Functional Ambulation Scale Research Articles

Poststroke depression: risk factors and potential effects on functional recovery.

The factors that may cause poststroke depression were investigated in the literature focusing on lesion localization, age, stroke severity, and impairments in physical and cognitive function. The aim of this study was to examine the risk factors influencing the development of poststroke depression and to determine the effect of depression on the patients' functional improvement after rehabilitation. Patients in the first 6-month period after stroke who were hospitalized in the Physical Medicine and Rehabilitation Clinic were included in this study. Patients who were admitted to the hospital within 0-30 and 30-120 days from the date of stroke were considered early and late rehabilitation entrants, respectively. The sample of this study included 93 patients. Patients' demographic and clinical characteristics, complications, and medical history were recorded. Upper extremity motor function, ambulation, and mood were evaluated according to the Frenchay Arm Test, the Functional Ambulation Scale, and the Beck Depression Inventory, respectively. The Functional Independence Measure (FIM) was applied to patients at admission to the hospital, at discharge, and 1 month after discharge (follow-up). The mean age of the patients was 58 years and the mean disease duration was 53 days. Depression was diagnosed in 49 (53%) patients. Except for age and disease duration, none of the factors of sex, hemiplegic side, stroke severity, stroke etiology, neglect, spasticity, sedentary lifestyle, poststroke immobility, and early-onset or late-onset to rehabilitation was found to induce statistically significant differences in the development of depression. Statistically significant changes occurred in total FIM levels between the groups with and without depression between admission and discharge, admission and follow-up, and discharge and follow-up. The levels were significantly higher in patients without depression than in patients with depression. Depression was found in a high frequency in stroke patients. Younger age and long disease duration were found to be factors affecting the development of depression. FIM scores were observed to be lower in stroke patients with depression.

Wearable robotic exoskeleton for overground gait training in sub-acute and chronic hemiparetic stroke patients: preliminary results.

Recovery of therapeutic or functional ambulatory capacity in post-stroke patients is a primary goal of rehabilitation. Wearable powered exoskeletons allow patients with gait dysfunctions to perform over-ground gait training, even immediately after the acute event. To investigate the feasibility and the clinical effects of an over-ground walking training with a wearable powered exoskeleton in sub-acute and chronic stroke patients. Prospective, pilot pre-post, open label, non-randomized experimental study. A single neurological rehabilitation center for inpatients and outpatients. Twenty-three post-stroke patients were enrolled: 12 sub-acute (mean age: 43.8±13.3 years, 5 male and 7 female, 7 right hemiparesis and 5 left hemiparesis) and 11 chronic (mean age: 55.5±15.9 years, 7 male and 4 female, 4 right hemiparesis and 7 left hemiparesis) patients. Patients underwent 12 sessions (60 min/session, 3 times/week) of walking rehabilitation training using Ekso™, a wearable bionic suit that enables individuals with lower extremity disabilities and minimal forearm strength to stand up, sit down and walk over a flat hard surface with a full weight-bearing reciprocal gait. Clinical evaluations were performed at the beginning of the training period (t0), after 6 sessions (t1) and after 12 sessions (t2) and were based on the Ashworth scale, Motricity Index, Trunk Control Test, Functional Ambulation Scale, 10-Meter Walking Test, 6-Minute Walking Test, and Walking Handicap Scale. Wilcoxon's test (P<0.05) was used to detect significant changes. Statistically significant improvements were observed at the three assessment periods for both groups in Motricity Index, Functional Ambulation Scale, 10-meter walking test, and 6-minute walking test. Sub-acute patients achieved statistically significant improvement in Trunk Control Test and Walking Handicap Scale at t0-t2. Sub-acute and chronic patient did not achieve significant improvement in Ashworth scale at t0-t2. Twelve sessions of over-ground gait training using a powered wearable robotic exoskeleton improved ambulatory functions in sub-acute and chronic post-stroke patients. Large, randomized multicenter studies are needed to confirm these preliminary data. To plan a completely new individual tailored robotic rehabilitation strategy after stroke, including task-oriented over-ground gait training.

