Rehab Centers: Patients’ Views on the Impact of Stroke on Their Roles and Self: A Thematic Synthesis of Qualitative Studies.

Patients’ views on the impact of stroke on their roles and self: A thematic synthesis of qualitative studies.

Filed under: Rehab Centers

Arch Phys Med Rehabil. 2013 Jan 18;
Satink T, Cup EH, Ilott I, Prins J, de Swart BJ, Nijhuis-van der Sanden MW

OBJECTIVE: To synthesise patients’ views on the impact of stroke on their roles and self. DATA SOURCES: PubMed, CINAHL, Embase, PsycINFO and Cochrane searched from inception to September 2010, using a combination of relevant MeSH and free text terms. This search was supplemented by reference tracking. STUDY SELECTION: Qualitative studies reporting the views of people post stroke. The search yielded 494 records. Opinion papers, quantitative studies or those reporting somatic functioning were excluded. Thirty three studies were included. DATA EXTRACTION: Data extraction involved identifying all text presented as ‘results’ or ‘findings’ in the included studies, and importing this into software for the analysis of qualitative data. DATA SYNTHESIS: The abstracted text was coded and then subject to a thematic analysis and synthesis, which was discussed and agreed by the research team. Three over-arching themes were identified. These were 1) Managing discontinuity is a struggle; 2) Regaining roles: to continue or adapt?; and 3) Context influences management of roles and self. Regaining valued roles and self was an on-going struggle, and discontinuity and uncertainty were central to the adjustment process after stroke. CONCLUSION: The thematic synthesis provides new insights into the post stroke experience. Regaining or developing a new self and roles was problematic. Interventions targeted at self-management should be focused on the recognition of this problem, and included in rehabilitation, to facilitate adjustment and continuity as far as possible in life post stroke.
HubMed – rehab

 

Size Doesn’t Matter: Cortical Stroke Lesion Volume is Not Associated with Upper Extremity Motor Impairment and Function in Mild, Chronic, Hemiparesis.

Filed under: Rehab Centers

Arch Phys Med Rehabil. 2013 Jan 18;
Page SJ, Gauthier L, White S

OBJECTIVE: To determine: (a) the relationship between lesion volume and upper extremity (UE) motor impairment using the UE section of the Fugl-Meyer (FM); and (b) the relationship between lesion volume and UE functional outcomes using the Arm Motor Ability Test (AMAT) Functional Ability (FA) and Time scales. DESIGN: Secondary, retrospective analysis of randomized controlled trial data SETTING: Not applicable PARTICIPANTS: 139 subjects with chronic stroke (83 males; mean age of all subjects = 56.7 + 11.2 years; mean time since stroke onset = 59.6 + 65.6 months; 90 subjects with right hemiparesis) and stable, active, distal UE movement. INTERVENTION: Data were collected related to subjects’ lesion volum and UE movement prior to their participation in a multicenter randomized controlled trial. MAIN OUTCOME MEASURES: The FM and the AMAT. RESULTS: Neither age nor lesion volume was related to FM performance. The p-value for the regression coefficient of lesion volume was 0.045 in the AMAT FA model and 0.016 in the AMAT Time model. Lesion volume accounted for only an additional 1.7% (AMAT FA) to 3.1% (AMAT Time) of the variability in motor function, and was not clinically meaningful. CONCLUSIONS: Data suggest no relationship between lesion volume and UE impairment, and a small, clinically insignificant relationship between lesion volume and UE motor function. Stroke affects metabolic changes in intact regions, and causes diffuse structural loss in anatomically remote regions from the infarction. These other factors may account for variance in motor outcomes following stroke.
HubMed – rehab

 

A Quality Assurance Study On The Accuracy Of Measuring Physical Function Under Current Conditions For Use of Clinical Video Telehealth.

Filed under: Rehab Centers

Arch Phys Med Rehabil. 2013 Jan 18;
Hoenig H, Tate L, Dumbleton S, Montgomery C, Morgan M, Landerman LR, Caves K

