing tests (prompt and response) with an …

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

Rehabilitation Practice and Science

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

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

Rehabilitation Practice and Science

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

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

Rehabilitation Practice and Science

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

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

Rehabilitation Practice and Science

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

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

Rehabilitation Practice and Science

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

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

Rehabilitation Practice and Science

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

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

Exercise Science Faculty Research and Publications

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

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

Physical Therapy Publications

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

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

Student Research Posters

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

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

The Open Journal of Occupational Therapy

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

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

Department of Physical Therapy Faculty Papers

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

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

Collected Faculty Scholarship

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

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

Physical Therapy Faculty Articles and Research

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

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

Dissertations, Masters Theses, Capstones, and Culminating Projects

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

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

Results: Data was analyzed using the Pearson’s …

Exploration Of Linguistic And Extra-Linguistic Factors In Stroke Knowledge And Emergency Response: Studies Of Input, Output, And Outcome, Laura L. O. Froeschke

Dissertations

This dissertation is comprised of three studies centered on addressing factors that influence stroke knowledge and decision-making during the acute stroke emergency in both general and Hispanic populations. The first study provided data on patterns of explicit stroke knowledge in a sample of 94 Hispanic subjects. This study assessed relationships between stroke knowledge (Stroke Action Test; STAT; Billings-Gagliardi & Mazor, 2005) and subjects’ typical language use (Short Acculturation Scale for Hispanics; Marín, Sabogal, VanOss Marín, Otero-Sabogal, Pérez-Stable, 1987). No relationship was found between language use (Spanish/English) and stroke symptom knowledge. Contrastingly, STAT scores were found to …

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 …