Postural Assessment Scale For Stroke Patients Research Articles

Effects of trunk stabilization exercises on balance, functionality and abdominal muscle thickness in hemiplegic patients.

This study aims to investigate the effects of trunk stabilization exercises (TSEs) in addition to conventional exercises in patients with stroke on balance, functionality and abdominal muscle thickness as measured by ultrasonography (USG) and to compare the patients' non-paretic side abdominal muscle thickness with healthy population. Between April 2019 and June 2019, a total of 26 hemiparesis/hemiplegic patients with stroke (15 males, 11 females; mean age: 62.3±7.8 years; range, 52 to 71 years) confirmed by neurological examination or computed tomography (CT) / magnetic resonance imaging (MRI) and 20 age-matched healthy volunteers (12 males, 8 females; mean age: 62.3±7.2 years; range, 53 to 70 years) were included in the study. The patients were randomized into two groups. In the first group (n=13), TSE were performed in addition to conventional neurorehabilitation program, five times/week for a total of four weeks. The second group (n=13) was given conventional neurorehabilitation program, five times/week for a total of four weeks. Also, healthy volunteers as the third group were compared with the patient population. The evaluations were made at the beginning and end of the treatment. The Berg Balance Scale (BBS), Barthel Index (BI), Postural Assessment Scale for Stroke Patients (PASS), and Functional Reach Test (FRT) were used. Abdominal muscle thickness at rest and contraction were evaluated using USG. Ten patients in Group 1 and 10 patients in Group 2 completed study. A significant improvement was observed in all abdominal muscles in both groups (p<0.05), indicating no significant difference between the groups (p>0.05). There was a statistically significant improvement for BBS and FRT in both groups. The PASS and BI scores showed a significant improvement only in TSE group. Both the TSE and conventional neurorehabilitation program provided significant improvements in abdominal muscle thickness, balance and trunk control. For postural control and functionality, additional TSE seems to be more effective.

Impact of Early Mobilization on Patients With Acute Ischemic Stroke Treated With Thrombolysis or Thrombectomy: A Randomized Controlled Trial

Background Early mobilization (EM) within 24 to 72 hours post-stroke may improve patients’ performance and ability. However, after intravenous thrombolysis (IVT) or mechanical thrombectomy (MT), the increased risk of hemorrhagic complications impacts the implementation of early out-of-bed mobilization. Few studies have investigated EM after IVT or MT for acute ischemic stroke (AIS), and its impact in these patients is unknown. Objective To investigate the effect of EM on AIS treated with IVT or MT.| Methods We recruited 122 patients with first AIS; 60 patients were treated with IVT, and 62 patients were treated with MT. For each IVT and MT cohort, the control groups received standard early rehabilitation, and the intervention groups received an EM protocol. The training lasted 30 minutes/day, 5 days/week until discharge. Main Outcomes Measures The effectiveness of the interventions was evaluated using the motor domain of the Functional Independence Measure (FIM-motor) and the Postural Assessment Scale for Stroke Patients (PASS) at baseline, 2-week, 4-week, and 3-month post-stroke, the Functional Ambulation Category 2-week post-stroke, and the total length of stay at the stroke center. Results Both IVT and MT treatment groups showed improved FIM-motor and PASS scores over time; however, only the IVT EM group had significantly improved FIM-motor performance within 1 month after stroke than the control group. Conclusion. An EM protocol with the same intervention time and session frequency per day as in the standard care protocol was effective in improving the functional ability of stroke patients after IVT.

The minimal important difference for the Postural Assessment Scale for Stroke Patients in the subacute stage

BackgroundThe minimal important difference (MID) of the Postural Assessment Scale for Stroke Patients (PASS) remains unknown, limiting the interpretation of change scores. ObjectivesTo estimate the MID of the PASS in patients with subacute stroke. MethodsData at admission and discharge for 240 participants were retrieved from a longitudinal study. The “mobility” item of the Barthel Index was used as the anchor for indicating the improvement of posture control. Receiver operating characteristic (ROC) method was used to estimate the anchor-based MID of the PASS. ResultsThe ROC method identified a MID of 3.0 points, with a sensitivity of 81.0 % and a specificity of 75.6 %. ConclusionThe MID of the PASS was 3.0 points, indicating that if a patient achieves an improvement of 3.0 or more points on the PASS, they have a clinically important improvement in posture control. Our results can help in interpreting change scores and aid in understanding the clinical values of treatment outcomes.

