Gillian Baer

Trunk movements in older subjects during sit-to-stand

Sitting to standing (STS) is an activity that is performed many times during the course of a day and is an important prerequisite to the achievement of many functional goals. This article presents the results from a pilot study, the purpose of which was to develop a method for investigating the activity of sit-to-stand. The study describes STS timing and patterns of trunk movement during standing up in a population of 30 normal older adult subjects (mean age, 61.6 years; SD, 7.7 years). Data were gathered using a three-dimensional movement analysis system, CODA-3. Time taken to stand up was recorded, as were the trunk movements of pelvic and shoulder rotation, trunk lateral flexion, pelvic and shoulder lateral shift, and backward shoulder movement to achieve stance. Results show that normal subjects stood up quickly (mean, 1.67 sec; SD, .27 sec; range, 1.26 to 2.13 sec), and despite large amounts of trunk forward flexion and upward motion necessary to achieve the task of standing up, only small amounts of trunk rotation, trunk lateral flexion, and trunk lateral shift were measured during the activity. The identification of these movements characteristics may be beneficial in assisting with analysis of the STS movement pattern.

Physiotherapy Treatment Approaches for Stroke

Graeme J. Hankey MD, FRCP Section Editor: There are several different approaches to physiotherapy treatment after stroke. These can broadly be divided into approaches that are based on neurophysiological, motor learning, or orthopaedic principles. Some physiotherapists base their treatment on a single approach, whereas others use a mixture of components from a number of different approaches. The practical application of these approaches can result in substantial differences in patient treatment. At present, the Bobath Approach, based on neurophysiological principles, probably remains the most widely used approach in the Western world.1–5 However, there is a lack of convincing evidence to support any specific physiotherapy treatment approach.3,6 This systematic review aims to assess the effects of physiotherapy treatment if it is based on orthopaedic, motor learning, or neurophysiological principles, or on a mixture of these treatment principles. We searched the Cochrane Stroke Group Trials Register …

A comparison of treadmill walking and overground walking in independently ambulant stroke patients: A pilot study

Purpose. The purpose of the study was to compare the spatio-temporal and joint kinematic gait parameters of stroke patients walking on a treadmill and overground, to examine the assumption that patients walking on a treadmill will approximate the requirements of walking overground. Methods. Ten independently ambulant chronic stroke patients were included in the study. Vicon™ was used to collect spatio-temporal and joint kinematic data during overground walking at comfortable speed and at matched speed on the treadmill. Results. Walking on the treadmill demonstrated statistically significantly lower cadence, and longer step times of the non-hemiplegic and hemiplegic limbs. Absolute stance times of both limbs, absolute double support time, relative stance time and relative double support time were significantly longer during treadmill walking. Compared to overground walking, the inter-limb symmetries of step time, stance time, and stance/swing time ratio were significantly greater on the treadmill. During treadmill walking, joint kinematic data showed statistically significant changes with greater flexion of the nonhemiplegic knee and hip at initial contact, and less hip extension of the hemiplegic limb. Maximal ankle plantarflexion and knee extension of the hemiplegic limb occurred later in the gait cycle on the treadmill. Conclusion. These differences suggest it may be useful to use treadmill in conjunction with overground walking to focus on improving specific walking deficits in patients with stroke.

Physical Rehabilitation Approaches for the Recovery of Function and Mobility After Stroke: Major Update

Various physical rehabilitation approaches may be used to promote recovery of function and mobility after stroke. Controversy and debate about the relative effectiveness of approaches persist. We aimed to determine whether physical rehabilitation approaches are effective in recovery of function and mobility in people with stroke, and to assess whether any one physical rehabilitation approach is more effective than any other approach. A stakeholder group, comprising stroke survivors, caregivers, and physiotherapists, made decisions using consensus-making techniques relating to the scope and focus of this updated review.1 We performed a comprehensive search (to December 2012), …

User involvement in a Cochrane systematic review: using structured methods to enhance the clinical relevance, usefulness and usability of a systematic review update

BackgroundThis paper describes the structured methods used to involve patients, carers and health professionals in an update of a Cochrane systematic review relating to physiotherapy after stroke and explores the perceived impact of involvement.MethodsWe sought funding and ethical approval for our user involvement. We recruited a stakeholder group comprising stroke survivors, carers, physiotherapists and educators and held three pre-planned meetings during the course of updating a Cochrane systematic review. Within these meetings, we used formal group consensus methods, based on nominal group techniques, to reach consensus decisions on key issues relating to the structure and methods of the review.ResultsThe stakeholder group comprised 13 people, including stroke survivors, carers and physiotherapists with a range of different experience, and either 12 or 13 participated in each meeting. At meeting 1, there was consensus that methods of categorising interventions that were used in the original Cochrane review were no longer appropriate or clinically relevant (11/13 participants disagreed or strongly disagreed with previous categories) and that international trials (which had not fitted into the original method of categorisation) ought to be included within the review (12/12 participants agreed or strongly agreed these should be included). At meeting 2, the group members reached consensus over 27 clearly defined treatment components, which were to be used to categorise interventions within the review (12/12 agreed or strongly agreed), and at meeting 3, they agreed on the key messages emerging from the completed review. All participants strongly agreed that the views of the group impacted on the review update, that the review benefited from the involvement of the stakeholder group, and that they believed other Cochrane reviews would benefit from the involvement of similar stakeholder groups.ConclusionsWe involved a stakeholder group in the update of a Cochrane systematic review, using clearly described structured methods to reach consensus decisions. The involvement of stakeholders impacted substantially on the review, with the inclusion of international studies, and changes to classification of treatments, comparisons and subgroup comparisons explored within the meta-analysis. We argue that the structured approach which we adopted has implications for other systematic reviews.

