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Poster 95 Hemiparetic Gait: Comparison between Overground and Treadmill Walking
2011 ACRM-ASNR ANNUAL CONFERENCE ABSTRACTS
the effects of hf-rTMS and lf-rTMS. Design: Hemiparetic stroke patients with onset within 1 month and motor function of upper extremity more than Brunnstrom stage 3 were included. The patients were divided into three groups: patients with hf-rTMS (n⫽9), lf-rTMS (n⫽13) and sham group (n⫽12). Setting: Tertiary hospital in Seoul, Korea Interventions: The hf-rTMS group received stimulation at 10Hz applied over hot spot of affected hemisphere for 10 minutes. (10-second stimulation, 50-second break, 1,000 pulse, 80% of the resting motor threshold). The lf-rTMS group received low frequency stimulation over hot spot of unaffected hemisphere for 20 minutes (1Hz, 1200 pulse, 100% of the resting motor threshold). The sham group received sham stimulation over unaffected hemisphere for 20 minutes. The treatment period was two weeks (five days per week). Main Outcome Measures: The Fugl-Meyer Assessment (FMA) score, Manual Function Test (FMT) and Korean version of Modified Bathel Index (K-MBI) evaluated before, immediately after, one month and three months later. Results: In the comparison of three groups, FMA score was significantly improved after 1 month on hf-rTMS group (⌬FMA score: 13.3⫾9.3, 19.1⫾12.8, 6.2⫾6.7, p⬍0.05). MFT was significantly improved after 1 month on lf-rTMS group. (⌬MFT: 4.6⫾3.2, 10.2⫾4.6, 3.8⫾3.1, p⬍0.05) Also, FMA scores and MFT were significantly improved after 3 months in the lf-rTMS group (⌬FMA 15.4⫾11.6, 23.4⫾17.2, 2.6⫾16.4,⌬MFT: 5.9⫾4.1, 13.6⫾7.5, 1.5⫾6.9, p⬍0.05). Conclusions: lf-rTMS of the unaffected motor cortex improved motor function of upper extremities in subacute stroke patients more than hf-rTMS or sham stimulation. Key Words: Repetitive transcranial magnetic stimulation; Stroke; Motor function; Rehabilitation. Poster 93 Use of Theory and Motor Learning Principles in Post-Stroke Walking Training Research: A Scoping Review. Vince DePaul (McMaster University, Hamilton, Ontario, Canada, St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada), Laurie Wishart. Disclosure: None disclosed. Objectives: (1) To explore the extent, nature, and impact of theory, and (2) to document the application of motor learning principles in walking training research in community dwelling adults with stroke. Data Sources: Search included electronic data bases (Medline, EMBASE, PubMed, AMED, PsychInfo and CINAHL) from 1995 to March 11, 2011 and a hand search of references from studies and reviews. Study Selection: Two investigators independently reviewed titles, abstracts and full articles. Articles were included if they met the following criteria: 1) effectiveness study design; 2) participants were community dwelling, ambulatory, adults with stroke; 3) walking focused intervention and outcomes. Interventions included over-ground walking, treadmill (with and without support), robotics, and walking in virtual environments. Thirty studies were selected for data extraction. Data Extraction: A standardized data extraction form was used by two investigators to independently review the selected papers. Completed data forms were reviewed and themes identified. Data Synthesis: In the majority of studies, theoretic framework was implied rather than explicitly stated. Theories included; 1) exercise theory, 2) neuroplasticity, 3) central pattern generator control of stepping, and 4) systems theory. Most papers did not explicitly refer to or apply motor learning principles. However, some provided description of the motor learning variables of training specificity, intensity, variability and guidance. Feedback and order of practice were rarely described. Theoretic framework and definition of the task of walking seemed to influence content of interventions and extent of application of motor learning principles. Conclusions: Theory is frequently not explicitly stated, and motor learning principles are inconsistently applied in post-stroke walking training literature. In the future, explicit use of theory and consideration of motor learning principles may be useful in designing effective walking interventions and coherent research trials. Key Words: Stroke; Gait; Rehabilitation; Learning; Review.
