Trajectories of stroke recovery of impairment, function, and quality of life in response to 12-month mobility and fitness intervention

2021 ◽  
pp. 1-12
Author(s):  
Catherine Boissoneault ◽  
Dorian K. Rose ◽  
Tyler Grimes ◽  
Michael F. Waters ◽  
Anna Khanna ◽  
...  
Keyword(s):  
Functional Disability ◽  
Functional Mobility ◽  
Stroke Recovery ◽  
Stroke Survivors ◽  
Significant Group ◽  
Long Duration ◽  
Treatment Support ◽  
Clinically Significant ◽  
And Function

BACKGROUND: Gait deficits and functional disability are persistent problems for many stroke survivors, even after standard neurorehabilitation. There is little quantified information regarding the trajectories of response to a long-dose, 12-month intervention. OBJECTIVE: We quantified treatment response to an intensive neurorehabilitation mobility and fitness program. METHODS: The 12-month neurorehabilitation program targeted impairments in balance, limb coordination, gait coordination, and functional mobility, for five chronic stroke survivors. We obtained measures of those variables every two months. RESULTS: We found statistically and clinically significant group improvement in measures of impairment and function. There was high variation across individuals in terms of the timing and the gains exhibited. CONCLUSIONS: Long-duration neurorehabilitation (12 months) for mobility/fitness produced clinically and/or statistically significant gains in impairment and function. There was unique pattern of change for each individual. Gains exhibited late in the treatment support a 12-month intervention. Some measures for some subjects did not reach a plateau at 12 months, justifying further investigation of a longer program (>12 months) of rehabilitation and/or maintenance care for stroke survivors.

Abstract TMP49: Depressive Symptoms After Stroke are Linked Longitudinally between Stroke Survivors and Their Family Caregivers

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
David L Roth ◽  
Orla C Sheehan ◽  
Jin Huang ◽  
J. D Rhodes ◽  
Suzanne E Judd ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Depressive Symptoms ◽  
Family Caregivers ◽  
Short Form ◽  
Well Being ◽  
Stroke Survivor ◽  
Stroke Survivors ◽  
Post Stroke ◽  
Clinically Significant

Background: Multiple previous investigations have documented persistent elevations in depressive symptoms after stroke for stroke survivors and for family caregivers. However, relatively few studies have examined both groups simultaneously, and none have tested for possible predictive linkages in longitudinal analyses. Methods: We collected interview data from 248 stroke survivors and their primary family caregivers who were enrolled in the Caring for Adults Recovering from the Effects of Stroke (CARES) project. CARES is an ancillary study to the national REasons for Geographic and Racial Differences in Stroke (REGARDS) study. Stroke survivors and caregivers were interviewed at 9-, 18-, 27- and 36-months after an adjudicated stroke event. Measures administered to both groups included the 20-item Center for Epidemiological Studies Depression Scale (CESD) and the 12-item Short Form Health Survey (SF-12) of health-related quality of life. Cross-lagged panel analyses were used to investigate linkages between stroke survivors and caregivers over time on these measures. Results: Clinically significant levels of depressive symptoms, as defined by a score of 16 or more on the CESD, were found for 17.0% of the stroke survivors and 13.7% of the caregivers at 9-months after stroke. Longitudinal models revealed that high stroke survivor depressive symptoms at 9-months post-stroke predicted increases in caregiver depressive symptoms at 18-months post-stroke (standardized adjusted regression coefficient = 0.18, p = 0.003). No longitudinal predictive effects were found for caregiver depressive symptoms on stroke survivor outcomes or for the SF-12 measures. Conclusions: Clinically significant levels of depressive symptoms were relatively rare 9-months after stroke in this population-based sample of stroke survivors and family caregivers. Stroke survivor depressive symptoms longitudinally predict caregiver depressive symptoms, but caregiver well-being was not found to longitudinally predict stroke survivor depression or quality of life. Treating elevated depressive symptoms in stroke survivors may also improve caregiver well-being.