The Relationship of Trunk Control with Lower Extremity Sense, Balance, and Walking in Individuals with Stroke

Objective: This study was conducted to investigate the relationship between trunk control and lower extremity sense, balance and gait in stroke individuals.&#x0D; Methods: Thirty subacute and chronic stroke patients were included in the study (mean age 52. 2 14.4 years). Trunk Impairment Scale (TIS) and Turkish version of Postural Assessment Scale for Stroke Patients (PASS-T) was used for evaluating the body control, and Tinetti Balance Test (TBT) was used for evaluating balance. Tinetti Gait Test (TGT) and Ten Meter Walking Test (TMWT) were applied for evaluating walking. The light touch sense and proprioception, Fugl-Meyer Assessment of Sensorimotor Function (FMASF) for lower extremity were used. Furthermore, neglect, plantar pressure sense and stereognosis for lower extremity were evaluated.&#x0D; Results: There was a significant positively strong correlation between TIS and TBT, TGT and FMSMFT, and negatively strong correlation between TIS and TMWT (p

Evaluation of the relationship of balance and posture with speech functions in stroke patients

Aim: Balance disorders, postural dysfunctions, and speech disorders are common after stroke. This study aims to investigate whether there is a connection between language and speech function and posture and balance in paralyzed patients and to which speech area function the connection is related.Methods: Eighteen stroke patients with speech impairment and no cognitive impairment were included in the study. Balance and postures of stroke patients were evaluated using the Berg Balance Test (BBT) and Postural Assessment Scale for Stroke Patients (PASS-T), while their quality of life was evaluated using the Stroke and Aphasia Quality of Life-39 Test (SAQOL-39). Patients’ speech functions were evaluated using the Gülhane Aphasia Test-2 (GAT-2), voice-related assessments were made with the Voice-Related Quality of Life Scale (V-RQOL), and objective voice analysis.Results: The mean age of the participants was 59.10±14.72 years, the mean score of the Mini-Mental Test was 26.16±2.00. According to statistical analysis, there was a significant relationship between BBT score and GAT-2 (r: 0.552, p=0.017), and BBT score and SAQOL-39 mean score (r: 0.589, p=0.010), there was no significant relationship between BBT and V-RQOL (r: -0.075, p=0.768). While there was a significant relationship between PASS-T (r: 0.499, p=0.035) and SAQOL-39, no significant relationship was found with GAT-2 (r: 0.388, p=0.112). In addition, a significant correlation was found between the SAQOL-39 mean score and the GAT-2 total score (r: 0,606, p=0.008).Conclusion: It was observed that there is a significant relationship between balance functions and speech function and quality of life, and patients with good balance have better functional independence and speech functions. However, it was found that posture did not change speech function. Due to the importance of evaluation in treatment, it is thought that the evaluation of stroke patients who will receive speech and language therapy in terms of balance and postural functions will contribute to the speech functions of patients.

Application of a virtual reality tracker-based system to measure seated postural stability in stroke patients

