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At least 865 records · Page 48Linked to original sources
PubMed1996

Standing balance during internally produced perturbations in subjects with hemiplegia: validation of the balance scale.

OBJECTIVE: To examine the concurrent validity of the Berg Balance Scale (BBS) in subjects with hemiparesis after stroke by correlating functional balance performance on the BBS with laboratory measures of balance (center of pressure [CP] and electromyographic [EMG] activity of leg musculature during rapid arm flexion and during quiet stance). DESIGN: Concurrent validation study. Consistency of performance was determined through repeat measures obtained from 13 subjects. SETTING: Laboratory. PATIENTS: Twenty-four volunteers with longstanding hemiparesis from cerebrovascular accident (CVA) were tested. MAIN OUTCOME MEASURES: BBS scores were compared with CP excursion speed during (1) self-initiated rapid unilateral arm flexion with the nonhemiplegic arm and (2) quiet stance. The peak tangential arm acceleration and the sequence of EMG events in the posterior leg muscles were monitored during the arm flexion movement. RESULTS: In the arm flexion condition, BBS performance was significantly correlated with arm acceleration and CP excursion speed (multiple regression R = .81). BBS performance was also related to the presence of anticipatory activation of ipsilateral hamstrings during the rapid arm flexion movement. BBS performance and CP excursion speed during quiet stance were also significantly related (r = .76). The initial and repeat measures were not significantly different in magnitude (paired tests of difference, p < .01). CONCLUSION: The BBS appears to reflect differing abilities to tolerate the internally produced perturbation to standing balance associated with forward arm flexion in individuals with hemiparesis from CVA.

Aged↗
PubMed1996

Gait training efficacy using a home-based practice model in chronic hemiplegia.

OBJECTIVE: The efficacy of a home practice model for gait training was evaluated in 18 hemiplegic subjects 2.3 years (range, 1 to 5) after stroke. DESIGN: Uncontrolled case series. SETTING: Referral center. SUBJECTS: Patients at least 1 year poststroke referred to an outpatient rehabilitation program. INTERVENTION: Patients were taught home programs in two or more 2- to 5-day blocks averaging 35 physical therapy (PT) contact hours (range, 9.5 to 62.5); training extended over a mean of 22 months (range, 10 to 65). Training emphasized weight bearing, balance, segmental control, stretching, and bracing. MAIN OUTCOME MEASURES: Gait changes were measured using the newly developed Wisconsin Gait Scale (WGS). The patient-rated Falls Efficacy Scale (FES) was administered before and after training to 8 subjects, and the Health Status Questionnaire (HSQ) was retrospectively administered to all subjects to appraise subjective pretraining to posttraining changes and current psychological status. RESULTS: The average WGS score significantly improved (p < .05). Patients perceived that gait training increased the quality of their functional activities (p < .05). In a subset of patients, the FES showed that fear of falling was decreased (p < .05). Perception of well-being was comparable to a normative nonstroke reference population except for physical functioning. Compared to the only other published series (using traditional outpatient programming), the current model was of comparable cost. CONCLUSION: Despite the literature indicating a plateau in mobility function by 6 months after stroke, postacute training of gait in hemiplegic subjects using a home-based training model results in improved gait and the perception of improved function. Additionally, we provide validation for the newly developed Wisconsin Gait Scale, an instrument of gait measurement that may assist in comparing outcomes.

Activities of Daily Living↗
PubMed1999

Bridging activity as a mode of stress testing for persons with hemiplegia.

OBJECTIVE: To establish a stress testing protocol for hemiplegic persons using graded bridging activity at the rates of 3 to 24 repetitions per minute. DESIGN: Paired comparisons of exercise parameters and admission and discharge data between hemiplegic and control groups. SETTING: Inpatient rehabilitation program of a tertiary rehabilitation center in Japan. PATIENTS: (1) Preliminary study: five hemiplegic patients. (2) Comparison with normal subjects: 39 hemiplegic patients and 10 age-matched controls. (3) Study of reproducibility: five hemiplegic patients and five controls. (4) Longitudinal changes: 30 hemiplegic patients. MAIN OUTCOME MEASURES: Oxygen consumption (VO2), heart rate (HR), and HR oxygen coefficient (regression coefficient between HR and VO2). RESULTS: The testing protocol was applicable to 88.6% of hemiplegic patients. The relationship between HR and VO2 was linear, and HR oxygen coefficient was significantly lower in hemiplegic patients than the controls. The intraclass correlation coefficients were greater than 0.7 for VO2, HR, and HR oxygen coefficient, indicating satisfactory reproducibility. HR decreased longitudinally for the same stress levels and the HR oxygen coefficient increased, indicating improved fitness level. CONCLUSIONS: The bridging activity protocol is a useful mode for stress-testing hemiplegic persons. The linearity between HR and VO2 with this protocol allows us to use the indices of fitness obtainable from this relationship.

Activities of Daily Living↗
PubMed1999

Shoulder pain and dysfunction in hemiplegia: effects of functional electrical stimulation.

