Using Subthreshold Vibratory Stimulation During Poststroke Rehabilitation Therapy: A Case Series

2021 ◽  
pp. 153944922110422
Author(s):  
Amanda A. Vatinno ◽  
Lucion Hall ◽  
Hannah Cox ◽  
Alison Fluharty ◽  
Catilyn Taylor ◽  
...  
Keyword(s):  
Case Series ◽  
Minimal Detectable Change ◽  
Therapy Outcomes ◽  
Vibratory Stimulation ◽  
Clinically Important Difference ◽  
Stroke Impact Scale ◽  
Impact Scale ◽  
Function Test ◽  
Wolf Motor Function Test

Subthreshold vibratory stimulation to the paretic wrist has been shown to prime the sensorimotor cortex and improve 2-week upper extremity (UE) therapy outcomes. The objective of this work was to determine feasibility, safety, and preliminary efficacy of the stimulation over a typical 6-week therapy duration. Four chronic stroke survivors received stimulation during 6-week therapy. Feasibility/safety/efficacy were assessed at baseline, posttherapy, and 1-month follow-up. For feasibility, all participants wore the device throughout therapy and perceived the stimulation comfortable/safe. Regarding safety, no serious/moderate intervention-related adverse events occurred. For efficacy, all participants improved in Wolf Motor Function Test and UE use in daily living based on accelerometry and stroke impact scale. Mean improvements at posttherapy/follow-up were greater than the minimal detectable change/clinically important difference and other trials with similar therapy without stimulation. In conclusion, the stimulation was feasible/safe for 6-week use. Preliminary efficacy encourages a larger trial to further evaluate the stimulation as a therapy adjunct.

Minimal Detectable Change and Clinically Important Difference of the Stroke Impact Scale in Stroke Patients

2010 ◽  
Vol 24 (5) ◽  
pp. 486-492 ◽  
Author(s):  
Keh-chung Lin ◽  
Tiffany Fu ◽  
Ching-yi Wu ◽  
Yen-ho Wang ◽  
Jung-sen Liu ◽  
...  
Keyword(s):  
Minimal Detectable Change ◽  
Detectable Change ◽  
Stroke Patients ◽  
Clinically Important Difference ◽  
Stroke Impact Scale ◽  
Impact Scale

Poster 59 Minimal Detectable Change and Clinically Important Difference of the Stroke Impact Scale 16 in Stroke Patients

PM&R ◽  
2015 ◽  
Vol 7 ◽  
pp. S111-S111
Author(s):  
Blanca Palomino Aguado ◽  
Maria Santos Oliete ◽  
Pilar Sanchez ◽  
Belen Alonso Alvarez ◽  
Jose Acosta Batlle ◽  
...  
Keyword(s):  
Minimal Detectable Change ◽  
Detectable Change ◽  
Stroke Patients ◽  
Clinically Important Difference ◽  
Stroke Impact Scale ◽  
Impact Scale

scholarly journals Recovery of Visuospatial Neglect Subtypes and Relationship to Functional Outcome Six Months After Stroke

2021 ◽  
pp. 154596832110329
Author(s):  
Margaret J. Moore ◽  
Kathleen Vancleef ◽  
M. Jane Riddoch ◽  
Celine R. Gillebert ◽  
Nele Demeyere
Keyword(s):  
Functional Outcomes ◽  
Stroke Severity ◽  
Visuospatial Neglect ◽  
Recovery Pattern ◽  
Stroke Impact Scale ◽  
Impact Scale ◽  
Significant Difference ◽  
Initial Severity