BackgroundPostural stability while sitting is an important indicator of balance and an early predictor for future functional improvement in neurorehabilitation, but the evaluation is usually dependent on clinical balance function measures. Meanwhile, instrumental posturography has been used widely to obtain quantitative data and characterize balance abilities and underlying control mechanisms, but not as often for sitting balance. Moreover, traditional kinetic methods using a force platform to test sitting stability often require modification and are costly. We proposed a tracker-based posturography with a commercial virtual reality system, the VIVE Pro system (HTC, Inc. Taiwan), to record the trunk displacement (TD) path with a lumbar tracker for evaluation of sitting stability. The goals were to test the reliability and validity of the TD parameters among stroke patients.MethodsTwenty-one stroke individuals and 21 healthy adults had their postural sway measured with this system under four sitting conditions, i.e., sitting on a solid surface or a soft surface, with eyes open or closed. The test–retest reliability of the TD parameters was evaluated with intraclass correlation coefficients in 22 participants. We also tested the discriminative validity of these parameters to discriminate between stroke and healthy controls, and among four sitting conditions. Furthermore, the TD parameters were correlated with the three balance function tests: the Berg Balance Scale (BBS), the Postural Assessment Scale for Stroke Patients (PASS) and the Function in Sitting Test (FIST).ResultsThe results indicated that the TD parameters obtained by tracker-based posturography had mostly moderate to good reliability across the four conditions, with a few exceptions in the solid surface and eyes open tasks. The TD parameters could discriminate the postural stability between sitting on solid and soft surfaces. The stroke group had more seated postural sway than the control group, especially while sitting on a soft surface. In addition, velocity measures in the sagittal and frontal planes had moderate to high correlations with the PASS and BBS scores.ConclusionsThis tracker-based system is a cost-effective option for the clinical assessment of body stability for stroke patients in a seated position and shows acceptable reliability and validity.

Comparison of the postural assessment scale for stroke and the berg balance scale among ambulatory patients with chronic stroke

&lt;p&gt;臨床上中風病患姿勢控制評估量表及柏格氏平衡量表常被使用於評估中風病患的平衡功能，柏格氏平衡量表因為地板效應，並不適合用來評估急性中風或嚴重失能的中風病患。本研究聚焦於可行走的慢性中風病人，共收案23人，發現中風病患姿勢控制評估量表及柏格氏平衡量表之間具有統計學上的高度相關（斯皮爾曼等級相關係數為.93, P&lt;0.05），但因中風病患姿勢控制評估量表更為全面並且施作更省時，對可行走的慢性中風病人是更好的選擇。另外我們也發現中風病患姿勢控制評估量表的動態項目與拿掉閉眼行走項目的柏格氏平衡量表之間具有更高度相關（斯皮爾曼等級相關係數為.99, P&lt;0.05），是否能取代柏格氏平衡量表作為中風的預後因子需要未來更多的研究。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;Background and purpose: We examined the correlation between the scores of the Postural Assessment Scale for Stroke Patients (PASS) and those of the Berg Balance Scale (BBS) among ambulatory patients with chronic stroke. If the PASS scores are strongly correlated with the BBS scores, the PASS would be a superior alternative for evaluation because it can be administered faster and is more comprehensive. Methods: The PASS and BBS scores of 23 independently ambulatory patients with chronic stroke were collected and analyzed using Spearman&amp;rsquo;s rank correlation. Because the BBS includes more items for assessing dynamic balance function, we also analyzed the correlation between the scores of the changing posture subscale of the PASS and the scores of the BBS. Results: The Spearman rank correlation coefficient (r) between the BBS and PASS scores was .93 (P&lt;0.05), that between the changing posture scores and BBS scores was .87 (P &lt;0.05). Conclusions: Our study indicated that among ambulatory patients with stroke, the PASS and BBS scores were strongly correlated. Thus, the PASS is a superior alternative for evaluating patients with stroke because it is faster to administer and more comprehensive. Contrary to our hy-pothesis, the degree of the correlation between the changing posture scores and the BBS scores was not higher than that of the correlation between the PASS and BBS scores. Nev-ertheless, we believe that the PASS is still a more effective test for evaluating balance func-tion among ambulatory patients with stroke.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Postural Maintenance Is Associated With Walking Ability in People Receiving Acute Rehabilitation After a Stroke.