Clinical characteristics affecting motor recovery and ambulation in stroke patients

[Purpose] To describe the clinical characteristics affecting motor recovery and ambulation in stroke patients. [Subjects and Methods] Demographic and clinical characteristics of 53 stroke patients (31 M, 22 F), such as age, gender, etiology, hemiplegic side, Brunnstrom stage, functional ambulation scale scores, history of rehabilitation, and presence of shoulder pain and complex regional pain syndrome were evaluated. [Results] The etiology was ischemic in 79.2% of patients and hemorrhagic in 20.8%. Brunnstrom hand and upper extremity values in females were lower than in males. Complex regional pain syndrome was observed at a level of 18.9% in all patients (more common in females). Brunnstrom hand stage was lower in complex regional pain syndrome patients than in those without the syndrome. Shoulder pain was present in 44.4% of patients. Brunnstrom lower extremity values and functional ambulation scale scores were higher in rehabilitated than in non-rehabilitated cases. [Conclusion] Brunnstrom stages of hand and upper extremity were lower and complex regional pain syndrome was more common in female stroke patients. Shoulder pain and lower Brunnstrom hand stages were related to the presence of complex regional pain syndrome.

Establishing the Turkish version of the SIGAM mobility scale, and determining its validity and reliability in lower extremity amputees

Purpose: The aim of this study is to adapt the Special Interest Group in Amputee Medicine (SIGAM) mobility scale to Turkish, and to test its validity and reliability in lower extremity amputees.Material and methods: Adaptation of the scale into Turkish was performed by following the steps in American Association of Orthopedic Surgeons (AAOS) guideline. Turkish version of the scale was tested twice on 109 patients who had lower extremity amputations, at hours 0 and 72. The reliability of the Turkish version was tested for internal consistency and test–retest reliability. Structural validity was tested using the “scale validity” method. For this purpose, the scores of the Short Form-36 (SF-36), Functional Ambulation Scale (FAS), Get Up and Go Test, and Satisfaction with the Prosthesis Questionnaire (SATPRO) were calculated, and analyzed using Spearman’s correlation test.Results: Cronbach’s alpha coefficient was 0.67 for the Turkish version of the SIGAM mobility scale. Cohen's kappa coefficients were between 0.224 and 0.999. Repeatability according to the results of the SIGAM mobility scale (grades A–F) was 0.822. We found significant and strong positive correlations of the SIGAM mobility scale results with the FAS, Get Up and Go Test, SATPRO, and all of the SF-36 subscales.Conclusion: In our study, the Turkish version of the SIGAM mobility scale was found as a reliable, valid, and easy to use scale in everyday practice for measuring mobility in lower extremity amputees.Implications for RehabilitationAmputation is the surgical removal of a severely injured and nonfunctional extremity, at a level of one or more bones proximal to the body.Loss of a lower extremity is one of the most important conditions that cause functional disability.The Special Interest Group in Amputee Medicine (SIGAM) mobility scale contains 21 questions that evaluate the mobility of lower extremity amputees.Lack of a specific Turkish scale that evaluates rehabilitation results and mobility of lower extremity amputees, and determines their needs, directed us to perform a study on this topic when we took the number of amputations performed in our country into consideration.SIGAM mobility scale is directed at rehabilitation specialists who are working in amputee medicine. Turkish version of this scale was found both reliable and valid in our study and hence it can be used in clinical practice and studies.

Demographic and Clinical Features of Hospitalized Multiple Sclerosis Patients Undergoing a Rehabilitation Program at our Clinic

Objective: The aim of this study was to investigate the sociodemographic and clinical characteristics as well as rehabilitation methods of patients with multiple sclerosis (MS) undergoing an inpatient rehabilitation program. Material and Methods: A retrospective analysis of 104 patients with MS from 2007 to 2012 undergoing a rehabilitation program in a special rehabilitation unit was performed. Sociodemographic data were recorded. Disease-related characteristics such as disease duration, initial symptoms, the type of MS, medications, and the results of imaging methods were recorded. The examination findings of the neuromuscular system, body involvement, and functional level were determined. The ambulatory status was evaluated using Functional Ambulation Scale, activities of daily living were evaluated using Functional Independence Measure (FIM), and the neurologic status was determined using Kurtzke Expanded Disability Status Scale (EDSS). The orthosis and aid devices used for rehabilitation, applications for spasticity and neurogenic bladder status, and additional rehabilitation methods used were recorded. Results: The mean age was 40.53±9.40 years. Of a total of 104 patients, 68 (65.4%) were female and 36 (34.6%) were male. When the patients were grouped according to the score of GDDS, 40.4% were moderate and 59.6% were severely disabled. A one-unit increase in EDSS caused a 7.032 unit decrease in the FIM score (p=0.0001). A one-unit increase in EDSS caused a 0.017 unit increase in the duration of hospitalization (p=0.078). A oneunit increase in disease duration caused a 0.082 unit decrease in the FIM score (p=0.050). A one-unit increase in disease duration caused a 0.189 unit increase in the duration of hospitalization (p=0.0001). A one-unit increase in disease duration caused a 2.89 unit increase in number of hospitalizations (p=0.0001). Conclusion: Although MS is a progressive disease, rehabilitation applications play an enormous role in functional development. The course of rehabilitation should be planned individually for each patient.

