Stroke Rehabilitation Outcomes Research Articles

Impact of BDNF -196 G>A and BDNF -270 C>T Polymorphisms on Stroke Rehabilitation Outcome: Sex and Age Differences

Background: Genetic factors, including gene polymorphisms, are promising in determining stroke rehabilitation outcome. Brain-derived neurotrophic factor (BDNF) is one of the most attractive because of its role in neuroplasticity and brain repair. Objective: The aim of present study was to assess the role of BDNF -196 G>A (val66met) and -270 C>T on clinical parameters and functional outcome in patients with ischemic and hemorrhagic stroke. Additional analyses according to sex and age (≤55 and >55 years) were performed. Methods: Three hundred thirty-eight patients (287 with ischemic and 51 with hemorrhagic stroke) were evaluated in terms of neurological deficit (National Institute of Heath Stroke Scale [NIHSS]), activities of daily living (Barthel Index [BI]), and everyday functionality (Rankin score [RS]) before and after rehabilitation. BDNF polymorphism genotyping was performed by polymerase chain reaction restriction fragment length polymorphism analysis. Results: In multivariative analysis, unfavorable outcome of stroke rehabilitation (RS ≥2) was associated with independent factors: ischemic stroke (odds ratio [OR], 2.59; 95% CI, 1.03-6.47), female gender (OR, 2.80; 95% CI, 1.39-5.64), depression (OR, 4.24; 95% CI, 1.45-12.35), falls (OR, 2.61; 95% CI, 1.16-5.87), and BDNF -196 GG polymorphism (OR, 2.18; 95% CI, 1.09-4.35). The differences of functional parameters measured with BI and RS on admission and at discharge are apparent only for comparisons between patients ≤55 and >55 years old carrying BDNF -196 GA+AA genotypes but not in those carrying -196 GG genotype; the differences were evident in women but not in men. Conclusions:BDNF -196 G>A polymorphism might affect functional outcome of stroke rehabilitation, but this hypothesis needs further verification.

Systematic Review of Leisure Therapy and Its Effectiveness in Managing Functional Outcomes in Stroke Rehabilitation

Background: Evidence suggests that the incorporation of leisure activities in adult stroke rehabilitation can contribute to improved physical, cognitive, and psychological outcomes. However, differences in study design and treatment delivery may affect these findings. Furthermore, the magnitude of therapeutic change associated with leisure therapy is unclear, with few quantitative reviews available. Objective: To synthesize and evaluate the empirical evidence examining leisure therapy in stroke rehabilitation. Methods: Eight independent studies (N = 615 participants) were identified from a comprehensive database search. Study quality was evaluated using the Oxford Levels of Evidence. Pre- and posttreatment data for participants who received leisure therapy, in comparison with peers who received standard care or no treatment, were evaluated by calculating Cohen’s d effect sizes and 95% confidence intervals. Results: No studies met the criteria for the highest level of methodological rigor, although all used randomization procedures. Leisure therapy contributed to significant short-term improvements in psychological outcomes, namely quality of life and mood (d range, 2.10 to 0.54), in addition to leisure-specific outcomes, including increased participation in and satisfaction with leisure activities (d range, 0.81 to 1.23). Longer term effects of treatment could not be determined, with one study providing data and reporting nonsignificant effects (d range, -0.07 to 0.17). Conclusions: There is some evidence that leisure therapy offers an opportunity to enhance short-term treatment gains in community-based stroke rehabilitation. Further controlled research is needed to establish its longer term effects and assist the development of evidence-based guidelines for this treatment.

Predicting outcome in a postacute stroke rehabilitation programme

This study aims to evaluate and predict outcome as part of routine quality assessment of an inpatient stroke rehabilitation programme. By relating functional outcome to patient characteristics, including variables from the quality of life domain, we aim to find a set of variables that can be useful for prognosis, stratification and programme improvement. Data were collected, before and after rehabilitation, from a prospective quality registration database. Included were 250 patients in inpatient stroke rehabilitation after sustaining a first or recurrent ischemic or haemorrhagic stroke. Functional status was measured with the Barthel Index and the Academic Medical Centre Linear Disability Score. Health-related quality of life (HrQoL) was measured with the COOP/WONCA and the Nottingham Health Profile. Significant improvements were found on all outcome measures. A lower functional admission score, older age, more severe stroke, more pain and more negative emotional reactions on admission were found to be independent predictors of a lower outcome score, explaining 39.5% of its variance. Subjective (HrQoL) factors such as negative emotion and pain have an adverse effect on outcome of stroke rehabilitation, in addition to stroke severity, age and functional status at admission. These factors need to be taken into account in screening, clinical decision making and treatment design.

