Stroke Physiotherapy Research Articles

Kinematics Mathematical Modelling of Lower Limb Exoskeleton for Paralyzed Stroke Patients

This paper presents the development of a lower limb rehabilitation robot to be used with bedridden patients. Strokes are one of the significant causes of death in 17% of the 109,155 medically certified death in 2020 in Malaysia. In most cases, stroke paralysis affects the opposite side of the damaged brain, and any part of the body can be affected. 90% of stroke patients get paralysis to some degree. Patients can recover from the disease and restore body motions by undergoing paralysis stroke physiotherapy, which involves numerous sessions with patients. There were several successful robotic rehabilitations in recent years; however, their design is inflexible and large, requiring the patient to sit or stand in a static position. This project will be built on a motor-driven parallel architecture that will offer motion assistance throughout the human’s wide range of motion (ROM). This project development is divided into two parts: structure design and simulation. The design process for the lower limb devices used syncretization and mathematical analysis. The structure design is from the kinematic analysis. The mathematical models are then used to design in MATLAB simulation which is trajectory simulation. The outcome shows that the simulations that have been developed is compatible with the motion of human lower limb. This robot develops for bedridden use of lower limb rehabilitation exercises.

55 A MOBILITY PROFILE OF STROKE PATIENTS ADMITTED TO A LEVEL 4 ACUTE HOSPITAL OVER A 6-MONTH PERIOD

Abstract Background In order to best direct physiotherapy stroke resources and further service development it is important to characterise the mobility of stroke patients presenting to an acute hospital. Methods A previous audit completed in 2018 in the same organisation established that by using the Berg Balance Scale (BBS) and the Mobility Scale for Acute Stroke (MSAS) as admission outcome measures, a baseline profile could be established while limiting the floor and ceiling effects. A retrospective audit was completed of all patients referred to the stroke physiotherapy service admitted with acute stroke in a 6 month period. An excel spreadsheet was used to record patients’ admission BBS and MSAS. This was recorded along with the mainstay of physiotherapy treatment and discharge destination. Results 145 stroke patients were assessed by stroke physiotherapy between Oct 2021 and April 2022. Of those patients 30% scored full marks on the MSAS which indicates that they were independently mobile with or without an aid post stroke. 26% of patients scored 3 or less on the BBS which would imply they were unable to sit without help. Conclusion This audit provides valuable information on the mobility profile of stroke patients presenting to an acute Level 4 hospital. On admission, patients seem to fall into 3 distinct categories based on their physical function post stroke. One group remained independently mobile post stroke, one group were heavily dependent being unable to sit without assistance and the final cohort requiring some level of supervision or assistance for mobility and balance. This information could be used to facilitate therapy and resource planning.

Principles into Practice: An Observational Study of Physiotherapists use of Motor Learning Principles in Stroke Rehabilitation

Objective(s)To describe a) how motor learning principles are applied during post stroke physiotherapy, with a focus on lower limb rehabilitation; and b) the context in which these principles are used, in relation to patient and/or task characteristics. DesignDirect non-participation observation of routine physiotherapy sessions, with data collected via video recording. A structured analysis matrix and pre-agreed definitions were used to identify, count and record: type of activity; repetitions; instructional and feedback statements (frequency and type); strategies such as observational learning and augmented feedback. Data was visualised using scatter plots, and analysed descriptively. Setting6 UK Stroke Units Participants89 therapy sessions were observed, involving 55 clinicians and 57 patients. ResultsProportion of time spent active within each session ranged from 26% to 98% (mean 85, SD 19). The frequency of task repetition varied widely, with a median of 3.7 repetitions per minute (IQR 2.1–8.6). Coaching statements were common (mean 6.46 per minute), with 52% categorised as instructions, 14% as feedback, and 34% as verbal cues/motivational statements. 13% of instructions and 6% of feedback statements were externally focussed. Examining the use of different coaching behaviours in relation to patient characteristics found no associations. Overall, practice varied widely across the dataset. ConclusionsTo optimise the potential for motor skill learning, therapists must manipulate features of their coaching language (what they say, how much and when) and practice design (type, number, difficulty and variability of task). There is an opportunity to implement motor learning principles more consistently, to benefit motor skill recovery following stroke. Trial registration numberClinicaltrials.gov (NCT03792126). Contribution of the Paper•The findings from this study highlight opportunities for therapists to consider how they use verbal instructions and feedback in a specific and precise way, in order to support the process of motor learning. There is scope within routine clinical practice to use the many and varied types of feedback more robustly.•This study provides insight into how therapists apply motor learning principles stroke rehabilitation settings, and potential associations with a range of patient characteristics.

