Sheila Lennon

Control of Human Voluntary Movement

New updated! The latest book from a very famous author finally comes out. Book of control of human voluntary movement, as an amazing reference becomes what you need to get. Whats for is this book? Are you still thinking for what the book is? Well, this is what you probably will get. You should have made proper choices for your better life. Book, as a source that may involve the facts, opinion, literature, religion, and many others are the great friends to join with.

The Effectiveness of the Bobath Concept in Stroke Rehabilitation: What is the Evidence?

Background and Purpose— In the Western world, the Bobath Concept or neurodevelopmental treatment is the most popular treatment approach used in stroke rehabilitation, yet the superiority of the Bobath Concept as the optimal type of treatment has not been established. This systematic review of randomized, controlled trials aimed to evaluate the available evidence for the effectiveness of the Bobath Concept in stroke rehabilitation. Method— A systematic literature search was conducted in the bibliographic databases MEDLINE and CENTRAL (March 2008) and by screening the references of selected publications (including reviews). Studies in which the effects of the Bobath Concept were investigated were classified into the following domains: sensorimotor control of upper and lower limb; sitting and standing, balance control, and dexterity; mobility; activities of daily living; health-related quality of life; and cost-effectiveness. Due to methodological heterogeneity within the selected studies, statistical pooling was not considered. Two independent researchers rated all retrieved literature according to the Physiotherapy Evidence Database (PEDro) scale from which a best evidence synthesis was derived to determine the strength of the evidence for both effectiveness of the Bobath Concept and for its superiority over other approaches. Results— The search strategy initially identified 2263 studies. After selection based on predetermined criteria, finally, 16 studies involving 813 patients with stroke were included for further analysis. There was no evidence of superiority of Bobath on sensorimotor control of upper and lower limb, dexterity, mobility, activities of daily living, health-related quality of life, and cost-effectiveness. Only limited evidence was found for balance control in favor of Bobath. Because of the limited evidence available, no best evidence synthesis was applied for the health-related quality-of-life domain and cost-effectiveness. Conclusions— This systematic review confirms that overall the Bobath Concept is not superior to other approaches. Based on best evidence synthesis, no evidence is available for the superiority of any approach. This review has highlighted many methodological shortcomings in the studies reviewed; further high-quality trials need to be published. Evidence-based guidelines rather than therapist preference should serve as a framework from which therapists should derive the most effective treatment.

Virtual reality in stroke rehabilitation: still more virtual than real.

Purpose. To assess the utility of virtual reality (VR) in stroke rehabilitation. Method. The Medline, Proquest, AMED, CINAHL, EMBASE and PsychInfo databases were electronically searched from inception/1980 to February 2005, using the Keywords: Virtual reality, rehabilitation, stroke, physiotherapy/physical therapy and hemiplegia. Articles that met the studys inclusion criteria were required to: (i) be published in an English language peer reviewed journal, (ii) involve the use of VR in a stroke rehabilitation setting; and (iii) report impairment and/or activity oriented outcome measures. Two assessors independently assessed each studys quality using the American Academy for Cerebral Palsy and Developmental Medicine (AACPDM) grading system. Results. Eleven papers met the inclusion criteria: Five addressed upper limb rehabilitation, three gait and balance, two cognitive interventions, and one both upper and lower limb rehabilitation. Three were judged to be AACPDM Level I/Weak, two Level III/Weak, three Level IV/Weak and three Level V quality of evidence. All articles involved before and after interventions; three randomized controlled trials obtained statistical significance, the remaining eight studies found VR-based therapy to be beneficial. None of the studies reported any significant adverse effects. Conclusion. VR is a potentially exciting and safe tool for stroke rehabilitation but its evidence base is too limited by design and power issues to permit a definitive assessment of its value. Thus, while the findings of this review are generally positive, the level of evidence is still weak to moderate, in terms of research quality. Further study in the form of rigorous controlled studies is warranted.

