Susanne Palmcrantz

Clinical application of the Hybrid Assistive Limb (HAL) for gait training—a systematic review

Objective: The aim of this study was to review the literature on clinical applications of the Hybrid Assistive Limb system for gait training. Methods: A systematic literature search was conducted using Web of Science, PubMed, CINAHL and clinicaltrials.gov and additional search was made using reference lists in identified reports. Abstracts were screened, relevant articles were reviewed and subject to quality assessment. Results: Out of 37 studies, 7 studies fulfilled inclusion criteria. Six studies were single group studies and 1 was an explorative randomized controlled trial. In total, these studies involved 140 participants of whom 118 completed the interventions and 107 used HAL for gait training. Five studies concerned gait training after stroke, 1 after spinal cord injury (SCI) and 1 study after stroke, SCI or other diseases affecting walking ability. Minor and transient side effects occurred but no serious adverse events were reported in the studies. Beneficial effects on gait function variables and independence in walking were observed. Conclusions: The accumulated findings demonstrate that the HAL system is feasible when used for gait training of patients with lower extremity paresis in a professional setting. Beneficial effects on gait function and independence in walking were observed but data do not allow conclusions. Further controlled studies are recommended.

Long-term health states relevant to young persons with stroke living in the community in southern Stockholm – a study of self-rated disability and predicting factors

Purpose: The purpose was to explore self-rated long-term disability and to analyze whether initial stroke-related, personal and environmental factors can predict disability in a population-based sample of community-dwelling young (<65 years) persons suffering a stroke in 2000–2006. Method: Data on initial stroke-related, personal and environmental factors were retrieved from medical records. A study-specific posted questionnaire was used. Results: Of the 158 young persons with stroke, 78% had suffered a mild stroke. Tiredness was the most commonly reported mental impairment (86%) followed by impaired memory (67%). A majority reported limitations/restrictions in returning to leisure activities (58%) and work (52%). Stroke-related, personal and environmental factors failed to predict self-reported mental and physical impairments, but predicted activity limitations/participation restrictions with an acceptable power of accuracy (0.70–0.73) but a low sensitivity (0.28–0.59). Conclusions: A majority of these young persons were diagnosed with a mild stroke but experienced long-term mental impairments and activity limitations/participation restrictions that could not be predicted by initial stroke-related, personal and environmental factors solely. Therefore, regular long-term assessments irrespective of initial stroke severity are warranted in order to identify disabilities and improve the state of health among young persons with stroke when needed. Implications for Rehabilitation A majority of young persons with stroke are diagnosed with a mild stroke but experience long-term disability that cannot be predicted by initial stroke-related factors solely. Regular long-term assessments are warranted in order to identify disabilities and improve the state of health among young persons with stroke.

Assessing feasibility and acceptability of study procedures: getting ready for implementation of national stroke guidelines in out-patient health care

BackgroundEven though Swedish national guidelines for stroke care (SNGSC) have been accessible for nearly a decade access to stroke rehabilitation in out-patient health care vary considerably. In order to aid future interventions studies for implementation of SNGSC, this study assessed the feasibility and acceptability of study procedures including analysis of the context in out-patient health care settings.MethodsThe feasibility and acceptability of recruitment, observations and interviews with managers, staff and patients were assessed, as well as the feasibility of surveying health care records.ResultsTo identify patients from the the hospitals was feasible but not from out-patient care where a need to relieve clinical staff of the recruitment process was identified. Assessing adherence to guidelines and standardized evaluations of patient outcomes through health care records was found to be feasible and suitable assessment tools to evaluate patient outcome were identified. Interviews were found to be a feasible and acceptable tool to survey the context of the health care setting.ConclusionIn this feasibility study a variety of qualitative and quantitative data collection procedures and measures were tested. The results indicate what can be used as a set of feasible and acceptable data collection procedures and suitable measures for studying implementation of stroke guidelines in an out-patient health care context.

Young individuals with stroke: a cross sectional study of long-term disability associated with self-rated global health

BackgroundPerceived disability after stroke may persist long-term even among young individuals with mild stroke and may be related to age-related expectations of health and recovery. Thus, in order to appreciate the magnitude of perceived disability in a younger stroke population studies are needed to explore perceived health-related differences between young individuals with stroke and a matched general population. Further, to provide long-term measures by health care, relevant to the same young individuals with stroke, their perceived long-term functioning and disability associated with health need to be explored.MethodsThe generic questionnaire EQ-5D was used to compare ratings of global health and disability between young individuals living in the community up to 6 years after stroke (n = 150) and an age and geographically matched general population (n = 2661). Stroke related medical data were retrieved from medical records and the study specific questionnaire, the MYS-questionnaire, was used to assess self-rated disability associated with global health.ResultsAmong the young individuals 79% had suffered a mild stroke, 45% rated a low global health compared to 15% of the matched general population and a higher proportion rated problems in mobility, self-care, usual activities and anxiety/depression. Among the young individuals with stroke, limitations and restrictions in leisure activities, work, reading as well as low level of physical activity, utilizing personal care provider or personal assistance and tiredness were negatively associated with self-rated global health (R square 0.60).ConclusionThe negative effects of stroke, on self-rated global health among young individuals living in the community, appear to be substantial, multi factorial and long-standing which call for interdisciplinary research collaborations and team measures by health care long-term.

