Rivermead Mobility Index Scores Research Articles

An integrated approach to the assessment of balance and functional mobility in individuals with history of severe traumatic brain injury

Individuals who experienced severe Traumatic Brain Injury (sTBI) are often characterized by relevant motor dysfunctions which are likely to negatively affect activities of daily living and quality of life and often persist for years. However, detailed objective information about their magnitude are scarce. The aim of this study was to quantitatively assess the extent of motor deficits in terms of postural control effectiveness under static and dynamic conditions and to investigate the existence of possible correlations between the results of clinical tests and instrumental measures. Postural sway and functional mobility (i.e., instrumented Timed Up and Go test, iTUG) were objectively measured in 18 individuals with sTBI and 18 healthy controls using a pressure plate and a wearable inertial sensor. Additionally, participants with history of sTBI completed the Rivermead Mobility Index (RMI). One-way ANOVA and Spearman's rank correlation analysis were employed to examine differences between the two groups and determine potential correlations between the instrumental tests and clinical scales.The results show that people with sTBI were characterized by larger sway area and longer iTUG walking sub-phase. Significant correlations were also detected between RMI scores and iTUG total duration, as well as the walking phase. Taken together, these findings suggest that, even years after the initial injury, individuals with sTBI appear characterized by impaired postural control and functional mobility, which appears correlated with the RMI score. The integration of instrumental measures with clinical scales in the routine assessment and treatment of individuals with sTBI would result in more comprehensive, objective, and sensitive evaluations, thus improving precision in treatment planning, enabling ongoing progress monitoring, and highlighting the presence of motor deficits even years after the initial injury. Such integration is of importance for enhancing the long-term quality of life for individuals with sTBI.

A Case Study of Combined Korean Medicine Treatment of Paraplegia Diagnosed as Spinal Cord Infarction

Spinal cord infarction is one of the rare strokes with no clear signs of serious nerve damage or after-effects. This study reports on the effectiveness of a combined treatment of Korean medicine and acupuncture on bilateral paraplegia, dysuria, and constipation in a patient with sudden-onset spinal cord infarction. An 84-year-old male patient was diagnosed with spinal cord infarction in August 2022. After diagnosis by whole spine MRI, he received treatment for two months at another hospital, but the improvement was insignificant. He then received Korean medicine treatment, and during this period, his lower extremity manual muscle test grade improved from 3 to 4 and his modified Rivermead mobility index score increased by 13 points, compared with hospitalization. Dysuria improved with acupuncture, and constipation improved with herbal medicine treatment. A combination of herbal medicine and acupuncture can be used to treat paraplegia, dysuria, and constipation caused by spinal cord infarction.

Efficacy of hippotherapy simulator exercise program in patients with stroke: a randomized single-blind clinical trial

ABSTRACT Objectives The aim of this study was to investigate the effect of hippotherapy simulator on balance, postural control, mobility, functional capacity and independence level in people with stroke. Methods This study involved 26 people with stroke aged 18–65, who were randomly assigned to a Hippotherapy Simulator Group (HSG; n = 13) and a Conventional Exercise Group (CEG; n = 13). Patients underwent assessments using the Berg Balance Scale (BBS), Postural Assessment Scale for Stroke (PAS-S), Timed Up and Go Test (TUG), Rivermead Mobility Index (RMI), 2-Minute Walking Test (2-MWT), and Barthel Daily Living Activity Index (BI) to evaluate balance, postural control, mobility, functional capacity, and independence before and after treatment. In the HSG, participants received 30 sessions of conventional exercises and hippotherapy simulator – a mechanical and robotic equipment with a dynamic saddle simulating horse movement – exercises over 6 weeks. Meanwhile, the CEG underwent 30 sessions of conventional exercises alone for 6 weeks. Results In the post-therapy evaluation between groups, BBS (p = 0.004) and 2-MWT (p < 0.001) scores were higher in HSG compared to CEG. However, no statistically significant difference was found between the two groups in terms of PAS-S, RMI, TUG and BI scores (p > 0.05). Statistically significant differences were found between BBS, PAS-S, RMI, TUG, BI and 2-MWT scores before and after treatment in both groups (p < 0.05). Conclusions Hippotherapy simulator can be added to conventional exercises to improve balance and functional capacity in people with stroke.