Background/Objective. This study aims to investigate how complex visuospatial neglect behavioural phenotypes predict long-term outcomes, both in terms of neglect recovery and broader functional outcomes after 6 months post-stroke. Methods. This study presents a secondary cohort study of acute and 6-month follow-up data from 400 stroke survivors who completed the Oxford Cognitive Screen’s Cancellation Task. At follow-up, patients also completed the Stroke Impact Scale questionnaire. These data were analysed to identify whether any specific combination of neglect symptoms is more likely to result in long-lasting neglect or higher levels of functional impairment, therefore warranting more targeted rehabilitation. Results. Overall, 98/142 (69%) neglect cases recovered by follow-up, and there was no significant difference in the persistence of egocentric/allocentric (X2 [1] = .66 and P = .418) or left/right neglect (X2 [2] = .781 and P = .677). Egocentric neglect was found to follow a proportional recovery pattern with all patients demonstrating a similar level of improvement over time. Conversely, allocentric neglect followed a non-proportional recovery pattern with chronic neglect patients exhibiting a slower rate of improvement than those who recovered. A multiple regression analysis revealed that the initial severity of acute allocentric, but not egocentric, neglect impairment acted as a significant predictor of poor long-term functional outcomes (F [9,300] = 4.742, P < .001 and adjusted R2 = .098). Conclusions. Our findings call for systematic neuropsychological assessment of both egocentric and allocentric neglect following stroke, as the occurrence and severity of these conditions may help predict recovery outcomes over and above stroke severity alone.

scholarly journals A comparison of the effects and usability of two exoskeletal robots with and without robotic actuation for upper extremity rehabilitation among patients with stroke: a single-blinded randomised controlled pilot study

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Jin Ho Park ◽  
Gyulee Park ◽  
Ha Yeon Kim ◽  
Ji-Yeong Lee ◽  
Yeajin Ham ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Pilot Trial ◽  
Stroke Survivors ◽  
Robotic Rehabilitation ◽  
Time Interaction ◽  
Stroke Impact Scale ◽  
Impact Scale ◽  
Wolf Motor Function Test ◽  
Upper Extremity Rehabilitation ◽  
Randomised Controlled

Abstract Background Robotic rehabilitation of stroke survivors with upper extremity dysfunction may yield different outcomes depending on the robot type. Considering that excessive dependence on assistive force by robotic actuators may interfere with the patient’s active learning and participation, we hypothesised that the use of an active-assistive robot with robotic actuators does not lead to a more meaningful difference with respect to upper extremity rehabilitation than the use of a passive robot without robotic actuators. Accordingly, we aimed to evaluate the differences in the clinical and kinematic outcomes between active-assistive and passive robotic rehabilitation among stroke survivors. Methods In this single-blinded randomised controlled pilot trial, we assigned 20 stroke survivors with upper extremity dysfunction (Medical Research Council scale score, 3 or 4) to the active-assistive robotic intervention (ACT) and passive robotic intervention (PSV) groups in a 1:1 ratio and administered 20 sessions of 30-min robotic intervention (5 days/week, 4 weeks). The primary (Wolf Motor Function Test [WMFT]-score and -time: measures activity), and secondary (Fugl-Meyer Assessment [FMA] and Stroke Impact Scale [SIS] scores: measure impairment and participation, respectively; kinematic outcomes) outcome measures were determined at baseline, after 2 and 4 weeks of the intervention, and 4 weeks after the end of the intervention. Furthermore, we evaluated the usability of the robots through interviews with patients, therapists, and physiatrists. Results In both the groups, the WMFT-score and -time improved over the course of the intervention. Time had a significant effect on the WMFT-score and -time, FMA-UE, FMA-prox, and SIS-strength; group × time interaction had a significant effect on SIS-function and SIS-social participation (all, p < 0.05). The PSV group showed better improvement in participation and smoothness than the ACT group. In contrast, the ACT group exhibited better improvement in mean speed. Conclusions There were no differences between the two groups regarding the impairment and activity domains. However, the PSV robots were more beneficial than ACT robots regarding participation and smoothness. Considering the high cost and complexity of ACT robots, PSV robots might be more suitable for rehabilitation in stroke survivors capable of voluntary movement. Trial registration The trial was registered retrospectively on 14 March 2018 at ClinicalTrials.gov (NCT03465267).