Assessment on self-care, mobility and social function of children with spina bifida in Turkey.

The aim of the study was to investigate the functional performance in children with spina bifida, using the Pediatric Evaluation of Disability Inventory (PEDI) to look into capacity of twenty-eight children with spina bifida with lesions at different levels in different dimensions of self-care, mobility and social function. Mean age of the patients was 3.5 ± 2.3 (1–10) years. In the muscle test carried out, 13 patients (44.8%) had no movements including pelvic elevation in lower extremity muscles and they were at level 5. Sixteen patients (54%) were non-ambulatory according to the Hoofer ambulation classification. Raw and scale scores in the self-care, mobility and social function domains both in the functional skill scale and in the caregiver scale were found to be lower compared to the data of the normal population. A statistically significant correlation was observed in the self-care values of the Functional Skills Scales and the Caregiver Assistance Scale measurements, which was positive for age and negative for Functional Ambulation Scale and muscle test (P < 0.05). A positive relation was found between the Functional Skills Scales-mobility area and age while a negative relation was observed between Functional Ambulation Scale and muscle test (P < 0.005). A negative relation was also found between Caregiver Assistance Scale-mobility and Functional Ambulation Scale and muscle test (P < 0.005). In our study, the functional performance of the children was found to be low. Low-level lesions, encouraging muscular strength and independence in mobility are all very important factors for functional independence.

Can High-Sensitivity C-Reactive Protein and Ferritin Predict Functional Outcome in Acute Ischemic Stroke? A Prospective Study

Background: Inflammation may not only be the consequence of brain infarction but it may also contribute to ischemic damage. However, the role of inflammatory markers in predicting functional outcome in stroke remains controversial. Objective: This study was conducted to evaluate the predictive value of admission high-sensitivity C-reactive protein (hs-CRP) and ferritin levels for functional disability in patients with acute ischemic stroke at 3-month follow-up and investigate the relationship between inflammatory markers and subtypes, severity, and risk factors of ischemic stroke. Methods: Sixty-two patients were examined prospectively within 48 hours after onset of ischemic stroke. Plasma hs-CRP and ferritin measurements were obtained from patients within 48 hours after onset and at 3-month follow-up. Patients were divided into 2 groups based on the level of hs-CRP: elevated (serum hs-CRP ≥0.5 mg/dL) and normal (serum hs-CRP<0.5 mg/dL) hs-CRP groups. Stroke severity was analyzed by the National Institutes of Health Stroke Scale (NIHSS) and functional disability was assessed by the Functional Independence Measure (FIM) and Functional Ambulation Scale (FAS). Stroke subtypes were classified according to the Oxfordshire Community Stroke Project. Results: Except for the correlation between hs-CRP levels and FIM scores on admission, no significant correlation was found between laboratory markers and FIM, FAS, and NIHSS scores and stroke subtypes on admission and at 3-month follow-up (P > .05). Conclusion: This study revealed that neither hs-CRP nor ferritin levels could predict functional disability 3 months after stroke onset. FIM, FAS, and NIHSS scores were more useful in predicting functional outcome 3 months after stroke onset than the laboratory markers evaluated in this study.

