Effects of Task-Specific and Impairment-Based Training Compared With Usual Care on Functional Walking Ability After Inpatient Stroke Rehabilitation: LEAPS Trial.

Effects of Task-Specific and Impairment-Based Training Compared With Usual Care on Functional Walking Ability After Inpatient Stroke Rehabilitation: LEAPS Trial.

Neurorehabil Neural Repair. 2013 Mar 15;
Nadeau SE, Wu SS, Dobkin BH, Azen SP, Rose DK, Tilson JK, Cen SY, Duncan PW,

BACKGROUND: . After inpatient stroke rehabilitation, many people still cannot participate in community activities because of limited walking ability. OBJECTIVE: . To compare the effectiveness of 2 conceptually different, early physical therapy (PT) interventions to usual care (UC) in improving walking 6 months after stroke. METHODS: . The Locomotor Experience Applied Post-Stroke (LEAPS) study was a single-blind, randomized controlled trial conducted in 408 adults with disabling hemiparetic stroke. Participants were stratified at baseline (2 months) by impairment in walking speed: severe (<0.4 m/s) or moderate (0.4 to %%T::7%%0.4 m/s and moderate to >0.8 m/s than UC participants (95% confidence interval [CI] = 7%-29%), and HEP participants were 17% more likely to transition (95% CI = 5%-29%). Mean gain in walking speed in LTP participants was 0.13 m/s greater (95% CI = 0.09-0.18) and in HEP participants, 0.10 m/s greater (95% CI = 0.05-0.14) than in UC participants. CONCLUSIONS: . Progressive PT, using either walking training on a treadmill and overground, conducted in a clinic, or strength and balance exercises conducted at home, was superior to UC in improving walking, regardless of severity of initial impairment. HubMed – rehab


Is Impaired Control of Reactive Stepping Related to Falls During Inpatient Stroke Rehabilitation?

Neurorehabil Neural Repair. 2013 Mar 15;
Mansfield A, Inness EL, Wong JS, Fraser JE, McIlroy WE

BACKGROUND: . Individuals with stroke fall more often than age-matched controls. Although many focus on the multifactorial nature of falls, the fundamental problem is likely the ability for an individual to generate reactions to recover from a loss of balance. Stepping reactions to recover balance are particularly important to balance recovery, and individuals with stroke have difficulty executing these responses to prevent a fall following a loss of balance. OBJECTIVE: . The purpose of this study is to determine if characteristics of balance recovery steps are related to falls during inpatient stroke rehabilitation. METHODS: . We conducted a retrospective review of individuals with stroke attending inpatient rehabilitation (n = 136). Details of falls experienced during inpatient rehabilitation were obtained from incident reports, nursing notes, and patient interviews. Stepping reactions were evoked using a “release-from-lean” postural perturbation. Poisson regression was used to determine characteristics of stepping reactions that were related to increased fall frequency relative to length of stay. RESULTS: . In all, 20 individuals experienced 29 falls during inpatient rehabilitation. The characteristics of stepping reactions significantly related to increased fall rates were increased frequency of external assistance to prevent a fall to the floor, increased frequency of no-step responses, increased frequency of step responses with inadequate foot clearance, and delayed time to initiate stepping responses. CONCLUSIONS: . Impaired control of balance recovery steps is related to increased fall rates during inpatient stroke rehabilitation. This study informs the specific features of stepping reactions that can be targeted with physiotherapy intervention during inpatient rehabilitation to improve dynamic stability control and potentially prevent falls. HubMed – rehab


State Rehabilitation Services Tailored to Employment Status Among Cancer Survivors.

J Occup Rehabil. 2013 Mar 16;
Chiu CY, Chan F, Strauser D, Feuerstein M, Ditchman N, Cardoso E, O’Neill J, Muller V

Purpose. Previous analyses of vocational rehabilitation services for unemployed cancer survivors indicated that counseling and guidance, job search assistance, and job placement services are significantly associated with increased odds for employment. However, many cancer survivors with jobs to return to may require vocational interventions that are different from unemployed cancer survivors. It is unclear whether the public rehabilitation system provides vocational services that are based on the work status of cancer survivors rather than providing the same set of services for all cancer survivors. This study examined whether differences in the types of services were indeed based on the employment status of those with a history of cancer at the time of application. Methods. Administrative data on 1,460 cancer survivors were obtained through the US Rehabilitation Services Administration Case Service Report (RSA-911) dataset for fiscal year 2007. Data on demographic characteristics and vocational service patterns were extracted and analyzed. Multiple discriminant analysis was used to identify differential services received by cancer survivors based on employment status at time of application for vocational rehabilitation services. Results. Results of the multiple discriminant analysis indicated one significant canonical discriminant function, with Wilks’s ? = .92, ? (2)(19, N = 1,456) = 114.87, p < .001. The correlations between the discriminating variables and the significant canonical discriminant function were highest for diagnoses and treatment (-.526), job placement (.487), transportation (.419), job search (.403), vocational training (.384), job readiness (.344), university training (.307), and rehabilitation technology (-.287). The group centroids along the significant discriminant function (the distance of each group from the center of the canonical function) indicated that the employed applicant group (-.542) and the unemployed applicant group (.153) can be differentiated based on vocational rehabilitation services received, with the employed applicant group receiving primarily diagnostic and treatment services and rehabilitation technology/job accommodation services, while the unemployed applicant group received more vocational training, job seeking skills training, and job placement services. Conclusions. Employed cancer survivors who are at risk of losing their job and unemployed cancer survivors who are looking for a job receive different vocational services tailored to needs, suggesting that state vocational rehabilitation services for cancer survivors is responsive to individual client needs. HubMed – rehab


Multifidus and Paraspinal Muscle Group Cross-Sectional Areas of Patients With Low Back Pain and Controls: A Systematic Review With a Focus on Blinding.

Phys Ther. 2013 Mar 15;
Fortin M, Macedo LG

BACKGROUND:: Several studies have investigated differences in paraspinal muscle morphology between LBP patients and controls. However, inconsistencies in the results of some of these studies may limit generalizations. PURPOSE:: To systematically review studies evaluating paraspinal muscle morphology in LBP patients and controls, with a focus on the effects of blinding. DATA SOURCES:: An electronic search was performed using relevant databases. Study quality was evaluated using the NewCastle assessment score. STUDY SELECTION:: Case-control studies investigating paraspinal muscle size between LBP patients and healthy controls were included. Studies that compared paraspinal muscle size between symptomatic and asymptomatic sides of unilateral LBP patients were also included. DATA EXTRACTION:: Studies investigating the same outcome, at the same spinal level, for the same muscle and population were pooled using RevMan 5.1. Mean difference with 95% CI was calculated for each study. DATA SYNTHESIS:: Eleven studies were included. All, but one pooled result were statistically significant different between groups, suggesting that paraspinal muscles are smaller in chronic LBP patients than controls, and on the symptomatic side of chronic unilateral LBP patients. In acute unilateral LBP patients there was no significant difference between sides. A qualitative examination demonstrated a trend towards an increased effect size when outcome assessors were unblinded. LIMITATIONS:: Limitations of this review include the small number of studies included and their small sample size. Misclassification of blinding status may have occurred when the study did not report blinding status. CONCLUSION:: Evidence suggests that paraspinal muscles are significantly smaller in patients with chronic LBP than in controls. Although no definite conclusion could be taken as to the effects of blinding, future imaging studies should consider the use blinded outcome assessors. HubMed – rehab