OBJECTIVE: To determine if conditions for use of clinical video telehealth technology might affect the accuracy of measures of physical function. DESIGN: Repeated measures. SETTING: Veterans Administration Medical Center PARTICIPANTS: 3 healthy adult volunteers for a sample size of n=30 independent trials for each of 3 physical function tasks. INTERVENTIONS: None MAIN OUTCOME MEASURES: 3 tasks capturing differing aspects of physical function: fine-motor coordination (number of finger taps in 30 seconds), gross-motor coordination (number of gait deviations in 10 feet), and clinical spatial relationships (identifying proper height for a cane randomly preset ± 0-2 inches from optimal), with performance simultaneously assessed in-person and video recorded. Inter-rater reliability and criterion validity was determined for measurement of these 3 tasks scored according to 5 different methods: (1) in-person (community standard), (2) slow motion review of the video recording (criterion gold standard), (3-5) full speed review at 3 different internet bandwidths (64 kps, 384 kps, 768 kps). RESULTS: Fine motor coordination – Inter-rater reliability was variable (r=0.43-0.81) and criterion validity poor at 64 kps and 384 kps, but both were acceptable at 768 kps (reliability r=0.74, validity ?=0.81). Gross motor coordination – Inter-reliability was variable (range r=0.53-0.75) and criterion validity was poor at all bandwidths (?=0.28-0.47). Motionless spatial relationships – Excellent reliability (r=0.92-0.97) and good criterion validity (?=0.84-0.89) at all of the tested bandwidths. CONCLUSIONS: Internet bandwidth had differing effects on measurement validity and reliability for the fine motor task, the gross motor task and spatial relationships, with results for some tasks at some transmission speeds well below acceptable quality standards and community standard.
HubMed – rehab

 

Telerehabilitation: remote multimedia-supported assistance and mobile monitoring of balance training outcomes can facilitate the clinical staff’s effort.