Quality of Life and Functionality of Patients With Heel Reconstruction After Landmine Explosions

Landmine injuries cause extensive soft and bony tissue loss of the weight-bearing areas, particularly the heel. Reconstruction of these injuries is challenging, and there are no studies that report long-term functional results. To determine the quality of life and long-term functionality of patients who had heel reconstruction with free muscle flap after landmine injuries. A case-control study. Nine male patients who had heel reconstruction with free muscle flap. Ten male volunteers without any gait disorder were included in the study as the control group. Functional ambulation scale, visual analog scale, energy expenditure index, 6-minute walking test, 10-m walking test, and Short Form 36 were performed to determine the quality of life and functionality of the participants. There were no statistically significant differences between the 2 groups in terms of functional ambulation scale, energy expenditure index, 6-minute walking test, and 10-m walking test. Regarding Short Form 36 scores, all subgroup values were lower in the reconstruction group, whereas only those of general health, vitality, and physical-emotional role limitation subgroups showed statistical significance. Mean visual analog scale scores were found to be statistically different between the groups (P < .05). Mean Freiburg Ankle scores showed moderate functionality. Despite the associated physical and emotional trauma, combat-injured veterans with heel reconstruction after landmine injuries had adequate and functional ambulation at long-term follow-up. Early rehabilitation and close cooperation between surgeons and rehabilitation physicians during the care of these patients will enhance patient outcomes.

Quality of Life and Functionality of Patients with Heel Reconstruction after Landmine Explosions

INTRODUCTION: Landmine injuries cause extensive soft and bony tissue loss of the weight bearing areas, particularly the heel. The aim of this study is to determine the quality of life and long term functionality of the patients who had heel reconstruction with free muscle flap following after landmine injuries (1–3). METHODS: Nineteen male patients who had heel reconstruction with free muscle flap were included in the study. Nine male volunteers without any gait disorder were included in the study as the control group. Functional Ambulation Scale (FAS), Energy Expenditure Index (EEI), 6-minute walking test (6MWT), 10-meter walking test (10MWT), Short Form 36 (SF-36) and Visual Analogue Scale (VAS) were used for evaluation (4). In patients with heel reconstruction, we also performed Freiburg ankle evaluation test and Graves radiologic evaluation test. RESULTS: There were no statistically significant differences between the two groups in terms of FAS, EEI, 6 MWT and 10 MWT. Regarding SF-36 scores, all subgroup values were lower in the reconstruction group whereas only those of general health, vitality and physical-emotional role limitation subgroups showed statistical significance. Mean VAS scores were found to be statistically different between groups (p<0.05). Mean Freiburg ankle scores showed moderate functionality. CONCLUSION: Although some physical and emotional role limitations, patients with heel reconstruction have adequate and functional ambulation at long term follow up. Considering the fact that our patient group comprised young men, we think that further studies can be conducted in similar subjects at older ages as well.

Comparison of Quality of Life and Functionality in Patients with Traumatic Unilateral below Knee Amputation and Salvage Surgery

The aim of this study was to compare the functionality during daily activities and quality of life of patients with transtibial amputation vs. salvage surgery after severe lower limb trauma. Ten patients with unilateral below knee amputation and nine patients with salvage surgery after severe lower limb trauma were enrolled. Functional Ambulation Scale (FAS), Visual Analogue Scale (VAS), Short Form 36 (SF-36) Energy Expenditure Index (EEI), 6-Minute Walking Test (6MWT) and 10-Meter Walking Test (10MWT) were used for the evaluation of subjects. Patients in the salvage group were also evaluated radiologically with Graves' radiological assessment method and Freiburg ankle scoring system. All patients were classified as grade 5 according to FAS. All SF-36 subgroup values were higher in the amputation group whereas only those of general health and vitality reached statistical significance (p < 0.05). The visual analogue scale (VAS) has been used to assess the efficacy of pain management. Mean VAS scores were found to be statistically higher in the salvage group (p < 0.005). Reoperation rates were one in 10 amputee and six in nine salvage patients. Mean Freiburg ankle scores of the patients in the salvage group were 55.33 +/- 15.51 which was consistent with moderate functionality. According to Graves' radiological assessment; four patients had grade 3 degeneration, four had grade 2 and one had grade 1 degeneration in the ankle joints. Mean EEI values, 6-MWT and 10-MWT results were not significantly different between the groups (p values > 0.05). Although amputation still remains as the last resort both for patients and the physicians, our results demonstrated that reoperation rates, quality of life (general health and vitality) and pain scores were better in amputee patients.

