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Biomedical subjects

Stephen J Page

Publications and source records attributed to Stephen J Page.

At least 19 recordsLinked to original sources
PubMed2007

Adventure tourism and adventure sports injury: the New Zealand experience.

The primary aims of this study were to establish a client injury baseline for the New Zealand adventure tourism and adventure sport sector, and to examine patterns and trends in claims for injury during participation in adventure activities. Content analysis of narrative text data for compensated injuries occurring in a place for recreation and sport over a 12-month period produced over 15,000 cases involving adventure tourism and adventure sport. As found in previous studies in New Zealand, highest claim counts were observed for activities that are often undertaken independently, rather than commercially. Horse riding, tramping, surfing and mountain biking were found to have highest claim counts, while hang gliding/paragliding/parasailing and jet boating injuries had highest claim costs, suggesting greatest injury severity. Highest claim incidence was observed for horse riding, with female claimants over-represented for this activity. Younger male claimants comprised the largest proportion of adventure injuries, and falls were the most common injury mechanism.

Adult↗
PubMed2006

Back from the brink: electromyography-triggered stimulation combined with modified constraint-induced movement therapy in chronic stroke.

OBJECTIVE: To determine the efficacy of a regimen that combines electromyography-triggered neuromuscular stimulation (ETMS) with modified constraint-induced movement therapy (mCIMT) in patients with chronic stroke. DESIGN: Pre-post, case series. SETTING: Outpatient rehabilitation hospital. PARTICIPANTS: Six subjects who had had a stroke more [corrected] than 1 year before the study and who had upper-limb hemiparesis. All subjects were only able to activate the affected wrist extensors. INTERVENTION: Subjects underwent ETMS twice every weekday in 35-minute increments during an 8-week period. One week after they completed the ETMS regimen, and after the outcome measures were readministered, subjects participated in mCIMT, which consisted of structured therapy sessions that emphasized use of the more affected arm in valued activities. The sessions were held 3 times a week for 10 weeks. The less affected arms were also restrained 5 days a week for 5 hours. MAIN OUTCOME MEASURES: The Fugl-Meyer Assessment (FMA) of motor recovery, Action Research Arm Test (ARAT), and goniometry. RESULTS: Subjects had nominal changes on the ARAT (mean change, 0.3), and no functional changes after ETMS. However, they had a mean increase of 21.5 degrees in affected wrist extension and an improved ability to perform the wrist items of the FMA (reflected by a mean increase of 4.1 points on the FMA), which qualified them for mCIMT. After mCIMT, subjects had a 15.5-point change on the FMA, an 11.4-point change on the ARAT, and a new ability to perform valued activities. CONCLUSIONS: ETMS alone does not result in functional changes. However, it may elicit sufficient active affected wrist and finger extension increases to permit possible participation in mCIMT, which can result in marked functional gains. This study is among the first to show improved function in stroke patients who initially had little hand motor control, and it is among the first to effectively combine 2 singularly efficacious regimens.

Adolescent↗
PubMed2006

Cortical reorganization following modified constraint-induced movement therapy: a study of 4 patients with chronic stroke.

OBJECTIVE: To determine whether cortical changes occur following participation in a program of modified constraint-induced movement therapy (mCIMT). DESIGN: Pre-post, case series. SETTING: Outpatient rehabilitation hospital. PARTICIPANTS: Two men and 2 women with unilateral stroke occurring more than 1 year prior to study entry and moderate stable motor deficits. INTERVENTION: Subjects participated in mCIMT, comprised of structured, 30-minute therapy sessions emphasizing affected arm use in valued activities, which occurred 3 days a week for 10 weeks. Their unaffected arms were restrained 5 days a week for 5 hours. MAIN OUTCOME MEASURES: The Action Research Arm Test (ARAT), upper-extremity portion of the Fugl-Meyer Assessment (FMA), Motor Activity Log (MAL), and functional magnetic resonance imaging (fMRI) at 4T were administered before and after mCIMT. RESULTS: Three subjects exhibited score increases on the MAL, ARAT, and FMA, representing increased affected arm use, impairment, and function. These subjects reported new ability to perform valued activities with the affected hand, such as writing. These subjects also displayed cortical reorganization on fMRI. One subject exhibited minimal affected arm use changes, modest function changes, and no cortical fMRI changes. CONCLUSIONS: Increased affected arm use during mCIMT appears to induce cortical reorganization, as measured by fMRI. In patients who responded to mCIMT, cortical reorganization was positively related to degree of increase in affected arm use and ability. Because mCIMT is more easily administered than longer duration protocols, mCIMT may be a more practicable way of studying plasticity.