A Retrospective Analysis of Stroke Survivors’ Health-Related Quality of Life and Function

2020 ◽  
Vol 28 (1) ◽  
pp. 181-189
Author(s):  
Kimberly Hreha ◽  
◽  
Caitlin Denzer-Weiler ◽  
Karen West Mackasek ◽  
Jeffrey Zhang ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Retrospective Analysis ◽  
Stroke Survivors ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related ◽  
And Function

scholarly journals Innovative Long-Dose Neurorehabilitation for Balance and Mobility in Chronic Stroke: A Preliminary Case Series

2020 ◽  
Vol 10 (8) ◽  
pp. 555
Author(s):  
Catherine Boissoneault ◽  
Tyler Grimes ◽  
Dorian K. Rose ◽  
Michael F. Waters ◽  
Anna Khanna ◽  
...  
Keyword(s):  
Gait Speed ◽  
Case Series ◽  
Functional Independence ◽  
Limb Movement ◽  
Chronic Stroke ◽  
Small Sample ◽  
Functional Mobility ◽  
Stroke Survivors ◽  
Convenience Sample ◽  
Long Duration

(1) Objective: The objective was two-fold: (a) test a protocol of combined interventions; (b) administer this combined protocol within the framework of a six-month, intensive, long-duration program. The array of interventions was designed to target the treatment-resistant impairments underlying persistent mobility dysfunction: weakness, balance deficit, limb movement dyscoordination, and gait dyscoordination. (2) Methods: A convenience sample of eight chronic stroke survivors (>4 months post stroke) was enrolled. Treatment was 5 days/week, 1–2.5 h/day for 6 months, as follows: strengthening exercise, balance training, limb/gait coordination training, and aerobic exercise. Outcome measures: Berg Balance Scale (BBS), Fugl-Meyer Lower Limb Coordination (FM), gait speed, 6 Minute Walk Test (6MWT), Timed up and Go (TUG), Functional Independence Measure (FIM), Craig Handicap Assessment Rating Tool (CHART), and personal milestones. Pre-/post-treatment comparisons were conducted using the Permutation Test, suitable for ordinal measures and small sample size. (3) Results: For the group, there was a statistically (p ≤ 0.04) significant improvement in balance, limb movement coordination (FM), gait speed, functional mobility (TUG), and functional activities (FIM). There were measurable differences (minimum detectible change: MDC) in BBS, FM, gait speed, 6MWT, and TUG. There were clinically significant milestones achieved for selected subjects according to clinical benchmarks for the BBS, 6MWT, gait speed, and TUG, as well as achievement of personal milestones of life role participation. Effect sizes (Cohen’s D) ranged from 0.5 to 1.0 (with the exception of the (6MWT)). After six months of treatment, the above array of gains were beyond that reported by other published studies of chronic stroke survivor interventions. Personal milestones included: walking to mailbox, gardening/yardwork, walking a distance to neighbors, return to driving, membership at a fitness center, vacation trip to the beach, swimming at local pool, returning to work, housework, cooking meals. (4) Conclusions: Stroke survivors with mobility dysfunction were able to participate in the long-duration, intensive program, with the intervention array targeted to address impairments underlying mobility dysfunction. There were either clinically or statistically significant improvements in an array of measures of impairment, functional mobility, and personal milestone achievements.

scholarly journals Effectiveness of Motor Re-Learning Programme along with Functional Electrical Stimulation on Functional Mobility and Quality of Life in Subjects with Sub-Acute Stroke - An Experimental Study

2021 ◽  
Author(s):  
Sanika Balpande ◽  
Mohd Irshad Qureshi ◽  
Sandeeep Iratwar ◽  
Rakesh Kovela ◽  
Ragini Dadgal ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Functional Mobility ◽  
Stroke Survivors ◽  
Control Groups ◽  
Clinical Trial Registry ◽  
Gait Parameters ◽  
Registration Number ◽  
Group Members ◽  
Pre Treatment

Abstract Background: The cerebrovascular episode is one of the significant causes of adult injury. This research will aim to investigate the effect of MRP along with FES on ankle dorsiflexors of improving gait parameters for functional mobility and enhancing quality of life in stroke survivors. Method: The participants will be enrolled in experimental or control groups with a ratio of 1:1 allocation. The study group members would receive MRP along with FES following baseline tests over a span of 6 weeks. Conventional participant will experience only FES. Both participants were measured with outcome measures and Gait parameters for pre-treatment and post-treatment. Discussion: Most research indicated that MRP is successful because it takes a lengthy period of time; however in the case of FES it is known that it is not efficient without some physiotherapy intervention. The results of the analysis will benefit stroke survivors, and provide a newly developed recovery process.The clinical trial registry-India(CTRI) registration number for this trial is CTRI/2021/05/033578.