Effects of Action Observation Training and Mirror Therapy on the Electroencephalograms of Stroke Patients

Purpose: This study examined the effectiveness of action observation training (AOT) and mirror therapy in improving the electroencepha lograms (EEG) of stroke patients. Methods: Patients were allocated randomly to three groups: an action observation training with activity (AOTA) group (n=12), a mirror therapy with activity (MTA) group (n=11), and an AOT-only group (n=12). All groups received conventional physiotherapy in five 60-minute sessions over six weeks. The AOTA, MTA, and AOT groups practiced AOTA, MTA, and AOT, respectively, in three 30-minute ses sions over six weeks. The differences between the pre- and post-treatment EEGs were assessed using a paired t-test. Comparisons be tween the groups were performed using one-way ANOVA. Results: The participants in the AOTA and MTA groups showed significant improvement in the EEG. AOTA improved the alpha waves of the prefrontal, temporal, and parietal lobes significantly (p<0.05). MTA improved the alpha waves of the temporal lobe significantly (p<0.05). AOT did not result in significant improvement Conclusion: AOTA and MTA improve stroke patients’ EEGs. Mirror neuron activation combined with conventional stroke physiotherapy promotes motor recovery and functioning. The effect is enhanced when the actions are executed after observation. Further research into mirror neuron activation will be needed to develop methods to improve the EEGs of stroke patients.

The Application of Physiotherapy in Cerebral Stroke from the Evidence-Based Medicine Standtpoint

The review summarizes the results of the search for high-quality clinical studies related to the use of physical therapy methods in stroke rehabilitation meeting modern requirements from the point of view of evidence-based medicine. To solve this problem, the following databases are used: Physiotherapy Evidence Database – PEDro, Cochrane Library, PubMed, Stroke, Articles presenting the results of randomized controlled trials (RCTS) are selected. To search for information, the queries “physiotherapy”, “electrotherapy”, “evidence-based physiotherapy”, “electrostimulation”, “transcranial magnetostimulation”, “Transcutaneous Electrical Nerve Stimulation”, “magnetotherapy”, “cryotherapy”were used. Despite the obvious lack of research on a large number of applied physiotherapy factors and individual methods of influence, the modern evidence base of physiotherapy in stroke has recently been supplemented by a considerable number of studies. It is mainly related to the section of electrotherapy, which allow us to talk about individual methods of exposure as based on a high-quality evidence base that allows to form recommendations of a high level of evidence. Additional research is needed to make recommendations on other physiotherapy methods and factors.

Changes of Motor Function according to Attention Differences in Stroke Patients: A Randomized Controlled Trial, Pilot Study

PURPOSE: The purpose of this study was to investigate the changes of electroencephalography (EEG) activity on balance and gait while physiotherapy in stroke patients.METHODS: General physiotherapy was applied to 18 stroke patients for 30 minutes per session, 5 times a week, for a total 4 weeks. EEG measured for one week while intervention. Based on the attention score, group was classified into high and low attention groups. We used functional reaching test to measure dynamic balance and GAITRite to measure spatiotemporal variables during gait.RESULTS: In the high attention group, the sensorimotor rhythm wave was high and the dynamic balance was significantly increased (p&lt;.05). There were significant differences in stance time, single support time, and double support time among temporal variables (p&lt;.05). There were significant differences in step length, stride length, swing % of cycle, stance % of cycle, single support % of cycle, and double support % of cycle among the spatial gait variables (p&lt;.05).CONCLUSIONS: The high attention during physiotherapy helps improvement of balance and gait ability in stroke patients, therefore, it may be considered in intervention.

EFFICACY OF ERIGO TILT-TABLE AND CONVENTIONAL PHYSIOTHERAPY ON REHABILITATION OUTCOME WITHIN HAEMORRHAGIC AND ISCHEMIC STROKE PATIENTS