Adult↗
PubMed2006

Mental practice with motor imagery: evidence for motor recovery and cortical reorganization after stroke.

OBJECTIVES: To measure the efficacy of a program combining mental and physical practice with the efficacy of a program composed of only constraint-induced movement therapy (CIMT) or only mental practice on stroke patients' levels of upper-extremity impairment and upper-extremity functional outcomes and to establish the relationship between changes in blood-oxygen-level dependent (BOLD) functional magnetic resonance imaging response during a specific motor or imagery task and improvement in motor function between intervention groups. DESIGN: Case series. SETTING: Licensed, 56-bed, freestanding, university-affiliated rehabilitation hospital. PARTICIPANTS: Three men and 1 woman with moderate upper-limb hemiparesis after stroke were randomized. INTERVENTIONS: Two patients received mental practice and CIMT, 1 patient received only mental practice, and 1 received only CIMT. MAIN OUTCOME MEASURES: Wolf Motor Function Test (WMFT), Motor Activity Log (MAL), Sirigu break test, Movement Imagery Questionnaire-Revised, and Vividness of Movement Imagery Questionnaire. RESULTS: The mental practice intervention alone led to slight improvement in certain functional and mental imagery measures (Sirigu, MAL, WMFT) but did not result in a clinically meaningful improvement with notable right cerebellar hemisphere activation that was not present before intervention. After CIMT, only the single patient showed clinically meaningful improvement of his affected hand as exhibited by decreased times on the MAL and WMFT. The patient showed increased bilateral cortical activation in both the motor and premotor areas during execution of a finger flexion and extension task. In contrast, during a second task, which was an imagined flexion and extension task, motor, occipital, and inferior parietal activation mainly in the contralateral hemisphere were observed. After 2 weeks of CIMT plus mental practice a patient with a lesion restricted to the parietal cortex showed little improvement in upper-extremity function and mental imagery in comparison with the patient with damage to nonparietal areas, who showed clinically meaningful improvement. The pattern of activation after 2 weeks of CIMT plus mental practice in the patient with nonparietal damage led to more focal contralateral activation in primary motor cortex when executing a voluntary flexion and extension task. CONCLUSIONS: The case series indicates that for these patients with chronic, moderate upper-extremity impairment after stroke, a 2-week regimen of CIMT or CIMT plus mental practice only (in 1 case) resulted in modest changes occurring as a decrease in impairment, with functional improvement. Mental practice alone did not result in a clinically meaningful improvement in upper-limb impairment. We describe how these interventions may elicit "plastic" changes in the brain. Further investigations to determine the appropriate delivery and dosing of both physical and mental practice, as well as to determine whether mental practice-induced changes positively correlate with distinct patterns of cortical activation, should be undertaken before the efficacy of their use can be ascertained among patients with limitations comparable with these participants.

Aged↗
PubMed2005

Effects of mental practice on affected limb use and function in chronic stroke.

OBJECTIVE: To determine the efficacy of a mental practice (MP) protocol in increasing the function and use of the more affected limb in stroke patients. DESIGN: Randomized, controlled, multiple baseline, pre-post, case series. SETTING: Outpatient rehabilitation hospital. PARTICIPANTS: Eleven patients who had a stroke more than 1 year before study entry (9 men; mean age, 62.3+/-5.1 y; range, 53-71 y; mean time since stroke, 23.8 mo; range, 15-48 mo; 10 strokes exhibiting upper-limb hemiparesis on the dominant side) and who exhibited affected arm hemiparesis and nonuse. INTERVENTION: All patients received 30-minute therapy sessions 2 days a week for 6 weeks. The sessions emphasized activities of daily living (ADLs): 6 subjects randomly assigned to the MP condition concurrently received sessions requiring daily MP of the ADLs; 5 subjects (control group) received an intervention consisting of relaxation techniques. MAIN OUTCOME MEASURES: The Motor Activity Log and Action Research Arm (ARA) test. RESULTS: Affected limb use as rated by MP patients and their caregivers increased (1.55, 1.66, respectively), as did patient and caregiver ratings of quality of movement (2.33, 2.15, respectively) and ARA scores (10.7). In contrast, the controls showed nominal increases in the amount they used their affected limb and in limb function. A Wilcoxon test on the ARA scores revealed significantly ( P =.004) greater changes in the MP group's scores. CONCLUSIONS: Participation in an MP protocol may increase a stroke patient's use of his/her more affected limb. Data further support that the protocol resulted in correlative, MP-induced, motor function improvements. The mechanisms whereby MP increases affected arm use are unknown. Perhaps using the more affected limb becomes more salient through MP, or perhaps motor schema are altered during MP to integrate limb use.