The Postural Assessment Scale for Stroke Patients (PASS) assesses the ability of people post stroke to maintain or change a given posture from lying to standing, and the items on which people with different walking status perform differently may suggest potential interventions. The purpose of this study was to (1) examine the association of PASS scores at admission for acute rehabilitation with walking status at admission and 3months post stroke (3 M), and (2) identify PASS items that discriminate walking status. In this prospective observational study, 93 people post stroke were assessed with the PASS and a 2.44-m gait speed test at admission, with walking status assessed by telephone interview at 3 M. Those who could walk over a 2.44-m distance without the assistance of a walking aid or another person were considered to be independent in walking; others were considered to be dependent. Those who were dependent at admission were divided into the "regained independence" and "remained dependent" groups based on their status at 3 M. The association of the PASS at admission with 3 levels of walking status (independent at admission, regained independence, and remained dependent) was examined using the Kruskal-Wallis test. For those dependent at admission, the association of PASS score at admission with walking status at 3 M was examined using logistic regression and receiver operating curve analysis. PASS scores at admission differed significantly across the 3 walking status groups and were significantly associated with walking status at 3 M (odds ratio = 0.864; 95% CI = 0.798-0.935) over and above length of stay. People post stroke who were dependent at admission and had PASS scores ≥22 were more likely to regain independence at 3 M. Nine PASS items differed among the 3 groups. PASS score is significantly associated with walking status at admission and at 3 M. The identified 9 items suggest possible interventions for acute rehabilitation. This study identified 9 PASS items that could guide clinicians in selecting interventions for acute rehabilitation.

Kronik İnmede İnmeli Hastalar için Postüral Değerlendirme Ölçeği'nin Psikometrik Özelliklerinin Berg Denge Ölçeği ve Brunel Denge Değerlendirmesi ile Karşılaştırılması

Objective: The purpose of the present study was to verify the validity of the Turkish version of the Postural Assessment Scale for Stroke Patients (PASS) in chronic stroke, and to compare its validity, reliability, and responsiveness characteristics with Berg Balance Scale (BBS), Brunel Balance Assessment (BBA).Method: 49 chronic stroke patients were included in the study. Those participating in the study were applied PASS, BBS and BBA on the first day. To measure the test-retest reliability, the second assessment for the scales was performed by the same physiotherapist 1 week after the initial evaluation.Results: According to the correlation analysis, a very high level of correlation was found between the PASS first and second assessment scores (r = 0.984). Cronbach Alpha Coefficient was found to be 0.995 (excellent). The Intraclass Correlation Coefficient (ICC) value for PASS was 0.995. A high level of correlation was found between PASS, BBS and BBA. No ceiling and floor effects were observed for PASS.Conclusion: The results of our study showed that Turkish version of PASS is a valid and reliable scale in chronic stroke patients and all these three scales, which are commonly used to assess balance in stroke patients are, made repeatable measurements in patients with chronic stroke. The test re-test reliability values of these three scales were found to be excellent. Minimal detectable change values, which are used to determine a real change in balance in stroke patients by clinicians, were found to be close to each other for these balance scales.

Efficacy of lateral stair walking training in patients with chronic stroke: A pilot randomized controlled study.

Patients with chronic stroke have reduced capacity for performing activities of daily living (ADLs) and are at increased risk for falls during walking due to long-term changes to muscle tone and force, as well as movement control. To investigate the efficacy of lateral stair walking training on muscle strength of affected lower extremities, balance, ADLs, and gait ability in patients with chronic stroke. The experimental group received 15 min of lateral stair walking exercise along with 15 min of traditional physiotherapy, whereas the control group received only traditional physiotherapy for 30 min. Both groups received the intervention once a week for 12 weeks. Outcome measurements included muscle strength, postural assessment scale for stroke patients (PASS), Fugal-Meyer assessment for lower extremity (FMA-LE), Barthel index (BI), timed up and go test (TUG), and the gait parameters which were determined by the Reha-Watch system. A total of 24 participants completed the study. The experimental group showed significant improvements in hip extensor, flexor, and abductor strength of the affected limb, FMA-LE, BI, TUG, and gait parameters of stride length, velocity, and cadence. Significant differences in affected limb ankle plantar strength (p = 0.024), PASS (p = 0.017), BI (p = 0.039), TUG (p = 0.049), and gait velocity (p < 0.001) were observed between the 2 groups. Lateral stair walking training alongside physical therapy resulted in significant improvements in hip muscle strength and gait parameters in patients with chronic stroke. Our results support the incorporation of lateral stair walking training into clinical rehabilitation programs. Lateral stair walking training in patients with chronic stroke can be used as an effective treatment to improve gait, balance performance, and ADLs.

Postural Assessment Scale for Stroke Patients in Acute, Subacute and Chronic Stage: A Construct Validity Study.

