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Poster 64 Influence of Biofeedback on Gait Training of Hemiparetic Subjects: Randomized Controlled Clinical Trial
2011 ACRM-ASNR ANNUAL CONFERENCE ABSTRACTS
with brain injury, in stroke survivors. Design: This Internet survey was commissioned by the National Stroke Association (NSA) and Avanir Pharmaceuticals, and conducted by infogroup/Opinion Research Corporation. Setting: Respondents were located across the United States. Participants: Potential respondents were drawn from the NSA database of stroke survivors and caregivers and emailed a link to the survey. Eligible respondents were stroke survivors or main caregivers of stroke survivors, as confirmed by screening questions, with PBA symptoms, defined as a score of ⱖ 13 on the Center for Neurologic Study Lability Scale (CNS-LS), administered during the screening portion of the survey. Interventions: Fifty-four questions were asked for screening and data collection. Main Outcome Measures: Primary measures included the frequency, burdensomeness, limitations, interference with activities, and impact on life situation of PBA, and the sufficiency of PBA treatment. Results: Of 30,641 recipients emailed, 578 answered the screening questions, and 304 (53%) screened positive for PBA (ⱖ 13 CNS-LS score), including 229 (75%) stroke survivors. Among eligible respondents, 27% experienced PBA episodes frequently or often, and 27% described their symptoms as moderate to severe. More than half (52%) of respondents said PBA was extremely, very, or somewhat burdensome, and substantial percentages said PBA interfered extremely, very, or somewhat often with social activities and other leisure (38%), spending time with friends/ family (39%), and talking on the phone (33%). PBA also contributed at least somewhat in about a third of respondents to having trouble maintaining friends (31%) and becoming housebound (30%). Only 38% of respondents were treated for PBA, of whom almost half (47%) were dissatisfied with their treatment. Conclusions: PBA occurs in about half of stroke survivors and often imposes a significant burden, but is under treated. Key Words: Cerebrovascular accident; Affect; Stroke; Data collection; Rehabilitation. Poster 63 Retention of Motor Changes in Chronic Stroke Survivors Who Were Administered Mental Practice. Stephen Page (University of Cincinnati, Cincinnati, OH), Valerie Hermann, Peter Levine. Disclosure: None disclosed. Objective: To determine retention of motor changes 3 months after participation in a regimen comprised of mental practice combined with repetitive task specific training (MP ⫹ RTP). Design: Prospective, blinded, cohort, pre-post study. Setting: Outpatient rehabilitation hospital. Participants: Twenty-one individuals in the chronic stage of stroke (mean age ⫽ 66.1 ⫾ 8.1 years; age range ⫽ 56 to 76 years; mean time since stroke at study enrollment ⫽ 58.7 months; range 13 to 129 months) exhibiting mild to moderate impairments of hand function. Interventions: All individuals had been randomly assigned to receive a 10-week regimen comprised of MP emphasizing paretic upper extremity use during valued activities. Directly after each of these sessions, subjects were administered audiotaped MP. We assessed this group’s paretic upper extremity motor levels before, after, and 3 months after intervention. Main Outcome Measures: The upper extremity section of the Fugl-Meyer Assessment of Sensorimotor Impairment (FM), the Action Research Arm test (ARAT), the Arm Motor Ability test (AMAT), and Box and Block test (BB). Results: None of the scores significantly changed from the period directly after intervention to the 3-month post testing period (FM:t⫽0.817; ARAT: t⫽0.923; AMAT:t⫽0.898, t⫽0.818, and t⫽0.967 for the functional ability, quality of movement, and time scales, respectively; BB: t⫽0.892). Conclusions: Changes in paretic upper extremity movement realized through MP ⫹ RTP participation are retained 3 months after the intervention has concluded. Key Words: Hemiplegia; Cerebrovascular accident; Occupational therapy; Rehabilitation. Poster 64 Influence of Biofeedback on Gait Training of Hemiparetic Subjects: Randomized Controlled Clinical Trial. Ana Lindquist
1711
(Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil) Ana Brasileiro, Larissa Lucena, Gabriela Gama, Emilia Silva. Disclosure: None disclosed. Objective: To evaluate the immediate effects of biofeedback, visual and auditory, combined with treadmill training with partial body weight support (BWS) on walking functions of hemiplegic subjects. Design: Randomized controlled trial. Setting: Stroke patients in ambulatory care. Participants: We studied 30 subjects in the chronic stage of stroke, 18 men and 12 women, mean age 56.4 ⫾ 6.9 years, time of injury of 32.5 ⫾ 19.5 months, with right (35%) or left (65%) hemiparesis. One subject was excluded for failing to complete training. Interventions: The subjects underwent treadmill training with BWS during 20 minutes (control group), combined with visual biofeedback (experimental group I), given by the monitor of the treadmill; or auditory biofeedback (experimental group II), using a metronome with frequency of 115% of the cadence of the individual. The subjects were evaluated by kinematics, and the data were obtained by the Motion Analysis System Qualisys. Main Outcome Measures: The hypothesis was formulated