Functional status and quality of life in young adults with cerebral palsy

Objective: To identify the sociodemographic characteristics, pain level, quality of life, functional state, mobility, and depression level in adults with cerebral palsy (CP). Material and methods. Our study included 78 adults with CP (mean age 24.75±7.66 years, 40.5% males) and 79 control subjects (mean age 26.74±6.72 years, 38.5% males). The quality of life, depression, and mobility of all participants were evaluated. In addition, functional status, functional independence and activity level were evaluated in the adult CP group. The depression level was determined by the Beck Depression Inventory (BDI), the mobility level was identified via Rivermead Mobility Index (RMI), and the quality of life was evaluated by the Short Form-36 (SF-36). The functional level of adults with CP was assessed with Gross Motor Function Classification System. Functional independence and activity level were evaluated using the Functional Independence Measure scale (FIM). Pain level was assessed with Visual Analogue Scale (VAS). Results. The patient and control groups were statistically different in terms of their educational status, marital status, duration of marriage, employment status, and monthly income (p&lt;0.05). SF-36 summary scale scores and subgroup scores, as well as RMI and FIM scores of CP patients, were lower than in the control group. In addition, we revealed a statistically significant positive correlation of FIM scores with SF-36 physical and mental components, along with a statistically significant negative correlation of VAS with FIM, and of FIM with GMFCS: p&lt;0.001, r= 0.450; p=0.013, ^0.279; p=0.022, r= -0.257; p&lt;0.001, r= -0.741, respectively. Conclusion. We established that the quality of life, along with the mobility and functional levels, were lower in young adults with CP than in the control group, while the depression and pain levels were higher vs. control group. Hence, pain, depression, mobility, functional level, and quality of life should be assessed during the follow-up of adult patients with CP

Is virtual reality training superior to conventional treatment in improving lower extremity motor function in chronic hemiplegic patients?

This study aims to examine the effect of virtual reality (VR) training, frequently included in rehabilitation programs, on lower extremity functional status, mobility, balance, and walking speed in chronic stroke patients. This randomized, controlled study was conducted with 60 chronic stroke patients (26 males, 34 females; mean age: 64.0 years; range, 33 to 80 years) who presented to the physical therapy and rehabilitation outpatient clinic of the Kütahya Health Sciences University Evliya Çelebi Training and Research Hospital between February 2019 and February 2020. The participants were randomized to the VR group and the control group by simple randomization with 1:1 allocation. The VR group received 30 min of VR training and 30 min of conventional physiotherapy, while the control group received 60 min of conventional physiotherapy. The patients were evaluated before and after treatment using the Fugl-Meyer Assessment-Lower Extremity (FMA-LE), Rivermead Mobility Index (RMI), 10-m walk test (10MWT), and Berg Balance Scale (BBS). The FMA-LE, RMI, 10MWT, and BBS scores significantly improved in both groups after treatment (p<0.001). The post-treatment change in the FMA-LE score was significantly higher in the VR group than in the control group (Z=-3.560, p<0.001). Similarly, the change in the BBS score was significantly higher in the VR group (Z=-3.769, p<0.001). Post-treatment changes in the RMI and 10MWT were not significant (p>0.05). Virtual reality training combined with conventional physiotherapy was found to be superior to conventional physiotherapy alone in improving lower extremity functional status in chronic stroke patients; therefore, adding a VR component to rehabilitation programs will have a favorable impact on treatment outcomes.

INVESTIGATING THE EFFECTS OF SPORTS ON THE QUALITY OF LIFE IN PERSONS WITH PHYSICAL DISABILITIES

Purpose: Sport is an important tool in improving the quality of life of individuals with disabilities. The study aim to examine the life quality of individuals with physical disabilities with different functionality levels in relation to sports.&#x0D; Methods: A total of 36 individuals with physical disabilities participated in the study. The participants included individuals without any regular exercise (non-sportive, NS), those who played Boccia (B), and persons who played Wheelchair basketball (WCB) who could not provide independent ambulation. The Rivermead Mobility Index (RMI), Functional Independency Measurement (FIM), Trunk Impairment Scale (TIS), and World Health Organization Quality of Life Instrument for People with Intellectual and Physical Disabilities (WHOQOL-DIS) were used for evaluating motor impairment of the trunk, functionality levels, mobility, and quality of life (QoL), respectively.&#x0D; Results: Group B had lower RMI scores compared to group NS (p0.05), but higher in the WCB group (p