The modified Rivermead Mobility Index: validity and reliability

Purpose : This paper presents the evaluation of the following psychometric properties of the Modified Rivermead Mobility Index (MRMI): face/content validity, responsiveness, testretest reliability, inter-rater reliability and internal consistency. This mobility scale represents a further development of the Rivermead Mobility Index (RMI). In its new form the scoring was adapted from a two-point to a six-point scale. The number of test items was reduced from fifteen to eight items in order to measure mobility-related items that physiotherapists consider being essential for demonstrating treatment effects in patients following a stroke. Method : A consensus exercise with forty-two physiotherapists attending a stroke care conference established face/content validity. Inter-rater and test-retest reliability were examined by assessing thirty patients by two independent raters selected from a pool of eight physiotherapists in two different settings, an elderly care unit and a stroke rehabilitation unit. All patients were hospitalised and had experienced a stroke within the past six weeks. Responsiveness was examined by calculating the effect size statistic on the admission and discharge score of sixteen acute patients following stroke. Results : The results showed that the modified RMI was: responsive to change (effect size = 1.15), stable when tested on two occasions (paired t-test = 0.732; p 0.47), highly reliable between raters (ICC = 0.98; p<0.001) with high internal consistency (Cronbachs alpha = 0.93). Conclusions : These results suggest that when using the Modified RMI to assess patients in the early stages following stroke, similar results can be obtained by different raters, regardless of experience. However there needs to be a difference of more than 4.5 points (degree of measurement error at 95% confidence level) in the overall score to detect true changes in the patients level of mobility.

Self-management programmes for people post stroke: a systematic review

Objective: To examine the evidence base underlying self-management programmes specific to stroke survivors. Data sources: Eleven electronic databases were searched using combinations of keywords related to stroke and self-management. Review methods: Studies involving adults with a clinical diagnosis of stroke, which explored self-management interventions, were included. Study selection was verified by two reviewers who independently conducted methodological quality appraisal and data extraction using a tool developed by The American Academy for Cerebral Palsy and Developmental Medicine. Results: Fifteen studies were included in this review. Significant treatment effects in favour of the self-management intervention were found in six out of nine randomized controlled trials, and three out of six non-randomized trials in our review. Four randomized controlled trials involving more than 100 participants per trial reported statistically significant results in favour of the self-management group in relation to measures of disability, confidence in recovery, the stroke specific quality of life (sub-scales of family roles and fine motor tasks), and the physical component scale of the short form SF-36 Score. The wide range of outcome measures used prevented comparison across studies. Conclusions: This review provides some preliminary support for the potential importance of self-management interventions after stroke. The most appropriate content and best approach for delivery of these interventions remains to be determined. Further high-quality randomized controlled trials are needed to test the feasibility, acceptability, and efficacy of stroke self-management programmes.

Virtual reality in the rehabilitation of the arm after hemiplegic stroke: a randomized controlled pilot study

Objective: To assess the feasibility of a trial to investigate the effectiveness of virtual reality-mediated therapy compared to conventional physiotherapy in the motor rehabilitation of the arm following stroke, and to provide data for a power analysis to determine numbers for a future main trial. Design: Pilot randomized controlled trial. Setting: Clinical research facility. Participants: Eighteen people with a first stroke, 10 males and 8 females, 7 right and 2 left side most affected. Mean time since stroke 10.8 months. Interventions: Participants were randomized to a virtual reality group or a conventional arm therapy group for nine sessions over three weeks. Main measures: The upper limb Motricity Index and the Action Research Arm Test were completed at baseline, post intervention and six weeks follow-up. Results: Outcome data were obtained from 95% of participants at the end of treatment and at follow-up: one participant withdrew. Compliance was high; only two people reported side-effects from virtual reality exposure. Both groups demonstrated small (7–8 points on upper limb Motricity Index and 4 points on the Action Research Arm Test), but non-significant, changes to their arm impairment and activity levels. Conclusion: A randomized controlled trial of virtual reality-mediated therapy comparable to conventional therapy would be feasible, with some suggested improvements in recruitment and outcome measures. Seventy-eight participants (39 per group) would be required for a main trial.

