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Client-Centered Care
2012 ACRM–ASNR Annual Conference Abstracts
Stroke Diagnosis Poster 63 Check Your Assumptions at the Door: The Importance of Patient/ Client-Centered Care. Cynthia A. Robinson (University of Washington, Seattle, WA). Disclosure: None disclosed. The ability to participate, including the ability to walk in the community, is very important to survivors of stroke. But, why do some individuals successfully walk in the community, while others with similar or apparently lesser physical sequelae of stroke do not return to walking in the community? The International Classification of Functioning, Disability and Health (ICF) provides an excellent framework to examine this question. The ICF model guides us to consider the health condition as well as physical, environmental and personal factors associated with participation. The model also guides us to consider both objective and subjective measures of participation. An overarching goal of this symposium is to translate recent research examining physical, environmental and personal factors associated with functional outcomes, specifically the ability to walk in the community following stroke, to clinical practice. While rehabilitation clinical practice has traditionally focused on facilitating recovery of physical function, the research suggests that personal factors, in particular self-efficacy, may play a more critical role in determining who will walk in the community following a stroke. In addition, while many rehabilitation professionals emphasize objective outcome measures, recent research reveals the important contribution of subjective outcome measures. The results of this recent research will be used to suggest evidence-based intervention strategies and valid and reliable outcome measures, especially those addressing self-efficacy and the subjective perspective. Participants are invited to engage in discussion regarding future research that could better inform our clinical practice. Key Words: Stroke; Community integration and participation; Clinical practice; Rehabilitation. Poster 64 Effects of Dynamic-Intensive Exercise for Gait Ability in Chronic Stroke Patients: A Randomized Controlled Trial. Ryo Kondo (Hamamatsu University School of Medicine, University Hospital, Hamamatsu, Shizuoka Prefecture, Japan). Disclosure: None disclosed. Objective: To identify the effects of dynamic-intensive exercise program with a physiotherapist for gait ability in chronic stroke patients. Design: A single-blind randomized controlled trial. Setting: Rehabilitation section in the hospital. Participants: Twenty-two subjects more than six months after stroke onset. Subjects were divided into two groups: dynamic-intensive exercise group (D group, n⫽11) and control group (C group, n⫽11). Interventions: The physiotherapist conducted dynamic-intensive exercise about 60 minutes to the D group two times a week for three months. The dynamic-intensive exercise consisted of stepping forward and backward onto a block, squatting exercise, a 30-meter walk as fast as possible and jumping exercise. The C group underwent the same exercise at home without the physiotherapist’s conducting. Main Outcome Measures: Stroke patients were assessed by maximal isometric strength of the both knee extensors and flexors using the Biodex system three isokinetic dynamometer, timed up and go (TUG) test, maximal and comfortable 10-meters walking time (10MWT), and six-minutes walking distance (6MD). We measured them before the exercise and at the time point of one, two, and three months after intervention. Results: The D group significantly improved compared with the C group in the non-affected knee extensor muscle strength, maximal and comfortable 10MWT, TUG test, and 6MD at three months (p⬍0.05). Conclusions: The designed dynamic-intensive exercise with a physiotherapist was more effective in improving the gait ability than without a physiotherapist in chronic stroke patients. Key Words: Stroke; Motor function; Clinical practice; Rehabilitation.
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Poster 65 Evidence of Inter-Rater Reliability in Scoring the Kessler Foundation Neglect Assessment Process. Priyanka P. Shah (Kessler Foundation Research Center, West Orange, NJ), Kimberly Hreha, Peii Chen. Disclosure: None disclosed. Objective: Spatial neglect, a debilitating post-stroke disorder, is highly prevalent, but clinicians have difficulty in reliably identifying it. To enhance recognition of spatial neglect and to lower the burden of translating results from paper-and-pencil tests, we have advocated the use of the Catherine Bergego Scale (CBS). However, the practice and scoring of CBS may vary significantly depending on how one interprets each observation item. In efforts to standardize this tool with detailed instructions, we developed the Kessler Foundation Neglect Assessment Process (KF-NAP). The present study evaluates the interrater reliability in scoring the CBS via the KF-NAP. Design: Two independent raters, equally trained in the KF-NAP, scored 11 videorecorded sessions of four neglect patients. Setting: Community-based. Participants: Four stroke survivors (age: M ⫽ 69 ⫾ 9.69 years; stroke onset: M ⫽ 0.69 ⫾ 0.11 years) underwent one to four KF-NAP sessions. Interventions: Not applicable. Main Outcome: Inter-rater reliability is excellent. Measures: The KF-NAP contains a 10-item observation scale. Each item, scored from zero (no neglect) to three (severe neglect), evaluates laterality in everyday activities; higher score indicating worse performance. Correlation of scores between raters is estimated by R2 and 95% confidence interval (CI). Results: Scores assigned by rater1 (M ⫽ 11.6 ⫾ 4.49) and rater2 (M ⫽ 11.2 ⫾ 4.65) are significantly correlated (R2⫽ 0.94; b ⫽ 0.94, t(9) ⫽ 12.85, p. Conclusions: The good inter-rater reliability in scoring the KF-NAP advances its standardization as a reliable functional assessment for spatial neglect. Key Words: Stroke; Cognition and perception; Clinical