during data collection. Results: There were no statistical differences between groups in any variable spatiotemporal and angular motion, but within each group there was an increase in walking speed and stride length after the training. The group of visual biofeedback increased the stance period and reduced the swing period and reason of symmetry, and the group auditory biofeedback reduced the double stance period. The plantar flexion increased in the visual biofeedback group. Conclusions: There are no differences between the immediate effects of gait training on a treadmill with BWS performed with and without visual or auditory biofeedback. However, the visual biofeedback can promote changes in a larger number of variables spatiotemporal and angular gait. Key Words: Stroke; Biofeedback; Gait; Hemiparesis; Rehabilitation. Poster 65 3 Dimensional Instrumented Gait Analyses (3DIGA): A Novel Approach to Analyze Post Stroke Gait Disorder. Abhishek Srivastava (Kokilaben Hospital, Maharashtra, India), Shirish Hastak. Disclosure: None disclosed. Objective: To analyze post stroke gait disorder. Design: Descriptive analytical study. Setting: Gait Analysis Laboratory of a tertiary research center. Participants: Patients with first episode of supratentorial stroke ⬎ 3 months post stroke duration that can follow 3 step commands and were able to walk with Functional Ambulatory Category III or higher. Interventions: 3DIGA using BTSTm system with 6 Infrared optical cameras to evaluate temporal, distance and kinematic parameters. Ten walking trials were conducted for each subject and representative sample were analyzed. Main Outcome Measures: Temporal, distance and kinematic parameters. Results: Thirty patients; 22 Men & 8 Women, age range: 17-78 years (mean 51.84), post stroke duration: 4-60 months (m 24.21) were included. 21 (70%) subjects required walking aid to complete the gait analysis. Analysis revealed significantly increased stride time 20-200% (m 99.21%), reduced cadence 15-90% (m 46.31%), step length 20-85% (m 57.31%) and gait velocity 40-95% (m 73.94%) as compared to age matched normal individuals. External foot progression was observed in 21 (70%) subjects. Sagittal plane kinematics revealed: sustained ankle dorsi-flexion, knee flexion and hip extension in 12 (40%) and ankle planter-flexion, knee extension and hip flexion in 18 (60%) of subjects respectively. Exaggerated hip abduction (65%) and internal rotation (55%) were most common abnormalities noted in coronal and horizontal plane kinematics respectively. Conclusions: 3DIGA provides significant insight into the biomechanical basis, objective evidence and quantification of post stroke gait disorder. Key Words: Biomechanics; Gait analysis; Kinematics; Rehabilitation; Stroke. Arch Phys Med Rehabil Vol 92, October 2011
with brain injury, in stroke survivors. Design: This Internet survey was commissioned by the National Stroke Association (NSA) and Avanir Pharmaceuticals, and conducted by infogroup/Opinion Research Corporation. Setting: Respondents were located across the United States. Participants: Potential respondents were drawn from the NSA database of stroke survivors and caregivers and emailed a link to the survey. Eligible respondents were stroke survivors or main caregivers of stroke survivors, as confirmed by screening questions, with PBA symptoms, defined as a score of ⱖ 13 on the Center for Neurologic Study Lability Scale (CNS-LS), administered during the screening portion of the survey. Interventions: Fifty-four questions were asked for screening and data collection. Main Outcome Measures: Primary measures included the frequency, burdensomeness, limitations, interference with activities, and impact on life situation of PBA, and the sufficiency of PBA treatment. Results: Of 30,641 recipients emailed, 578 answered the screening questions, and 304 (53%) screened positive for PBA (ⱖ 13 CNS-LS score), including 229 (75%) stroke survivors. Among eligible respondents, 27% experienced PBA episodes frequently or often, and 27% described their symptoms as moderate to severe. More than half (52%) of respondents said PBA was extremely, very, or somewhat burdensome, and substantial percentages said PBA interfered extremely, very, or somewhat often with social activities and other leisure (38%), spending time with friends/ family (39%), and talking on the phone (33%). PBA also contributed at least somewhat in about a third of respondents to having trouble maintaining friends (31%) and becoming housebound (30%). Only 38% of respondents were treated for PBA, of whom almost half (47%) were dissatisfied with their treatment. Conclusions: PBA occurs in about half of stroke survivors and often imposes a significant burden, but is under treated. Key Words: Cerebrovascular accident; Affect; Stroke; Data collection; Rehabilitation. Poster 63 Retention of Motor Changes in Chronic Stroke Survivors Who Were Administered Mental Practice. Stephen Page (University of Cincinnati, Cincinnati, OH), Valerie Hermann, Peter Levine. Disclosure: None disclosed. Objective: To determine retention of motor changes 3 months after participation in a regimen comprised of mental practice combined with repetitive task specific training (MP ⫹ RTP). Design: Prospective, blinded, cohort, pre-post study. Setting: Outpatient rehabilitation hospital. Participants: Twenty-one individuals in the chronic stage of