Tara S. Patterson

Active Finger Extension Predicts Outcomes After Constraint-Induced Movement Therapy for Individuals With Hemiparesis After Stroke

Background and Purpose— Constraint-induced movement therapy (CIMT) is a rehabilitative strategy used primarily with the post-stroke population to increase the functional use of the neurologically weaker upper extremity through massed practice while restraining the lesser involved upper extremity. Whereas research evidence supports CIMT, limited evidence exists regarding the characteristics of individuals who benefit most from this intervention. The goal of this study was to investigate the potential of 5 measures to predict functional CIMT outcomes. Methods— A convenience sample of 55 individuals, >6 months after stroke, was recruited that met specific inclusion/exclusion criteria allowing for individuals whose upper extremity was mildly to severely involved. They participated in CIMT 6 hours per day. Pretest, post-test, and follow-up assessments were performed to assess the outcomes for the Wolf Motor Function Test (WMFT). The potential predictors were minimal motor criteria (active extension of the wrist and 3 fingers), active finger extension/grasp release, grip strength, Fugl–Meyer upper extremity motor score, and the Frenchay score. A step-wise regression analysis was used in which the potential predictors were entered in a linear regression model with simultaneous entry of the dependent variables’ pretest score as the covariate. Two regressions models were determined for the dependent variable, for immediate post-test, and for follow-up post-test. Results— Finger extension was the only significant predictor of WMFT outcomes. Conclusions— When using finger extension/grasp release as a predictor in the regression equations, one can predict individual’s follow-up scores for CIMT. This experiment provides the most comprehensive investigation of predictors of CIMT outcomes to date.

Reduction of freezing of gait in Parkinson's disease by repetitive robot-assisted treadmill training: a pilot study

BackgroundParkinsons disease is a chronic, neurodegenerative disease characterized by gait abnormalities. Freezing of gait (FOG), an episodic inability to generate effective stepping, is reported as one of the most disabling and distressing parkinsonian symptoms. While there are no specific therapies to treat FOG, some external physical cues may alleviate these types of motor disruptions. The purpose of this study was to examine the potential effect of continuous physical cueing using robot-assisted sensorimotor gait training on reducing FOG episodes and improving gait.MethodsFour individuals with Parkinsons disease and FOG symptoms received ten 30-minute sessions of robot-assisted gait training (Lokomat) to facilitate repetitive, rhythmic, and alternating bilateral lower extremity movements. Outcomes included the FOG-Questionnaire, a clinician-rated video FOG score, spatiotemporal measures of gait, and the Parkinsons Disease Questionnaire-39 quality of life measure.ResultsAll participants showed a reduction in FOG both by self-report and clinician-rated scoring upon completion of training. Improvements were also observed in gait velocity, stride length, rhythmicity, and coordination.ConclusionsThis pilot study suggests that robot-assisted gait training may be a feasible and effective method of reducing FOG and improving gait. Videotaped scoring of FOG has the potential advantage of providing additional data to complement FOG self-report.

Reliability of Upper Extremity Kinematics While Performing Different Tasks in Individuals With Stroke

ABSTRACT Assessments of upper extremity performance typically include qualitative rather than quantitative measures of functional ability. Kinematic analysis is an objective, discriminative measure that quantifies movement biomechanics; however, the use within the poststroke impaired upper extremity is not well established. The purpose of this study was to examine the reliability of upper extremity kinematics in 18 individuals with stroke and 9 healthy controls. Participants performed reaching and grasping tasks over 2 separate days and metrics included movement time, peak velocity, index of curvature, trunk displacement, maximum aperture, and percentage of the movement cycle where maximum aperture occurred. The results showed moderate to high intraclass correlation and low standard error of measurement values for most variables, demonstrating that kinematic analysis may be a feasible and useful tool to quantify upper extremity movement after stroke.

Speed- and cane-related alterations in gait parameters in individuals with multiple sclerosis.