Systematic Review of Leisure Therapy and Its Effectiveness in Managing Functional Outcomes in Stroke Rehabilitation

Systematic Review of Leisure Therapy and Its Effectiveness in Managing Functional Outcomes in Stroke Rehabilitation

International Symposium

Subacute Stroke Rehabilitation System and Outcome Subacute Stroke Rehabilitation in Korea…Won-Seok KIM，Nam-Jong PAIK 410Cancer Rehabilitation： Research, Training, and Practice Current Status of Cancer Rehabilitation in Japan and Challenge…Tetsuya TSUJI 414Current Status of the System for Specialists in Rehabilitation Medicine and Challenges：An International Comparative Approach Physical Medicine & Rehabilitation Residency Training and Certification in the United States…William L BOCKENEK 419 Woman Doctors as Specialists in Rehabilitation Medicine : Present and Future…Toyoko ASAMI 423

Effect of Swiss Ball Training on Balance in Hemiplegic Patient

Background: Stroke is sudden loss of neurological function caused by interruption of blood flow to the brain. Loss of muscle strength, spasticity and imbalance play a role in functional disability in stroke. Balance status is one of the predictors of outcome of stroke rehabilitation. Exercises on dynamic surface like Swiss ball is becoming common mean of treatment in stroke patients.

The effect of protein and calorie intake on prealbumin, complications, length of stay, and function in the acute rehabilitation inpatient with stroke

Nutrition's impact on stroke rehabilitation outcomes is controversial. Existing studies utilize albumin without correcting for inflammation in nutritional assessments. Here, prealbumin was used and inflammation assessed to determine if nutrition impacts rehabilitation outcomes. Determine the effect of dietary intake on prealbumin level, number of complications, length of stay, and Functional Independence Measure (FIM) efficiency in rehabilitation stroke inpatients. Patients had admission and discharge prealbumin and C-reactive protein (CRP) levels drawn; and, weekly protein and calorie counts obtained. Patients were followed for number of complications, length of stay, and FIM efficiency. Mean protein and calorie intake was 57.6 ± 16.2 g/d and 1452.2 ± 435.8 kcal/d, respectively. 77.6% of patients had normal prealbumin on admission with 94.9% on discharge. Prealbumin increased significantly from admission to discharge (22.3 ± 6.2 mg/dL vs. 24.6 mg/dL ± 5.1 mg/dL, P = 0.007). Number of complications and length of stay were predicted by CRP in regression models. Total, motor, and cognitive FIM efficiencies were not universally affected by prealbumin levels, protein intake, or calorie intake. Nearly all hypoprealbuminemic stroke rehabilitation inpatients correct their levels eating a non-supplemented diet. Number of complications, length of stay, and functional outcomes in this patient are not affected by prealbumin levels, protein intake, or calorie intake.

Stroke-related motor outcome measures: Do they quantify the neurophysiological aspects of upper extremity recovery?

Various stroke rehabilitation outcome measures are used in clinical and research practice. Severe upper extremity paresis serves as a challenge for the selection of an appropriate outcome measure. No single measure is universally acceptable and sufficient to record the minute clinically important changes. The objectives of the present review were to explore the stroke-specific upper extremity motor outcome measures and to better understand those measures' ability to quantify upper extremity motor recovery. Seven outcome measures were selected for this review. The criteria used to select outcome measures for this review included performance-based tools that assessed the upper extremity's voluntary motor control and outcome measures which had been used for the past 10 years. A critical review that referred to motor recovery stages and volitional control was performed. The upper extremity components of each measure were compared with the neurophysiological aspects of recovery (Brunnstrom Recovery Stages) and analyzed for their clinical relevance. The concepts of minimal detectable change and minimal clinically important difference were also considered while examining the outcome measures. The findings of this review reveal that there were very few measures available to precisely assess the upper extremity motor components and volitional control. Most of the measures are functional and performance-based. Only Fugl-Meyer Assessment was found to explore the individual joint motor control as per the sequential recovery stages. Further, there is a need to develop stroke-specific upper extremity outcome measures. Scoring criteria of the acceptable measures may be modified to discern precise and progressive, but clinically significant motor changes.

