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Poster 68 Effect of Dual-Task Gait Training on Obstacle Negotiation After Stroke: A Case Study
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2012 ACRM–ASNR Annual Conference Abstracts
Poster 67 Afferent Stimulation Provided by Glove Electrode during TaskSpecific Arm Exercise Following Stroke. Jane E. Sullivan (Feinberg School of Medicine, Northwestern University, Chicago, IL), Lois D. Hedman, Donna Hurley.
Poster 69 Pedometers to Augment the Health of Stroke Survivors: A Pilot Study. Jane E. Sullivan (Feinberg School of Medicine, Northwestern University, Chicago, IL), Lauren Espe, Amanda Kelly, Laura Vielbig.
Disclosure: None disclosed. Objectives: Sensory amplitude electrical stimulation (SES) and repetitive practice can improve arm dysfunction when delivered separately following stroke. Our objective was to determine if repetitive practice was more effective when administered concurrent with SES. Design: Subjects were randomly assigned to an SES (n ⫽ 20) or sham stimulation (n ⫽ 18) group. Setting: Home-based. Participants: Thirty-eight subjects with chronic stroke and mean Fugl-Meyer Assessment (FMA) score 28/66 (15-45). Intervention: Subjects engaged in task-based home exercise for 30 minutes, twice daily, for four weeks while wearing a glove electrode on the impaired hand.Experimental subjects received SES; control subjects received sham stimulation during exercise. Main Outcome Measures: FMA and Arm Motor Ability Test (AMAT). Results: There were no significant betweengroup differences for outcome measures. There was a significant difference between the pre and post-test scores in the SES group AMAT median time (p ⫽ .003 95% CI: (⫺14.304, ⫺6.365); ES: .84). Practice time was not associated with changes in outcomes. Subjects with more sensorimotor dysfunction had significantly greater improvements on AMAT median time (p ⫽ .037). There was a significant relationship between baseline FMA score and FMA change score (r ⫽ .402; p ⫽ .006). Conclusions: This study describes a unique SES delivery system via glove electrode that enabled delivery of SES during home-based arm task practice in stroke survivors. Task practice with concurrent SES did not demonstrate significantly better effects than task practice with sham stimulation; however, there was a trend for greater improvement in one activity measure. Key Words: Stroke; Motor function; Clinical practice; Rehabilitation.
Disclosure: None disclosed. Objectives: The aim of this study was to determine if a pedometerbased exercise intervention would have an effect on gait speed, walking distance, health-related quality of life, and balance self-efficacy in community dwelling adults with chronic stroke. Design: Experimental design –Pre-test, post-test, follow-up. Setting: Community-based. Participants: Eleven stroke survivors, five women, six men; mean time since stroke 12.2 (1.5-25) years; mean age 60.4 (41-87) years; side of involvement seven – left, four – right. Intervention: Participants wore pedometer daily for six-weeks. Weekly phone calls were made by investigators to track step count progress and assist participants with goal setting. Main Outcome Measures: Six-Minute Walk Test (6MWT), 10 Meter Walk Test (10MWT), Stroke Impact Scale (SIS), and Activity-Specific Balance Confidence Scale (ABC). Results: All subjects completed the intervention without adverse events. There were no group mean statistically significant improvements on the outcome measures. All subjects improved on at least one outcome measure at post-test. Eight subjects improved on 6MWT scores. Three subjects improved on multiple outcomes during both the intervention period and the three-month follow up. These subjects were slightly younger (mean age 57); had statistically more recent stroke onset than other subjects (p⫽0.24) and tended to have lower initial scores on 6MWT (p⫽0.194). Two of these subjects’ improvement exceeded the MCID for the 6MWT. Conclusions: The small number and heterogeneous characteristics of subjects limit generalizability. This study demonstrates that stroke subjects can use pedometers safely to monitor activity. Future research should explore optimal subject and intervention characteristics of this intervention. Key Words: Stroke; Health and wellness; Clinical practice; Rehabilitation.