(1) Background: Observational scales are the most common methodology used to assess postural control and balance in people with stroke. The aim of this paper was to analyse the construct validity of the Postural Assessment Scale for Stroke Patients (PASS) scale in post-stroke patients in the acute, subacute, and chronic stroke phases. (2) Methods: Sixty-one post-stroke participants were enrolled. To analyze the construct validity of the PASS, the following scales were used: the Functional Ambulatory Category (FAC), the Wisconsin Gait Scale (WGS), the Barthel Index (BI) and the Functional Independence Measure (FIM). (3) Results: The construct validity of the PASS scale in patients with stroke at acute phase was moderate with the FAC (r = −0.791), WGS (r = −0.646) and FIM (r = −0.678) and excellent with the BI (r = 0.801). At subacute stage, the construct validity of the PASS scale was excellent with the FAC (r = 0.897), WGS (r = −0.847), FIM (r = −0.810) and BI (r = −0.888). At 6 and 12 months, the construct validity of the PASS with the FAC, WGS, FIM and BI was also excellent. (4) Conclusions: The PASS scale is a valid instrument to assess balance in post-stroke individuals especially, in the subacute and chronic phases (at 6 and 12 months).

Early Rehabilitation in Acute Care Inpatient Wards May Be Crucial to Functional Recovery 3Months After Ischemic Stroke.

Early rehabilitation in acute care inpatient wards may maximize functional outcome at 3months after stroke in survivors of stroke. It is unknown whether functional change during acute care hospitalization is significantly associated with functional recovery at 3months in survivors of acute stroke. The purposes of this study were to examine the association of the Barthel Index (BI) at 3months with functional change as measured with the Barthel Index (ΔBI) in an acute care inpatient ward and to identify the factors associated with ΔBI and who could benefit from an early rehabilitation program. In this prospective longitudinal study, 76 patients with ischemic stroke in an acute care inpatient ward received early rehabilitation of up to 2 sessions per day for 5 d/wk during their stay. Therapy density was calculated as the proportion of total therapy sessions completed. At admission and discharge, they were assessed with the BI and the Postural Assessment Scale for Stroke Patients (PASS). Demographic and health-related information was also collected. The Barthel Index (BI) was reassessed at 3months. ΔBI in the acute care inpatient ward significantly predicted the BI at 3months, over and above the other significant variables; in addition, therapy density and change in PASS were significantly associated with ΔBI. Patients with moderate initial functional dependence had the largest ΔBI, followed by the group with a more severe condition. ΔBI in acute care inpatient wards may be an important predictor of the BI at 3months. Therapy density and change in PASS were significantly associated with ΔBI. Survivors of acute stroke who receive up to 2 rehabilitation sessions per day for 5 d/wk early in their hospitalization have better functional recovery at 3months after stroke.

The reliability and validity of the Turkish version of Brunel Balance Assessment (BBA-T)

ABSTRACTBackground: The Brunel Balance Assessment Scale (BBA) is a valid, reliable scale for evaluating functional balance and mobility in patients with stroke. It should also be fast, simple, portable and inexpensive for use in clinical practice.Objectives:The aim of this study was to evaluate the reliability and validity of the Turkish version of Brunel Balance Assessment (BBA-T) in post-stroke patients.Methods: One hundred and five stroke patients (49 female, 56 male) with a mean age of 65.45 ± 11.33 years were included. Standardize Mini-Mental Test (SMMT), BBA, Berg Balance Scale (BBS), Rivermead Mobility Index (RMI) and Postural Assessment Scale for Stroke Patients (PASS) were performed to the patients.Results: According to correlation analysis, a very strong relationship was found between first and second evaluation total BBA-T scores (r = 0.909). Cronbach’s alpha coefficient was excellent. According to the Pearson correlation analysis performed to test inter-observer reliability, a very high correlation (r = 0.946) was observed among BBA total scores performed by the first and second physiotherapists. The BBA-T correlated with the BBS (r = 0.879), RMI (r = 0.862), and PASS (0.847). There was no floor observed for the BBA-T scale in this sample. However, the ceiling effect was found.Conclusions: The results of our study indicate that the Turkish version of BBA-T is a reliable and valid balance and mobility scale that can be used in the rehabilitation of stroke patients.