Regional Variation in Stroke Rehabilitation Outcomes

ObjectiveTo examine and describe regional variation in outcomes for persons with stroke receiving inpatient medical rehabilitation. DesignRetrospective cohort design. SettingInpatient rehabilitation units and facilities contributing to the Uniform Data System for Medical Rehabilitation from the United States. ParticipantsPatients (N=143,036) with stroke discharged from inpatient rehabilitation during 2006 and 2007. InterventionsNot applicable. Main Outcome MeasuresCommunity discharge, length of stay (LOS), and discharge functional status ratings (motor, cognitive) across 10 geographic service regions defined by the Centers for Medicare and Medicaid Services (CMS). ResultsApproximately 71% of the sample was discharged to the community. After adjusting for covariates, the percentage discharged to the community varied from 79.1% in the Southwest (CMS region 9) to 59.4% in the Northeast (CMS region 2). Adjusted LOS varied by 2.1 days, with CMS region 1 having the longest LOS at 18.3 days and CMS regions 5 and 9 having the shortest at 16.2 days. ConclusionsRehabilitation outcomes for persons with stroke varied across CMS regions. Substantial variation in discharge destination and LOS remained after adjusting for demographic and clinical characteristics.

First-Year Outcomes after Stroke Rehabilitation: A Multicenter Study in Thailand

Stroke affects the long-term quality of life and the well-being of patients and families. Stroke patients gain benefits from rehabilitation. Authors reported 1-year outcomes of stroke rehabilitation in 327 patients registered to the Thai Stroke Rehabilitation Registry. The outcomes included death rate, readmission rate, functional ability score (Barthel Index, BI), and factors affecting BI score. Of 327 patients, 214 (65.4%) had adequate follow-up data for analysis. The average age was 62.1 ± 12.5 years, and 57.9% were male. The mortality rate was 2.5% and the readmission rate was 11.2%. The number of the patients who could function independently increased from 5.5% at discharge to 22.9% and 25.5% at month 6 and month 12, respectively. The change in functional ability level of 214 patients included improvement (51.5%), deterioration (12.8%), and equivocal (35.7%). The low functional score at month 12 was significantly correlated with longer length of stay (LOS), longer onset to admission interval, and higher depression score at month-12. In conclusion, approximately half of the patients had an improvement in the disability level for at least one grade at 1-year follow-up. The low functional score by the end of the first year is associated with longer LOS during the first admission, delay in rehabilitation program, and psychological depression.

Rehabilitation Outcomes of Stroke Patients With and Without Diabetes

ObjectiveTo investigate the relation of diabetes comorbidity and the rehabilitation outcomes of patients with stroke. DesignSecondary data analysis. SettingInpatient rehabilitation facilities. ParticipantsPatients with stroke (N=35,243) who received inpatient rehabilitation in 2004 through 2008. InterventionsNone. Main Outcome MeasuresFIM, length of stay, and discharge destination. ResultsMean age ± SD of the sample was 71.0±13.2 years. The percent of the sample of Medicare beneficiaries was 53.8%, whereas 46.2% had other sources of funding. Of the patients in the sample, 34.5% had a comorbidity of diabetes, with 17.2% classified as tier-eligible and 82.8% as nontier eligible. Findings included that patients in this sample with diabetes were admitted for rehabilitation services at a younger age than those without diabetes and support previous studies in which tier-eligible diabetes comorbidities moderated by patient age were found to be significant predictors of stroke rehabilitation outcomes. Furthermore, similar findings remained regardless of payer source. ConclusionsThis study provides additional evidence that diabetes as a comorbidity is significantly related to stroke rehabilitation outcome, but the relation is moderated by patient age.

