Kristine K. Miller

Balance and Balance Self-Efficacy Are Associated With Activity and Participation After Stroke: A Cross-Sectional Study in People With Chronic Stroke

OBJECTIVESnTo (1) examine the relationships between multiple poststroke mobility variables (gait speed, walking capacity, balance, balance self-efficacy, and falls self-efficacy) and activity and participation; and (2) determine which poststroke mobility variables are independently associated with activity and participation.nnnDESIGNnThis is the primary analysis of a prospective cross-sectional study completed to understand the impact of mobility on activity and participation in people with chronic stroke.nnnSETTINGnUniversity-based research laboratory, hospitals, and stroke support groups.nnnPARTICIPANTSnPeople (N=77) with stroke greater than 6 months ago were included in the study if they were referred to occupational or physical therapy for physical deficits as a result of the stroke, completed all stroke related inpatient rehabilitation, had residual functional disability, scored a ≥4 out of 6 on the short, 6-item Mini-Mental State Examination, and were between the ages of 50 and 85.nnnINTERVENTIONSnNot applicable, this is a cross-sectional data collection of 1 timepoint.nnnMAIN OUTCOME MEASURESnWe measured activity and participation with the validated International Classification of Functioning, Disability and Health Measure of Participation and Activities. Other variables included gait speed (10-meter walk), walking capacity (6-minute walk), balance (Berg Balance Scale), balance self-efficacy (Activities Specific Balance Confidence Scale), and falls self-efficacy (Modified Falls Efficacy Scale).nnnRESULTSnOnly balance self-efficacy was found to be independently associated with poststroke activity (β=-.430, P<.022, 95% confidence interval [CI], -.247 to -.021) and participation (β=-.439, P<.032, 95% CI, -.210 to -.010).nnnCONCLUSIONSnAmong people with chronic stroke, balance self-efficacy, not physical aspects of gait, was independently associated with activity and participation. While gait training continues to be important, this study indicates a need to further evaluate and address the psychological factors of balance and falls self-efficacy to obtain the best stroke recovery.

Poststroke Balance Improves With Yoga A Pilot Study

Background and Purpose— Balance impairment is common after stroke; modified yoga may be able to improve balance and other important poststroke variables. Scientific-evidence is needed to support such treatment interventions. The purpose of this study was to assess the impact of a yoga-based rehabilitation intervention on balance, balance self-efficacy, fear of falling (FoF), and quality of life after stroke. Methods— This was a prospective, randomized, pilot study of yoga-based rehabilitation for people with chronic stroke. All yoga sessions were taught by a registered yoga therapist, occurred twice per week for 8 weeks and included seated, standing, and floor postures with relaxation and meditation. Balance was assessed with the Berg Balance Scale, balance self-efficacy with the Activities-specific Balance Confidence Scale, FoF with a dichotomous yes/no question, and quality of life with the Stroke Specific Quality of Life scale. Results— There were no significant differences between wait-list control (n=10) and yoga (n=37) groups in baseline or follow-up scores. However, using within-group comparisons, yoga group data demonstrated significant improvement in balance (Berg Balance Scale, 41.3±11.7 vs 46.3±9.1; P<0.001) and FoF (51% vs 46% with FoF; P<0.001). Conclusions— A group yoga-based rehabilitation intervention for people with chronic stroke has potential in improving multiple poststroke variables. Group yoga may be complementary to rehabilitation, may be possible in medical-based and community-based settings, and may be cost-effective. Further testing of group yoga-based rehabilitation interventions is warranted. Clinical Trial Registration— URL: http://clinicaltrials.gov. Unique Identifier: NCT01109602.

Balance Is Associated with Quality of Life in Chronic Stroke

Abstract Objective: To investigate the association between balance and quality of life (QOL) in chronic stroke survivors by (1) examining the associations between balance and QOL scores; (2) identifying the frequency of balance impairment and poststroke falls; and (3) determining the differences in QOL scores between persons with and those without balance impairment. Methods: This is a secondary analysis of a cross-sectional study. People who had a stroke more than 6 months earlier from 3 Midwest states were included in the study if they met the following criteria: were referred to occupational or physical therapy for poststroke physical deficits; had self-reported stroke-related physical deficits; completed all stroke-related rehabilitation; had residual functional disability; had a score of ≥4 out of 6 on the short 6-item Mini-Mental State Examination; and were between 50 and 85 years old (n = 59). The main outcome measures included the Berg Balance Scale (BBS) to assess balance and the Stroke Specific Quality of Life Scale (SS-QOL) to assess QOL. Number of falls since stroke was self-reported. Results: Mean BBS score was 44 ± 8 and mean SS-QOL score was 46 ± 8; these scores were significantly correlated (r = .394, P = .002). Seventy-six percent of the sample reported a fall since stroke. Persons with balance impairment (BBS score ≤46; n = 29; 49%) had an average BBS score of 39 ± 7 and significantly worse SS-QOL scores than those without balance impairment (42 ± 8 vs 49 ± 7; P = .001). Conclusion: In the chronic stroke population, balance impairment and fall risk are associated with lower QOL scores. If balance can be improved and maintained into the chronic phases of stroke, it is likely that individuals will benefit with improved QOL.