Previous literature reporting gait parameters in the MS population has largely focused on preferred walking speed without the use of an assistive device. However, these data may not fully represent daily activity, as individuals with MS vary their speed or use a cane when walking. In this exploratory study, 11 MS participants and 13 controls walked at both maximal and preferred speed for a distance of 25-feet. Participants with MS that used a cane daily (n=6) were asked to complete additional trials with their cane. When walking unassisted at both speeds, MS participants displayed significantly reduced velocity, cadence, stride length, step length ratio, single support and swing time, as well as increased double support and stance time compared to controls. Cane use resulted in significantly higher velocities when walking at maximal speeds, and showed significantly improved variability, gait asymmetry, and bilateral coordination at preferred walking speed. In conclusion, the use of a cane may significantly improve gait for individuals with MS. Furthermore, gait parameters should be measured at both maximal and preferred speeds, with and without a cane, as its use may mask underlying gait impairment.

Improved Fall-Related Efficacy in Older Adults Related to Changes in Dynamic Gait Ability

Background Low fall-related efficacy is associated with the number and severity of future falls in older adults with balance disorders. Objective The purpose of this study was to examine whether improvements in clinical measures of balance after an intervention program were associated with changes in efficacy. Design. A prospective, nonexperimental, pretest-posttest design was used. Methods Sixty-three people (43 men, 20 women; mean [±SD] age=76.6±4.9 years) with a history of at least 2 falls in the previous 12 months were enrolled between 2004 and 2008 to participate in a 12-week home exercise program. Balance deficits were identified using the Berg Balance Scale (BBS) and the Dynamic Gait Index (DGI), and participants were evaluated monthly. Hierarchical linear regression was used to assess the relationship between measures of balance (BBS and DGI) and efficacy (Falls Efficacy Scale) before intervention. A second model examined the relationship between changes in balance and changes in efficacy after participation in the program. Results Preintervention scores of efficacy were significantly associated with age, depression, and BBS and DGI scores. After controlling for age, depression, and strength (force-generating capacity), BBS and DGI scores together accounted for 34% of the variance in preintervention efficacy. Significant improvements were noted in efficacy, BBS and DGI scores, and depression after intervention. When controlling for preintervention efficacy and changes in depression, the changes in DGI and BBS scores together explained 11% of the variance in the change in fall-related efficacy; however, only DGI scores contributed uniquely. Limitations These results are tempered by the absence of a control group to examine the role of time on changes in efficacy. Conclusions The results suggest that increased emphasis on mobility during rehabilitation leads to improved confidence to perform activities of daily living without falling.

Response to Intensive Upper Extremity Therapy by Individuals with Ataxia from Stroke

Abstract Objective: This study investigated whether or not individuals with ataxia from stroke improve their upper extremity motor function with intense motor practice. Method: Three individuals with ataxia from chronic stroke completed modified constraint-induced movement therapy (CIMT) protocols. Stroke Participants 1 and 2 completed 60 hours and Stroke Participant 3 completed 30 hours of graded task practice while being asked to wear a mitt on the nonparetic arm for 90% of waking hours. Outcome measures were the upper extremity subscale of the Fugl-Meyer Motor Assessment, Wolf Motor Function Test, Motor Activity Log, and kinematics of reaching. Results: All stroke participants improved on either the Fugl-Meyer or the Wolf tests and increased their daily use of the paretic upper extremity. Participants 1 and 2 also improved on all kinematic measures: maximum velocity and time to maximum velocity increased, while index of curvature, number of peaks in the velocity profile, and trunk movement decreased. Participant 3 improved on some kinematic measures (smoother velocity profile, increased time to maximum velocity, decreased number of peaks in the velocity profile) but not all (decreased maximum velocity, increased index of curvature). Conclusion: Individuals with ataxia from stroke can improve their motor function with intense motor practice.

Feasibility of entrainment with ankle mechanical perturbation to treat locomotor deficit of neurologically impaired patients

Entraining human gait with periodic torque from a robot may provide a novel approach to robot-aided walking therapy that is competent to exploit the natural oscillating dynamics of human walking. To test the feasibility of this strategy we applied a periodic ankle torque to neurologically impaired patients (one with stroke and one with multiple sclerosis). As observed in normal human walking, both patients adapted their gait periods to synchronize with the perturbation by phase-locking the robotic torque at terminal stance phase. In addition, their gait cadence became significantly faster due to the training with clear after effects when the perturbation ceased. These results support a new strategy for walking therapy that exploits an embedded neural oscillator interacting with peripheral mechanics and the resulting natural dynamics of walking, which are essential but hitherto neglected elements of walking therapy.