Thrombectomy in patients with basilar artery thrombosis

Introduction. This article is devoted to the discussion of a life-threatening condition - basilar artery thrombosis (BAT). The article presents the results of a comparative analysis of two groups of patients with angiographically confirmed BAT: with and without reperfusion therapy.Relevance. Basilar artery thrombosis is a life-threatening condition in which mortality can reach 95%, and severe neurological deficits and dependence in everyday life on others (modified Ran-kin Scale (mRS), score 4–5) are observed in 65% of surviving patients. Ischemic stroke (IS) due to BAT is diagnosed in 1–4% of patients with acute cerebrovascular event (ACVE). Currently, reperfusion therapy (RT) in the form of systemic thrombolytic therapy (sTLT) with rt-PA and/or thrombectomy (TE) is the only effective and safe method for treating patients with IS. In randomized trials, it was found that RT, whether it is sTLT, TE or a combination of these techniques, despite the best degree of functional recovery in patients by day 90 from the onset of the disease, does not lead to a statistically significant decrease in mortality. Nevertheless, the results of 10 prospective studies of the use of endovascular treatment in patients with IS in the posterior circulation system indicate that this type of therapy leads to a decrease in 90-day mortality from 95% to 16–47% in case of successful recanalization (mTICI (modified Thrombolysis in Cerebral Infarction), 2–b–3).Aim of study. To assess the safety and efficacy of TE in patients with BAT.Material and methods. This study included 15 patients with IS, admitted within the 6-hour therapeutic window, and confirmed BAT by CT and/or MRangiography. The baseline level of wakefulness was assessed using the Glasgow Coma Scale (GCS), and the severity of neurological deficit was assessed by the National Institutes of Health Stroke Scale (NIHSS).Results. Basilar artery thrombectomy was performed in 7 patients (endovascular treatment group), 8 patients received no endovascular treatment (standard therapy group). Good clinical outcomes by day 90 from the onset of the disease (mRS, score 0–2) were observed in 57.1% of patients in the endovascular treatment group and in 12.5% of patients in the standard therapy group. However, these differences were not statistically significant (p&gt;0.05). There were also no differences between the two groups in functional outcomes and Rivermead mobility index (RMI) by day 90 from the onset of the disease (Barthel Index of Activities of Daily Living (BI) score 97±5.0 and 100, RMI score 14.0±0.0 and 15 in the endovascular treatment group and standard therapy group, respectively). Mortality by day 90 in the endovascular treatment group was 42.9% (3 patients), in the standard therapy group — 87.5% (7 patients). In the subgroup of patients with GCS score at admission no more than score 8, there was a statistically significant strong two-way negative correlation between TE performance and mortality (r=-1.0; p=0.000), as well as a positive correlation between TE and a Rankine score by day 90 (r=0.956; p=0.003). Mortality was statistically significantly lower in the endovascular treatment group compared to the standard therapy group (0% versus 100%, respectively, p=0.025). Clinical outcomes of the disease by day 90 were statistically significantly better in the endovascular treatment group: mRS, score 0–2 in 100% of cases versus 0% in the standard treatment group (p=0.028).Conclusion. Currently, the only effective treatment for basilar artery thrombosis is thrombectomy. The possibility of performing thromboectomy in these cases should be considered in all patients, regardless of the severity of the stroke and the decrease in the level of wakefulness, since endovascular treatment in this case is a life-saving procedure. The symptom of a hyperdense basilar artery can be used as a diagnostic tool for suspected basilar artery thrombosis, but should not rule out angiography. In our series of observations, the mortality rate in patients who underwent thrombectomy was 42.9%. Good functional outcomes (mRS, score 0–2) and the absence mobility limitation (RMI, score 14) were observed in 57.1% of patients by day 90 after thrombectomy.

Independence in Daily Activities after Stroke among Occupational Therapy Patients and Its Relationship with Unilateral Neglect.

More research is needed to better understand the impact of occupational therapy (OT) in stroke patients and syndromes of unilateral neglect (UN) and anosognosia. A prospective, observational, longitudinal design was conducted on a sample of 27 OT patients. The objectives were to examine: (1) the presence of UN and anosognosia; (2) the functional outcomes; and (3) the association of UN at baseline with functional status at discharge from OT. The outcomes were Barthel (functional independence) and the Rivermead Mobility Index (RMI). The baseline proportion of participants with UN was 33% according to the Star Cancellation Test (STC), and 48.1% according to the Catherine Bergego Scale (CBS) therapist-version. There was a significant difference between the therapist and participant-rated CBS scores (p = 0.004). Functional independence improved significantly between the initial and final assessments (p < 0.001); the effect size (r) was large (r = 0.61). There was a significant improvement in RMI scores (p < 0.001), which was large in size (r = 0.59). Both the STC and CBS-therapist scores were significantly correlated with the Barthel (p < 0.001, p = 0.005, respectively) and with the RMI (p = 0.004, p = 0.028, respectively). The participants substantially enhanced their functional status skills. UN and anosognosia were common problems, and neglect was associated with worse OT program outcomes.