Background: Stroke, either haemorrhagic or ischemic in nature, has the ability to culminate in devastating clinical outcomes thus effective rehabilitation is needed. Objective: To analyze the efficacy of Erigo tilt-table over conventional physiotherapy between ischemic and haemorrhagic stroke patients. Methods: A total of 110 haemorrhagic and ischemic stroke patients (age [Formula: see text] years, [Formula: see text] days after stroke) were assigned randomly into four groups, haemorrhagic conventional physiotherapy group ([Formula: see text]), haemorrhagic Erigo tilt-table group ([Formula: see text]), ischemic conventional physiotherapy group ([Formula: see text]) and ischemic Erigo tilt-table group ([Formula: see text]). The National Institutes of Health Stroke Scale (NIHSS), Mini Mental Scale Examination (MMSE), Modified Ashworth Scale, Quality of Life (QOL) and muscle strength outcomes were assessed at baseline, after the intervention (30th) and on 90th day of follow up. Results: In haemorrhagic Subjects, Erigo tilt-table patients had significant improvement ([Formula: see text]) in outcome variables NIHSS, Ashworth, QOL, absolute upper and lower limb strength except for MMS as compared to Conventional Physiotherapy Group. Whereas in ischemic Subjects, there was no statistically significant difference between both groups([Formula: see text]) on 30th as well as on 90th day comparison. Conclusions: Erigo tilt-table training are found to be effective than conventional physiotherapy in haemorrhagic stroke whereas in ischemic stroke both the interventions are equally effective.

How are balance and mobility problems after stroke treated in England? An observational study of the content, dose and context of physiotherapy

Objective: To describe the dose, intensity and context of physiotherapy for balance and mobility problems after stroke. Design: Process mapping to describe the context and non-participant observation of therapy sessions to describe the dose and content of therapy. Setting: Four inpatient stroke units in North-West England. Participants: Therapy staff and previously mobile stroke survivors who were treating, or receiving treatment for balance and mobility problems in the participating units. Results: Two units were stand-alone rehabilitation units; two offered a service at the weekends. One had no access to community-based rehabilitation. All had dedicated treatment facilities but often did not use them because of lack of space and difficulty transporting patients. Twenty-two patients participated and 100 treatment sessions were observed. Practicing walking, sit-to-stand and transfers were the most frequent objectives and interventions usually with the therapist(s) physically facilitating the patient’s movements. The dose of practise was low; mean repetitions of sit-to-stand per session was 5 (SD 6.4); mean time spent upright per session was 11.24 (SD = 7) minutes, and mean number of steps per session was 202 (SD 118). The mean number of staff per patient was 2.1 (SD = 0.6, mode = 2), usually involving two qualified therapists. Falls prevention or management, wheelchair skills and bed mobility were not practised. Conclusion: Stroke physiotherapy for balance and mobility problems features low-dose, low-intensity therapist-led practice, mainly of walking and sit-to-stand. Staff:patient ratios were high. Therapists need to organize treatment sessions to maximize the intensity of functional task practice.

Efficacy of Trunk Regimes on Balance, Mobility, Physical Function, and Community Reintegration in Chronic Stroke: A Parallel-Group Randomized Trial

The study objective was to examine the efficacy of plinth and Swiss ball-based trunk exercise regimes on balance, mobility, physical function, and community reintegration compared with standard physiotherapy in chronic stroke. This observer-blinded parallel-group randomized trial was conducted in outpatient stroke units. People with chronic stroke aged between 30 and 75 years, first onset of unilateral cortical lesion, poor trunk performance, 10 m independent walking ability with or without walking aids, and absence of pusher syndrome were included. Trunk Impairment Scale 2.0, Brunel Balance Assessment, Tinetti scale, gait speed, Stroke Impact Scale-16, and Reintegration to Normal Living Index were the measures. Experimental interventions involved the practice of selective upper and lower trunk movements using either plinth or Swiss ball. Control group received standard physiotherapy. All the patients practiced 1 hour exercise session, 3 sessions a week over a duration of 6 weeks and followed up after 3 and 12 months. Of 108 patients allocated into 3 groups, baseline characteristics were similar. Postintervention compared with control group, the plinth, and Swiss ball groups showed significant mean changes in the outcome measures: trunk impairment scale 2.0 (3.6;4.1 points), Brunel Balance Assessment (1-level), Tinetti scale (5;5.2 points), gait speed (.06;.08 m/s), Stroke Impact Scale-16 (8.7;7.2 points), and community reintegration (7.6;8.8 points). These improvements were retained during 3-12 months' follow-up. Statistical significant was set at P < .05. Plinth and Swiss ball-based trunk exercise regimes showed significant improvements in balance, mobility, physical function, and community reintegration in chronic stroke as against standard physiotherapy.

Incorporating a Cognitive Strategy Approach into an Outpatient Stroke Physiotherapy Programme: Case Report.

