Peter Altenburger

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

OBJECTIVES To (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. DESIGN This 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. SETTING University-based research laboratory, hospitals, and stroke support groups. PARTICIPANTS People (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. INTERVENTIONS Not applicable, this is a cross-sectional data collection of 1 timepoint. MAIN OUTCOME MEASURES We 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). RESULTS Only 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). CONCLUSIONS Among 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.

Is walking faster or walking farther more important to persons with chronic stroke

Purpose: The purposes of this mixed-methods study were to (1) investigate whether walking faster or walking farther was more important for getting “out and about” to persons with chronic stroke and (2) explore explanations for walking preferences. Method: A convenience sample of 77 adults with chronic stroke completed questionnaires and walking outcomes in one visit. Participants were asked whether walking faster or farther was more important to them for getting “out and about”, and differences between response groups (faster vs. farther) were evaluated. Participants also described their preference for walking faster or farther. Qualitative responses were analyzed using content analysis. Results: The majority of participants (76%; n = 58) reported walking farther was more important, while 18% (n = 14) reported walking faster was more important. Statistically significant differences were not found between response groups for any variable. Primary themes identified from participant preferences for walking faster included: (1) faster speed equals better walking ability and (2) getting places faster/quicker. Primary themes from preferences for walking farther included: (1) engaging in activity and participation within home and community; (2) walking farther at a slower pace; and (3) fatigue with walking. Conclusions: Individual preferences for walking faster versus walking farther by persons with chronic stroke should be considered by clinicians when making decisions for rehabilitation. Implications for Rehabilitation Individual preferences for walking faster versus walking farther by patients with chronic stroke should be considered by rehabilitation clinicians when making decisions about examination and intervention. The majority of participants with chronic stroke in this study indicated the importance of walking farther in order to better engage in activities both at home and away from home. Interventions that focus on improving endurance and energy conservation may need to be used for persons with chronic stroke who want to walk father in order to maximize their potential for walking longer distances.

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.

Full-Text Publication of Abstract-Presented Work in Physical Therapy: Do Therapists Publish What They Preach?

Background and Objective Professional meetings, such as the American Physical Therapy Associations (APTAs) Combined Sections Meeting (CSM), provide forums for sharing information relevant to physical therapy. An indicator of whether therapists fully disseminate their work is the number of full-text peer-reviewed publications that result. The purposes of this study were: (1) to determine the full-text publication rate of work presented in abstract form at CSM and (2) to investigate factors influencing this rate. Methods A systematic search was undertaken to locate full-text publications of work presented in abstract form within the Orthopaedic and Sports Physical Therapy sections at CSM between 2000 and 2004. Eligible publications were published within 5 years following abstract presentation. The influences of APTA section, year of abstract presentation, institution of origin, study design, sample size, study significance, reporting of a funding source, and presentation type on full-text publication rate were assessed. Characteristics of full-text publications were explored. Results Work presented in 1 out of 4 abstracts (25.4%) progressed to full-text publication. Odds of full-text publication increased if the abstract originated from a doctorate-granting or “other” institution, reported findings of an experimental study, reported a statistically significant finding, included a larger sample size, disclosed a funding source, or was presented as a platform presentation. More than one third (37.8%) of full-text publications were published in the Journal of Orthopaedic and Sports Physical Therapy or Physical Therapy, and 4 out of 10 full-text publications (39.2%) contained at least one major change from information presented in abstract form. Conclusions The full-text publication rate for information presented in abstract form within the Orthopaedic and Sports Physical Therapy sections at CSM is low relative to comparative disciplines. Caution should be exercised when translating information presented at CSM into practice.

The effect of random or sequential presentation of targets during robot-assisted therapy on children

BACKGROUND Robot assisted upper extremity therapy has been shown to be effective in adult stroke patients and in children with cerebral palsy (CP) and other acquired brain injuries (ABI). The patients active involvement is a factor in its efficacy. However, this demands focused attention during training sessions, which can be a challenge for children. OBJECTIVE To compare results of training requiring two different levels of focused attention. Differences in short term performance and retention of gains as a function of training protocol as measured by the Fugl-Meyer (FM) were predicted. METHODS Thirty-one children with CP or ABI were randomly divided into two groups. All received 16 one hour sessions of robot-assisted therapy (twice a week for 8 weeks) where they moved a robot handle to direct a cursor on the screen toward designated targets. One group had targets presented sequentially in clockwise fashion, the other presented in random order. Thus, one group could anticipate the position of each target, the other could not. RESULTS Both groups showed significant functional improvement after therapy, but no significant difference between groups was observed. CONCLUSIONS Assist-as-needed robotic training is effective in children with CP or ABI with small non-significant differences attributed to attentional demand.

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

OBJECTIVES To 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. DESIGN Prospective cross-sectional study. SETTING University-based research laboratory, hospitals, and stroke support groups. PARTICIPANTS A 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. INTERVENTIONS Not applicable; 1-time cross-sectional data collection. MAIN OUTCOME MEASURES During 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. RESULTS During 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. CONCLUSIONS Predicting 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.

The Influence of Mood-Related Variables on Activity and Participation in Individuals With Chronic Stroke

Little information exists about the influence of mood-related variables on the activity and participation of survivors of chronic stroke despite the known implications of anxiety and depression on overall participation patterns. Grounded within International Classification of Functioning, Disability, and Health, this study examined 77 individuals with chronic stroke to determine the influence of depression, anxiety, and sense of coherence on activity and participation. Backward stepwise regression revealed that depression and anxiety were both independent predictors of activity and participation, but that sense of coherence did not predict either activity or participation. Implications for practice and research are provided.

Poster 67 Therapeutic-Yoga after Stroke: Effect on Walking Recovery

Results: Percent change scores per assessment before and after the 6 week home program. FMA-UE: subjects 1 and 4 had no change, subject 2 had a 33% increase, subject 3 had a 25% decrease. AMAT: Subject 1, 2, 4 had increases, 14.9%, 8.3%, 23.1% respectively. Subject 3 had no change. MAL (amount of use scale): subject 1, 2, 3, 4 experienced increased scores, 1360%, 280%, 45.2%, and 170% respectively. Conclusions: All subjects were successfully trained with the Myomo in the clinic and used the device at home independently for a 6 week period, indicating the feasibility of our study design. The FMA-UE, an impairment level outcome measure, showed the least improvement. However, most subjects experienced improvements on the AMAT and the MAL, both activity level assessments. Despite minimal improvements in motor impairments, the improvements in MAL suggest that subjects increased integration their affected arm in functional tasks during the 6 week program.