scholarly journals Terapia de movimento induzido pela restrição na hemiplegia: um estudo de caso único

2008 ◽  
Vol 15 (3) ◽  
pp. 298-303 ◽  
Author(s):  
Daniela Virgínia Vaz ◽  
Rafaela Fernandes Alvarenga ◽  
Marisa Cotta Mancini ◽  
Tatiana Pessoa da Silva Pinto ◽  
Sheyla Rossana Cavalcanti Furtado ◽  
...  
Keyword(s):  
Action Research ◽  
Motor Activity ◽  
Motor Function ◽  
Function Test ◽  
Wolf Motor Function Test

A terapia de movimento induzido por restrição (TMIR) tem mostrado resultados positivos em indivíduos hemiparéticos após acidente vascular cerebral; consiste na contenção do membro superior não-afetado e treinamento intensivo do membro afetado. Este estudo visou documentar longitudinalmente os efeitos da TMIR na funcionalidade do membro superior de um indivíduo com hemiparesia esquerda crônica. Neste estudo de caso único tipo ABA, as fases linha de base (A) duraram duas semanas e a intervenção (B) compreendeu a contenção do membro sadio com um splint e cinco sessões semanais de 3 horas de treino do membro superior afetado, durante duas semanas. As medidas de funcionalidade Action Research Arm (ARA) e de qualidade de movimento e destreza Wolf Motor Function Test (WMFT) foram coletadas cinco vezes por semana, e a medida de qualidade e freqüência de uso do membro superior, Motor Activity Log (MAL), uma vez por semana por seis semanas. Os dados coletados foram tratados estatisticamente. Os resultados mostram ganhos significativos na qualidade de movimento (WMFT) durante a intervenção (p<0,05), mantidos no follow-up (p>0,05). Quanto à destreza (WMFT) e funcionalidade (ARA), foram detectadas tendências significativas de ganho durante as quatro primeiras semanas; após a intervenção, houve estabilização do desempenho (p<0,05). A análise do MAL acusou efeitos sem relevância clínica. Os resultados mostram que a TMIR propiciou ganhos de desempenho motor do paciente com hemiparesia crônica.

scholarly journals Responsiveness, Minimal Clinically Important Difference, and Validity of the MoCA in Stroke Rehabilitation

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Ching-Yi Wu ◽  
Shuan-Ju Hung ◽  
Keh-chung Lin ◽  
Kai-Hua Chen ◽  
Poyu Chen ◽  
...  
Keyword(s):  
Cognitive Deficits ◽  
Minimal Clinically Important Difference ◽  
Criterion Validity ◽  
Stroke Survivors ◽  
Future Studies ◽  
Clinically Important Difference ◽  
Stroke Impact Scale ◽  
Impact Scale ◽  
Before And After ◽  
Larger Sample

Objective. Persons with stroke frequently suffer from cognitive impairment. The Montreal Cognitive Assessment (MoCA), a recently developed screening tool, is sensitive to poststroke cognitive deficits. The present study assessed its psychometric and clinimetric properties (i.e., responsiveness, minimal clinically important difference (MCID), and criterion validity) in stroke survivors receiving rehabilitative therapy. Method. The MoCA and the Stroke Impact Scale (SIS) were administered to 65 stroke survivors before and after 4 to 5 weeks of therapy. The effect size and standardized response mean (SRM) were calculated for responsiveness. Anchor- and distribution-based methods were used to estimate the MCID. Criterion validity was measured with the Spearman correlation coefficient. Results. The responsiveness of the MoCA was moderate (SRM=0.67). Participants exceeding the MCID according to the anchor- and distribution-based approaches were 33 (50.77%) and 20 (30.77%), respectively. Fair to good concurrent validity was reported between the MoCA and the SIS communication subscale. The MoCA had satisfactory predictive validity with the SIS communication and memory subscales. Conclusion. This study may support the responsiveness, MCID, and criterion validity of the MoCA in stroke populations. Future studies with larger sample sizes are needed to validate the current findings.