Purpose: Cognitive Orientation to daily Occupational Performance (CO-OP) has demonstrated an effect on skill performance, compared with the usual outpatient rehabilitation, in people living with stroke when implemented by occupational therapists. This study explored refining CO-OP for delivery by both occupational therapists and physiotherapists. Client Description: Two cases were recruited and treated using the CO-OP approach, which augments task-specific training with cognitive strategies and guided discovery. Intervention: Case 1 was a 79-year-old woman, 31 days after parietal stroke, and Case 2 was a 45-year-old man, 62 days after bilateral brain stem stroke. Case 1 withdrew from the study for medical reasons. Outcome measures applied were the Canadian Occupational Performance Measure, the Stroke Impact Scale (SIS), the Self-Efficacy Gauge, the Berg Balance Scale, the Box and Block Test, and the 2-minute walk test. Measures and Outcomes: After 10 sessions, Case 2 made gains in most measures, including a 22-point gain in the SIS mobility domain. Implications: The therapists reported that the combined delivery required additional communication with the patients but was feasible. Case 2 reported physical and mobility gains larger than the mean changes seen in past CO-OP research. Although these results cannot be generalized, findings suggest that the inter-professional application of CO-OP warrants further investigation.

The effects of action observation training and mirror therapy on gait and balance in stroke patients.

[Purpose] The aim of this study was to evaluate the effects of action observation training and mirror therapy to improve on balance and gait function of stroke patients. [Subjects and Methods] The participants were randomly allocated to one of three groups: The action observation training with activity group practiced additional action observation training with activity for three 30-minute session for six weeks (n=12). The mirror therapy with activity group practiced additional mirror therapy with activity for three 30-minute sessions for six weeks (n=11). The only action observation training group practiced additional action observation training for three 30-minute sessions for weeks (n=12). All groups received conventional therapy for five 60-minute sessions over a six-week period. [Results] There were significant improvements in balance and gait function. The action observation training with activity group significantly improved subjects’ static balance. The action observation training with activity group and the mirror therapy with activity group significantly improved subjects’ gait ability. [Conclusion] The activation of mirror neurons combined with a conventional stroke physiotherapy program enhances lower-extremity motor recovery and motor functioning in stroke patients.

Client’s role and participation in stroke physiotherapy encounters: an observational study

Client participation is a basic principle in rehabilitation encounters. Coping at home after stroke requires self-confidence and autonomy, which can be enhanced by active collaboration and knowledge sharing. Earlier studies show, however, that clients are not always offered the role of an active participant in physiotherapy practice. A contradiction remains between official rhetoric and clinical practice. The purpose of this study was to investigate the interaction between the client and the physiotherapist in stroke rehabilitation sessions. Eight video-recorded treatment sessions were observed after an educational intervention that focused on client participation. Discourse analysis was used to examine the client’s involvement in the sessions. Four discourses were identified: taking on expert talk, inviting the client to participate in self-guided planning, neglecting emotional talk and supporting reflection. The client’s active participation manifested as responding to instructions, making plans, solving problems, expressing feelings, and evaluating personal performance and progress. The physiotherapists preferred the hands-off approach and invited the client to take an active role. However, they found it difficult to deal with the client’s expressions of fear and uncertainty. More attention should be paid to the client’s emotional expressions to enhance the client’s self-efficacy and self-management skills after stroke.

Occupational Therapy and Physiotherapy in Acute Stroke: Do Rural Patients Receive Less Therapy?

Objective. To assess whether acute stroke patients in rural hospitals receive less occupational therapy and physiotherapy than those in metropolitan hospitals. Design. Retrospective case-control study of health data in patients ≤10 days after stroke. Setting. Occupational therapy and physiotherapy services in four rural hospitals and one metropolitan hospital. Participants. Acute stroke patients admitted in one health district. Main Outcome Measures. Frequency and duration of face-to-face and indirect therapy sessions. Results. Rural hospitals admitted 363 patients and metropolitan hospital admitted 378 patients. Mean age was 73 years. Those in rural hospitals received more face-to-face (p > 0.0014) and indirect (p = 0.001) occupational therapy when compared to those in the metropolitan hospital. Face-to-face sessions lasted longer (p = 0.001). Patients admitted to the metropolitan hospital received more face-to-face (p > 0.000) and indirect (p > 0.000) physiotherapy when compared to those admitted to rural hospitals. Face-to-face sessions were shorter (p > 0.000). Almost all were seen within 24 hours of referral. Conclusions. Acute stroke patients in Australian rural hospital may receive more occupational therapy and less physiotherapy than those in metropolitan hospitals. The dose of therapy was lower than recommended, and the referral process may unnecessarily delay the time from admission to a patient's first therapy session.