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Poster 94 Coping Style Predicts Depression, Burden and Life Dissatisfaction in Carers of Patients with Subarachnoid Hemorrhage. Esther Jacobs (Rijndam revalidatiecentrum, Rotterdam, The Netherlands), Majanka Heijenbrok-Kal, Mike van Kessel, L Khajeh, F van Kooten, Gerard Ribbers. Disclosure: None disclosed. Objective: To assess the effect of coping style on depression, burden and life satisfaction of carers of patients with a subarachnoid hemorrhage (SAH). Design: Cross-sectional study. Setting: Carers of patients with SAH admitted to the neurology department of a university medical centre were asked to participate. Participants: Carers including partners, parents, and offspring of patients with SAH. Intervention: Not applicable. Main Outcome Measures: Coping style was assessed with the Utrecht Coping List, depression with the Goldberg Depression Scale (GDS), burden with the Social Competence Questionnaire and life satisfaction with the Life Satisfaction Questionnaire. Results: In total, 41 carers participated, including 35 partners, 3 parents and 3 sons or daughters. The mean age was 56 years (SD 13.4 years), and 24 (58.5%) carers were male. Of these, 9 (22%) presented with depressive symptoms (GDSⱖ2). The mean burden score and life satisfaction score of the carers were 37.8 (SD 7.38) and 5.04 (SD 0.60), respectively. A palliative coping style was a significant predictor of the presence of depressive symptoms (OR⫽1.45, p⬍0.016). A passive coping style was a significant predictor of a higher burden score (B⫽1.61, p⬍0.024), adjusted for morbidity of the carer (B⫽11.9, p⬍0.013). Moreover, a passive coping style predicted a lower life satisfaction score (B-0.96, p⬍0.028). Conclusions: Carers of SAH patients with a palliative or passive coping style experience more depressive symptoms and higher burden and are less satisfied with life than carers with other coping styles. Rehabilitation programs for SAH patients should also include caregiver support programs which focus on coping. Key Words: Rehabilitation. Poster 95 Hemiparetic Gait: Comparison between Overground and Treadmill Walking. Ana Lindquist (Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil), Luciana Mendes, Cinthia Moreno, Emilia Silva, Heloisa Britto. Disclosure: None disclosed. Objective: Compare articular kinematics and space-time parameters of overground and treadmill hemiparetic gait, to confirm the assumption that the gait produced by duration of treadmill training is similar to overground gait. Design: Descriptive cross-sectional study. Setting: Stroke patients in ambulatory care. Participants: A convenience sample of persons with chronic hemiparesis (N⫽17) were recruited from outpatient physical therapy clinics. Interventions: Not applicable. Main Outcome Measures: Spatiotemporal and kinematics gait parameters of overground walking and after 5, 10 and 15 minutes of treadmill walking. Results: Five minutes of treadmill walking led to an increase in cadence, amplitude of hip and knee movement and knee flexion at initial contact; reduction in stride length, paretic limb step time, peak knee extension and dorsiflexion in stance; as well as delayed peak knee flexion and ankle dorsiflexion in swing as compared to overground walking. After 15 minutes of treadmill walking only amplitude of hip movement, knee angle at first contact and peak knee extension in stance were equivalent to overground walking. Conclusions: Fifteen minutes of treadmill walking was insufficient to achieve equivalence in space-temporal and angular variables of hemiparetic individuals during treadmill and overground walking. However, it allowed for an increase in articular movement of the paretic limb, a good clinical indicator in individuals with spasticity. Keywords: Walking; Stroke; Treadmill; Kinematics; Rehabilitation. Poster 96 Superficial Versus Deep Peroneal Nerve Stimulation during Plantar Loading in Acute Stroke: A Case Report. Karen J. Arch Phys Med Rehabil Vol 92, October 2011