stroke (mean age ⫽ 66.1 ⫾ 8.1 years; age range ⫽ 56 to 76 years; mean time since stroke at study enrollment ⫽ 58.7 months; range 13 to 129 months) exhibiting mild to moderate impairments of hand function. Interventions: All individuals had been randomly assigned to receive a 10-week regimen comprised of MP emphasizing paretic upper extremity use during valued activities. Directly after each of these sessions, subjects were administered audiotaped MP. We assessed this group’s paretic upper extremity motor levels before, after, and 3 months after intervention. Main Outcome Measures: The upper extremity section of the Fugl-Meyer Assessment of Sensorimotor Impairment (FM), the Action Research Arm test (ARAT), the Arm Motor Ability test (AMAT), and Box and Block test (BB). Results: None of the scores significantly changed from the period directly after intervention to the 3-month post testing period (FM:t⫽0.817; ARAT: t⫽0.923; AMAT:t⫽0.898, t⫽0.818, and t⫽0.967 for the functional ability, quality of movement, and time scales, respectively; BB: t⫽0.892). Conclusions: Changes in paretic upper extremity movement realized through MP ⫹ RTP participation are retained 3 months after the intervention has concluded. Key Words: Hemiplegia; Cerebrovascular accident; Occupational therapy; Rehabilitation. Poster 64 Influence of Biofeedback on Gait Training of Hemiparetic Subjects: Randomized Controlled Clinical Trial. Ana Lindquist
1711
(Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil) Ana Brasileiro, Larissa Lucena, Gabriela Gama, Emilia Silva. Disclosure: None disclosed. Objective: To evaluate the immediate effects of biofeedback, visual and auditory, combined with treadmill training with partial body weight support (BWS) on walking functions of hemiplegic subjects. Design: Randomized controlled trial. Setting: Stroke patients in ambulatory care. Participants: We studied 30 subjects in the chronic stage of stroke, 18 men and 12 women, mean age 56.4 ⫾ 6.9 years, time of injury of 32.5 ⫾ 19.5 months, with right (35%) or left (65%) hemiparesis. One subject was excluded for failing to complete training. Interventions: The subjects underwent treadmill training with BWS during 20 minutes (control group), combined with visual biofeedback (experimental group I), given by the monitor of the treadmill; or auditory biofeedback (experimental group II), using a metronome with frequency of 115% of the cadence of the individual. The subjects were evaluated by kinematics, and the data were obtained by the Motion Analysis System Qualisys. Main Outcome Measures: The hypothesis was formulated during data collection. Results: There were no statistical differences between groups in any variable spatiotemporal and angular motion, but within each group there was an increase in walking speed and stride length after the training. The group of visual biofeedback increased the stance period and reduced the swing period and reason of symmetry, and the group auditory biofeedback reduced the double stance period. The plantar flexion increased in the visual biofeedback group. Conclusions: There are no differences between the immediate effects of gait training on a treadmill with BWS performed with and without visual or auditory biofeedback. However, the visual biofeedback can promote changes in a larger number of variables spatiotemporal and angular gait. Key Words: Stroke; Biofeedback; Gait; Hemiparesis; Rehabilitation. Poster 65 3 Dimensional Instrumented Gait Analyses (3DIGA): A Novel Approach to Analyze Post Stroke Gait Disorder. Abhishek Srivastava (Kokilaben Hospital, Maharashtra, India), Shirish Hastak. Disclosure: None disclosed. Objective: To analyze post stroke gait disorder. Design: Descriptive analytical study. Setting: Gait Analysis Laboratory of a tertiary research center. Participants: Patients with first episode of supratentorial stroke ⬎ 3 months post stroke duration that can follow 3 step commands and were able to walk with Functional Ambulatory Category III or higher. Interventions: 3DIGA using BTSTm system with 6 Infrared optical cameras to evaluate temporal, distance and kinematic parameters. Ten walking trials were conducted for each subject and representative sample were analyzed. Main Outcome Measures: Temporal, distance and kinematic parameters. Results: Thirty patients; 22 Men & 8 Women, age range: 17-78 years (mean 51.84), post stroke duration: 4-60 months (m 24.21) were included. 21 (70%) subjects required walking aid to complete the gait analysis. Analysis revealed significantly increased stride time 20-200% (m 99.21%), reduced cadence 15-90% (m 46.31%), step length 20-85% (m 57.31%) and gait velocity 40-95% (m 73.94%) as compared to age matched normal individuals. External foot progression was observed in 21 (70%) subjects. Sagittal plane kinematics revealed: sustained ankle dorsi-flexion, knee flexion and hip extension in 12 (40%) and ankle planter-flexion, knee extension and hip flexion in 18 (60%) of subjects respectively. Exaggerated hip abduction (65%) and internal rotation (55%) were most common abnormalities noted in coronal and horizontal plane kinematics respectively. Conclusions: 3DIGA provides significant insight into the biomechanical basis, objective evidence and quantification of post stroke gait disorder. Key Words: Biomechanics; Gait analysis; Kinematics; Rehabilitation; Stroke. Arch Phys Med Rehabil Vol 92, October 2011