Rehabilitation and Therapy Commons^™

Effect Of Acute Care Discharge Delays On Inpatient Rehabilitation Facility (Irf) Utilization, Eric Garrard

Student Dissertations

Discharge delays present hospitals with challenges in managing costs for Medicare admissions. Meanwhile, Inpatient Rehabilitation Facilities (IRF) are subject to strict pre-admission requirements that can complicate efficient transitions of care for patients with intensive rehabilitation needs. The purpose of this retrospective quantitative correlational study was to examine any relationship between acute care discharge delays and IRF utilization. This study investigated whether length of stay (LOS) and Medicare Advantage prior authorization requirements impact IRF referrals by reviewing 3,747 medical records of acute stroke patients aged 65 years and older at a regionally integrated healthcare system over a 3-year period (2020- 2022). …

Influence Of Proximal And Distal Upper-Limb Motor Function On Self-Care Skills In Patients With Stroke, Masanobu Iwai, Kazuya Takeda, Soichiro Koyama, Yuichi Hirakawa, Ikuo Motoya, Hiroaki Sakurai, Yoshikiyo Kanada, Nobutoshi Kawamura, Mami Kawamura, Shigeo Tanabe

Rehabilitation Practice and Science

Background/Purpose: Some studies have reported on the influence of proximal (shoulder, elbow, and forearm) and distal (hand and fingers) upper limb function on self-care skills; however, the possibility of a spurious correlation caused by the level of function of the other affected region (proximal or distal) was not eliminated. This study investigated the partial correlations between the proximal or distal function of the affected upper limb with self-care skills after controlling for the effect of the other affected region.

Methods: This retrospective cross-sectional study included 53 patients with stroke. We examined the relationship between the proximal or distal Fugl–Meyer Assessment- …

Criteria And Indicators For Centers Of Clinical Excellence In Stroke Recovery And Rehabilitation: A Global Consensus Facilitated By Isrra, Rachel C. Stockley, Marion F. Walker, Margit A. Murphy, Noor A. A. Aziz, Philemon Amooba, Leonid Churliov, Amanda Farrin, Natalie A. Fini, Emma Ghaziani, Erin Godecke, Tania Gutierrez-Panchana, Jie Jia, Thoshenthri Kandasamy, Patrice Lindsay, John Solomon, Vincent Thijs, Tierney Tindall, Donna C. Tippett, Caroline Watkins, Elizabeth Lynch

Research outputs 2022 to 2026

Background: The aim of the International Stroke Recovery and Rehabilitation Alliance is to create a world where worldwide collaboration brings major breakthroughs for the millions of people living with stroke. A key pillar of this work is to define globally relevant criteria for centers that aspire to deliver excellent clinical rehabilitation and generate exceptional outcomes for patients. Objectives: This paper presents consensus work conducted with an international group of expert stroke recovery and rehabilitation researchers, clinicians, and people living with stroke to identify and define criteria and measurable indicators for Centers of Clinical Excellence (CoCE) in stroke recovery and rehabilitation. …

Adapting A Telehealth Physical Activity And Diet Intervention To A Co-Designed Website For Self-Management After Stroke: Tutorial, Dina Pogrebnoy, Lee Ashton, Brian A. Beh, Meredith Burke, Richard Cullen, Jude Czerenkowski, Julie Davey, Amy M. Dennett, Kevin English, Erin Godecke, Nicole Harper, Elizabeth Lynch, Lesley Macdonald-Wicks, Amanda Patterson, Emily Ramage, Ben Schelfhaut, Dawn B. Simpson, Karly Zacharia, Coralie English

Research outputs 2022 to 2026

People who experience a stroke are at a higher risk of recurrent stroke when compared with people who have not had a stroke. Addressing modifiable risk factors like physical inactivity and poor diet has been shown to improve blood pressure, a leading contributor to stroke. However, survivors of stroke often experience challenges with accessing risk reduction services including long wait lists, difficulty with transportation, fatigue, impaired function, and diminished exercise capacity. Providing health interventions via a website can extend the reach when compared with programs that are only offered face to face or via real-time telehealth. Given global challenges of …

Examining The Efficacy Of Music-Applied Therapies On The Upper Extremity Of Post-Stroke Patients: A Systematic Review And Meta-Analysis, Haley Galvis

Honors Undergraduate Theses

Stroke is the second most common cause of death worldwide, due to an interruption of blood flow to the brain, which ultimately results in necrotic cell death. This pathological cascade has ramifications in neurological motor, sensory, and behavior deficits. Recent research has used a therapeutic application of music as a vehicle to improve motor function of post-stroke patients. Music-supported therapy is a newer class of music therapy that works to improve motor function through a standardized program of keyboard and drum exercises, and it is continuing to be integrated into the field of rehabilitation.