the effects of hf-rTMS and lf-rTMS. Design: Hemiparetic stroke patients with onset within 1 month and motor function of upper extremity more than Brunnstrom stage 3 were included. The patients were divided into three groups: patients with hf-rTMS (n⫽9), lf-rTMS (n⫽13) and sham group (n⫽12). Setting: Tertiary hospital in Seoul, Korea Interventions: The hf-rTMS group received stimulation at 10Hz applied over hot spot of affected hemisphere for 10 minutes. (10-second stimulation, 50-second break, 1,000 pulse, 80% of the resting motor threshold). The lf-rTMS group received low frequency stimulation over hot spot of unaffected hemisphere for 20 minutes (1Hz, 1200 pulse, 100% of the resting motor threshold). The sham group received sham stimulation over unaffected hemisphere for 20 minutes. The treatment period was two weeks (five days per week). Main Outcome Measures: The Fugl-Meyer Assessment (FMA) score, Manual Function Test (FMT) and Korean version of Modified Bathel Index (K-MBI) evaluated before, immediately after, one month and three months later. Results: In the comparison of three groups, FMA score was significantly improved after 1 month on hf-rTMS group (⌬FMA score: 13.3⫾9.3, 19.1⫾12.8, 6.2⫾6.7, p⬍0.05). MFT was significantly improved after 1 month on lf-rTMS group. (⌬MFT: 4.6⫾3.2, 10.2⫾4.6, 3.8⫾3.1, p⬍0.05) Also, FMA scores and MFT were significantly improved after 3 months in the lf-rTMS group (⌬FMA 15.4⫾11.6, 23.4⫾17.2, 2.6⫾16.4,⌬MFT: 5.9⫾4.1, 13.6⫾7.5, 1.5⫾6.9, p⬍0.05). Conclusions: lf-rTMS of the unaffected motor cortex improved motor function of upper extremities in subacute stroke patients more than hf-rTMS or sham stimulation. Key Words: Repetitive transcranial magnetic stimulation; Stroke; Motor function; Rehabilitation. Poster 93 Use of Theory and Motor Learning Principles in Post-Stroke Walking Training Research: A Scoping Review. Vince DePaul (McMaster University, Hamilton, Ontario, Canada, St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada), Laurie Wishart. Disclosure: None disclosed. Objectives: (1) To explore the extent, nature, and impact of theory, and (2) to document the application of motor learning principles in walking training research in community dwelling adults with stroke. Data Sources: Search included electronic data bases (Medline, EMBASE, PubMed, AMED, PsychInfo and CINAHL) from 1995 to March 11, 2011 and a hand search of references from studies and reviews. Study Selection: Two investigators independently reviewed titles, abstracts and full articles. Articles were included if they met the following criteria: 1) effectiveness study design; 2) participants were community dwelling, ambulatory, adults with stroke; 3) walking focused intervention and outcomes. Interventions included over-ground walking, treadmill (with and without support), robotics, and walking in virtual environments. Thirty studies were selected for data extraction. Data Extraction: A standardized data extraction form was used by two investigators to independently review the selected papers. Completed data forms were reviewed and themes identified. Data Synthesis: In the majority of studies, theoretic framework was implied rather than explicitly stated. Theories included; 1) exercise theory, 2) neuroplasticity, 3) central pattern generator control of stepping, and 4) systems theory. Most papers did not explicitly refer to or apply motor learning principles. However, some provided description of the motor learning variables of training specificity, intensity, variability and guidance. Feedback and order of practice were rarely described. Theoretic framework and definition of the task of walking seemed to influence content of interventions and extent of application of motor learning principles. Conclusions: Theory is frequently not explicitly stated, and motor learning principles are inconsistently applied in post-stroke walking training literature. In the future, explicit use of theory and consideration of motor learning principles may be useful in designing effective walking interventions and coherent research trials. Key Words: Stroke; Gait; Rehabilitation; Learning; Review.