The effect of robot-assisted gait training on cortical activation in stroke patients: A functional near-infrared spectroscopy study.

To investigate the effects of the robot-assisted gait training on cortical activation and functional outcomes in stroke patients. The patients were randomly assigned: training with Morning Walk® (Morning Walk group; n = 30); conventional physiotherapy (control group; n = 30). Rehabilitation was performed five times a week for 3 weeks. The primary outcome was the cortical activation in the Morning Walk group. The secondary outcomes included gait speed, 10-Meter Walk Test (10MWT), FAC, Motricity Index-Lower (MI-Lower), Modified Barthel Index (MBI), Rivermead Mobility Index (RMI), and Berg Balance Scale (BBS). Thirty-six subjects were analyzed, 18 in the Morning Walk group and 18 in the control group. The cortical activation was lower in affected hemisphere than unaffected hemisphere at the beginning of robot rehabilitation. After training, the affected hemisphere achieved a higher increase in cortical activation than the unaffected hemisphere. Consequently, the cortical activation in affected hemisphere was significantly higher than that in unaffected hemisphere (P = 0.036). FAC, MBI, BBS, and RMI scores significantly improved in both groups. The Morning Walk group had significantly greater improvements than the control group in 10MWT (P = 0.017), gait speed (P = 0.043), BBS (P = 0.010), and MI-Lower (P = 0.047) scores. Robot-assisted gait training not only improved functional outcomes but also increased cortical activation in stroke patients.

Sensor-based technology for upper limb rehabilitation in patients with multiple sclerosis: A randomized controlled trial.

Sensor-based technological therapy devices may be good candidates for neuromotor rehabilitation of people with Multiple Sclerosis (MS), especially for treating upper extremities function limitations. The sensor-based device rehabilitation is characterized by interactive therapy games with audio-visual feedback that allows training the movement of shoulders, elbows, and wrist, measuring the strength and the active range of motion of upper limb, registering data in an electronic database to quantitatively monitoring measures and therapy progress. This study aimed to investigate the effects of sensor-based motor rehabilitation in add-on to the conventional neurorehabilitation, on increasing the upper limb functions of patients with MS. Thirty patients were enrolled in the study and randomly assigned to the experimental group and the control group. The training consisting of twelve sessions of upper limb training was compared with twelve sessions of upper limb sensory-motor training, without robotic support. Both rehabilitation programs were performed for 40 minutes three times a week, for 4 weeks, in addition to conventional therapy. All patients were evaluated at the baseline (T0) and after 4 weeks of training (T1). The within-subject analysis showed a statistically significant improvement in both groups, in the Modified Barthel Index and in the Rivermead Mobility Index scores and a significant improvement in Multiple Sclerosis Quality of Life-54 in the experimental. The analysis of effectiveness revealed that, compared with baseline (T0), the improvement percentage in all clinical scale scores was greater in the experimental group than the control group. Proposed training provides an intensive and functional-oriented rehabilitation that objectively evaluates achieved progress through exercises. Therefore, it can represent a good complementary strategy for hand rehabilitation in MS patients.

AB0955 FEATURES OF THE PAIN SYNDROME IN RHEUMATOID ARTHRITIS (RA)