Fatigue and Pain: Relationships with Physical Performance and Patient Beliefs after Stroke

Abstract Background: Fatigue and pain are common after stroke, potentially impacting stroke recovery. Objective: This study examines the frequency and impact of fatigue and pain in people with chronic stroke. Method: Seventy-seven people with chronic stroke completed a one-time assessment consisting of a battery of self-report and performance tools to describe and quantify mobility issues post stroke. We assessed the proportion of individuals with fatigue and pain and the relationship between fatigue and pain and other variables including gait (10-meter walk and 6-minute walk test), balance (Berg Balance Scale), activity and participation (ICF Measure of Participation and Activities), chronic disease self-efficacy (Chronic Disease Self-Efficacy Scale), and balance self-efficacy (Activity-Specific Balance Confidence Scale). Additionally, subgroup comparisons were made between participants with and without coexisting fatigue and pain. Results: Fatigue and pain were reported by 66% and 45% of study participants, respectively. Thirty-four percent of the sample reported co-existing fatigue and pain. Participants with coexisting fatigue and pain demonstrated significantly lower chronic disease and balance self-efficacy and decreased activity than participants without coexisting fatigue and pain. Individually, fatigue correlated with balance, chronic disease self-efficacy, balance self-efficacy, activity, and participation, whereas pain correlated with chronic disease self-efficacy, balance self-efficacy, and activity. Conclusion: Fatigue and pain are common after stroke and are negatively correlated with outcomes important to rehabilitation. Efforts focused on examining the impact of interventions on fatigue and pain are warranted. It is possible that changes to these body structure limitations could positively impact functional recovery and community re-entry after stroke.

Yoga leads to multiple physical improvements after stroke, a pilot study

OBJECTIVEnTo assess change in physical functioning (pain, range of motion (ROM), strength, and endurance) after 8 weeks of therapeutic-yoga.nnnDESIGNnPlanned analyses of data from a randomized pilot study of yoga after stroke.nnnSETTINGnUniversity-based research laboratory.nnnPARTICIPANTSnPeople with chronic stroke (N=47) randomized to therapeutic-yoga (n=37) or wait-list control (n=10).nnnINTERVENTIONSn16 sessions of therapeutic yoga (twice a week/8 weeks). Yoga was delivered in a standardized and progressive format with postures, breathing, and meditation, and relaxation in sitting, standing, and supine.nnnMAIN MEASURESnPain was assessed with the PEG, a 3-item functional measure of the interference of pain. ROM included neck and hip active and passive ROM measurements). Upper and lower extremity strength were assessed with the arm curl test and chair-to-stand test, respectively. Endurance was assessed with the 6-minute walk and modified 2-min step test.nnnRESULTSnAfter a Bonferroni Correction, pain, neck ROM, hip passive ROM, upper extremity strength, and the 6-min walk scores all significantly improved after 8 weeks of engaging in yoga. No changes occurred in the wait-list control group.nnnCONCLUSIONSnA group therapeutic-yoga intervention may improve multiple aspects of physical functioning after stroke. Such an intervention may be complementary to traditional rehabilitation.

Feasibility and results of a case study of yoga to improve physical functioning in people with chronic traumatic brain injury

Abstract Purpose: The purpose of this mixed-methods case study was to investigate whether an 8-week 1:1 yoga program was feasible and beneficial to people with traumatic brain injury (TBI). Method: This was a mixed-methods case study of one-to-one yoga for people with TBI included three people. We completed assessments before and after the 8-week yoga intervention and included measures of balance, balance confidence, pain, range of motion, strength and mobility. Qualitative interviews were included at the post-assessment. We include a percent change calculation and salient quotes that represent the perceived impact of the yoga intervention. Results: All participants completed the yoga intervention and all demonstrated improvements in physical outcome measures. For the group, balance increased by 36%, balance confidence by 39%, lower extremity strength by 100% and endurance by 105%. Qualitative data support the use of yoga to improve multiple aspects of physical functioning, one participant stated: “I mean it’s rocked my world. It’s changed my life. I mean all the different aspects. I mean physically, emotionally, mentally, it’s given me you know my life back…”. Conclusions: Yoga, delivered in a one-to-one setting, appears to be feasible and beneficial to people with chronic TBI. Implications for Rehabilitation Chronic traumatic brain injury (TBI) leads to many aspects of physical functioning impairment. Yoga delivered in a one-to-one setting may be feasible and beneficial for people with chronic TBI.