A content analysis of stroke physical therapy intervention using stroke physiotherapy intervention recording tool.

[Purpose] Physical therapy for recovery of function in people with stroke is known to be effective, but which type of physical therapy intervention is most effective is uncertain because a concrete and detailed record of interventions is done. This study aimed to record, analyze, and describe the content of physical therapy interventions for recovery of function after stroke using stroke physiotherapy intervention recording tool (SPIRIT). [Subjects and Methods] A convenience sample of 23 physical therapists from a rehabilitation hospital in Chung-nam recorded the interventions for 73 patients with stroke who were treated for 30 minutes in 670 treatment sessions. Treatment session contents were recorded using SPIRIT. Descriptive statistics were used to describe the interventions accurately and to investigate the differences according to time since stroke. [Results] Facilitation techniques were the most frequently used interventions (n=1,342, 35.1%), followed by practice (n=1,056, 27.6%), and exercise (n=748, 19.6%) in the physical therapists’ clinical practice. [Conclusion] This pattern shows that physical therapists were focused on functional activity. Organizing or teaching patient activities for independent practice interventions (n=286, 7.5%) were used to encourage patient activity and independence outside the treatment sessions. Interventions according to time since stroke were not significantly different.

Brain-controlled functional electrical stimulation therapy for gait rehabilitation after stroke: a safety study.

BackgroundMany stroke survivors have significant long-term gait impairment, often involving foot drop. Current physiotherapies provide limited recovery. Orthoses substitute for ankle strength, but they provide no lasting therapeutic effect. Brain-computer interface (BCI)-controlled functional electrical stimulation (FES) is a novel rehabilitative approach that may generate permanent neurological improvements. This study explores the safety and feasibility of a foot-drop-targeted BCI-FES physiotherapy in chronic stroke survivors.MethodsSubjects (n = 9) operated an electroencephalogram-based BCI-FES system for foot dorsiflexion in 12 one-hour sessions over four weeks. Gait speed, dorsiflexion active range of motion (AROM), six-minute walk distance (6MWD), and Fugl-Meyer leg motor (FM-LM) scores were assessed before, during, and after therapy. The primary safety outcome measure was the proportion of subjects that deteriorated in gait speed by ≥0.16 m/s at one week or four weeks post-therapy. The secondary outcome measures were the proportion of subjects that experienced a clinically relevant decrease in dorsiflexion AROM (≥2.5°), 6MWD (≥20 %), and FM-LM score (≥10 %) at either post-therapy assessment.ResultsNo subjects (0/9) experienced a clinically significant deterioration in gait speed, dorsiflexion AROM, 6MWT distance, or FM-LM score at either post-therapy assessment. Five subjects demonstrated a detectable increase (≥0.06 m/s) in gait speed, three subjects demonstrated a detectable increase (≥2.5°) in dorsiflexion AROM, five subjects demonstrated a detectable increase (≥10 %) in 6MWD, and three subjects demonstrated a detectable increase (≥10 %) in FM-LM. Five of the six subjects that exhibited a detectable increase in either post-therapy gait speed or 6MWD also exhibited significant (p < 0.01 using a Mann–Whitney U test) increases in electroencephalogram event-related synchronization/desynchronization. Additionally, two subjects experienced a clinically important increase (≥0.16 m/s) in gait speed, and four subjects experienced a clinically important increase (≥20 %) in 6MWD. Linear mixed models of gait speed, dorsiflexion AROM, 6MWD, and FM-LM scores suggest that BCI-FES therapy is associated with an increase in lower motor performance at a statistically, yet not clinically, significant level.ConclusionBCI-FES therapy is safe. If it is shown to improve post-stroke gait function in future studies, it could provide a new gait rehabilitation option for severely impaired patients. Formal clinical trials are warranted.Electronic supplementary materialThe online version of this article (doi:10.1186/s12984-015-0050-4) contains supplementary material, which is available to authorized users.

