Cognitive Assessment and Rehabilitation Pathway for Stroke (CARPS).

Cognitive Assessment and Rehabilitation Pathway for Stroke (CARPS).

Top Stroke Rehabil. 2013 May-Jun; 20(3): 270-82
Taylor GH, Broomfield NM

Complex cognitive impairments are common after stroke and they can significantly impede individuals’ progress in rehabilitation. Treatment strategies that allow patients to compensate for such deficits are therefore an important part of multidisciplinary rehabilitation, as acknowledged by various clinical guidelines. In part due to the heterogeneity of poststroke cognitive impairments, the evidence base for treatments in this area is often unclear or inconsistent. There are no straightforward clinical tools or guidelines available to facilitate poststroke cognitive rehabilitation across cognitive domains. The present article proposes a cognitive assessment and rehabilitation pathway for stroke (CARPS), which aims to provide a structure to guide stroke rehabilitation teams in this difficult area of clinical practice. Practical treatment strategies are also discussed in some detail. Finally, the limitations of the proposed pathway are acknowledged, as is the importance of further research. HubMed – rehab

Transcranial magnetic stimulation combined with speech and language training in early aphasia rehabilitation: a randomized double-blind controlled pilot study.

Top Stroke Rehabil. 2013 May-Jun; 20(3): 250-61
Seniów J, Waldowski K, Le?niak M, Iwa?ski S, Czepiel W, Cz?onkowska A

Background: Functional neuroimaging studies with poststroke aphasia patients have shown increased activation of the unaffected hemisphere, which hypothetically reflects a maladaptive strategy of brain reorganization.Objective: We investigated whether repetitive transcranial magnetic stimulation (rTMS) inhibiting the right-hemisphere homologue of Broca’s area improves language restitution if combined with speech/language therapy.Methods: Forty aphasic patients during the subacute phase of ischemic stroke were randomized to a 3-week aphasia rehabilitation protocol in combination with real or sham rTMS. Naming, repetition, and comprehension were assessed using the Boston Diagnostic Aphasia Examination at baseline, immediately after therapy, and 15 weeks after completing treatment.Results: Although language functions improved in both experimental and control groups after 3 weeks, only slight group differences in degree of recovery were revealed between patients receiving rTMS and control participants. Follow-up revealed that severely aphasic rTMS patients demonstrated significantly greater improvement than patients receiving sham stimulation in repetition.Conclusions: Inhibitory rTMS applied to the right frontal language homologue is not effective for all poststroke aphasia patients, although it might benefit selected patients. HubMed – rehab

Item analysis of the berg balance scale in individuals with subacute and chronic stroke.

Top Stroke Rehabil. 2013 May-Jun; 20(3): 241-9
Straube D, Moore J, Leech K, Hornby TG

Purpose: The Berg Balance Scale (BBS) is one of the most commonly applied clinical measures of balance for individuals with stroke. This study used item analysis methods to investigate various psychometric aspects of the BBS in participants with subacute and chronic stroke.Methods: Secondary analysis of data from 69 participants was included. The Rasch measurement model was used to generate item fit statistics for each item of the BBS and assess scale precision across the continuum of balance.Results: Two of the 14 items of the BBS (standing on one foot and tandem standing) demonstrated misfit. The hierarchical scale demonstrated decreased precision at the higher end of the balance continuum.Discussion: The original instructions for the BBS indicate that the individual tested can choose the limb utilized in the single-limb stance and tandem stance items. Administration of these test items in this way to individuals with stroke may contribute to item misfit. Standardization of administration of the BBS to routinely use the involved lower extremity may support higher item difficulty, contribute to improved scale precision, and decrease the ceiling effect of the scale previously reported.Conclusion: The ability of participants to self-select the assessed lower extremity is most likely contributing to item misfit for 2 of the 14 BBS items. Standardized administration of these items may improve the ability of the BBS to more accurately measure initial balance impairment, as well as changes in balance due to spontaneous recovery and rehabilitation interventions. HubMed – rehab

Influence of lower extremity sensory function on locomotor adaptation following stroke: a review.

Top Stroke Rehabil. 2013 May-Jun; 20(3): 233-40
Wutzke CJ, Mercer VS, Lewek MD

Following stroke, people commonly demonstrate locomotor impairments including reduced walking speed and spatiotemporal asymmetry. Rehabilitation programs have been effective in increasing gait speed, but spatiotemporal asymmetry has been more resistant to change. The inability to modify gait patterns for improved symmetry may be related, in part, to impairments in lower extremity sensation. Assessment of lower extremity sensory impairments in people post stroke, including cutaneous and proprioceptive sensation, has been insufficiently studied. Conventional rehabilitation programs, including body weight-supported walking or robotic assistance, that modify sensory feedback intended to alter lower extremity movement patterns have shown limited success in improving gait symmetry. Rehabilitation programs that amplify specific gait asymmetries have demonstrated the potential to ultimately produce more symmetric gait, presumably by allowing individuals post stroke to more readily perceive their gait asymmetry. The effectiveness of such error augmentation paradigms, however, may be influenced by lower extremity sensation and the ability of the central nervous system to be aware of altered lower extremity movement. The purpose of this review is to critically examine the literature on lower extremity sensory function and its influence on gait adaptation in people post stroke. HubMed – rehab