Background:The neuropathic component is present in the mechanism of pain in RA in 36% of cases. The presence of anxiety-depressive disorders and a decrease in the quality of life in patients with RA are shown.Objectives:The study of the clinical features of pain in RA in men and women.Methods:The group consisted of 134 patients with RA (94 women and 40 men), aged 36 to 60 years (average age 48.6 ± 7.1 years) and disease duration from 1 year to 10 years (4.03 ± 1.6 years) hospitalized in the rheumatology department of the Republican Clinical Hospital (Cheboksary). At the time of inclusion in the study, all patients were in the active stage of the disease.An assessment of rheumatological and neurological status was carried out. Pain assessment was performed using: Visual Analog Scale (VAS); Ritchie articular index (RAI). The severity of neuropathic pain was determined using the diagnostic neuropathic pain questionnaire DN4 and PainDetect (sensitivity - 82.9%; specificity - 89.9%). To determine the psycho-emotional deviations used: general health questionnaire (anxiety and depression) - General Health Questionnaire (form GHQ – 28); HADS; Spilberger-Hanin situational and personal anxiety scale. Patient mobility limitations were assessed using the Rivermead mobility index score scale, and quality of life was quantified using the EQ-5D visual analogue scale.To assess the activity of the disease, the level of C-reactive protein (CRP), the erythrocyte sedimentation rate (ESR), and the DAS index - 28-CRP were used. To assess mental and physical functioning, a standardized questionnaire The Short Form-36 was used.To visualize the stage, survey radiographs were used in the direct projection of the metacarpophalangeal and metatarsophalangeal joints, wrist joints, proximal interphalangeal joints of the hands; distal parts of the feet.Results:An analysis of chronic pain syndrome in 36% of patients revealed a neuropathic component of pain (DN4: 5.7 ± 1.1 points, PainDetect: 16.3 ± 4.2).In the group of patients with neuropathic pain (n = 78) aged 55.1 ± 7.9 years, the duration of the disease was 3.4 ± 0.9 years, the more advanced and late clinical stages of the disease, III – IV radiological stages of RA were more common, were present neurological disorders and complaints characteristic of peripheral polyneuropathy. Rivermead mobility index in patients with neuropathic disorders, (n = 78) was 9.1 ± 0.8 points, in the absence of neuropathic disorders (n = 56), 11.2 ± 1.1 points. There were no significant differences in process activity (DAS index - 28 - CRP) and quality of life.According to the questionnaire of situational and personal anxiety, Spilberger-Khanin revealed moderate anxiety and mild - depressive disorders. Quality of life was reduced in all patients with RA.Pain syndrome in patients with neuropathic pain with symptomatic (NSAIDs, GC) and basic cytostatic therapy (methotrexate) showed that, despite the decrease in the severity of the inflammatory process, the positive dynamics was partial (VAS before therapy 6.4 ± 0, 7; VAS in the presence of therapy 4.3 ± 0.5 (p&gt; 0.05); PainDetect = 14.9 ± 4.4; DN4 = 4.3 ± 1.5).In men, statistically significant factors associated with pain were clinical parameters that accounted for 37% and 18% of pain variation (Ritchie articular index (CIR): Fsmc = 4.107, p &lt;0.001; SF-36: Fsmc = 2.107, p &lt;0.001) In women, the main significant factors associated with pain were the subjective feeling of pain and psychological characteristics that accounted for 12% of the pain variation (SF-36: Fsmc = 11.118, p &lt;0.001).Conclusion:A dynamic study of patients with RA in accordance with gender and age will further develop additional criteria for evaluating the effectiveness of complex therapy used to treat chronic pain, and will also increase the overall effectiveness of treatment.Disclosure of Interests:None declared

Comparison of the efficacy of Cellex and Cortexin in patients in the early recovery period of ischemic stroke

To compare the efficacy of Cellex and Cortexin in patients in the early recovery period of ischemic stroke (ERPIS) receiving basic therapy (BT). Forty patients were randomized into the cellex group (n=20) and the cortexin group 2 (n=20). Cellex was administered in a dose of 0.1 mg daily SC for 10 days and cortexin in a dose of 10 mg per 2 ml of 0.9% NaCl solution IM daily for 10 days. The efficacy of treatment was assessed with NIHSS, Bartel's index (BI), MMSE, the Rivermead Mobility Index (RMI), the Frontal Assessment Battery (FAB), Beck's depression scale (BDS). A more pronounced positive dynamics of NIHSS: 3 [2; 4.5] vs. 5 [2; 7] (p=0.03) and MMSE scores: 24 [21.5; 25] vs. 22 [20; 23] (p=0.04) was noted in the cellex group. Also, in this group, a more significant trend towards regression of depressive disorders (BDS) was revealed: 17.5 [14.5; 21] vs. 14 [13; 16] (p=0.064). The dynamics of RMI and FAB scores did not differ significantly between the groups. The use of cellex in comparison with cortexin is more effective in terms of the dynamics of regression of neurological and neurocognitive dysfunctions in patients with ERPIS.