Bone Loss During the Acute Stage Following Burn Injury

The aim of this study was to investigate the effect of burn injury on bone metabolism and bone densitometry in the early period. Twenty-one patients with >25% total body surface area (TBSA) burns and 20 healthy controls participated. TBSA burned, ambulation, and functional status were recorded. After 30 days, we measured bone mineral densities of the L1-L4 vertebrae, the left distal forearm, and the left proximal femur in the patients. At 1 and 4 weeks after the burn, changes in bone turnover were assessed in patients by changes in deoxypyridinoline levels in the urine and osteocalcin in the serum and compared with the values of control group. In patients, Z-scores < -1 were found in 71.42% of left distal forearm, 23.80% of left proximal femur, and in 42.85% of L1-L4 vertebrae measurements. No significant correlations existed between Z-scores and TBSA, Functional Ambulation Scale, or Functional Independent Measure. When compared with controls, there was no statistically significant decrease of osteocalcin (a marker of bone formation) levels in patients 1 and 4 weeks after burn injury. However, when compared with controls, a statistically significant difference was found regarding deoxypyridinoline (a marker for bone resorption) in patients 1 and 4 weeks after burn injury (P < .001 and P < .001, respectively). Decreases in bone mineral density occurred during the first month following burn injury, which seemed to be linked with increases in bone resorption during this period. No correlation existed between reduction in bone mineral density and functional status.

Ambulation training of neurological patients on the treadmill with a new Walking Assistance and Rehabilitation Device (WARD).

Patients with neurological walking impairment were rehabilitated with a new system, consisting of an apparatus to constantly relieve the body weight and a treadmill: The Walking Assistance and Rehabilitation Device (WARD). Patients were evaluated before and after rehabilitation with clinical scales and physiological measurements. To evaluate the effectiveness of the WARD in improving walking capability in these patients. The study was carried out in a clinical environment (IRCCS S. Lucia, Rehabilitation Hospital, Rome, Italy). Seven patients (six with spinal cord injuries, one with brain injury) underwent a 1 - 2 month training period with the WARD. During the WARD training the body weight constant unloading (BWCU) applied to the patient through the WARD was regularly evaluated. Oxygen consumption, carbon dioxide production and heart rate were measured in order to obtain energy and cardiac costs of walking. These measurements were carried out while walking with the WARD at an appropriate treadmill speed (ATS) and in the open field at the most comfortable speed (MCS). All measurements, in addition to clinical scores related to the walking capability, were carried out at the beginning of the WARD training period (BWT) and at the end (EWT). At the EWT the patients were tested walking with the WARD observing the same BWT conditions (same ATS and BWCU), referred to as beginning conditions second measurements (BCSM). The relationships between physiological costs and ATS were described through second order polynomial regression curves and studied. Comparing the data obtained at the BWT and EWT, the following results were found significantly different: (1) Clinical scores improved; (2) All patients increased their ATS; (3) The BWCU was reduced; (4) The Walking Energy Cost (WEC) and the Walking Cardiac Cost (WCC) measured when walking with the WARD at the ATS improved in all patients; and (5) The WEC and WCC measured in the open field improved in all patients. The WEC vs ATS curve found at the EWT in the BCSM was found significantly different from the BWT curve, demonstrating a major improvement due to the WARD training. Despite some limitations due to sample size and functional ambulation scale, this study has demonstrated that the WARD training is effective in improving the walking capability and efficiency of the patients.

Classification of Walking Handicap in the Stroke Population

The limited walking ability that follows a stroke restricts the patient's independent mobility about the home and community, a significant social handicap. To improve the in-hospital prediction of functional outcome, the relationships between impairment, disability, and handicap were assessed with clinical measures in 147 stroke patients. The patients' level of functional walking ability at home and in the community was assigned by expert clinicians to one of the six categories of a modified Hoffer Functional Ambulation scale at least 3 months after discharge. A 19-item questionnaire was further used to assess current customary mobility of the subjects. Functional muscle strength and proprioception were tested, and walking velocity was measured. The significant indicators of impairment, upright motor control knee flexion and extension strength, differentiated household from community ambulators. The addition of velocity improved the functional prediction. Proprioception was clinically normal in all walkers. The validity of the criteria for the six levels of walking handicap was confirmed statistically. Stepwise discriminant analysis reduced the ambulation activities on the questionnaire from 19 to 7. Redefinition of the criteria for patient classification using the coefficients and constants of the seven critical functions improved the prediction of patient walking ability to 84%. The results of this study offer a quantitative method of relating the social disadvantage of stroke patients to the impairment and disability sustained. The measurement of therapeutic outcome in relation to the social advantage for the patient would allow more efficient standardization of treatment and services.