Virtual reality in the rehabilitation of the upper limb after stroke: The user's perspective

Our group has developed a relatively low-cost virtual reality (VR) system for rehabilitation of the upper limb following stroke. Our system is immersive in that the participant views a representation of their arm and hand, reaching and retrieving objects in the virtual environment (VE), through a head-mounted display (HMD). This is thought to increase the participants sense of presence in the VE and may lead to improved rehabilitation outcomes. However, use of immersion, particularly with our low-cost system, may increase the incidence of side effects reported. Therefore, the aim of this project was to assess the interaction of healthy users and those following stroke, in terms of their experience of presence in the VE and the rate of self-reported side effects. Differences in rates of perceived exertion, levels of enjoyment, and sense of control between both groups were also explored.

Reasons for persistent disability in Guillain-Barre syndrome

The reasons for persistent disability in 10 Guillain-Barre syndrome patients were investigated. Patients were assessed between 11 and 35 months after disease onset with impairment, disability and handicap scales, a standard neurological examination and nerve conduction studies. All patients showed persistent limb weakness which affected independence in self-care in three patients and the pursuit of leisure and work activities in eight patients. The implications for clinical practice are discussed.

Key Physiotherapy Indicators for Quality of Stroke Care

Summary This paper was produced for the intercollegiate Stroke Working Party organised by the Royal College of Physicians. Quality indicators are highlighted which identify minimum performance standards for a physiotherapy service in stroke care in any environment. These indicators have been selected from the standards of practice published by the Chartered Society of Physiotherapy and the Specific Interest Groups representing community physiotherapy, elderly care, and neurology. In the first section of this paper the role of physiotherapists is identified followed by a discussion of structure, process and outcome in stroke rehabilitation. Two stages in stroke care are recognised: an initial acute stage focused on impairment, and a second stage focused on disability and handicap. This paper emphasises that neither specific approaches nor techniques should be prescribed in stroke rehabilitation, as evidence to support the superiority of one approach over another is lacking. Standards have been identified in the areas of assessment, goal setting, teamwork, treatment, education of patients and carers and expected outcomes. Each standard is followed by criteria: the key clinical activities that demonstrate that the standard is being achieved. Some of these standards are integrated into an interdisciplinary audit tool; others which are more profession-specific are included in a physiotherapy audit tool. Both of these tools will be published by the Royal College of Physicians following a consensus exercise and pilot phase. A consensus of good practice in stroke care is essential to improve the organisation and provision of services for patients following stroke. Physiotherapists are encouraged to adopt these quality standards on a national level.

What is Bobath? A survey of UK stroke physiotherapists' perceptions of the content of the Bobath concept to treat postural control and mobility problems after stroke

Objective. The aim of this study was to identify which interventions used to treat postural control and mobility are considered part of the Bobath concept (BC). Design. Hospital-based UK stroke physiotherapists identified interventions which they perceived to be part of the BC from a pre-published list of interventions used to treat postural control and mobility problems. Interventions that >75% of participants felt were part of the BC were classified as ‘definitely Bobath’. Interventions that <25% felt were part of the BC were classified as ‘definitely not Bobath’. Other interventions were classified as ‘unsure’; those indentified by 50–74% of participants as part of the BC were classified as ‘probably Bobath’ and those indentified 26–49% were classified as ‘probably not Bobath’. Results. Seventy-four physiotherapists from 33 hospitals participated. Facilitation, mobilizations and practicing components of activities were most strongly associated with the BC. Exercise and the use of equipment were identified as ‘not’ or ‘probably not Bobath’. There was uncertainty about practicing activities, teaching patients and carers and arranging independent practice. Conclusions. UK stroke physiotherapists perceive that the BC involves interventions that focus on facilitating movement, mobilization, practicing components of activities and some whole activities. Their views about what is not part of the BC and the areas where they are uncertain contrast with British and international teachers of the BC. Consequently, it was not possible to define a ‘typical package’ of treatment for postural control and mobility that represents the BC. Future research into the BC should focus on the effectiveness of specific, well-defined interventions.