Cardiorespiratory Stress is not Achieved During Routine Physiotherapy in Chronic Stroke

Background: Cardiorespiratory deconditioning is a well-established sequel of stroke and this may interfere with integration into community. In the chronic phase, when motor recovery has plateaued, rehabilitation should include cardiorespiratory training. Objective: To determine whether physiotherapy rehabilitation in the chronic phase of stroke provides enough stress in terms of duration (>10 min) and intensity (>40% of heart rate reserve - HRR) to induce cardiorespiratory benefits. Methods: Two physiotherapy sessions, at least one week apart, of 20 chronic stroke patients (mean time since the onset of the stroke of 26 months, mean age of 58 years, 45% male) were observed, in terms of duration (time) and intensity (40 %HRR). The activities were categorized as upper limb tasks, standing, stepping, basic walking, and advanced walking. Average duration and intensity for each participant across the two sessions were determined. Results: Lower limb activities, such as standing and walking were undertaken for 25 (SD 5) minutes; comprising 57% of the total session. The remainder of the session was taken up with upper limb activities (27%) or inactivity (16%). None of the activities reached the target intensity, with the highest average intensity being achieved during advanced walking (mean 32% HRR, SD 2). Conclusions: Routine physiotherapy did not provide sufficient duration or intensity to induce cardiorespiratory stress in this group of chronic stroke patients. The evidence practice gap needs to be closed for cardiorespiratory fitness to be trained.

A study of perceived factors affecting patients' participation in outpatient stroke physiotherapy exercise in Nigeria

Background/Aims: Stroke results in a range of disabilities, activities and restrictions which have been shown to benefit from physiotherapy rehabilitation and exercise. However there are numerous factors that prevent stroke patients from participating in their exercise programmes. The aim of this study was to explore the factors that were perceived to affect people with stroke in Nigeria in participating in their outpatient physiotherapy exercise. Methods: Semi-structured interviews were used to explore the topic. The interviews were transcribed and analyzed using thematic analysis. Eight male participants with stroke who were attending outpatient stroke physiotherapy in Nigeria were recruited in December 2009. Findings: The factors that were perceived to affect the participants' participation in their outpatient physiotherapy programme encompassed three dimensions: the internal and personal, the relational and experiential, and external factors. These dimensions were interconnected with the internal and personal factors being central to the participants' participation. Conclusions: This study has provided an insight into the factors that were important for a small group of Nigerian men post-stroke who were receiving out-patient stroke physiotherapy. This can lead to further research that could assist in informing the development of clinical practice and services.

Aspects on rehabilitation in stroke, psychosomatic and psychomotor physiotherapy

Aspects on rehabilitation in stroke, psychosomatic and psychomotor physiotherapy

What do acute stroke physiotherapists do to treat postural control and mobility? An exploration of the content of therapy in the UK

Objective: To investigate the content of acute stroke physiotherapy to treat postural control and mobility problems. Design: Stroke physiotherapists recorded the interventions used to treat postural control and mobility during treatment sessions. They recorded five sessions for at least five patients each. Descriptive statistics assessed the frequency with which the interventions were used. Setting: Hospital-based acute stroke care. Subjects: Thirty-six acute stroke physiotherapists recorded 2374 interventions in 364 treatment sessions for 76 patients. Main measures: The Stroke Physiotherapy Intervention Recording Tool. Results: Facilitation techniques were the most frequently used interventions (n = 1258, 53%) with exercise (n = 115, 5%), teaching others how to help the patient (n = 99, 4%) and provision of equipment (n = 63, 3%) the least frequently used. Conclusions: Acute stroke physiotherapists primarily use therapist-led ‘hands-on’ interventions to treat postural control and mobility problems. Interventions to promote activity or practice outside the treatment session are infrequently used.

What treatment packages do UK physiotherapists use to treat postural control and mobility problems after stroke?

Objective. The aim of this study was to identify the treatment packages (combinations of interventions) used to treat postural control and mobility problems for patients with stroke.Method. A convenience sample of 74 physiotherapists from 34 National Health Service hospitals recorded the interventions used to treat postural control and mobility problems for 251 patients with stroke in 1156 treatment sessions using the Stroke Physiotherapy Intervention Recording Tool (Tyson and Selley, Disabil Rehabil 2004;26:1184 – 1188). Descriptive statistics assessed the frequency with which the interventions were used and geometric coding indentified treatment packages.Results. The most frequently used interventions involved facilitation, practice of activities and their components and mobilisations. The least frequently used interventions involved the provision of equipment, teaching carers or professionals and exercise. Two treatment packages were identified; one involving the facilitation (of activities and their components) and the other involving whole activities (facilitation and practice).Conclusions. Interventions are often combined in two treatment packages to treat postural control and mobility problems after stroke. One involved facilitation (of whole and component activities) and the other involved practice and facilitation of whole activities. Future research in which conventional or standard UK stroke physiotherapy is delivered should focus on these interventions and exclude atypically used interventions.