This study aims to search areas …

Dance Intervention For Stroke Rehabilitation: Restoring Occupational Performance Through Creative Movement, Olivia Paige Allen

Graduate Theses, Dissertations, and Problem Reports (ETD)

Thousands of individuals are affected by cerebral vascular accidents, (CVA), also known as strokes in the United States each year, (CDC, 2023). Cerebral vascular accidents are one of the leading causes of death among the elderly population in the U.S. each year, (NIH et al., 2023). The deficits caused by a CVA can be global, from hemiparetic limbs and sensory loss to psychosocial impacts on an individual and their support system. In occupational therapy, the goal is to regain as much function and independence as possible for the individual who has experienced a CVA. Although many evidence-based intervention tools are …

Multi-Site Identification And Generalization Of Clusters Of Walking Behaviors In Individuals With Chronic Stroke And Neurotypical Controls, Natalia Sánchez, Nicolas Schweighofer, Sara J. Mulroy, Ryan T. Roemmich, Trisha M. Keshar, Gelsy Torres-Oviedo, Beth E. Fisher, James M. Finley, Carolee J. Winstein

Physical Therapy Faculty Articles and Research

Background

Objectives

Methods

Multi-Site Identification And Generalization Of Clusters Of Walking Behaviors In Individuals With Chronic Stroke And Neurotypical Controls, Natalia Sanchez, Nicolas Schweighofer, Sara J. Mulroy, Ryan T. Roemmich, Tricia M. Kesar, Gelsy Torres-Oviedo, Beth E. Fisher, James M. Finley, Carolee J. Winstein

Physical Therapy Faculty Articles and Research

Background

Objectives

Methods

Examining The Delivery Mode Of Mental Practice In Reducing Hemiparesis: A Randomized Controlled Trial, Teresa M. Green, Nicole M. Fromm, Farida Sita Gayle, Jinna Lee, Wanyi Wang, Asha K. Vas

The Open Journal of Occupational Therapy

Background: Mental Practice (MP) is an effective intervention to address upper extremity (UE) hemiparesis post-stroke. However, parameters for the delivery mode of MP have not been defined. Therefore, this study's purpose was to define delivery mode parameters by comparing the effectiveness of audio-guided and video-guided MP.

Method: Eighteen participants, < 1-month post-stroke, with UE hemiparesis were randomized to a MP, repetitive task practice (RTP) or control group. The MP groups performed audio-guided or video-guided MP, 5x/week. The RTP group physically performed the functional tasks. The control group received traditional stroke rehabilitation. The Fugl-Meyer Assessment (FMA-UE) and Wolf Motor Function Test (WMFT) were used to assess change in UE hemiparesis.

Results: Wilcoxon signed-rank test demonstrated audio MP increased FMA-UE scores from pretest (Mdn = 34.0, Mean = 34.0, SD =9.56) to posttest (Mdn = 49.0, Mean = 49.6, SD =7.5), p = .042, r = .64. Similar improvement in FMA-UE scores was found with traditional therapy. Audio MP decreased WMFT …

Stroke Recovery Is A Journey: Prediction And Potentials Of Motor Recovery After A Stroke From A Practical Perspective, Sheng Li

Faculty, Staff and Student Publications

Stroke recovery is a journey. Stroke survivors can face many consequences that may last the rest of their lives. Assessment of initial impairments allows reasonable prediction of biological spontaneous recovery at 3 to 6 months for a majority of survivors. In real-world clinical practice, stroke survivors continue to improve their motor function beyond the spontaneous recovery period, but management plans for maximal recovery are not well understood. A model within the international classification of functioning (ICF) theoretical framework is proposed to systematically identify opportunities and potential barriers to maximize and realize the potentials of functional recovery from the acute to …

Feasibility And Outcomes Of Supplemental Gait Training By Robotic And Conventional Means In Acute Stroke Rehabilitation, Mukul Talaty, Alberto Esquenazi

Moss-Magee Rehabilitation Papers

INTRODUCTION: Practicality of implementation and dosing of supplemental gait training in an acute stroke inpatient rehabilitation setting are not well studied but can have positive impact on outcomes.