Validity and interrater/intrarater reliability of the Turkish version of the postural assessment scale for stroke patients (PASS-Turk)

ABSTRACTBackground: There is no Turkish version of the Postural Assessment Scale for Stroke patients (PASS).Objectives: To translate and make the cross-cultural adaptation of the PASS into the Turkish language and evaluate the reliability and validity of the Turkish version (PASS-Turk).Methods: Sixty patients with stroke who had survived the three-week acute period were included in the study. The first researcher applied the scale to the participants twice with 5-day intervals. The second researcher applied the scale once at the same time with the first researcher. The reliability of PASS-Turk and its subsections was evaluated using Cronbach’s alpha coefficient. In addition, item-total correlation and test-retest reliability were calculated. The interobserver agreement was assessed using the intraclass correlation coefficient. The construct validity of PASS-Turk was assessed using Pearson’s product-moment correlation and principal component analyses. The Berg Balance Scale (BBS) and motor subscale of the Functional Independence Measure (FIM) were used for validity.Results: The Cronbach’s alpha coefficients of the PASS-Turk scale were 0.903 for the subsection of “maintaining posture,” 0.940 for the subsection of “changing a posture,” and 0.953 for the total PASS-Turk scale. The first and second researcher evaluations were perfectly consistent with each other in terms of PASS-Turk total scores (ICC = 0.999, 95% CI: 0.998–0.999, and p < .001). A strong positive correlation was found between PASS-Turk and BBS and the motor subscale of FIM.Conclusion: PASS-Turk is a valid and reliable scale for the evaluation of posture and balance of patients with stroke.

Construct validity of the Wisconsin Gait Scale in acute, subacute and chronic stroke

ObjectiveTo assess the construct validity of the Wisconsin Gait Scale (WGS) in subjects after stroke. MethodsA retrospective observational study was conducted at inpatient rehabilitation hospital. Data from 61 stroke patients was compiled. The Functional Ambulatory Categories (FAC), the Berg Balance Scale (BBS), the Postural Assessment Scale for Stroke Patients (PASS), the Barthel Index (BI) and the Functional Independence Measure (FIM) were selected to analyze the WGS construct validity at four specific time points after stroke (acute, subacute and chronic stages). Spearman correlation coefficients investigated the relationship between WGS and clinical measures. ResultsThe construct validity of the WGS in patients with stroke at acute stage was moderate with the FAC (r=−.773), the BBS (r=−.676), the PASS (r=−.646) and the FIM (r=−.592). At subacute stage, the construct validity of the WGS was excellent with the FAC (r=−878), the BBS (r=−.882), the PASS (r=−.847) and the BI (r=−.813). The correlation was moderate with the FIM (r=−.693). At six and twelve months, the construct validity of WGS with the FAC, the BBS, the PASS, the BI and the FIM was excellent (r ≥ .8). ConclusionThe WGS has moderate construct validity with walking, balance and functionality scales in patients with acute stroke. The correlation with the FAC, the BBS, the PASS and the BI at subacute and chronic stages was excellent.

Development of a Computerized Adaptive Testing System for Assessing 5 Functions in Patients with Stroke: A Simulation and Validation Study

ObjectiveThe authors aimed to develop and validate the Computerized Adaptive Testing System for Assessing 5 Functions in Patients with Stroke (CAT-5F) based on the Barthel Index (BI), Postural Assessment Scale for Stroke patients (PASS), and Stroke Rehabilitation Assessment of Movement (STREAM) to improve the efficiency of assessment. The purposes of the CAT-5F assessment are to describe patients’ levels of impairments or disabilities in the 5 functions and to serve as an outcome measure in patients with stroke. DesignThis is a data-mining study based on data from a previous study using simulation analysis to develop and validate the CAT-5F. SettingOne rehabilitation unit in a medical center in Taiwan served as the setting for this study. ParticipantsData were retrieved from totals of 540 (initial assessment) and 309 (discharge assessment) participants with stroke assessed in a previous study. The assessment data (N=540) were from the BI, PASS, and STREAM. InterventionsNot applicable. Main Outcome MeasuresThe outcome measures for this study were from BI, PASS, and STREAM. ResultsThe CAT-5F using the optimal stopping rule (limited reliability increased <0.010) had good Rasch reliability across the 5 functions (0.86-0.96) and needed 12.7 items, on average, for the whole administration. The concurrent validity (Pearson product-moment correlation coefficient, r=0.91-0.96) and responsiveness (standardized response mean=0.33-0.91) of the CAT-5F were sufficient in the patients. ConclusionThe CAT-5F has sufficient administrative efficiency, reliability, concurrent validity, and responsiveness to simultaneously assess basic activities of daily living, postural control, upper extremity/lower extremity motor functions, and mobility in patients with stroke.