Activities of Daily Living↗
PubMed2005

Modified constraint-induced therapy in acute stroke: a randomized controlled pilot study.

BACKGROUND AND PURPOSE: To determine modified constraint-induced therapy (mCIT) feasibility and compare its efficacy to traditional rehabilitation (TR) in acute stroke patients exhibiting upper limb hemiparesis. METHOD: Before-after, multiple baseline, randomized controlled pilot study. SETTING: Rehabilitation hospital. PATIENTS: Ten stroke patients < 14 d poststroke and exhibiting upper limb hemiparesis and affected limb nonuse. INTERVENTIONS: Five patients were administered mCIT, consisting of structured therapy emphasizing more affected arm use in valued activities 3 d/week for 10 weeks and less affected arm restraint 5 d/week for 5 h. Five other patients received 1/2 sessions of traditional motor rehabilitation for the affected arm, which included affected limb manual dexterity exercises and stretching, as well as compensatory strategies with the unaffected limb. The TR regimens occurred 3 d/week for 10 weeks. MAIN OUTCOME MEASURES: The Fugl-Meyer Assessment of Motor Recovery (Fugl-Meyer), Action Research Arm Test (ARA), and Motor Activity Log (MAL). RESULTS: Before intervention, all patients exhibited stable motor deficits and more affected arm nonuse. After intervention, mCIT patients displayed increased affected arm use (+ 2.43 on the MAL amount of use scale), uniformly exhibited increases on the Fugl-Meyer and ARA (mean change scores = + 18.7 and + 21.7, respectively), and were able to again perform valued activities. TR patients exhibited nominal change in affected limb use (+ 0.07 on the MAL amount of use scale) and modest changes on the Fugl-Meyer and ARA (+ 4.4 and + 4.8, respectively). Fugl-Meyer and ARA changes were significant for the mCIT group only (P < 0.01). CONCLUSIONS: mCIT is a promising regimen for improving more affected limb use and function in acute cerebrovascular accident. However, larger confirmatory studies need to be performed.

Acute Disease↗
PubMed2005

Psychometric evaluation of the Motor Readiness Questionnaire for Stroke.

OBJECTIVE: To determine the validity, repeatability and stability of the Motor Readiness Questionnaire for Stroke (MRQS). SUBJECTS: One hundred and eighty-seven stroke patients (160 men; 143 white; mean age = 57.5+/-8.8; mean time since stroke = 10.1+/-7.3 months) at a rehabilitation hospital in the Midwestern United States. DESIGN: Prospective survey, in which the MRQS was administered to each patient once. The MRQS was also administered to 25 subjects twice to measure test-retest reliability. MAIN OUTCOME MEASURES: The MRQS, a transtheoretical model-based, 23-item self-report survey was administered to examine reliability (internal consistency and stability), validity (concurrent) and factor structure. RESULTS: The MRQS showed good reliability for its component scales and total score, and the previously identified MRQS factor structure was confirmed. Stability and concurrent validity were also high. CONCLUSIONS: The MRQS appears to adequately capture stroke patients' motivational readiness and has ability to discriminate between individuals in various stages of readiness. MRQS scores appear to be repeatable over time. However, more research is needed before the MRQS is used.

Female↗
PubMed2005

Home-based electromyography-triggered stimulation in chronic stroke.

OBJECTIVES: (1) To determine the feasibility of a home-based electromyography-triggered neuromuscular stimulation (ETMS) programme; and (2) to determine ETMS efficacy in increasing affected wrist extension and reducing affected arm impairment. DESIGN: Randomized, controlled, pre-post, cross-over design. SETTING: Outpatient rehabilitation hospital. PATIENTS: Twelve chronic stroke patients with palpable muscle contraction in their affected wrist extensors but no movement (7 males; mean age = 59.75 years, age range 44-75 years; mean time since stroke = 52.75 months, range 13-131 months). INTERVENTION: Subjects were randomly assigned to receive either: (a) ETMS use twice every weekday in 35-min increments during an eight-week period followed by an eight-week home exercise programme (ETMS/home exercise programme) (n=8); or (b) an eight-week home exercise programme followed by use of ETMS twice every weekday in 35-min increments during an eight-week period (home exercise programme) (n=4). MAIN OUTCOME MEASURES: The Fugl-Meyer, Action Research Arm Test and goniometry. RESULTS: After home exercise programme participation, subjects showed nominal or no changes on any of the outcome measures. After ETMS, patients showed modest impairment reductions, as shown by the Fugl-Meyer, and no Action Research Arm Test changes. However, both groups showed a 21 degree increase in active affected wrist extension after ETMS use. CONCLUSION: ETMS use is feasible in the home environment. Neither participation in a traditional home exercise programme nor ETMS use conveyed changes on the Fugl-Meyer or Action Research Arm Test. However, ETMS use increased active affected limb extension. This new movement may provide a potential pathway for subjects to participate in other interventions, such as modified constraint induced therapy.