Poster 68 Effect of Dual-Task Gait Training on Obstacle Negotiation After Stroke: A Case Study. Anastasia Kyvelidou (Northeastern University, Boston, MA), Raymond Villalobos, Dagmar Sternad, Prudence Plummer-D’Amato. Disclosure: None disclosed. Objective: To determine the effect of dual-task gait training (DTGT) on obstacle negotiation in a person after stroke. Design: Case study, pre-post design. Setting: University laboratory, rehabilitation hospital. Participant: A community-dwelling female (64 years old), 10 months post-ischemic stroke, with minimal cognitive impairment, moderate lower extremity motor impairment and gait speed 0.66 m/s. Intervention: DTGT consisted of twelve 30-minute sessions over four weeks. The participant performed gait training activities simultaneously with cognitive tasks involving attention, memory, and executive functioning with verbal responses. Main Outcome Measures: Obstacle testing conducted pre and post DTGT consisted of five walking trials in two obstacle conditions: low and high (5% and 15% of leg length). We measured toe-obstacle distances of the trail limb at takeoff, of the lead and trail limb at obstacle height, and of the trail and lead limb vertical clearance heights. Results: In the low obstacle condition the subject demonstrated increased horizontal distance parameters and decreased vertical clearance heights from pre- to posttraining. In the high obstacle condition both horizontal and vertical parameters decreased after training. Moreover, before DTGT lead limb was always the nonparetic (right) limb, while after DTGT paretic and nonparetic limbs were used interchangeably as lead limbs during obstacle crossing. Conclusions: DTGT optimized safety by increasing horizontal pre-obstacle distances and reducing vertical clearance distances, especially in the low obstacle condition. DTGT may be an effective rehabilitation approach for improving gait during attentiondemanding tasks, such as obstacle avoidance, in people after stroke. Key Words: Stroke; Motor function; Clinical practice; Rehabilitation. Arch Phys Med Rehabil Vol 93, October 2012
Poster 70 Balance Confidence Following Stroke Rehabilitation Predicts SelfReported Physical Function and Mobility Twelve Months Later. Krista Best (University of British Columbia, Vancouver, BC, Canada), William C. Miller, Janice J. Eng. Disclosure: None disclosed. Objective: To test the hypotheses that balance confidence one month after stroke rehabilitation is a predictor of self-reported physical function, mobility, and stroke recovery 12 months later. Design: A single cohort was followed for 12 months after discharge from stroke rehabilitation. Self-reports of physical function, mobility, and stroke recovery, obtained from subscales of the Stroke Impact Scale (SIS), comprised the dependent variables. The independent variable, balance confidence, was measured using the Activities-specific Balance Confidence (ABC) scale. Covariates included basic mobility, depression, social support, age and sex. Multiple linear regressions were used to explore the influence of ABC on SIS subscales using forced entry. Setting: Multi-site, Canada, community-based (Kelowna, Victoria, Vancouver). Participants: Seventy-two community-living stroke survivors, ⱖ50 years of age, 72%M. Intervention: Not applicable. Main Outcome Measures: ABC scale was administered within one month of discharge from stroke rehabilitation. The Stroke Impact Scale (SIS) was administered 12 months post-discharge from stroke rehabilitation. Results: Participants had mean ABC scores of 64/100 at one month, which increased to 73/100 at 12 months. ABC at one month was the strongest predictor of self-reported physical function and mobility after stroke, explaining 67% and 51% of the variance respectively. ABC was not a significant predictor of perceived stroke recovery. Conclusions: Findings from this study support the need to address balance confidence early in stroke rehabilitation through suitable interventions that are specifically designed to modify low balance confidence after stroke. There is literature to support effective interven-
2012 ACRM–ASNR Annual Conference Abstracts
Poster 67 Afferent Stimulation Provided by Glove Electrode during TaskSpecific Arm Exercise Following Stroke. Jane E. Sullivan (Feinberg School of Medicine, Northwestern University, Chicago, IL), Lois D. Hedman, Donna Hurley.
Poster 69 Pedometers to Augment the Health of Stroke Survivors: A Pilot Study. Jane E. Sullivan (Feinberg School of Medicine, Northwestern University, Chicago, IL), Lauren Espe, Amanda Kelly, Laura Vielbig.
Disclosure: None disclosed. Objectives: Sensory amplitude electrical stimulation (SES) and repetitive practice can improve arm dysfunction when delivered separately following stroke. Our objective was to determine if repetitive practice was more effective when administered concurrent with SES. Design: Subjects were randomly assigned to an SES (n ⫽ 20) or sham stimulation (n ⫽ 18) group. Setting: Home-based. Participants: Thirty-eight subjects with chronic stroke and mean Fugl-Meyer Assessment (FMA) score 28/66 (15-45). Intervention: Subjects engaged in task-based home exercise for 30 minutes, twice daily, for four weeks while wearing a glove electrode on the impaired hand.Experimental subjects received SES; control subjects received sham stimulation during exercise. Main Outcome Measures: FMA and Arm Motor Ability Test (AMAT). Results: There were no significant betweengroup differences for outcome measures. There was a significant difference between the pre and post-test scores in the SES group AMAT median time (p ⫽ .003 95% CI: (⫺14.304, ⫺6.365); ES: .84). Practice time was not associated with changes in outcomes. Subjects with more sensorimotor dysfunction had significantly greater improvements on AMAT median time (p ⫽ .037). There was a significant relationship between baseline FMA score and FMA change score (r ⫽ .402; p ⫽ .006). Conclusions: This study describes a unique SES delivery system via glove electrode that enabled delivery of SES during home-based arm task practice in stroke survivors. Task practice with concurrent SES did not demonstrate significantly better effects than task practice with sham stimulation; however, there was a trend for greater improvement in one activity measure. Key Words: Stroke; Motor function; Clinical practice; Rehabilitation.