Visual outcomes after bilateral implantation of Versario intraocular lenses – six month follow-up

2021 ◽  
Author(s):  
Karolina Podboraczynska-Jodko ◽  
Wojciech Lubiński
Keyword(s):  
Postoperative Complications ◽  
Case Series ◽  
Intraocular Lenses ◽  
Normal Range ◽  
Visual Outcomes ◽  
Function Test ◽  
Healthy Control ◽  
Defocus Curve ◽  
The Mean

Abstract PurposeTo study visual outcomes after implantation of Versario intraocular lenses (IOLs) Patients and MethodsIn 20 selected patients (40 eyes) uneventful, bilateral cataract surgeries with implantation of trifocal Versario (IOLs) were performed. Designprospective case series. Six months after surgery the following parameters were analysed: binocular uncorrected visual acuities (log MAR): for distance (UDVA) at 4 m, for intermediate (UIVA) at 60, 70, 80 cm and for near (UNVA) at 40 cm, photopic defocus curve, mesopic and photopic contrast sensitivities (CSs), spectacle independence, visual function test questionnaire (modified VFQ-25), subjective symptoms and postoperative complications. ResultsSix months after surgery, the mean of binocular visual acuities were as follows: UDVA: -0.12 ± 0.08; UIVA (60 cm): +0.07 ± 0.10, (70 cm): +0.05 ± 0.11, (80cm): +0.07 ± 0.09; UNVA (40cm): +0.12 ± 0.08. CSs in mesopic and scotopic conditions for distance and photopic for near were between normal range of age- match healthy control. All patients were spectacle independent. General satisfaction was high and equal 9.37±0.83. No severe glare and halo were detected. There were no postoperative complications. ConclusionsThe bimanual MICS with the Versario lenses implantation was a safe and effective method for patients who want to be spectacle independent at different distances.

Translation and validation of the stroke impact scale 3.0 into urdu for Pakistan

2021 ◽  
pp. 1-12
Author(s):  
Umair Ahmed ◽  
Hossein Karimi ◽  
Syed Amir Gilani ◽  
Ashfaq Ahmad
Keyword(s):  
Psychometric Properties ◽  
Discriminant Validity ◽  
Hand Function ◽  
Minimal Detectable Change ◽  
Stroke Impact Scale ◽  
Impact Scale ◽  
Assess Quality ◽  
Test Retest Reliability ◽  
Translation And Validation

BACKGROUND: The Stroke Impact Scale version 3.0 (SIS 3.0) is a self-reported outcome measure designed to assess quality of life (QoL) following a stroke. Although the psychometric properties of the SIS 3.0 are identified as superior to the generic QoL scales, it has not been translated and tested in Pakistan. OBJECTIVE: To validate the Urdu version of the SIS 3.0 (USIS 3.0) for Pakistan. METHODS: A prospective cohort of 116 patients with mild to moderate stroke reported their recovery using the USIS 3.0. The patients were concurrently assessed on the established tools to assess the validity and were re-evaluated to determine the test-retest reliability, precision, minimal detectable change (MDC), and minimal clinically important difference (MCID). RESULTS: The reliability and internal consistency of USIS were satisfactory except for the emotion domain. The correlations of USIS with the established tools were strong. The discriminant validity was also significant across the levels of the modified Rankin scale (MRS). Only hand function and communication domains exhibited significant floor and ceiling effects, respectively. Regarding weighted K, values ranged from 0.53 to 0.88. CONCLUSIONS: The USIS 3.0 has satisfactory psychometric properties and can be used in clinical and research settings for stroke survivors.

scholarly journals Minimal Detectable Change Scores for the Wolf Motor Function Test