Safety and efficacy of co-careldopa as an add-on therapy to occupational and physical therapy in patients after stroke (DARS): a randomised, double-blind, placebo-controlled trial

SummaryBackgroundDopamine is a key modulator of striatal function and learning and might improve motor recovery after stroke. Previous small trials of dopamine agonists after stroke provide equivocal evidence of effectiveness on improving motor recovery. We aimed to assess the safety and efficacy of co-careldopa plus routine occupational and physical therapy during early rehabilitation after stroke.MethodsThis double-blind, multicentre, randomised controlled trial of co-careldopa versus placebo in addition to routine NHS occupational and physical therapy was done at 51 UK NHS acute inpatient stroke rehabilitation services. We recruited patients with new or recurrent clinically diagnosed ischaemic or haemorrhagic (excluding subarachnoid haemorrhage) stroke 5–42 days before randomisation, who were unable to walk 10 m or more, had a score of less than 7 points on the Rivermead Mobility Index, were expected to need rehabilitation, and were able to access rehabilitation after discharge from hospital. Participants were assigned (1:1) using stratified random blocks to receive 6 weeks of oral co-careldopa or matched placebo in addition to routine NHS physiotherapy and occupational therapy. The initial two doses of co-careldopa were 62·5 mg (50 mg of levodopa and 12·5 mg of carbidopa) and the remaining doses were 125 mg (100 mg of levodopa and 25 mg of carbidopa). Participants were required to take a single oral tablet 45–60 min before physiotherapy or occupational therapy session. The primary outcome was ability to walk independently, defined as a Rivermead Mobility Index score of 7 or more, at 8 weeks. Primary and safety analyses were done in the intention-to-treat population. The trial is registered on the ISRCTN registry, number ISRCTN99643613.FindingsBetween May 30, 2011, and March 28, 2014, of 1574 patients found eligible, 593 (mean age 68·5 years) were randomly assigned to either the co-careldopa group (n=308) or to the placebo group (n=285), on an average 18 days after stroke onset. Primary outcome data were available for all 593 patients. We found no evidence that the ability to walk independently improved with co-careldopa (125 [41%] of 308 patients) compared with placebo (127 [45%] of 285 patients; odds ratio 0·78 [95% CI 0·53–1·15]) at 8 weeks. Mortality at 12 months did not differ between the two groups (22 [7%] vs 17 [6%]). Serious adverse events were largely similar between groups. Vomiting during therapy sessions, after taking the study drug, was the most frequent adverse event and was more frequent in the co-careldopa group than the placebo group (19 [6·2%] vs 9 [3·2%]).InterpretationCo-careldopa in addition to routine occupational and physical therapy does not seem to improve walking after stroke. Further research might identify subgroups of patients with stroke who could benefit from dopaminergic therapy at different doses or times after stroke with more intensive motor therapy.FundingMedical Research Council.

Assessing the validity and reliability of the Turkish version of the Trunk Impairment Scale in stroke patients.

OBJECTIVE:To determine the validity and reliability of the Turkish version of the Trunk impairment scale (TIS), used in the evaluation of somatic, motor, and coordination disturbances in stroke patients, and provide a culturally adapted version for use in the Turkish population.METHODS:A total of 80 patients who were either hospitalized at our facility and rehabilitated for stroke or admitted at our outpatient clinics were included in this study. Reliability was evaluated by the internal consistency (Cronbach α) and test reproducibility [intra-class correlation coefficient (ICCC)] methods, and validity was evaluated by the correlation between subgroups and the total scores of the TIS and Berg Balance Scale (BBS), Brunnstrom phases, Barthel index (BI), Rivermead mobility index (RMI), and Short Form-36 (SF-36) scores.RESULTS:The mean age of the patients was 63.00±12.1 years. Out of a total of 80 subjects, 34 were female and 46 were male. The reliability of the scale was evaluated by the internal consistency, inter- and intra-observer reliability, and test reproducibility. The findings showed that the Turkish form of the scale was reliable at a good level. The test values were as follows; Cronbach α: >0.70, ICCC: 0.969–1, subgroups and total score comparison: 0. The correlation between TIS and BBS was considerably high in the validity analysis (p<0.001). Further, significant associations among the BI, RMI, KF-36, Brunnstrom, and TIS scores were found (p<0.001), which indicate the structural validity of this scale.CONCLUSION:TIS is a scale used in measuring the motor derangement that develops after a stroke. It has sufficient reliability, internal consistency, and validity for use in clinical practice and stroke investigations. Our study has shown that TIS used for the evaluation of body balance is valid and reliable for the Turkish population.