OBJECTIVE: To determine the influence of functional electrical stimulation (FES) on subluxation and shoulder pain in hemiplegic patients. DESIGN: Controlled study of 24 months' duration beginning in the first month after onset of stroke. SUBJECTS AND SETTING: One hundred twenty hemiplegic patients with both subluxed and painful shoulder were followed for rehabilitation before and after discharge between 1989 and 1993. All subjects received conventional rehabilitation based on the Bobath concept. In addition, patients were alternately assigned to a control group or to receive additional FES for 5 weeks on muscles surrounding their subluxed and painful shoulder. MAIN MEASURES: Clinical examinations, including range of motion, pain assessment, and x-rays, were performed at the start of the study, between the second and fourth weeks after onset of stroke, and subsequently at 6, 12, and 24 months. RESULTS: The FES group showed significantly more improvement than the control group in both pain relief (80.7% vs. 55.1%, p<.01) and reduction of subluxation (78.9% vs. 58.6%, p<.05). Furthermore, recovery of arm motion appeared to be significantly improved in the FES group (77.1% vs. 60.3% in the control group, p<.01). CONCLUSION: The FES program was significantly effective in reducing the severity of subluxation and pain and possibly may have facilitated recovery of the shoulder function in hemiplegic patients.

Adult↗
PubMed1999

Resistance to passive shoulder external rotation in persons with hemiplegia: evaluation of an assessment system.

OBJECTIVES: To determine the LIDO Active System's reliability and validity in measuring resistance to passive external rotation (RPER) of the shoulder in subjects who have sustained a cerebrovascular accident (CVA). STUDY DESIGN: Twenty hemiplegic subjects, between the ages of 38 and 78 yrs, participated in the study; 14 agreed to be tested on two occasions, for the reliability phase of the study. OUTCOME MEASURES: RPER, measured by the LIDO Active system; tone in the internal rotator musculature, measured by the Ashworth Scale; and shoulder external rotation range of motion, measured by a standard goniometer. RESULTS: Test-retest reliability of RPER measured on the LIDO system was demonstrated with intraclass correlation coefficients of .95 and .67 on the affected and nonaffected limb, respectively. Differences in RPER between the affected and nonaffected limb were significant (p<.01) and RPER on the affected limb correlated significantly with Ashworth measures of muscle tone (Spearman's rho = .62). CONCLUSION: The LIDO Active System provided reliable and valid measures of RPER of the shoulder in hemiplegic subjects. The LIDO system may be a useful device for objective measurement of the effectiveness of medical and rehabilitation interventions designed to bring muscle tone into the normal range and decrease contracture in the shoulder musculature.

Adult↗
PubMed1992

Partial remission of hemiplegia and somatoparaphrenia through vestibular stimulation in a case of unilateral neglect.

In a case of long lasting severe neglect resulting from a large right parieto-temporo-occipital infarct, vestibular stimulation produced a temporary reduction of the motor deficit and disappearance of the somatoparaphrenic delusion, in addition to the already reported improvement of extrapersonal and personal neglect and anosognosia. These data open new perspectives in the understanding of the neglect syndrome and of functional involvement of the parietal lobe in space representation.

Aged↗
PubMed2000

[The evolution and prognosis of disability in patients with hemiplegia].

BACKGROUND: In order to plan the objectives of the rehabilitation treatment after a stroke, it is necessary to know the functional prognosis of the patient. The main prognostic factors of disability in the hemiplegic patient, by means of an analysis of his neurological deficits (aphasia, disorientation, urinary incontinence, hemianopsia, sensitive disorders, anosognosia, muscular paresis, and control of trunk) are investigated. PATIENTS AND METHOD: 73 inpatients who were admitted to a Rehabilitation department after suffering a stroke were included. The inpatients clinical and functional evaluation was carried out just when they were admitted to Rehabilitation, in the third month, sixth month, and one year after stroke. The Barthel Index, modified by Shah in 1989, was used to evaluated the degree of disability. RESULTS: Most of the neurological deficits (strength deficit, sensitive deficit, trunk balance, aphasia) show a similar recuperation pattern, with the main recuperation in the third month, and stabilization at about the sixth month after stroke. Fifty-seven percent of the patients reach an elemental level of independence (Barthel Index > 90) in the achievement of the activities of daily living. A severe deficit of strength in the upper extremities or a deterioration of the deep sensitivity mean 9 and 13 times more risk of obtaining a bad functional result, respectively, than the patients who don't have this conditions, independently of other associated clinical deficits. The clinical variables with more prognostic value are the level of paresis (p < 0.001; Rho = 0.66), the sensitive disorders (p < 0.001; Rho = 0.57) and the instability of trunk control (p < 0.001; Rho = 0.53). CONCLUSION: There is not only one clinical variable, but a group of physical deficits which have an influence in the functional prognosis of the hemiplegic patient after stroke. The most relevant variables are the level of paresis, the deficit in deep sensitivity and the deficit in trunk control.

Activities of Daily Living↗