Examination of Sustained Gait Speed During Extended Walking in Individuals With Chronic Stroke

OBJECTIVESnTo determine if individuals with chronic stroke were able to sustain their peak gait speed during the 6-minute walk test (6MWT), and to explore this sustainability across community ambulation potential subgroups.nnnDESIGNnProspective cross-sectional study.nnnSETTINGnUniversity-based research laboratory, hospitals, and stroke support groups.nnnPARTICIPANTSnA sample of individuals with chronic stroke (N=48) completed a series of questionnaires and physical outcome measures, including gait mat assessment, during a single visit.nnnINTERVENTIONSnNot applicable; 1-time cross-sectional data collection.nnnMAIN OUTCOME MEASURESnDuring the 6MWT, we measured peak gait speed and end gait speed to assess sustainability, along with beginning gait speed, total distance walked, and rating of perceived exertion. We also assessed maximum gait speed during the 10-meter walk test (10MWT). Finally, we examined these gait outcomes across the subgroups.nnnRESULTSnDuring the 6MWT, peak gait speed declined from .89m/s (SD=.38) to an end speed of .82m/s (SD=.36), whereas perceived exertion increased from 7.7 (SD=2.6) to 11.8 (SD=3.6). This peak gait speed was slower than the 10MWT maximum speed of 1.06m/s (SD=.51), but faster than the 6MWT beginning speed of .81m/s (SD=.34). The unlimited community ambulator subgroup was the primary contributor to sustainability differences.nnnCONCLUSIONSnPredicting community ambulation potential based on the discrete gait speed from the 10MWT and endurance based on the average from the 6MWT might be incomplete if gait speed sustainability is not also assessed.

OA10.03. Improved activity, participation, and quality of life for individuals with chronic stroke following an 8-week yoga intervention.

Methods For this pilot study, individuals were randomized 3:1 into the experimental group or wait list control. Forty-seven individuals were recruited into the study, with 37 individuals randomized to the yoga arm, and 10 randomized into the control group. Twenty-nine individuals completed the yoga intervention (22% attrition). The yoga intervention occurred twice per week for 1 hour each session, and was designed for individuals with chronic stroke (>6 months post event). All yoga classes were led by a registered yoga therapist. To measure activity and participation, the ICF Measure of Participation and Activity (IMPACT) subscales were utilized (lower scores indicate higher activity or participation). To measure quality of life, the Stroke Survivor Quality of Life (SSQOL) scale was utilized. Paired t-tests were utilized to compare the baseline and 8-week scores on each of the measures for both groups.

P05.58. Yoga is a feasible intervention for veterans with chronic stroke

Results Four primary themes emerged from the data. Related to preconceived notions, veterans identified that they did not know what to expect, in part because stretching activities seemed too simple to help. While we called this “balance exercise,” veterans had mixed feelings about calling this yoga. All were more accepting of this by the end of the study. However, several, in addition to saying they wouldn’t know what to expect from yoga, said “men don’t do yoga” while another compared it to voodoo. The veterans identified that benefits from participation in a group post-stroke yoga intervention included: acknowledgement of the idea that while there was no pain and the yoga was gentle, it was still effective and powerful; the yoga activities could be done at home alone; and it filled the gap after rehabilitation. Finally, we learned that when working with veterans who had seen combat, there were some important considerations when designing an intervention. These included making sure the participants were not seated with their backs to the door, and introducing all helpers at the beginning of each session, and identifying their role.

P02.166. Group yoga intervention leads to improved balance and balance self-efficacy after stroke

Methods This is a prospective pilot study of a modified yoga intervention. All study participants: had chronic stroke (>9 months); completed all rehabilitation after stroke; were able to stand but self-reported some residual disability related to walking, balance, or functional loss after stroke; and scored > 4 out of 6 on the Short Mini Mental Status Exam. Forty-seven individuals with stroke were recruited and randomized 3:1 to yoga or waitlist control. The yoga group completed one hour yoga sessions twice a week for 8 weeks. Yoga was taught by a certified yoga therapist and included modified physical postures, yoga breathing, bilateral movements, and concluded with relaxation while seated, standing, and supine. Assessments before and after the 8 weeks included: Berg Balance Score (balance), Activities Balance Confidence Scale (ABC, balance self-efficacy), and Falls-Efficacy Scale (falls-efficacy). We compared groups with a t-test/Mann Whitney. We used paired t-tests to compare baseline and 8-week data.