scholarly journals Efficacy of transcranial direct current stimulation and over-ground walking task on functional mobility and quality of life of stroke survivors

2020 ◽  
Vol 4 (2) ◽  
pp. 049-056
Author(s):  
Adeagbo Caleb A ◽  
Gbiri Caleb AO ◽  
Olawale Olajide A
Keyword(s):  
Quality Of Life ◽  
Direct Current ◽  
Transcranial Direct Current Stimulation ◽  
Functional Mobility ◽  
Stroke Survivors ◽  
Anodal Tdcs ◽  
Direct Current Stimulation ◽  
Significant Difference ◽  
Over Ground Walking

Introduction: High proportion of stroke survivors have impaired functional mobility and decrease in overall quality of life (QoL). Transcranial direct current stimulation (tDCS) (non-invasive brain stimulation) and over-ground walking task (OGWT) (functional task-oriented training) have been suggested to improve functional mobility and QoL of stroke survivors. Hence, this study determined the efficacy of tDCS (anodal and cathodal) with OGWT on functional mobility and QoL of stroke survivors. Materials and methods: Seventy eight (78) stroke survivors were randomised into three groups: anodal group (anodal tDCS with OGWT); cathodal group (cathodal tDCS with OGWT) and control group (OGWT only). Participants had two sessions of intervention per week for six weeks. Functional mobility was assessed using 10 meter walk test (10MWT) measuring steps, time and velocity while QoL was measured using Stroke Specific QoL (SSQoL) scale. Significance level was set at p < 0.05. Results: Participants (46 males) were aged 56.78 ± 10.24 years. The groups were matched for functional mobility and QoL at baseline and only work/productivity domain of SSQoL showed statistically significant difference (p = 0.028). Each group showed statistically significant improvement between baseline and post-intervention scores of items in functional mobility (p ≤ 0.001) and total SSQoL (p ≤ 0.001). Anodal group showed better statistically significant improvement in step (p = 0.008), time (p = 0.024), velocity (p = 0.001) and total SSQoL (p = 0.016) among the groups when the mean differences were compared. Conclusion: tDCS with OGWT is efficacious in improving functional mobility and QoL of stroke survivors. Specifically anodal tDCS with OGWT showed better clinical improvement in step, time, velocity and QoL in stroke survivors.

scholarly journals The Effects of Cupping Massage in Patients with Chronic Neck Pain - A Randomised Controlled Trial

2017 ◽  
Vol 24 (1) ◽  
pp. 26-32 ◽  
Author(s):  
Felix J. Saha ◽  
Stefan Schumann ◽  
Holger Cramer ◽  
Claudia Hohmann ◽  
Kyung-Eun Choi ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Adverse Events ◽  
Neck Pain ◽  
Functional Disability ◽  
Intervention Group ◽  
Chronic Neck Pain ◽  
Wait List ◽  
Significant Group ◽  
Public Health Burden

Background: Chronic neck pain is a major public health burden with only limited evidence for the effectiveness of complementary therapies. This study aimed to test the efficacy of cupping massage in patients with neck pain. Patients and Methods: Patients with chronic non-specific neck pain were randomly assigned to cupping massage or a wait list control. The intervention group received 5 cupping massages on a twice-weekly basis while the control patients continued their usual treatments. The primary outcome measure was neck pain intensity (0-100 mm visual analogue scale (VAS)) after 3 weeks. Secondary outcomes included pain on movement, functional disability, health-related quality of life, mechanical detection and pain thresholds and adverse events. Results: 50 patients (52.6 ± 10.3 years, 92% female) were randomised to either cupping massage or a wait list (N = 25 each). Patients in the cupping group reported significantly less neck pain post intervention (difference per protocol -14.3 mm, 95% confidence interval (CI) -27.7 to -1.0, p = 0.037; difference intention-to-treat -10.8 mm, 95% CI -21.5 to -0.1, p = 0.047). Significant group differences in favour of the intervention were further found for pain on movement (p = 0.019) and functional disability (p < 0.001), the quality-of-life subscales pain (p = 0.002) and mental health (p = 0.003) and the mental component summary (p = 0.036). Changes were also found for pressure pain sensitivity at the site of maximal pain (p = 0.022). Five adverse events were reported. Conclusions: Cupping massage appears to be effective in reducing pain and increasing function and quality of life in patients with chronic non-specific neck pain. More rigorous studies are needed to confirm and extend these results.