Effectiveness of commercially available gaming devices in upper limb stroke rehabilitation

Abstract Background: Hemiparesis of the upper extremity is estimated to affect 50–75% of individuals who experience a stroke. Recently the use of commercially available off-the-shelf (COTS) gaming technology has shown promise for providing interactive rehabilitation. The existing evidence however, has not yet been reviewed systematically to determine the effectiveness of such gaming devices in upper limb (UL) rehabilitation post-stroke. Objectives: To determine the effectiveness of COTS gaming technology for UL rehabilitation in post-stroke patients and to assess the feasibility, and effect on quality of life (QoL). Methods: A systematic search of the databases CINAHL, MEDLINE, PsycINFO, Pubmed, SPORTDiscus, and SCOPUS was conducted. Quality scoring of the included articles was based on the Effective Public Health Practice Project (EPHPP) quality assessment tool for quantitative studies. Results: In total, eight studies were included for review. The commercial gaming devices were found to be feasible for use among post-stroke individuals. The devices were found to be effective as an adjunct to conventional stroke rehabilitation, and were feasible in relation to time taken, cost-effectiveness, safety, and the positive effect on the QoL of the stroke population. Conclusions: As the findings of the current review are primarily based on lower levels of research, it is not possible to make recommendations regarding the use of these devices in clinical practice. However, findings of the included studies did indicate that rehabilitation including gaming technology had a positive effect on the UL rehabilitation of stroke patients.

Physiotherapy and Neurology: Towards Research-based Practice

Summary Summary This paper explores the current practices of physiotherapists working in neurology and argues that a techniques versus science imbalance makes it necessary to develop a scientific knowledge base within physiotherapy practice. Scepticism, determinism and empiricism are identified as three major elements underpinning a scientific approach. Each element is defined, elaborated upon and pragmatic recommendations offered in order to facilitate the implementation of these elements in physiotherapy practice.

Challenges in integrating international evidence relating to stroke rehabilitation: experiences from a Cochrane systematic review

There are many randomized controlled trials relating to stroke rehabilitation being carried out in China, which are often published in Chinese-language journals. A recent update to our Cochrane systematic review of physical rehabilitation to improve function and mobility after stroke included 96 trials; over half (51) were conducted in China; 37 of these included studies were published in Chinese. Analyses within this Cochrane review support the conclusion that physical rehabilitation, using a mix of components from different approaches, is effective for the recovery of function and mobility after stroke. The inclusion of the Chinese studies had a substantial impact on the volume of evidence and, consequently, the conclusions. In this paper, we explore whether it is appropriate to draw implications for clinical practice throughout the world from evidence relating to a complex rehabilitation intervention delivered within one particular geographical healthcare setting. We explore the unique challenges associated with incorporating the body of evidence from China, particularly the Chinese-language publications, and identify the ongoing debate about the quality of Chinese research publications. We conclude that the growing body of evidence from China has important implications for future systematic reviews and evidence-based stroke care, but analysis and interpretation raise challenges, and improved reporting is critical.

A new system for the measurement of displacements of the human body with widespread applications in human movement studies

This paper reports the development, construction and use of a new system for the measurement of linear kinematics in one, two or three dimensions. The system uses a series of rotary shaft encoders and inelastic tensioned strings to measure the linear displacement of key anatomical points in space. The system is simple, inexpensive, portable, accurate and flexible. It is therefore suitable for inclusion in a variety of motion analysis studies. Details of the construction, calibration and interfacing of the device to an IBM PC computer are given as is a full mathematical description of the appropriate measurement theory for one, two and three dimensions. Examples of the results obtained from the device during gait, running, rising to stand, sitting down and pointing with the upper limb are given. Finally it is proposed that, provided the constraints of the system are considered, this method has the potential to measure a variety of functional human movements simply and inexpensively and may therefore be a valuable addition to the methods available to the motion scientist.

Treadmill training to improve mobility for people with sub-acute stroke: a phase II feasibility randomized controlled trial:

Objective: This phase II study investigated the feasibility and potential effectiveness of treadmill training versus normal gait re-education for ambulant and non-ambulant people with sub-acute stroke delivered as part of normal clinical practice. Design: A single-blind, feasibility randomized controlled trial. Setting: Four hospital-based stroke units. Subjects: Participants within three months of stroke onset. Interventions: Participants were randomized to treadmill training (minimum twice weekly) plus normal gait re-education or normal gait re-education only (control) for up to eight weeks. Main Measures: Measures were taken at baseline, after eight weeks of intervention and at six-month follow-up. The primary outcome was the Rivermead Mobility Index. Other measures included the Functional Ambulation Category, 10-metre walk, 6-minute walk, Barthel Index, Motor Assessment Scale, Stroke Impact Scale and a measure of confidence in walking. Results: In all, 77 patients were randomized, 39 to treadmill and 38 to control. It was feasible to deliver treadmill training to people with sub-acute stroke. Only two adverse events occurred. No statistically significant differences were found between groups. For example, Rivermead Mobility Index, median (interquartile range (IQR)): after eight weeks treadmill 5 (4–9), control 6 (4–11) p = 0.33; or six-month follow-up treadmill 8.5 (3–12), control 8 (6–12.5) p = 0.42. The frequency and intensity of intervention was low. Conclusion: Treadmill training in sub-acute stroke patients was feasible but showed no significant difference in outcomes when compared to normal gait re-education. A large definitive randomized trial is now required to explore treadmill training in normal clinical practice.