OBJECTIVES: To determine the feasibility of early, intense supplemental gait training in inpatient stroke rehabilitation, compare functional outcomes and the specific mode of delivery.

DESIGN AND SETTING: Assessor blinded, randomized controlled trial in a tertiary Inpatient Rehabilitation Facility.

PARTICIPANTS: Thirty acute post-stroke patients with unilateral hemiparesis (≥ 18 years of age with a lower limb MAS ≤ 3).

INTERVENTION: Lokomat® or conventional gait training (CGT) in addition to standard mandated therapy time. …

Does Spasticity Correlate With Motor Impairment In The Upper And Lower Limbs In Ambulatory Chronic Stroke Survivors??, Sheng Li, Jaskiran Ghuman, Javier Gonzalez-Buonomo, Xinran Huang, Aila Malik, Nuray Yozbatiran, Gerard E Francisco, Hulin Wu, Walter R Frontera

Faculty, Staff and Student Publications

OBJECTIVE: This study aimed to explore correlations between spasticity and motor impairments in the upper and lower limbs in ambulatory chronic stroke survivors.

DESIGN: We performed clinical assessments in 28 ambulatory chronic stroke survivors with spastic hemiplegia (female: 12; male: 16; mean ages = 57.8 ± 11.8 yrs; 76 ± 45 mos after stroke).

RESULTS: In the upper limb, spasticity index and Fugl-Meyer Motor Assessment showed a significant correlation. Spasticity index for the upper limb showed a significant negative correlation with handgrip strength of the affected side ( r = -0.4, P = 0.035) while Fugl-Meyer Motor Assessment for the …

Effects Of A Multi-Modal Gait Training Program In An Individual With Chronic Stroke: A Case Study, Anne Boddy, Lindsay A. Perry, Chitralakshmi K. Balasubramanian

Internet Journal of Allied Health Sciences and Practice

Purpose: Multi-modal gait training (MMGT) may improve impairments and functional limitations in individuals’ post-stroke. The purpose of this case study was to investigate effects of MMGT on gait and balance outcomes immediately post-intervention, 30-day short term (ST) and 1-year long term follow-up periods. Method: A 63-year-old patient, eight years post-stroke, participated in a MMGT program that included evidence-based gait interventions: unilateral treadmill training, inclined treadmill training at 8%, and over-ground fast walking. The eight sessions lasted 45-minutes each and consisted of the three interventions lasting 10-minutes each with rest breaks. Results: Self-selected (SS) and fastest comfortable gait speed revealed meaningful …

The Level Of Functionality Of The Affected Upper Limb In Stroke Patients Depends On The Type Of Therapy Used And The Lateralization Of The Subjects' Body - A Randomized Observational Study., Anna Olczak, Marcin Dornowski

Baltic Journal of Health and Physical Activity

Introduction: Impairment of the functions of the upper limb and hand is a major problem in stroke patients. The aim of the study was to evaluate various therapies in terms of their influence on changes in the activity of the affected, dominant, and non-dominant upper limb in patients after ischemic stroke. Material/Methods: This is a randomized, double-blinded study. The research was carried out in a rehabilitation clinic on a group of 60 stroke patients who were randomly assigned to groups differing in the rehabilitation program. The study group had physiotherapy based on the NDT Bobath concept and the control group …

Electric Field Navigated 1-Hz Rtms For Poststroke Motor Recovery: The E-Fit Randomized Controlled Trial, Dylan J. Edwards, Charle Y. Liu, Kari Dunning, Felipe Fregni, Jarmo Laine, Benjamin E. Leiby, Lynn M. Rogers, Richard L. Harvey

Moss-Magee Rehabilitation Papers

BACKGROUND: To determine if low-frequency repetitive transcranial magnetic stimulation targeting the primary motor cortex contralateral (M1_CL) to the affected corticospinal tract in patients with hemiparetic stroke augments intensive training–related clinical improvement; an extension of the NICHE trial (Navigated Inhibitory rTMS to Contralesional Hemisphere Trial) using an alternative sham coil.