1719
Poster 94 Coping Style Predicts Depression, Burden and Life Dissatisfaction in Carers of Patients with Subarachnoid Hemorrhage. Esther Jacobs (Rijndam revalidatiecentrum, Rotterdam, The Netherlands), Majanka Heijenbrok-Kal, Mike van Kessel, L Khajeh, F van Kooten, Gerard Ribbers. Disclosure: None disclosed. Objective: To assess the effect of coping style on depression, burden and life satisfaction of carers of patients with a subarachnoid hemorrhage (SAH). Design: Cross-sectional study. Setting: Carers of patients with SAH admitted to the neurology department of a university medical centre were asked to participate. Participants: Carers including partners, parents, and offspring of patients with SAH. Intervention: Not applicable. Main Outcome Measures: Coping style was assessed with the Utrecht Coping List, depression with the Goldberg Depression Scale (GDS), burden with the Social Competence Questionnaire and life satisfaction with the Life Satisfaction Questionnaire. Results: In total, 41 carers participated, including 35 partners, 3 parents and 3 sons or daughters. The mean age was 56 years (SD 13.4 years), and 24 (58.5%) carers were male. Of these, 9 (22%) presented with depressive symptoms (GDSⱖ2). The mean burden score and life satisfaction score of the carers were 37.8 (SD 7.38) and 5.04 (SD 0.60), respectively. A palliative coping style was a significant predictor of the presence of depressive symptoms (OR⫽1.45, p⬍0.016). A passive coping style was a significant predictor of a higher burden score (B⫽1.61, p⬍0.024), adjusted for morbidity of the carer (B⫽11.9, p⬍0.013). Moreover, a passive coping style predicted a lower life satisfaction score (B-0.96, p⬍0.028). Conclusions: Carers of SAH patients with a palliative or passive coping style experience more depressive symptoms and higher burden and are less satisfied with life than carers with other coping styles. Rehabilitation programs for SAH patients should also include caregiver support programs which focus on coping. Key Words: Rehabilitation. Poster 95 Hemiparetic Gait: Comparison between Overground and Treadmill Walking. Ana Lindquist (Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil), Luciana Mendes, Cinthia Moreno, Emilia Silva, Heloisa Britto. Disclosure: None disclosed. Objective: Compare articular kinematics and space-time parameters of overground and treadmill hemiparetic gait, to confirm the assumption that the gait produced by duration of treadmill training is similar to overground gait. Design: Descriptive cross-sectional study. Setting: Stroke patients in ambulatory care. Participants: A convenience sample of persons with chronic hemiparesis (N⫽17) were recruited from outpatient physical therapy clinics. Interventions: Not applicable. Main Outcome Measures: Spatiotemporal and kinematics gait parameters of overground walking and after 5, 10 and 15 minutes of treadmill walking. Results: Five minutes of treadmill walking led to an increase in cadence, amplitude of hip and knee movement and knee flexion at initial contact; reduction in stride length, paretic limb step time, peak knee extension and dorsiflexion in stance; as well as delayed peak knee flexion and ankle dorsiflexion in swing as compared to overground walking. After 15 minutes of treadmill walking only amplitude of hip movement, knee angle at first contact and peak knee extension in stance were equivalent to overground walking. Conclusions: Fifteen minutes of treadmill walking was insufficient to achieve equivalence in space-temporal and angular variables of hemiparetic individuals during treadmill and overground walking. However, it allowed for an increase in articular movement of the paretic limb, a good clinical indicator in individuals with spasticity. Keywords: Walking; Stroke; Treadmill; Kinematics; Rehabilitation. Poster 96 Superficial Versus Deep Peroneal Nerve Stimulation during Plantar Loading in Acute Stroke: A Case Report. Karen J. Arch Phys Med Rehabil Vol 92, October 2011