practice; Rehabilitation. Poster 66 Transcranial Direct Current Stimulation Improves Hand Sensation in Acute Stroke. Wasuwat - Kitisomprayoonkul (Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand). Disclosure: None disclosed. Objectives: To examine the effects of an anodal transcranial direct current stimulation (tDCS) on sensation of a hypesthetic hand in acute stroke patients. Design: Randomized controlled trial. Setting: Rehabilitation medicine services in medical school hospital. Participants: 20 acute ischemic stroke patients. Interventions: 20 minutes of 2 mA anodal tDCS over the ipsilesional primary sensory cortex or 30-sec stimulation as a sham. Main Outcome Measures: We hypothesized that tDCS improves sensation of the hypesthetic hand in acute stroke patients. Hand sensation tests (before stimulation, immediately after stimulation and 30 minutes later) included pinprick sensation, light touch sensation, joint proprioception, static 2-point discrimination of thumb and index, Moberg recognition test and Semmes-Weinstein monofilament (SWM). Results: Mean (SD) age of control and tDCS groups were 54.7(8.6) and 58. 0(11.9) years, consecutively. Mean (SD) onset were 5.3(1.8) and 9.7(17.8) days. When compared with the control group, the tDCS group significantly improved sensation of hypesthetic hand immediately after tDCS and 30 minutes after cessation (P ⬍ 0.05). Immediately after stimulation, 50% and 60-70% of tDCS group improved light touch and pinprick sensation, consecutively. Thirty minutes after tDCS cessation, 40% and 50% of the tDCS group improved light touch and pinprick sensation, consecutively. 40-70% of patients have an improvement in 5 out of 7 SWM-tested sites. Most patients in tDCS group had sensation improvement at least 1-level. Most patients in control group had no sensation improvement. Conclusions: Anodal tDCS improves hand sensation in acute stroke immediately after 20-min stimulation. This effect remains at least 30 minutes after stimulation Key Words: Stroke; Function and impairment-independent; Clinical practice; Rehabilitation. Arch Phys Med Rehabil Vol 93, October 2012
Stroke Diagnosis Poster 63 Check Your Assumptions at the Door: The Importance of Patient/ Client-Centered Care. Cynthia A. Robinson (University of Washington, Seattle, WA). Disclosure: None disclosed. The ability to participate, including the ability to walk in the community, is very important to survivors of stroke. But, why do some individuals successfully walk in the community, while others with similar or apparently lesser physical sequelae of stroke do not return to walking in the community? The International Classification of Functioning, Disability and Health (ICF) provides an excellent framework to examine this question. The ICF model guides us to consider the health condition as well as physical, environmental and personal factors associated with participation. The model also guides us to consider both objective and subjective measures of participation. An overarching goal of this symposium is to translate recent research examining physical, environmental and personal factors associated with functional outcomes, specifically the ability to walk in the community following stroke, to clinical practice. While rehabilitation clinical practice has traditionally focused on facilitating recovery of physical function, the research suggests that personal factors, in particular self-efficacy, may play a more critical role in determining who will walk in the community following a stroke. In addition, while many rehabilitation professionals emphasize objective outcome measures, recent research reveals the important contribution of subjective outcome measures. The results of this recent research will be used to suggest evidence-based intervention strategies and valid and reliable outcome measures, especially those addressing self-efficacy and the subjective perspective. Participants are invited to engage in discussion regarding future research that could better inform our clinical practice. Key Words: Stroke; Community integration and participation; Clinical practice; Rehabilitation. Poster 64 Effects of Dynamic-Intensive Exercise for Gait Ability in Chronic Stroke Patients: A Randomized Controlled Trial. Ryo Kondo (Hamamatsu University School of Medicine, University Hospital, Hamamatsu, Shizuoka Prefecture, Japan). Disclosure: None disclosed. Objective: To identify the effects of dynamic-intensive exercise program with a physiotherapist for gait ability in chronic stroke patients. Design: A single-blind randomized controlled trial. Setting: Rehabilitation section in the hospital. Participants: Twenty-two subjects more than six months after stroke onset. Subjects were divided into two groups: dynamic-intensive exercise group (D group, n⫽11) and control group (C group, n⫽11). Interventions: The physiotherapist conducted dynamic-intensive exercise about 60 minutes to the D group two times a week for three months. The dynamic-intensive exercise consisted of stepping forward and backward onto a block, squatting exercise, a 30-meter walk as fast as possible and jumping exercise. The C group underwent the same exercise at home without the physiotherapist’s conducting. Main Outcome Measures: Stroke patients were assessed by maximal isometric strength of the both knee extensors and flexors using the Biodex system three isokinetic dynamometer, timed up and go (TUG) test, maximal and comfortable 10-meters walking time (10MWT), and six-minutes walking distance (6MD). We measured them before the exercise and at the time point of one, two, and three months after intervention. Results: The D group significantly improved compared with the C group in the non-affected knee extensor muscle strength, maximal and comfortable 10MWT, TUG test, and 6MD at three months (p⬍0.05). Conclusions: The designed dynamic-intensive exercise with a physiotherapist was more effective in improving the gait ability than without a physiotherapist in chronic stroke patients. Key Words: Stroke; Motor function; Clinical practice; Rehabilitation.