Use of the Postural Assessment Scale for Stroke Patients in Determining Acute Care Discharge Recommendations

Purpose/Hypothesis: Acute care therapists face many barriers that limit the use of screening tools including time constraints and lack of measures appropriate for use in this setting. The Postural Assessment Scale for Stroke patients (PASS) was developed to assess sitting, lying, and standing balance in persons who experienced a stroke. The StrokEDGE taskforce highly recommends the PASS for acute care, as it has excellent psychometric properties and clinical utility. This project used the PASS and the modified Rankin Scale (mRS) to assess mobility in persons with an acute stroke. The purpose of this quality improvement project was to assess the feasibility of physical therapists' use of the PASS as a screening tool to assist with discharge recommendations. Description: Data were collected during a 6-month period from the neurology floor of a 782-bed acute care hospital. Persons admitted with an acute stroke and had received a therapy evaluation were included in the cohort. The goal was to assess the PASS during the initial evaluation within 48 hours of hospital admission. Concurrent data collected during this time included mRS scores, Functional Independence Measure (FIM) transfer and ambulation scores, and therapist discharge recommendations. Results/Conclusions: One hundred fifty-three subjects, with a mean age of 64.5 ± 15.5 years, were included in this cohort. The mean PASS score was 19.7 ± 11.1, the mean mRS score was 3.7 ± 2.2, and the mean FIM scores was 2.7 ± 2.4 for transfers and 3.7 ± 1.6 for ambulation. Of the persons discharged home (N = 40), mean PASS scores were 31.8 for those recommended for home physical therapy (N = 14), 32.6 for an outpatient therapy recommendation (N = 12), and 34.9 for those requiring no therapy at discharge (N = 14). The mean PASS scores for persons with an acute rehabilitation recommendation (N = 100) was higher than those recommended for a skilled nursing facility/subacute rehabilitation (N = 13), 15.7 as compared with 9.5, respectively. Using the Pearson correlation coefficient, the PASS had a strong correlation with the FIM transfers at r = 0.90 and ambulation at r = 0.86, with a strong negative correlation to the mRS at r =−0.77 (P &lt; .001). Clinical Relevance: Acute care therapists should consider using the PASS to help guide clinical decision making and discharge recommendations for persons hospitalized with a stroke.

Psychometric properties of Brief-Balance Evaluation Systems Test (Brief-BESTest) in evaluating balance performance in individuals with chronic stroke.

ObjectiveTo examine the psychometric properties of the Brief‐Balance Evaluation Systems Test (Brief‐BESTest) in individuals with chronic stroke.Materials and MethodsThis was an observational study with repeated measurements involving 50 participants with chronic stroke [mean (SD) age: 59.2 (7.3) years]. Each participant with stroke was evaluated with the Brief‐BESTest, Berg balance scale (BBS), Postural Assessment Scale for Stroke Patients (PASS), Fugl‐Meyer Motor Assessment (FMA), Chedoke‐McMaster Stroke Assessment (CMSA), Montreal Cognitive Assessment (MoCA), and Geriatric Depression Scale (GDS). Two raters (rater 1 and 2) provided the Brief‐BESTest scores of the first 27 participants independently to establish inter‐rater reliability. After 15 min of rest, the same 27 participants were evaluated with the Brief‐BESTest again by rater 1 to establish intra‐rater reliability. The Brief‐BESTest scores of the stroke group were also compared with those of the control group [n = 27, mean (SD) age: 56.7 (7.7) years].ResultsThe Brief‐BESTest had no substantial floor and ceiling effects, good intra‐rater (ICC 2,1 = 0.974) and inter‐rater (ICC 2,1 = 0.980) reliability and internal consistency (Cronbach's alpha = 0.818). The minimal detectable change at 95% confidence level was 2 points. The Brief‐BESTest showed moderate to very strong correlations with other balance (BBS and PASS) and motor impairment (FMA, CMSA) measures (r s = .547–.911, p < .001), thus revealing good concurrent and convergent validity. Its correlation with measures that evaluated other constructs was weaker (MoCA: r s = .437, p = .002) or non‐significant (GDS: r s = −0.152, p = .292), thus showing good discriminant validity. Good known‐groups validity was established, as the Brief‐BESTest was effective in distinguishing participants with stroke from controls (cutoff score: <18, area under curve: 0.942), and individuals with stroke who required assistive device for their outdoor mobility from those who did not (cutoff score <14, area under curve: 0.810).ConclusionsThe Brief‐BESTest has good reliability and validity in assessing balance function in individuals with chronic stroke.