METHODS: The present E-FIT trial (Electric Field Navigated 1Hz rTMS for Post-stroke Motor Recovery Trial) included 5 of 12 NICHE trial outpatient US rehabilitation centers. The stimulation protocol remained identical (1 Hz repetitive transcranial magnetic stimulation, M1_CL, preceding 60-minute therapy, 18 sessions/6 wks; parallel arm randomized clinical …

Impact Of Strokes: The Burden Of Care, Post-Cva Fatigue & Caregiver Role Strain, Tanya G. Schlemmer

Nursing Faculty Publications and Presentations

Strokes and cerebral vascular accidents (CVAs) and related disease events are an unfortunate circumstance that inflicts individuals around the world and impacts people every day as individuals and their caregivers. The consequences of these strokes or CVA events are life-changing for all those involved. As a result of long-term disability related to strokes, the caregiver may undergo many emotional, psychological, and physical factors that impact their daily lives. There is a relatively short period of time to react to the necessary change and as a result there may be differences in coping associated with these unexpected health circumstances. Many stoke …

The Nurosleeve, A User-Centered 3d Printed Hybrid Orthosis For Individuals With Upper Extremity Impairment, Mehdi Khantan, Mikael Avery, Phyo Thuta Aung, Rachel M. Zarin, Emma Hammelef, Nabila Shawki, Mijail Demian Serruya, Alessandro Naopli

Farber Institute for Neuroscience Faculty Papers

BACKGROUND: Active upper extremity (UE) assistive devices have the potential to restore independent functional movement in individuals with UE impairment due to neuromuscular diseases or injury-induced chronic weakness. Academically fabricated UE assistive devices are not usually optimized for activities of daily living (ADLs), whereas commercially available alternatives tend to lack flexibility in control and activation methods. Both options are typically difficult to don and doff and may be uncomfortable for extensive daily use due to their lack of personalization. To overcome these limitations, we have designed, developed, and clinically evaluated the NuroSleeve, an innovative user-centered UE hybrid orthosis.

METHODS: This …

Implementation Of An Intensive Amplitude-Focused Program With Stroke Patients In An Inpatient Rehabilitation Setting, Lauren R. Lafreniere

Department of Occupational Therapy Entry-Level Capstone Projects

This 16-week capstone experience with Southern Crescent Traumatic Brain Injury Center (SCTBI) focused on creating and implementing an intensive amplitude-focused program to improve functional and motor outcomes in stroke survivors. The student achieved Lee Silverman Voice Treatment-BIG (LSVT-BIG) certification to gain in-depth knowledge regarding neuroplasticity and recalibration of the sensorimotor system through high-amplitude movements. The student utilized the knowledge gained from the certification course to create an intensive high-amplitude program appropriate for acute stroke survivors in an inpatient rehabilitation setting. The program is comprised of exercises that are completed in either supine, seated, or sitting and focus on functional movements …

Using Predictive Validity To Compare Associations Between Brain Damage And Behavior, John F Magnotti, Jaclyn S Patterson, Tatiana T Schnur

Faculty, Staff and Student Publications

Lesion-behavior mapping (LBM) provides a statistical map of the association between voxel-wise brain damage and individual differences in behavior. To understand whether two behaviors are mediated by damage to distinct regions, researchers often compare LBM weight outputs by either the Overlap method or the Correlation method. However, these methods lack statistical criteria to determine whether two LBM are distinct versus the same and are disconnected from a major goal of LBMs: predicting behavior from brain damage. Without such criteria, researchers may draw conclusions from numeric differences between LBMs that are irrelevant to predicting behavior. We developed and validated a predictive …

Treatment Of Adult Spasticity With Botox (Onabotulinumtoxina): Development, Insights, And Impact, Alberto Esquenazi, Wolfgang H. Jost, Catherine C. Turkel, Theodore Wein, Rozalina Dimitrova