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Poster 65 Evidence of Inter-Rater Reliability in Scoring the Kessler Foundation Neglect Assessment Process. Priyanka P. Shah (Kessler Foundation Research Center, West Orange, NJ), Kimberly Hreha, Peii Chen. Disclosure: None disclosed. Objective: Spatial neglect, a debilitating post-stroke disorder, is highly prevalent, but clinicians have difficulty in reliably identifying it. To enhance recognition of spatial neglect and to lower the burden of translating results from paper-and-pencil tests, we have advocated the use of the Catherine Bergego Scale (CBS). However, the practice and scoring of CBS may vary significantly depending on how one interprets each observation item. In efforts to standardize this tool with detailed instructions, we developed the Kessler Foundation Neglect Assessment Process (KF-NAP). The present study evaluates the interrater reliability in scoring the CBS via the KF-NAP. Design: Two independent raters, equally trained in the KF-NAP, scored 11 videorecorded sessions of four neglect patients. Setting: Community-based. Participants: Four stroke survivors (age: M ⫽ 69 ⫾ 9.69 years; stroke onset: M ⫽ 0.69 ⫾ 0.11 years) underwent one to four KF-NAP sessions. Interventions: Not applicable. Main Outcome: Inter-rater reliability is excellent. Measures: The KF-NAP contains a 10-item observation scale. Each item, scored from zero (no neglect) to three (severe neglect), evaluates laterality in everyday activities; higher score indicating worse performance. Correlation of scores between raters is estimated by R2 and 95% confidence interval (CI). Results: Scores assigned by rater1 (M ⫽ 11.6 ⫾ 4.49) and rater2 (M ⫽ 11.2 ⫾ 4.65) are significantly correlated (R2⫽ 0.94; b ⫽ 0.94, t(9) ⫽ 12.85, p. Conclusions: The good inter-rater reliability in scoring the KF-NAP advances its standardization as a reliable functional assessment for spatial neglect. Key Words: Stroke; Cognition and perception; Clinical practice; Rehabilitation. Poster 66 Transcranial Direct Current Stimulation Improves Hand Sensation in Acute Stroke. Wasuwat - Kitisomprayoonkul (Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand). Disclosure: None disclosed. Objectives: To examine the effects of an anodal transcranial direct current stimulation (tDCS) on sensation of a hypesthetic hand in acute stroke patients. Design: Randomized controlled trial. Setting: Rehabilitation medicine services in medical school hospital. Participants: 20 acute ischemic stroke patients. Interventions: 20 minutes of 2 mA anodal tDCS over the ipsilesional primary sensory cortex or 30-sec stimulation as a sham. Main Outcome Measures: We hypothesized that tDCS improves sensation of the hypesthetic hand in acute stroke patients. Hand sensation tests (before stimulation, immediately after stimulation and 30 minutes later) included pinprick sensation, light touch sensation, joint proprioception, static 2-point discrimination of thumb and index, Moberg recognition test and Semmes-Weinstein monofilament (SWM). Results: Mean (SD) age of control and tDCS groups were 54.7(8.6) and 58. 0(11.9) years, consecutively. Mean (SD) onset were 5.3(1.8) and 9.7(17.8) days. When compared with the control group, the tDCS group significantly improved sensation of hypesthetic hand immediately after tDCS and 30 minutes after cessation (P ⬍ 0.05). Immediately after stimulation, 50% and 60-70% of tDCS group improved light touch and pinprick sensation, consecutively. Thirty minutes after tDCS cessation, 40% and 50% of the tDCS group improved light touch and pinprick sensation, consecutively. 40-70% of patients have an improvement in 5 out of 7 SWM-tested sites. Most patients in tDCS group had sensation improvement at least 1-level. Most patients in control group had no sensation improvement. Conclusions: Anodal tDCS improves hand sensation in acute stroke immediately after 20-min stimulation. This effect remains at least 30 minutes after stimulation Key Words: Stroke; Function and impairment-independent; Clinical practice; Rehabilitation. Arch Phys Med Rehabil Vol 93, October 2012