Disclosure: None disclosed. Objectives: The aim of this study was to determine if a pedometerbased exercise intervention would have an effect on gait speed, walking distance, health-related quality of life, and balance self-efficacy in community dwelling adults with chronic stroke. Design: Experimental design –Pre-test, post-test, follow-up. Setting: Community-based. Participants: Eleven stroke survivors, five women, six men; mean time since stroke 12.2 (1.5-25) years; mean age 60.4 (41-87) years; side of involvement seven – left, four – right. Intervention: Participants wore pedometer daily for six-weeks. Weekly phone calls were made by investigators to track step count progress and assist participants with goal setting. Main Outcome Measures: Six-Minute Walk Test (6MWT), 10 Meter Walk Test (10MWT), Stroke Impact Scale (SIS), and Activity-Specific Balance Confidence Scale (ABC). Results: All subjects completed the intervention without adverse events. There were no group mean statistically significant improvements on the outcome measures. All subjects improved on at least one outcome measure at post-test. Eight subjects improved on 6MWT scores. Three subjects improved on multiple outcomes during both the intervention period and the three-month follow up. These subjects were slightly younger (mean age 57); had statistically more recent stroke onset than other subjects (p⫽0.24) and tended to have lower initial scores on 6MWT (p⫽0.194). Two of these subjects’ improvement exceeded the MCID for the 6MWT. Conclusions: The small number and heterogeneous characteristics of subjects limit generalizability. This study demonstrates that stroke subjects can use pedometers safely to monitor activity. Future research should explore optimal subject and intervention characteristics of this intervention. Key Words: Stroke; Health and wellness; Clinical practice; Rehabilitation.
Poster 68 Effect of Dual-Task Gait Training on Obstacle Negotiation After Stroke: A Case Study. Anastasia Kyvelidou (Northeastern University, Boston, MA), Raymond Villalobos, Dagmar Sternad, Prudence Plummer-D’Amato. Disclosure: None disclosed. Objective: To determine the effect of dual-task gait training (DTGT) on obstacle negotiation in a person after stroke. Design: Case study, pre-post design. Setting: University laboratory, rehabilitation hospital. Participant: A community-dwelling female (64 years old), 10 months post-ischemic stroke, with minimal cognitive impairment, moderate lower extremity motor impairment and gait speed 0.66 m/s. Intervention: DTGT consisted of twelve 30-minute sessions over four weeks. The participant performed gait training activities simultaneously with cognitive tasks involving attention, memory, and executive functioning with verbal responses. Main Outcome Measures: Obstacle testing conducted pre and post DTGT consisted of five walking trials in two obstacle conditions: low and high (5% and 15% of leg length). We measured toe-obstacle distances of the trail limb at takeoff, of the lead and trail limb at obstacle height, and of the trail and lead limb vertical clearance heights. Results: In the low obstacle condition the subject demonstrated increased horizontal distance parameters and decreased vertical clearance heights from pre- to posttraining. In the high obstacle condition both horizontal and vertical parameters decreased after training. Moreover, before DTGT lead limb was always the nonparetic (right) limb, while after DTGT paretic and nonparetic limbs were used interchangeably as lead limbs during obstacle crossing. Conclusions: DTGT optimized safety by increasing horizontal pre-obstacle distances and reducing vertical clearance distances, especially in the low obstacle condition. DTGT may be an effective rehabilitation approach for improving gait during attentiondemanding tasks, such as obstacle avoidance, in people after stroke. Key Words: Stroke; Motor function; Clinical practice; Rehabilitation. Arch Phys Med Rehabil Vol 93, October 2012
Poster 70 Balance Confidence Following Stroke Rehabilitation Predicts SelfReported Physical Function and Mobility Twelve Months Later. Krista Best (University of British Columbia, Vancouver, BC, Canada), William C. Miller, Janice J. Eng. Disclosure: None disclosed. Objective: To test the hypotheses that balance confidence one month after stroke rehabilitation is a predictor of self-reported physical function, mobility, and stroke recovery 12 months later. Design: A single cohort was followed for 12 months after discharge from stroke rehabilitation. Self-reports of physical function, mobility, and stroke recovery, obtained from subscales of the Stroke Impact Scale (SIS), comprised the dependent variables. The independent variable, balance confidence, was measured using the Activities-specific Balance Confidence (ABC) scale. Covariates included basic mobility, depression, social support, age and sex. Multiple linear regressions were used to explore the influence of ABC on SIS subscales using forced entry. Setting: Multi-site, Canada, community-based (Kelowna, Victoria, Vancouver). Participants: Seventy-two community-living stroke survivors, ⱖ50 years of age, 72%M. Intervention: Not applicable. Main Outcome Measures: ABC scale was administered within one month of discharge from stroke rehabilitation. The Stroke Impact Scale (SIS) was administered 12 months post-discharge from stroke rehabilitation. Results: Participants had mean ABC scores of 64/100 at one month, which increased to 73/100 at 12 months. ABC at one month was the strongest predictor of self-reported physical function and mobility after stroke, explaining 67% and 51% of the variance respectively. ABC was not a significant predictor of perceived stroke recovery. Conclusions: Findings from this study support the need to address balance confidence early in stroke rehabilitation through suitable interventions that are specifically designed to modify low balance confidence after stroke. There is literature to support effective interven-