Moss-Magee Rehabilitation Papers

Upper and lower limb spasticity (ULS, LLS) often occur following a stroke or in patients with other neurological disorders, leading to difficulties in mobility and daily living and decreased quality of life. Prior to the use of onabotulinumtoxinA, antispastic medications had limited efficacy and often caused sedation. Phenol injections were difficult for physicians to perform, painful, and led to tissue destruction. The success of onabotulinumtoxinA in treating cervical dystonia led to its use in spasticity. However, many challenges characterized the development of onabotulinumtoxinA for adult spasticity. The wide variability in the presentation of spasticity among patients rendered it difficult to …

Vagus Nerve Stimulation Paired With Rehabilitation For Upper Limb Motor Impairment And Function After Chronic Ischemic Stroke: Subgroup Analysis Of The Randomized, Blinded, Pivotal, Vns-Rehab Device Trial, Jesse Dawson, Navzer D Engineer, Steven C Cramer, Steven L Wolf, Rushna Ali, Michael W O'Dell, David Pierce, Cecília N Prudente, Jessica Redgrave, Wuwei Feng, Charles Y Liu, Gerard E Francisco, Benjamin L Brown, Anand Dixit, Jen Alexander, Louis Demark, Vibor Krishna, Steven A Kautz, Arshad Majid, Brent Tarver, Duncan L Turner, Teresa J Kimberley

Faculty, Staff and Student Publications

BACKGROUND: Vagus Nerve Stimulation (VNS) paired with rehabilitation improved upper extremity impairment and function in a recent pivotal, randomized, triple-blind, sham-controlled trial in people with chronic arm weakness after stroke.

OBJECTIVE: We aimed to determine whether treatment effects varied across candidate subgroups, such as younger age or less injury.

METHODS: Participants were randomized to receive rehabilitation paired with active VNS or rehabilitation paired with sham stimulation (Control). The primary outcome was the change in impairment measured by the Fugl-Meyer Assessment Upper Extremity (FMA-UE) score on the first day after completion of 6-weeks in-clinic therapy. We explored the effect of VNS …

Occupation Based Program Enhancement: Promoting Social And Leisure Participation Post-Stroke, Emma Welch, Amy Lyons-Brown

Spring 2023 Virtual OTD Capstone Symposium

This presentation describes the importance of social and leisure participation for individuals who have had a stroke and explores the role of occupational therapy in promoting this area of occupation for the population.

Examining The Use Of Expressive Arts Therapies In Neurorehabilitation Treatment Planning, Rebecca J. Horner

Expressive Therapies Capstone Theses

Those undergoing neurorehabilitation after stroke and traumatic brain injury report a diminished sense of overall wellness. This paper examines the conceivable benefits of introducing expressive arts therapies, which is the therapeutic use and combination of the visual arts, movement, drama, music, writing and other intermodal creative processes, into physical therapy and neurorehabilitation treatment planning. Expressive arts therapies have the capacity to engage with an individual’s physical, emotional, social and spiritual states concurrently. They simultaneously offer the ability to promote an increased sense of well-being, address mind-body disconnects, and process trauma non-verbally.

The sections of this narrative literature review focus on …

Self-Regulation Processes Of Depressive Symptoms And Participation In Persons With Stroke Using Heart Rate Variability As A Real-Time Biomarker, Yejin Lee

WUSM Theses and Dissertations – All Programs

Depressive symptoms are a key risk factor for restrictions in participation in daily activities in persons with stroke. Thus, many researchers have attempted to develop interventions for relieving depressive symptoms after stroke, however, post-stroke depressive symptoms are still undertreated. To develop evidence-based approaches for reducing depressive symptoms, and thereby ultimately enhancing participation in daily activities, it is important to understand what moderates the associations between depressive symptoms and participation in daily activities in persons with stroke to employ the moderator as an intervention target.