2009 ◽  
Vol 23 (7) ◽  
pp. 662-667 ◽  
Author(s):  
Stacy L. Fritz ◽  
Sarah Blanton ◽  
Gitendra Uswatte ◽  
Edward Taub ◽  
Steven L. Wolf
Keyword(s):  
Motor Function ◽  
Reliability And Validity ◽  
Minimal Detectable Change ◽  
Detectable Change ◽  
Performance Time ◽  
Function Test ◽  
Wolf Motor Function Test ◽  
Individual Task ◽  
The Individual ◽  
Standard Error Of Measurement

Background. The Wolf Motor Function Test (WMFT) is an impairment-based test whose psychometrics have been examined by previous reliability and validity studies. Standards for evaluating whether a given change is meaningful, however, have not yet been addressed. Objectives. To determine the standard error of measurement (SEM) and minimal detectable change (MDC) for the WMFT. Methods. Data were collected from 6 university laboratories that participated in the EXCITE national clinical trial and included 96 individuals with sub-acute stroke (3—9 months). Measurements were made by blinded evaluators who were trained and standardized to administer the WMFT, which was completed on 2 occasions 2 weeks apart. No intervention was given between testing sessions. Results. The WMFT Performance Time score has a SEM of 0.2 seconds and a MDC95 of 0.7 seconds. The individual task timed items MDC 95 ranged from 1.0 second (turn key in lock) to 3.4 seconds (reach and retrieve) with individual task items demonstrating notablly higher variability than the average WMFT Performance Time. The average WMFT Functional Ability Scale SEM and MDC95 is 0.1 points. Conclusions. When assessing the effect of a therapeutic intervention, if an individual experiences an amount of change equal to or greater than the MDC, then one may be 95% confident that this margin of change is truly larger than measurement error and not a chance result. Thus, the determination of SEM and MDC in outcome assessments allows researchers and clinicians to distinguish which results are actual differences versus which results are simply changes resulting from error or chance.

scholarly journals Visuospatial neglect: Recovery & Functional outcome after 6 months.

2021 ◽  
Author(s):  
Margaret Jane Moore ◽  
Kathleen Vancleef ◽  
Jane Riddoch ◽  
Celine Gillebert ◽  
Nele Demeyere
Keyword(s):  
Functional Outcomes ◽  
Visuospatial Neglect ◽  
Recovery Pattern ◽  
Stroke Impact Scale ◽  
Impact Scale ◽  
Significant Difference ◽  
Initial Severity ◽  
Cognitive Screen

Abstract: Background/Objective: This study aims to investigate how complex visuospatial neglect behavioural phenotypes predict long-term outcomes, both in terms of neglect recovery and broader functional outcomes. Methods: This study presents a secondary cohort study of acute and 6 month follow up data from 400 stroke survivors who completed the Oxford Cognitive Screen Cancellation Task. At follow-up, patients also completed the Stroke Impact Scale questionnaire. These data were analysed to identify whether any specific combination of neglect symptoms is more likely to result in long-lasting neglect or higher levels of functional impairment, therefore warranting more targeted rehabilitation. Results: Overall, 98/142(69%) neglect cases recovered by follow-up and there was no significant difference in the persistence of egocentric/allocentric (X2(1)=0.66, p=0.418) or left/right neglect (X2(2)=0.781, p= 0.677). Egocentric neglect was found to follow a proportional recovery pattern with all patients demonstrating a similar level of improvement over time. Conversely, allocentric neglect followed a non-proportional recovery pattern with chronic neglect patients exhibiting a slower rate of improvement than those who recovered. A multiple regression analysis revealed that the initial severity of acute allocentric, but not egocentric, neglect impairment acted as a significant predictor of poor long-term functional outcomes (F(9,383)=3.96, p<0.001, R2=0.066). Conclusions: Our findings call for systematic neuropsychological assessment of both egocentric and allocentric neglect following stroke, as the occurrence and severity of these conditions may help predict recovery outcomes.

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