Biomedical subjects

Sarah F Tyson

Publications and source records attributed to Sarah F Tyson.

6 recordsLinked to original sources

PubMed2006

Distribution of weakness in the upper and lower limbs post-stroke.

OBJECTIVE: To assess the distribution of weakness in the upper and lower limbs post-stroke and the factors associated with weakness. METHOD: The design was a prospective cross-sectional survey. A consecutive sample of 75 patients (37 (49%) men, mean age 71.5 (SD 12.2) years, 46 (61%) left hemiplegics) with a first-time anterior-circulation stroke, tested 2 - 4 weeks post-stroke, were recruited from two NHS trusts. MAIN OUTCOME MEASURES: Weakness (Motricity Index, MI). RESULTS: Mean MI score was 58.5 (SD 39.6) and 69.1 (SD 33.6) for the upper and lower limb (p < 0.001), but examination of individual data indicated 36 (48%) had no/ negligible difference (0 +/- 9 points) in MI score between the limbs. When there was a difference, the lower limb was more frequently the stronger. There was no significant difference between the proximal and distal joints in either limb (p < 0.217 and 0.410). Severity of weakness was not associated with the subjects' demographics or stroke pathology, but was associated with neglect and sensation. CONCLUSIONS: Although group analysis showed that the leg was significantly stronger than the arm, individual analysis showed that most participants had a similar degree of weakness in both limbs. When there was a difference, the lower limb was more frequently the stronger. Proximal joints were not more severely affected than distal joints. Patient demographics and stroke pathology factors were not associated with weakness, but stroke-related impairments were.

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PubMed2006

Balance disability after stroke.

BACKGROUND AND PURPOSE: Balance disability is common after stroke, but there is little detailed information about it. The aims of this study were to investigate the frequency of balance disability; to characterize different levels of disability; and to identify demographics, stroke pathology factors, and impairments associated with balance disability. SUBJECTS: The subjects studied were 75 people with a first-time anterior circulation stroke; 37 subjects were men, the mean age was 71.5 years (SD=12.2), and 46 subjects (61%) had left hemiplegia. METHODS: Prospective hospital-based cross-sectional surveys were carried out in 2 British National Health Service trusts. The subjects' stroke pathology, demographics, balance disability, function, and neurologic impairments were recorded in a single testing session 2 to 4 weeks after stroke. RESULTS: A total of 83% of the subjects (n=62) had a balance disability; of these, 17 (27%) could sit but not stand, 25 (40%) could stand but not step, and 20 (33%) could step and walk but still had limited balance. Subjects with the most severe balance disability had more severe strokes, impairments, and disabilities. Weakness and sensation were associated with balance disability. Subject demographics, stroke pathology, and visuospatial neglect were not associated with balance disability. DISCUSSION AND CONCLUSION: Subjects with the most severe balance disability had the most severe strokes, impairments, and disabilities. Subject demographics, stroke pathology, and visuospatial neglect were not associated with balance disability.

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PubMed2004

The development of the Stroke Physiotherapy Intervention Recording Tool (SPIRIT).

PURPOSE: To develop a recording system that describes physiotherapy interventions for the rehabilitation of postural control post-stroke. METHODS DESIGN: A draft recording tool was developed using the method described by Edwards et al, involving literature searches and collaboration with senior clinicians. It was piloted with stroke physiotherapists using a cross-sectional survey design to assess validity, utility and completeness. Participants used the recording tool to record five treatment sessions. Feedback regarding the utility and completeness of the system was obtained via short semi-structured interviews. SETTING: 11 NHS Trusts. PARTICIPANTS: 35 stroke physiotherapists working in acute and rehabilitation settings recorded the treatment of 120 patients in 590 treatment sessions. RESULTS: A double-sided A4 form with a checklist of 79 physiotherapy interventions in 9 categories was produced: the Stroke Physiotherapy Intervention Recording Tool (SPIRIT). The participants found it quick and easy to use and reflective of clinical practice. There were a few missing interventions and some confusion regarding definition of terms. Revisions were to include the omitted interventions and to produce a user's booklet defining the categories and interventions. CONCLUSIONS: SPIRIT provides a system for recording physiotherapy treatment for stroke patients which reflects current clinical practice in acute and rehabilitation settings.

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PubMed2004

Development of the Brunel Balance Assessment: a new measure of balance disability post stroke.