Postural Assessment Scale for Stroke Patients Scores as a predictor of stroke patient ambulation at discharge from the rehabilitation ward.

The Postural Assessment Scale for Stroke Patients (PASS) is used to assess static and dynamic balance of stroke patients. PASS has demonstrated good measurement properties for reliability and validity, but its predictive effect for ambulation in stroke patients has not been investigated. The aim of this study was to investigate the predictive value of PASS for ambulation in patients with stroke after inpatient rehabilitation. In this retrospective study, a total of 341 stroke patients were recruited from a rehabilitation ward of a medical university hospital. Patients were assessed at baseline using PASS and observation of rolling ability, and divided into 2 groups at discharge: independently ambulatory (n = 246) and non-ambulatory (n = 95). Receiver operating characteristic curve and adjusted bivariate logistic regression was applied to analyse the predictive value of baseline PASS scores, variables of demographic data, and rolling ability at admission to inpatient rehabilitation. For all stroke patients, mean admission to the rehabilitation ward was 34.40 days after stroke and mean length of hospitalization 18.12 days. The receiver operating characteristic curve was obtained with a cut-off score of 3.5 points for static PASS, 8.5 points for dynamic PASS, and 12.5 points for total PASS, demonstrating the highest percentage of accurately predicted ability of independently walking at discharge. Adjusted bivariate logistic regression found rolling ability, static PASS and dynamic PASS to be predictors for ambulation of stroke patients at discharge. Initial static PASS score, dynamic PASS score and rolling can be predictors for independent ambulation of stroke patients after a course of inpatient rehabilitation.

The Additive Effects of Core Muscle Strengthening and Trunk NMES on Trunk Balance in Stroke Patients

ObjectiveTo investigate an additive effect of core muscle strengthening (CMS) and trunk neuromuscular electrical stimulation (tNEMS) on trunk balance in stroke patients.MethodsThirty patients with acute or subacute stroke who were unable to maintain static sitting balance for >5 minutes were enrolled and randomly assigned to 3 groups, i.e., patients in the CMS (n=10) group received additional CMS program; the tNMES group (n=10) received additional tNMES over the posterior back muscles; and the combination (CMS and tNMES) group (n=10) received both treatments. Each additional treatment was performed 3 times per week for 20 minutes per day over 3 weeks. Korean version of Berg Balance Scale (K-BBS), total score of postural assessment scale for stroke patients (PASS), Trunk Impairment Scale (TIS), and Korean version of Modified Barthel Index (K-MBI) were evaluated before and after 3 weeks of therapeutic intervention.ResultsAll 3 groups showed improvements in K-BBS, PASS, TIS, and K-MBI after therapeutic interventions, with some differences. The combination group showed more improvements in K-BBS and the dynamic sitting balance of TIS, as compared to the CMS group; and more improvement in K-BBS, as compared to the tNMES group.ConclusionThe results indicated an additive effect of CMS and tNMES on the recovery of trunk balance in patients with acute or subacute stroke who have poor sitting balance. Simultaneous application of CMS and tNMES should be considered when designing a rehabilitation program to improve trunk balance in stroke patients.