Adult↗
PubMed2005

Applying the transtheoretical model to the exercise behaviors of stroke patients.

Individuals with disabilities, including stroke, are frequently deconditioned. A variety of factors, including infrequent exercise participation, may be responsible for the deconditioning observed. According to the transtheoretical model (TTM), individuals progress through cognitive processes, termed stages, that indicate their readiness to undertake a particular healthy behavior, such as exercise. Our study examined 178 community-dwelling stroke patients' readiness to initiate an exercise program and their current exercise patterns. Using the Stages of Change Questionnaire, we found over 75% of respondents to be in the exercise preadoption stages of precontemplation, contemplation, or preparation. Moreover, participants classified in the postadoption stages of maintenance and action reported exercising significantly more than those in the preadoption stages. Individuals in the postadoption stages were also participating in significantly more sessions of strenuous or moderate exercise than those in the preadoption stages. It was concluded that the TTM is a valid theoretical framework to measure stroke patients' readiness to participate in exercise. However, additional research examining the psychosocial and functional factors mitigating these attitudes, and the stability of these attitudes, needs to be performed.

Adaptation, Physiological↗
PubMed2004

Reconsidering the motor recovery plateau in stroke rehabilitation.

Termination of motor rehabilitation is often recommended as patients with cerebrovascular accident (CVA) become more chronic and/or when they fail to respond positively to motor rehabilitation (commonly termed a "plateau"). Managed-care programs frequently reinforce this practice by restricting care to patients responding to therapy and/or to the most acute patients. When neuromuscular adaptation occurs in exercise, rather than terminating the current regimen, a variety of techniques (eg, modifying intensity, attempting different modalities) are used to facilitate neuromuscular adaptations. After presenting the concepts of the motor recovery plateau and adaptation, we similarly posit that patients with CVA adapt to therapeutic exercise but that this is not indicative of a diminished capacity for motor improvement. Instead, like traditional exercise circumstances, adaptive states can be overcome by modifying regimen aspects (eg, intensity, introducing new exercises). Findings suggesting that patients with chronic CVA can benefit from motor rehabilitation programs that apply novel or different parameters and modalities. The objectives of this commentary are to (1) to encourage practitioners to reconsider the notion of the motor recovery plateau, (2) to reconsider chronic CVA patients' ability to recover motor function, and (3) to use different modalities when accommodation is exhibited.

Activities of Daily Living↗
PubMed2004

Efficacy of modified constraint-induced movement therapy in chronic stroke: a single-blinded randomized controlled trial.

OBJECTIVE: To determine efficacy of a modified constraint-induced movement therapy (mCIMT) protocol for patients with chronic stroke. DESIGN: Multiple-baseline, pre-post, single-blinded randomized controlled trial. SETTING: Outpatient clinic. PARTICIPANTS: Seventeen patients who experienced stroke more than 1 year before study entry and who had upper-limb hemiparesis and learned nonuse. INTERVENTION: Seven patients participated in structured therapy sessions emphasizing more affected arm use in valued activities, 3 times a week for 10 weeks. Their less affected arms were also restrained 5d/wk for 5 hours (mCIMT). Four patients received regular therapy with similar contact time to mCIMT. Six patients received no therapy (control). MAIN OUTCOME MEASURES: The Fugl-Meyer Assessment of Motor Recovery (FMA), Action Research Arm (ARA) Test, and Motor Activity Log (MAL). RESULTS: The mCIMT patients exhibited greater motor changes on the FMA and ARA (18.4, 11.4) than regular therapy (6.0, 7.1) or control (-2.9, -4.5). Statistical analyses showed significant differences in motor improvement on the FMA (F(2,12)=11.2, P=.002) and the ARA (F(2,12)=14.0, P=.001). Post hoc analyses showed that, when pretreatment motor differences are controlled, mCIMT resulted in substantially higher posttreatment FMA and ARA scores. Amount and quality of arm use, measured by the MAL, improved only in mCIMT patients. CONCLUSIONS: mCIMT may be an efficacious method of improving function and use of the more affected arms of chronic stroke patients. Findings further affirm that repeated, task-specific practice is critical to reacquisition of function, whereas practice schedule intensity is less critical.