Filed under: Rehab Centers

Int J Rehabil Res. 2013 Jan 18;
Krpi? A, Savanovi? A, Cikajlo I

Telerehabilitation can offer prolonged rehabilitation for patients with stroke after being discharged from the hospital, whilst remote diagnostics may reduce the frequency of the outpatient services required. Here, we compared a novel telerehabilitation system for virtual reality-supported balance training with balance training with only a standing frame and with conventional therapy in the hospital. The proposed low-cost experimental system for balance training enabling multiple home systems, real-time tracking of task’s performance and different views of captured data with balance training, consists of a standing frame equipped with a tilt sensor, a low-cost computer, display, and internet connection. Goal-based tasks for balance training in the virtual environment proved motivating for the participating individuals. The physiotherapist, located in the remote healthcare center, could remotely adjust the level of complexity and difficulty or preview the outcomes and instructions with the application on the mobile smartphone. Patients using the virtual reality-supported balance training showed an improvement in the task performance time of 45% and number of collisions of 68%, showing significant improvements in the Berg Balance Scale, Timed ‘Up and Go’, and 10 m Walk Test. The clinical outcomes were not significantly different from balance training with only the standing frame or conventional therapy. The proposed telerehabilitation can facilitate the physiotherapists’ work and thus enable rehabilitation to a larger number of patients after release from the hospital because it requires less time and infrequent presence of the clinical staff. However, a comprehensive clinical evaluation is required to confirm the applicability of the concept.Eine Telerehabilitation kann Schlaganfallpatienten nach ihrer Entlassung aus dem Krankenhaus zu einer anhaltenden Rehabilitation verhelfen bei gleichzeitiger Senkung der Häufigkeit der beanspruchten Einrichtungen dank Ferndiagnose. Hier verglichen wir ein neuartiges System der Telerehabilitation mit virtuellem realitätsunterstütztem Gleichgewichtstraining einerseits mit einem Gleichgewichtstraining nur mit Stehständer und konventioneller krankenhausbasierter Therapie andererseits. Das geplante kostengünstige experimentelle System des Gleichgewichtstrainings für multiple Haussysteme, Echtzeit-Verfolgung der jeweiligen Aufgabe und unterschiedlichen Ansichten der erfassten Daten mit Gleichgewichtstraining umfasst einen Stehständer mit Kippsensor, einen preisgünstigen Computer mit Monitor und Internetanschluss. Die zielgerichteten Aufgaben für das Gleichgewichtstraining im virtuellen Umfeld motivierten die einzelnen Teilnehmer. Der Physiotherapeut im entlegenen Gesundheitszentrum konnte den Komplexitäts- und Schwierigkeitsgrad per Fernbedienung einstellen oder die Ergebnisse und Anweisungen mit Hilfe der Applikation eines Smartphones kontrollieren. Patienten, die sich einem virtuellen realitätsgestützten Gleichgewichtstraining unterzogen, wiesen bei der Zeit der Ausübung von Aufgaben eine Verbesserung von 45% und bei der Zahl der Kollisionen von 68% auf. Dies sind signifikante Verbesserungen bei der Berg-Balance-Skala, beim Timed Up-and-Go-Test zur Mobilitätsmessung und beim 10 m-Gehtest. Die klinischen Ergebnisse unterschieden sich nicht signifikant vom Gleichgewichtstraining ausschließlich mit Stehständer oder konventioneller Therapie. Die geplante Telerehabilitation kann die Arbeit von Physiotherapeuten erleichtern und die Rehabilitation somit einer größeren Zahl von Patienten nach Entlassung aus dem Krankenhaus zugängig machen, weil das klinische Personal dabei zeitlich weniger beansprucht wird und weniger häufig anwesend sein muss. Eine umfassende klinische Evaluierung zur Bestätigung der Anwendbarkeit des Konzepts ist jedoch erforderlich.Los servicios de telerehabilitación pueden ofrecer una rehabilitación prolongada a los pacientes con accidente cerebrovascular tras haber sido dados de alta del hospital, mientras que los diagnósticos a distancia pueden disminuir la frecuencia de los servicios requeridos por los pacientes externos. En este estudio se comparó un novedoso sistema de telerehabilitación para el entrenamiento del equilibrio basado en realidad virtual con la modalidad de entrenamiento del equilibrio donde solo se hace uso de un bipedestador y con el tratamiento convencional administrado en el hospital. El sistema experimental de bajo coste propuesto para el entrenamiento del equilibrio, el cual admite múltiples sistemas domóticos, seguimiento de las tareas a tiempo real y distintas vistas de las capturas de datos con entrenamiento del equilibrio, consiste en un bipedestador equipado con un sensor de inclinación, un ordenador de bajo coste, una pantalla y conexión a internet. Los ejercicios basados en los objetivos para el entrenamiento del equilibrio en el entorno virtual demostraron ser de gran motivación para los participantes. El fisioterapeuta, que se encontraba en el centro de salud a distancia, era capaz de ajustar mediante control remoto el nivel de complexidad y dificultad o visualizar los resultados y las instrucciones mediante la aplicación de un teléfono móvil inteligente. Aquellos pacientes que utilizaron el sistema de entrenamiento del equilibrio basado en la realidad virtual mostraron una mejora del 45% en el tiempo de ejecución de los ejercicios y un número de caídas del 68%, presentando a su vez mejoras significativas en la Escala de Equilibrio de Berg, la prueba de levantarse y caminar cronometrada y la prueba de la marcha de 10 minutos. Los resultados clínicos no fueron significativamente distintos a los del entrenamiento del equilibrio con bipedestador o los del tratamiento convencional. El sistema de telerehabilitación propuesto puede facilitar el trabajo de los fisioterapeutas y, por lo tanto, permitir la rehabilitación de un número mayor de pacientes tras haber sido dados de alta del hospital, ya que requiere una menor duración y una menor frecuencia de la presencia del personal clínico. Sin embargo, se precisa llevar a cabo una evaluación clínica exhaustiva con el fin de confirmar la aplicabilidad de dicho concepto.La rééducation à distance peut offrir une rééducation prolongée au patients victimes d’AVC après leur sortie de l’hôpital, les diagnostics à distance pouvant réduire la fréquence de consultation des services externes. Ici, nous avons comparé un système de rééducation à distance d’entraînement à l’équilibre par réalité virtuelle soutenu seulement par un cadre de support à un traitement hospitalier classique. Le système expérimental à bas prix proposé pour l’entraînement à l’équilibre permet le suivi en temps réel de l’exécution des tâches sur plusieurs systèmes à domicile et différentes interprétation des données capturées avec l’entraînement à l’équilibre ; il se compose d’un cadre de support équipé d’un capteur d’inclinaison, d’un ordinateur de faible coût avec écran et d’une connexion Internet. Les tâches axées sur des objectifs pour l’entraînement à l’équilibre dans l’environnement virtuel se sont avérées motivantes pour les participants. Le kinésithérapeute, situé dans le centre de soins à distance, pouvait ajuster le niveau de complexité et de difficulté ou prévisualiser les résultats et les instructions avec l’application sur un smartphone portable. Les patients utilisant l’entraînement à l’équilibre par réalité virtuelle ont présenté une amélioration de 45% dans l’exécution des tâches dans le temps et un nombre de collisions de 68%, ce qui traduit des améliorations significatives sur l’échelle d’équilibre de Berg, les mesures « Up and Go » temporisées et le test de marche de 10m. Les résultats cliniques n’étaient pas significativement différents de la rééducation à l’équilibre avec seulement le cadre de support ou la thérapie conventionnelle. La rééducation à distance proposée peut faciliter le travail des physiothérapeutes et ainsi permettre la rééducation d’un plus grand nombre de patients après leur sortie de l’hôpital, car elle nécessite moins de temps et une présence moins fréquente du personnel clinique. Toutefois, une évaluation clinique complète sera nécessaire pour confirmer l’applicabilité du concept.
HubMed – rehab

 

More Rehab Centers Information…