Distraction Osteogenesis in the Treatment of Craniofacial Anomalies: Applications and Outcomes

2020 ◽  
Vol 5 (6) ◽  
pp. 1469-1481 ◽  
Author(s):  
Joseph A. Napoli ◽  
Carrie E. Zimmerman ◽  
Linda D. Vallino
Keyword(s):  
Distraction Osteogenesis ◽  
Bone Growth ◽  
Upper Airway ◽  
Craniofacial Anomalies ◽  
Craniofacial Skeleton ◽  
Facial Skeleton ◽  
Psychosocial Impairment ◽  
And Function ◽  
Correct Structure

Purpose Craniofacial anomalies (CFA) often result in growth abnormalities of the facial skeleton adversely affecting function and appearance. The functional problems caused by the structural anomalies include upper airway obstruction, speech abnormalities, feeding difficulty, hearing deficits, dental/occlusal defects, and cognitive and psychosocial impairment. Managing disorders of the craniofacial skeleton has been improved by the technique known as distraction osteogenesis (DO). In DO, new bone growth is stimulated allowing bones to be lengthened without need for bone graft. The purpose of this clinical focus article is to describe the technique and clinical applications and outcomes of DO in CFA. Conclusion Distraction can be applied to various regions of the craniofacial skeleton to correct structure and function. The benefits of this procedure include improved airway, feeding, occlusion, speech, and appearance, resulting in a better quality of life for patients with CFA.

Surgery for Lung Cancer and the Consequences for the Swallow

2016 ◽  
Vol 1 (13) ◽  
pp. 162-168
Author(s):  
Pippa Hales ◽  
Corinne Mossey-Gaston
Keyword(s):  
Lung Cancer ◽  
Treatment Options ◽  
Vocal Cord Palsy ◽  
Subsequent Treatment ◽  
Physiological Reserve ◽  
Palliative Phase ◽  
And Function ◽  
The Impact ◽  
Swallow Function

Lung cancer is one of the most commonly diagnosed cancers across Northern America and Europe. Treatment options offered are dependent on the type of cancer, the location of the tumor, the staging, and the overall health of the person. When surgery for lung cancer is offered, difficulty swallowing is a potential complication that can have several influencing factors. Surgical interaction with the recurrent laryngeal nerve (RLN) can lead to unilateral vocal cord palsy, altering swallow function and safety. Understanding whether the RLN has been preserved, damaged, or sacrificed is integral to understanding the effect on the swallow and the subsequent treatment options available. There is also the risk of post-surgical reduction of physiological reserve, which can reduce the strength and function of the swallow in addition to any surgery specific complications. As lung cancer has a limited prognosis, the clinician must also factor in the palliative phase, as this can further increase the burden of an already compromised swallow. By understanding the surgery and the implications this may have for the swallow, there is the potential to reduce the impact of post-surgical complications and so improve quality of life (QOL) for people with lung cancer.

Behavioral and emotional differences between children of divorce and children from intact families: Clinical significance and mediating processes *This study is part of a dissertation () supported from the German research community.

2002 ◽  
Vol 61 (1) ◽  
pp. 5-14 ◽  
Author(s):  
Andreas Schick
Keyword(s):  
Self Esteem ◽  
Research Community ◽  
Children Of Divorce ◽  
Group Differences ◽  
Significant Group ◽  
Intact Families ◽  
Divorce Adjustment ◽  
Theoretical Assumptions ◽  
German Research ◽  
Clinically Significant

The following study is based on a sample of 241 9-13-year-old children (66 children from divorced parents, 175 children from non divorced parents). They were examined for differences regarding anxiety, self-esteem, different areas of competence, and degree of behavior problems. With a focus on the children’s experiences, the clinically significant differences were examined. Clinically significant differences, revealing more negative outcomes for the children of divorce, were only found for social anxiety and unstable performance. The frequency of clinical significant differences was independent of the length of time the parents had been separated. The perceived destructiveness of conflict between the parents one of four facets of interparental conflict in this study functioned as a central mediator of the statistically significant group differences. The children’s perception of the father’s social support was a less reliable indicator of variance. Further studies should try to make underlying theoretical assumptions about the effects of divorce more explicit, to distinguish clearly between mediating variables, and to investigate them with respect to specific divorce adjustment indicators.

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