Abstract
(1) Objective: The objective was two-fold: (a) test a protocol of combined interventions; (b) administer this combined protocol within the framework of a six-month, intensive, long-duration program. The array of interventions was designed to target the treatment-resistant impairments underlying persistent mobility dysfunction: weakness, balance deficit, limb movement dyscoordination, and gait dyscoordination. (2) Methods: A convenience sample of eight chronic stroke survivors (>4 months post stroke) was enrolled. Treatment was 5 days/week, 1–2.5 h/day for 6 months, as follows: strengthening exercise, balance training, limb/gait coordination training, and aerobic exercise. Outcome measures: Berg Balance Scale (BBS), Fugl-Meyer Lower Limb Coordination (FM), gait speed, 6 Minute Walk Test (6MWT), Timed up and Go (TUG), Functional Independence Measure (FIM), Craig Handicap Assessment Rating Tool (CHART), and personal milestones. Pre-/post-treatment comparisons were conducted using the Permutation Test, suitable for ordinal measures and small sample size. (3) Results: For the group, there was a statistically (p ≤ 0.04) significant improvement in balance, limb movement coordination (FM), gait speed, functional mobility (TUG), and functional activities (FIM). There were measurable differences (minimum detectible change: MDC) in BBS, FM, gait speed, 6MWT, and TUG. There were clinically significant milestones achieved for selected subjects according to clinical benchmarks for the BBS, 6MWT, gait speed, and TUG, as well as achievement of personal milestones of life role participation. Effect sizes (Cohen’s D) ranged from 0.5 to 1.0 (with the exception of the (6MWT)). After six months of treatment, the above array of gains were beyond that reported by other published studies of chronic stroke survivor interventions. Personal milestones included: walking to mailbox, gardening/yardwork, walking a distance to neighbors, return to driving, membership at a fitness center, vacation trip to the beach, swimming at local pool, returning to work, housework, cooking meals. (4) Conclusions: Stroke survivors with mobility dysfunction were able to participate in the long-duration, intensive program, with the intervention array targeted to address impairments underlying mobility dysfunction. There were either clinically or statistically significant improvements in an array of measures of impairment, functional mobility, and personal milestone achievements.
Highlights
Stroke is a leading cause of long-term disability worldwide, with annual frequency of stroke at 15 million, of which 5 million are permanently disabled [1]
The first purpose of the current work was to develop and administer an intensive neurorehabilitation mobility/fitness program containing an array of interventions for chronic stroke survivors, entitled “Safety, Functional Outcomes, and Recovery after Stroke (SOARS)”; this SOARS program was designed to target a fuller array of impairments preventing recovery of mobility [11], and was, composed of strengthening, balance training, limb movement and gait coordination training, and aerobic exercise
The Timed up and Go (TUG) functional mobility, showed statistically significant improvement, with 88% of participants exceeding the minimum detectible (measurable) change (MDC) by an average of 9.69 +/− 3.91 s (Table 3)
Summary
Stroke is a leading cause of long-term disability worldwide, with annual frequency of stroke at 15 million, of which 5 million are permanently disabled [1]. Even after standard rehabilitation has been completed, there is an unmet need in the realms of social reintegration, health-related quality of life, maintenance of activity, and self-efficacy for chronic stroke survivors, all of which are dependent upon functional capability that is not restored [5]. These problems persist due, essentially, to a gap in care. Some exhibited no change in limb dyscoordination, imbalance or poor endurance and physical fitness (for example, according to measures of V02 max (e.g., [7]))
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