Relevance of Location to Outcome of Stroke Rehabilitation

Rehabilitation after stroke is a process that plays an important role in improving and / or enhancing recovery beyond what would have occurred spontaneously. The choice of environment for provision of rehabilitation services, mode of organisation and delivery of services are pertinent to the outcome of rehabilitation. Yet limited information exists on the best way to organise stroke rehabilitation and the relative cost of such services. The involvement and empowerment of patients are inherent and integral to the rehabilitation process. Health policy should therefore be directed at the adoption of rehabilitation settings that stimulate the involvement of patients in their own rehabilitation process and at an affordable cost.

10.4172/2165-7025.1000182

Objective: To examine the extent to which daily physical activity and social participation are associated with clinical measures of motor function, balance, balance self-efficacy, functional mobility, and walking speed and distance in community-dwelling people with stroke. Methods: In a cross-sectional study, the Chedoke-McMaster stroke assessment (CMSA; leg and foot scales), Berg balance scale (BBS), activities-specific balance confidence (ABC) scale, timed ‘up and go’ (TUG), 5-meter walk test (5mWT), 6-minute walk test (6MWT), and the stroke impact scale (SIS; participation scale) were used to measure lower extremity motor function, balance, balance self-efficacy, functional mobility, walking speed and distance, and participation, respectively. Daily physical activity was estimated using time spent upright during standing and walking measured over a five-day period with a uniaxial accelerometer (activP AL). Results: Fifteen men and two women participated. The mean ± standard deviation age and time post-stroke were 71.4 ± 9.7 and 2.0 ± 0.1 years, respectively. Time spent upright per day was 192 ± 141 minutes and SIS participation scores were 68 ± 21 points. ABC scale ratings and comfortable gait speed correlated with physical activity (rho=0.66 and 0.50, p=0.004 and 0.043, respectively) and participation (rho=0.62 and 0.48, p=0.007 and 0.049, respectively). Time spent upright and participation scores were also correlated (rho=0.66, p=0.004). Conclusions: Balance self-efficacy and comfortable walking speed are moderately associated with time spent standing and walking per day as well as social participation in ambulatory, community-dwelling people with stroke. The ABC scale and the 5mWT are recommended as interpretable measures of outcome in stroke rehabilitation with relevance to community living.

How Useful is Imaging in Predicting Outcomes in Stroke Rehabilitation?

Neuroimaging plays an important role in acute stroke diagnosis and management, but it is not routinely used in rehabilitation settings. Incorporating imaging information in rehabilitation planning may eventually translate to better outcomes after stroke. Here we review the prediction of outcomes after stroke using magnetic resonance imaging. There are clear and specific relationships between the anatomy of the stroke lesion and impairments at the time of scanning, and at later time points in recovery. However, most studies demonstrate these relationships in groups of patients at the chronic stage. In order to be useful for rehabilitation, neuroimaging needs to provide prognostic information for individual patients at a much earlier stage. Recent studies have used diffusion tensor imaging and functional neuroimaging to address this, with promising results. Combining neuroimaging with clinical and neurophysiological assessments may also be useful. Future work in this area may support the tailoring of rehabilitation for individual patients based on their capacity for neural reorganization and recovery.

Postural control the best predictor of stroke rehabilitation outcome

Postural control the best predictor of stroke rehabilitation outcome

How does cognitive ability affect stroke rehabilitation outcomes?

Background: This paper discusses literature findings on the impact of pre-stroke degenerative cognitive impairments (pre-stroke dementia) on post-stroke rehabilitation outcomes. This association has practical implications for stroke rehabilitation services which are faced with the dilemma that pre-stroke cognitive impairment may be a cause of stroke and, on the other hand, stroke may cause cognitive deficits. Content: The link between pre-stroke dementia and stroke is described by explaining how vascular and neurodegenerative pathology contribute to stroke occurrence and to stroke related impairment. Stroke seems to be more closely related to dementia than previously thought and vascular factors appear to be at the core of a wide range of dementing disorders. The literature reviewed emphasises how cognitive performance at stroke onset can give indications about the anticipated level of post-stroke functional independence. Conclusion: The importance of assessing and monitoring cognitive performance of stroke survivors using reliable neuropsychological procedures is emphasised. The assessment results help to estimate rehabilitation potential, to plan the most effective interventions and to optimise post-hospital discharge arrangements. This helps clinicians on stroke units to make rehabilitation decisions addressing both cognitive variables and professional standards.