The Nottingham Fatigue after Stroke (NotFAST) study: factors associated with severity of fatigue in stroke patients without depression

Objective: To identify factors associated with post-stroke fatigue in a sample of stroke survivors without depression. Design: Cross-sectional cohort study. Setting: Recruitment was from four stroke units in the UK. Subjects: Participants were assessed within four to six weeks of first stroke; those with high levels of depressive symptoms (score ⩾7 Brief Assessment Schedule Depression Cards) were excluded. Main measures: Participants were assessed after stroke on the Fatigue Severity Scale of the Fatigue Assessment Inventory, the Rivermead Mobility Index, Nottingham Extended Activities of Daily Living scale, Beck Anxiety Index, Sleep Hygiene Index, 6m walk test, and measures of cognitive ability. Results: Of the 371 participants recruited, 103 were excluded and 268 were assessed. Of the latter, the mean age was 67.7 years (SD 13.5) and 168 (63%) were men. The National Institutes of Health Stroke Scale mean score was 4.96 (SD 4.12). Post-stroke fatigue was reported by 115 (43%) of participants, with 71 (62%) reporting this to be a new symptom since their stroke. Multivariate analysis using the Fatigue Severity Scale as the outcome variable found pre-stroke fatigue, having a spouse/partner, lower Rivermead Mobility Index score, and higher scores on both the Brief Assessment Schedule Depression Cards and Beck Anxiety Index were independently associated with post-stroke fatigue, accounting for approximately 47% of the variance in Fatigue Severity Scale scores. Conclusions: Pre-stroke fatigue, lower mood, and poorer mobility were associated with post-stroke fatigue.

Fluoxetine for Motor Recovery After Acute Ischemic Stroke: A Randomized Placebo-Controlled Trial

Hemiplegia and hemiparesis are the most common deficits caused by stroke. A few small clinical trials suggest that Fluoxetine enhances motor recovery but its clinical efficacy is unknown in our setting. A randomized placebo-controlled trial was conducted at Neurology and medicine ward of Chittagong Medical College Hospital from 1/1/2013 to 31/12/2013. One hundred and twenty eight patients, aged between 40-60 years with a diagnosis of acute ischaemic stroke who fulfilled the defined inclusion and exclusion criteria were selected for the study. Eligible patients were randomly assigned, using a simple lottery method, in a 1:1 ratio to Fluoxetine (20 mg once per day, orally) or placebo group for 3 months starting within 10 days after the onset of stroke. The primary outcome was the mean change in the Rivermead Mobility Index (RMI) score between inclusion (day 0) and day 90. RMI score was significantly changed from D 0 to D 90 in Fluoxetine group in comparison to placebo group (p <.001) and mean (±SD) improvement of RMI score in 90 days were significantly greater in the Fluoxetine group, than in the placebo group [7.08 (±3.26) vs. 4.40 (±2.53)]. Patients treated with Fluoxetine were nearly 3.2 times more likely to show motor improvement than placebo group and the NNT was 2. In patients with acute ischaemic stroke and with motor deficit, the early administration of Fluoxetine with physiotherapy enhanced motor recovery after 3 months.

Correlates of the timed 25 foot walk in a multiple sclerosis outpatient rehabilitation clinic.

The Timed 25 Foot Walk (T25FW), a test of maximum walking speed on a short distance, is commonly used to monitor ambulation status and to assess treatment outcomes in multiple sclerosis (MS). The main aim of this study was to determine how walking speed on the T25FW correlates with other clinician-reported and patient-reported measures in an outpatient MS rehabilitation clinic. We analyzed cross-sectional data systematically collected during a physiatry evaluation for the management of spasticity and walking limitations. In addition to demographic variables and the Expanded Disability Status Scale (EDSS), measures of body functions [lower extremity manual muscle testing (LE MMT), lower extremity Modified Ashworth Scale, Fatigue Severity Scale, leg pain], and measures of activity and quality of life (reported frequency of falls, Incapacity Status Scale, Rivermead Mobility Index, EQ5D health questionnaire, and Patient Health Questionnaire-9 items) were administered. A multivariate regression analysis was carried out. 199 patients were included in the analysis [age 49.41 (9.89) years, disease duration 15.40 (10.22) years, EDSS score 5.6 (1.2), and T25FW speed 70.93 (44.13) cm/s]. Both EDSS and LE MMT were correlated significantly with T25FW speed (R=0.692, P<0.001). After adjusting for EDSS and LE MMT, lower T25FW speed was associated with higher Incapacity Status Scale scores (R=0.316, P<0.001), lower Rivermead Mobility Index scores (R=0.540, P<0.001), and higher frequency of falls. EQ5D and Patient Health Questionnaire-9 items were not significantly associated with T25FW speed. Our findings support the clinical relevance of the T25FW in the rehabilitation of patients with MS.