Development, validity and reliability of a postal questionnaire assessing health states relevant to young persons with stroke in Sweden.

Purpose. The aim was to develop and test a postal questionnaire, the Swedish MYS questionnaire, for validity and reliability in order to survey health states relevant to young persons with stroke. Method. The questionnaire was designed with the International Classification of Functioning, Disability and Health as a frame and tested for content validity, face validity and readability by a group of experts including an occupational therapist, a physician, a physiotherapist, a psychologist, a speech and language therapist, a welfare officer and a selected sample of young persons with stroke (n  ==  15). To test the questionnaire for reliability in terms of stability a test–retest was performed on a selected sample of young persons (n  ==  20) with stroke. Results. The questionnaire was found to be valid in terms of content validity, face validity and readability and finally consisted of 59 questions encompassing health states relevant to young persons with stroke. The questionnaire was stable in the test–retest (κ; 0.40–1.0) except for two questions and one alternative answer. Conclusion. The Swedish MYS questionnaire is a valid and reliable questionnaire that can be used in postal surveys of young persons with stroke except for two questions and one answering alternative, which need to be tested further.

An interactive distance solution for stroke rehabilitation in the home setting - A feasibility study.

ABSTRACT Background: In this study an interactive distance solution (called the DISKO tool) was developed to enable home-based motor training after stroke. Objectives: The overall aim was to explore the feasibility and safety of using the DISKO-tool, customized for interactive stroke rehabilitation in the home setting, in different rehabilitation phases after stroke. Methods: Fifteen patients in three different stages in the continuum of rehabilitation after stroke participated in a home-based training program using the DISKO-tool. The program included 15 training sessions with recurrent follow-ups by the integrated application for video communication with a physiotherapist. Safety and feasibility were assessed from patients, physiotherapists, and a technician using logbooks, interviews, and a questionnaire. Qualitative content analysis and descriptive statistics were used in the analysis. Results: Fourteen out of 15 patients finalized the training period with a mean of 19.5 minutes spent on training at each session. The DISKO-tool was found to be useful and safe by patients and physiotherapists. Conclusions: This study demonstrates the feasibility and safety of the DISKO-tool and provides guidance in further development and testing of interactive distance technology for home rehabilitation, to be used by health care professionals and patients in different phases of rehabilitation after stroke.

Users perspectives on interactive distance technology enabling home-based motor training for stroke patients.

The aim of this work has been to develop a technical support enabling home-based motor training after stroke. The basis for the work plan has been to develop an interactive technical solution supporting three different groups of stroke patients: (1) patients with stroke discharged from hospital with support from neuro team; (2) patients with stroke whose support from neuro team will be phased out and (3) patients living with impaired motor functions long-term. The technology has been developed in close collaboration with end-users using a method earlier evaluated and described [12]. This paper describes the main functions of the developed technology. Further, results from early user-tests with end-users, performed to identify needs for improvements to be carried out during further technical development. The developed technology will be tested further in a pilot study of the safety and, usefulness of the technology when applied as a support for motor training in three different phases of the post-stroke rehabilitation process.

Development and validation of the Swedish national stroke register Riksstroke’s questionnaires in patients at 3 and 12 months after stroke: a qualitative study

Objectives Because healthcare and community organisations and treatment methods are always changing, continuous changes might also be needed in questionnaires that register patient-reported outcomes (PRO) and patient-reported experiences (PRE) of healthcare interventions and community support. Thus, the aim of this study was to test the content and face validity, including the readability, of two questionnaires used by the Swedish national stroke register Riksstroke to register PRO and PRE at 3 and 12 months poststroke. Design Clinicians’ and patients’ knowledge and experiences of current care, rehabilitation, community support and functioning after stroke as well as comments noted regarding the content and layout of the questionnaires were retrieved in focus-groups with expert clinicians and in patient interviews analysed with content analysis. A workgroup of experts with experience in stroke care, rehabilitation and research repeatedly revised the questionnaires regarding content, layout and consistency throughout the validation process. Participants The participants included allied healthcare professionals, nurses and physicians with extensive experience of working with stroke care and rehabilitation (expert clinicians) as well as patients who had suffered a stroke 3 or 12 months earlier and who were purposefully selected among those who had completed and returned the 3-month questionnaire. Setting Expert clinicians met at their work place in focus-groups. Patients were interviewed where they resided, that is, in their home or nursing home, including rural, town and city areas in Sweden. Results Based on clinical expertise and comments from the patients (n=47), the questionnaires were revised and then found to be valid in terms of content validity and face validity, including readability. Conclusions The present evaluation emphasises the need for testing aspects of validity, including readability, of questionnaires addressing PRO and PRE and for the recurrent revision of such questionnaires in order to maintain their validity in a society undergoing constant change.

Corrigendum to “Differences between younger and older individuals in their use of care and rehabilitation but not in self-perceived global recovery 1 year after stroke” [J Neurol Sci 321 (2012) 29–34]

a Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden b Division of Neurology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden c Department of Geriatric Medicine, Danderyd Hospital, Danderyd, Sweden d Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden e Dalarna University, School of Health and Social Studies, Falun, Sweden