Adult↗
PubMed2004

Modified constraint-induced therapy: a promising restorative outpatient therapy.

BACKGROUND AND PURPOSE: Stroke is the leading cause of disability in the United States, and upper limb hemiparesis is a primary impairment resulting in this disability. However, there remains a paucity of scientifically validated treatment regimens for hemiparesis. Data from randomized controlled studies suggest the effectiveness and efficacy of modified constraint-induced therapy (mCIT), a reimbursable, outpatient, upper limb training regimen. The purpose of this article is to review evidence and discuss the theoretical bases of mCIT for stroke-induced hemiparesis. The objective is to make stroke practitioners aware of the mCIT theoretical bases and of this clinically practical, efficacious protocol. CONCLUSIONS: mCIT is solidly grounded in motor learning principles, is practical and safe, and is both efficacious and effective. mCIT studies have shown efficacy using rigorous randomized controlled methods in both subacute and chronic stroke and have shown high effect sizes that have been independently confirmed. It thus seems reasonable to recommend mCIT for clinical application.

Ambulatory Care↗
PubMed2004

Mental and physical practice schedules in acquisition and retention of novel timing skills .

Research has indicated that random physical practice of a motor skill enhances effects of long-term learning more than blocked practice. Moreover, the use of mental rehearsal coupled with physical practice has been shown to accelerate motor skill acquisition in many different contexts and is better than no practice at all. Others have found that some mental rehearsal strategies are better than others for maximizing performance. This study examined how combinations of mental and physical practice schedules affected the learning of a coincidence timing task. 30 college students were randomly assigned to one of four treatment groups involving combinations of imagery and physical practice. Three tasks were utilized, each involving a particular speed (slow, medium, fast) on the Bassin Anticipation Timer. Conclusions were based on a three-way analysis of variance, using type of mental practice, type of physical practice, and sex as between-group factors, conducted separately for acquisition and retention trials. Type of physical practice was significantly related to performance. On the acquisition trials, random practice was associated with larger mean errors than blocked practice; however, the reverse was true for retention trials. There was no significant effect of type of mental practice in either the acquisition or retention phase. Sex was significantly related to performance for the retention trials only, where the 15 men made smaller errors than the 15 women.

Adult↗
PubMed2003

Modified constraint-induced therapy and botulinum toxin A: a promising combination.

Modified constraint-induced therapy and chemodenervation with botulinum toxin A are each efficacious in managing stroke-induced motor disorders; however, the application of these two promising modalities in combination is yet to be examined. This case study describes a 44-yr-old man who experienced a right middle cerebral artery infarct 14 mo before participating in modified constraint-induced therapy. After modified constraint-induced therapy completion, the patient exhibited substantial improvement in affected upper limb use and function but retained difficulty with finger extension secondary to hypertonicity and spasticity in the forearm flexor muscles. Selective chemodenervation of these muscles with botulinum toxin A greatly improved the patient's self-reported hand function and his scores using objective measures. The authors of this paper present this case to raise the idea of increasing treatment efficacy by combining these two modalities.

Activities of Daily Living↗
PubMed2003

Intensity versus task-specificity after stroke: how important is intensity?

Recent evidence suggests that intense training regimens can increase the use and function of the more affected limbs of stroke patients. The efficacy of these intense regimens has led some to conclude that intense training regimens should be more widely applied clinically and has caused some physicians to attempt implementation of more intense training regimens with stroke patients. However, intense protocols may not be needed to produce positive motor changes in some patients and may not be plausible in some environments or with some patients. In this commentary, we review the evidence supporting the efficacy of less intense, task-specific training regimens emphasizing the use of the more affected limb. We submit that intensity does not need to be altered to induce substantial clinical improvements, as some have suggested. Rather, the results of the studies suggest that the nature of stroke motor therapy itself can be altered to be more task-specific while remaining within the typical contact time parameters (i.e., 30-45 min/session), yet can be more efficacious than more traditional motor rehabilitative approaches.

Humans↗
PubMed2003

Motivating, game-based stroke rehabilitation: a brief report.

Stroke-induced hemiparesis is a debilitating impairment that compromises ability to perform many activities of daily living (ADLs). Many new therapies for hemiparesis, although intriguing, require exceptional patient motivation and/or may be difficult to implement in some clinical situations. This brief report revisits a motivating, game-based rehabilitation modality reported nearly three decades ago that has heretofore been ignored. Pilot data, examining the feasibility and efficacy of the device, are presented.

Activities of Daily Living↗