Correlation between mobility assessed by the Modified Rivermead Mobility Index and physical function in stroke patients.

[Purpose] The purpose of this study was to investigate the relationship between mobility assessed by the Modified Rivermead Mobility Index and variables associated with physical function in stroke patients. [Subjects and Methods] One hundred stroke patients (35 males and 65 females; age 58.60 ± 13.91 years) participated in this study. Modified Rivermead Mobility Index, muscle strength (manual muscle test), muscle tone (Modified Ashworth Scale), range of motion of lower extremity, sensory function (light touch and proprioception tests), and coordination (heel to shin and lower-extremity motor coordination tests) were assessed. [Results] The Modified Rivermead Mobility Index was correlated with all the physical function variables assessed, except the degree of knee extension. In addition, stepwise linear regression analysis revealed that coordination (heel to shin test) was the explanatory variable closely associated with mobility in stroke patients. [Conclusion] The Modified Rivermead Mobility Index score was significantly correlated with all the physical function variables. Coordination (heel to shin test) was closely related to mobility function. These results may be useful in developing rehabilitation programs for stroke patients.

Family Participation Can Improve Unilateral Spatial Neglect in Patients with Acute Right Hemispheric Stroke

Objective: Unilateral spatial neglect (USN) is one of the major behavioral disturbances in patients with cerebral lesions and often impairs the patients’ independence in activities of daily living (ADL). Although many studies have addressed the mechanism and assessment of USN, there have been only few reports on rehabilitation strategies for patients with USN. The present study examined whether family participation can contribute to an improvement in USN following an acute stroke. Design: This study compared the improvement at 3 weeks among patients treated with conventional exercise sessions and a program including the participation of family members. The study followed 34 stroke patients with hemiparesis and USN. Twenty had family participation in their therapy. The severity of USN was measured using the Behavioral Inattention Test (BIT) and a laterality index (LI). Mobility was assessed using the Rivermead Mobility Index (RMI), and ADL were assessed using the Barthel index. Results: The results showed a relationship between BIT score improvement and family participation, and the BIT score improvement reflected the LI improvement. The RMI and BIT scores showed that ADL improved more with than without family participation. Conclusion: Family participation improved not only the mobility but also USN, suggesting that it can make important contributions to acute stroke rehabilitation.

Infratentorial lesion volume correlates with sensory functional system in multiple sclerosis patients: a 3.0-Tesla MRI study

This study sought to correlate lesion volume in infratentorial areas using 3.0-T proton-density (PD)-weighted images with disability scales and appropriate functional system scores in patients with multiple sclerosis (MS). We examined 20 consecutive patients (13 women and 7 men) with a median age of 47 years (range 26-70). Neurological examination included the Expanded Disability Status Scale and its functional systems, the Barthel Index (BI) and the Rivermead Mobility Index (RMI). MRI scans were performed on a system operating at 3.0 T using a quadrature birdcage head coil. Acquired images imported as Digital Imaging and Communication in Medicine (DICOM) files, and the region of interest (ROI) files were converted to Neuroimaging Informatics Technology Initiative (NIfTI) format and normalised to the Montreal Neurological Institute (MNI) standard template. An automated segmentation algorithm was used to distinguish between supratentorial and infratentorial areas. Normalisation to the magnetisation-prepared rapid acquisition with gradient echo (MPRAGE) T1-weighted sequence allowed lesion volume estimation in the different anatomical areas. A significant correlation was found between infratentorial lesion volume and the sensory functional system score (rho=0.76, p=0.002). No significant correlation was found between supratentorial lesion volume and Expanded Disability Status Scale (EDSS), RMI and BI scores. The described method, by means of anatomical assignment of MS lesions, allows detection of significant correlation coefficients between clinical and MRI lesion burden in MS patients at the infratentorial level.