Relaxin key to improved stroke rehabilitation outcomes

Relaxin key to improved stroke rehabilitation outcomes

A Cross-Sectional Assessment of Stroke Rehabilitation in Nebraska Hospitals

Jones KJ, Cochran TM, Jensen LE, Roehrs TG, Volkman KG, Goldman AJ. A cross-sectional assessment of stroke rehabilitation in Nebraska hospitals. ObjectiveTo assess the structure and process of stroke rehabilitation in Nebraska hospitals. DesignCross-sectional mail survey using the Dillman tailored-design method of administration. SettingHospitals in Nebraska. ParticipantsApproximately 77% of the 84 Nebraska hospitals that provide stroke rehabilitation are critical access hospitals (CAHs) that are limited to 25 beds. Our study sample of hospitals (N=53) included the 19 hospitals licensed for 47 to 689 beds (non-CAHs) and a stratified random sample of 34 of the 65 CAHs. InterventionsNot applicable. Main Outcome MeasuresSelf-reported stroke rehabilitation team structure and processes, purposes of and barriers to the use of evidence-based standardized assessments, specific assessments used, and access to specialized stroke rehabilitation services and community resources. ResultsThirty-six (68%) of the 53 hospitals responded to the survey. Approximately 61% of the hospitals used an organized team to provide stroke rehabilitation; 8% of the hospitals—all non-CAHs—had a team dedicated to stroke rehabilitation. After adjusting for hospital size, having an organized team was significantly associated with the use of standardized assessments to improve communication, measure progress and outcomes, evaluate effectiveness of practice, and compare patient outcomes across conditions. Access to specialized stroke rehabilitation professionals and services was significantly greater in non-CAHs. ConclusionsHospital size and the presence of a team are determinants of the structure and process of stroke rehabilitation in Nebraska hospitals. Further research is needed to determine (1) whether team structure is a determinant of stroke rehabilitation outcomes across the continuum of care settings, (2) the needs of rural stroke survivors, and (3) whether technology can facilitate the use of stroke rehabilitation standardized assessments by rural health care professionals.

Clinical Utility of the AlphaFIM® Instrument in Stroke Rehabilitation

The AlphaFIM instrument is an assessment tool designed to facilitate discharge planning of stroke patients from acute care, by extrapolating overall functional status from performance in six key Functional Independence Measure (FIM) instrument items. To determine whether acute care AlphaFIM rating is correlated to stroke rehabilitation outcomes. In this prospective observational study, data were analyzed from 891 patients referred for inpatient stroke rehabilitation through an Internet-based referral system. Simple linear and stepwise regression models determined correlations between rehabilitation-ready AlphaFIM rating and rehabilitation outcomes (admission and discharge FIM ratings, FIM gain, FIM efficiency, and length of stay). Covariates including demographic data, stroke characteristics, medical history, cognitive deficits, and activity tolerance were included in the stepwise regressions. The AlphaFIM instrument was significant in predicting admission and discharge FIM ratings at rehabilitation (adjusted R² 0.40 and 0.28, respectively; P < 0.0001) and was weakly correlated with FIM gain and length of stay (adjusted R² 0.04 and 0.09, respectively; P < 0.0001), but not FIM efficiency. AlphaFIM rating was inversely related to FIM gain. Age, bowel incontinence, left hemiparesis, and previous infarcts were negative predictors of discharge FIM rating on stepwise regression. Intact executive function and physical activity tolerance of 30 to 60 mins were predictors of FIM gain. The AlphaFIM instrument is a valuable tool for triaging stroke patients from acute care to rehabilitation and predicts functional status at discharge from rehabilitation. Patients with low AlphaFIM ratings have the potential to make significant functional gains and should not be denied admission to inpatient rehabilitation programs.

Poster 80 Physical Therapy Activities in Stroke, Knee Arthroplasty, and Traumatic Brain Injury Rehabilitation and Functional Outcomes

(1) Examine similarities and differences in the mix of physical therapy activities among patients from different impairment groups, and (2) examine if the same PT activities are associated with functional improvement across impairment groups.