One possible mechanism to moderate such associations is self-regulation – cognitive, behavioral, and emotion regulation. Self-regulation …

The Effectiveness And Outcomes Of Oculomotor And Visual Field Deficit Rehabilitation Secondary To Ischemic Cerebrovascular Accident: A Literature Review, Maanas Chiplunkar

Rowan-Virtua Research Day

Visual field loss and oculomotor dysfunctions are two common vision deficits caused by cerebrovascular accidents. Oftentimes these deficits can result in a loss of independence for patients and depression. Neurovisual rehabilitation is a frequently overlooked aspect of stroke rehabilitation, so investigating the current rehab approaches and the factors that play a role in the effectiveness of these methods is crucial so that clinicians can provide more direct and focused treatment for their patients. This literature review research process used PubMed, NCBI, and EbscoHost as primary databases. Preliminary results showed that restitutive and compensatory rehabilitation approaches are effective for treating visual …

Hemiplegic Shoulder Pain Prevention: A Collaborative Approach With Nursing And Occupational Therapy In Acute Care, Ebonee V. Cole, Ms, Otr/L, Cbis

Post-Professional Occupational Therapy Doctorate Culminating Presentations

Introduction: Hemiplegic shoulder pain (HSP) is one of the most common and disabling complications of arm hemiplegia after stroke (Anwer & Alghadir, 2020), with a prevalence as high as 75% of strokes (Xie et al., 2021). HSP can develop as early as the second week (Praveen Raj et al., 2021), may continue several months after stroke in 65% of patients (Kumar, 2019), and is associated with reduced functional arm use (Kumar, 2019). Prevention is the ideal management strategy of HSP (K. Walsh, 2001). Implementing hemiplegic arm management techniques, such as positioning and handling, is key to preventing HSP. In the …

Community Support Post-Hospitalization: A Practitioner Resource, Della Dupre

Post-Professional Occupational Therapy Doctorate - Innovations in OT Symposium: Transforming Possibilities into Practice

No abstract provided.

Regaining Quality Of Life Painting Pet Portraits, Jennifer K. Fortuna

The Open Journal of Occupational Therapy

Tina Primer, an artist based in Illinois, provided the cover art for the Spring 2023 issue of The Open Journal of Occupational Therapy (OJOT). “Wriggly” is an 11” x 14” painting made from acrylic on stretched canvas. After a debilitating stroke, Tina began using art as therapy. When the strength in her dominant hand did not return, painting pet portraits provided the motivation to do things differently. Tina’s playful use of color and attention to detail capture each pet’s unique personality. Discovering a new way to paint improved Tina’s quality of life.

Experiences And Perspectives Of Filipino Patients With Stroke On Physical Therapy Telerehabilitation: A Phenomenological Study Protocol, Christopher G. Cruz, Donald S. Lipardo, Nicole Trizia S. Esplana, Beatrice Ann Q. Loa, Micah L. Dismaya, Janelle Meara Y. Lau, Mirzi Chelsea R. Quizzagan, Arianne B. Cardenas, Adellene Therese S. Celso, Hanz Lauren A. Taguinod, Kristian Joseph C. Martin, Leonardo S. Uy Iii

Philippine Journal of Physical Therapy

Introduction: Stroke is the third leading cause of death in the Philippines, so these patients must continuously undergo rehabilitation for faster recovery. With the rise of COVID-19, physical therapy (PT) telerehabilitation (TR) has emerged, where services are provided outside the usual rehabilitation setting for patients with stroke to continue their treatment while reducing the risk of acquiring COVID-19. However, it is a relatively new service in the country; hence, further research is needed to identify the factors and needs of these patients during TR, which may help improve PT TR services.

Objective: This study aims to explore the experiences …

Stiff Knee Gait Disorders As Neuromechanical Consequences Of Spastic Hemiplegia In Chronic Stroke, Sheng Li

Faculty, Staff and Student Publications

Stiff knee gait (SKG) is defined as decreased knee flexion during the swing phase. It is one of the most common gait disorders following stroke. Knee extensor spasticity is commonly accepted as the primary cause. Clinical management has focused on the reduction in knee extensor spasticity. Recent advances in understanding of post-stroke hemiplegic gait suggest that SKG can present as mechanical consequences between muscle spasticity, weakness, and their interactions with ground reactions during walking. Various underlying mechanisms are presented through sample cases in this article. They include ankle plantar flexor spasticity, knee extensor spasticity, knee flexor and extensor coactivation, and …