OBJECTIVE: To report the psychometric properties of the Brunel Balance Assessment (BBA), a new test of balance disability post stroke. DESIGN: Data from 92 subjects were collected and cohorts used to test hierarchical scaling, reliability and validity. Data from 80 people were used to test the hierarchical scaling using an inter-item correlation for redundancy, coefficient of reproducibility (CR) and scalability (CS) for the hierarchy and Cronbach's alpha coefficient for the internal consistency. Thirty-seven people participated in the reliability testing. Test-retest and inter-tester reliability were tested using the kappa coefficient. The testing was repeated on consecutive days to assess test-retest reliability and was scored simultaneously by two physiotherapists for inter-tester reliability. Fifty-five people participated in validity testing. The BBA was compared with the sitting Motor Assessment Scale (MAS), Berg Balance Test (Berg), Rivermead Mobility Index (RMI) using Spearman's rho. SETTING: Physiotherapy stroke services of six UK NHS trusts. PARTICIPANTS: Hemiplegic stroke patients were recruited from physiotherapy services and the BBA used to assess their balance. RESULTS: The order of the items was revised and the original 14-point scale reduced to 12 points in the scale development. The revised scale formed a hierarchical scale. Inter-item correlations were < 0.9, coefficients of reproducibility and scalability were 0.99 and 0.69 respectively and Cronbach's alpha was 0.92. Reliability was high (100% agreement) for both aspects of reliability. Correlations with other balance measures were significant (0.83-0.97, p < 0.01) indicating validity as measure of balance disability. CONCLUSION: The BBA is a reliable, valid, hierarchical measure of balance disability post stroke that is suitable for use in the clinical setting.

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PubMed2004

Reliability and validity of functional balance tests post stroke.

OBJECTIVE: To contribute to the reliability and validity of a series of functional balance tests for use post stroke. DESIGN: Within-session, test-retest and intertester reliability was tested using the kappa coefficient and intraclass correlations. The tests were performed three times and the first and third attempts compared to test the within-session reliability. The tests were repeated a few days later to assess test-retest reliability and were scored simultaneously by two physiotherapists to assess the intertester reliability. To test criterion-related validity the tests were compared with the sitting section of the Motor Assessment Scale, Berg Balance Scale and Rivermead Mobility Index using Spearman's rho. SETTING: Stroke physiotherapy services of six National Health Service hospitals. PARTICIPANTS: People with a post stroke hemiplegia attending physiotherapy who had no other pathology affecting their balance took part. Thirty-five people participated in the reliability testing and 48 people took part in the validity testing. MAIN OUTCOME MEASURES: The following functional balance tests were used: supported sitting balance, sitting arm raise, sitting forward reach, supported standing balance, standing arm raise, standing forward reach, static tandem standing, weight shift, timed 5-m walk with and without an aid, tap and step-up tests. RESULTS: The ordinal level tests (supported sitting and standing balance and static tandem standing tests) showed 100% agreement in all aspects of reliability. Intraclass correlations for the other tests ranged from 0.93 to 0.99. All the tests showed significant correlations with the appropriate comparator tests (r = 0.32-0.74 p < 0.05), except the weight shift test and step-up tests which did not form significant relationship with Berg Balance Scale (r = 0.26 and 0.19 respectively). CONCLUSION: These functional balance tests are reliable and valid measures of balance disability post stroke.

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PubMedDate not supplied

Measurement error in functional balance and mobility tests for people with stroke: what are the sources of error and what is the best way to minimize error?

OBJECTIVE: To assess the degree and source of measurement error in functional balance and mobility tests for people with stroke, and to identify the most effective method of data collection to minimize error. DESIGN: To assess the degree and source of error, the total, systematic, and random error were calculated for within-session, test-retest, and interrater testing. To identify the most effective method of data collection, the total error was calculated for 4 data collection methods: 1 familiarization trial, then scoring a 2nd trial; 2 familiarization trials, then scoring a 3rd trial; averaging 2 trials, then averaging 3 trials. SETTING: Stroke services in National Health Service hospitals. PATIENTS: Thirty-five people with a poststroke hemiplegia. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Five tests provided interval-level data: arm raise (sitting and standing), weight shift, tap, and step-up. Four tests provided ratio-level data: forward reach (sitting and standing) and 5-m timed walk (with and without an aid). RESULTS: Total measurement error ranged from zero for the step-up test to 55% for within-session error for the 5-m walk without an aid. Ratio data tests showed somewhat greater error than interval data tests (5%-55% vs. 0%-46%). A within-session practice effect for the standing forward reach, 5-m walk (with and without an aid), and weight shift tests was found. For the other tests, random error was greater than the systematic error. Interrater testing had the least error. For most tests, the average of 2 trials produced the least measurement error. For the 5-m walk, the mean obtained from 2 or 3 trials was equally effective. For the step-up test, the mean of 3 trials was slightly more effective. The overall error from all 3 sources was 3 lifts for sitting arm raise, 11 cm for sitting forward reach, 3 lifts for the standing arm raise, 7.5 cm for standing forward reach, 4.5 s for walking with an aid, 3 shifts on the weight shift test, 1.1 s for walking without an aid, 2 taps, and 1 step up. CONCLUSION: The tests using interval data showed less error than ratio-data tests and may be preferable measurement tools. Taking an average of 2 trials was the most accurate data collection method.

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