[Abstract] Aerobic Training in Canadian Stroke Rehabilitation Programs

Background and Purpose: Aerobic training (AT) is recommended for people after stroke, yet uptake and operationalization of AT in clinical practice in Canada have not been measured. We surveyed inclusion of structured AT and barriers to implementation in public inpatient/outpatient stroke rehabilitation programs across Canada.

Methods: A Web-based questionnaire was sent to 89 stroke rehabilitation program leads.

Results: Forty-six programs from 7 of 9 eligible Canadian provinces/territories completed the questionnaire. Seventy-eight percent of programs reported including AT, with most (75%) excluding participants with severe physical impairments, and 28% excluding those with coexisting cardiac conditions. A greater proportion of dedicated stroke rehabilitation programs prescribed AT, compared to nondedicated stroke units (68.8% vs 31.3%, P = 0.02). The top 2 challenges for programs that included and did not include AT were “insufficient time within therapy sessions” and “length of stay in rehabilitation.” Programs that did not include AT ranked “not a goal of most patients” and “not an organizational/program priority” as third and fourth, whereas they were ranked eighth and thirteenth by programs with AT. Best practice recommendations were inconsistently followed for conducting preparticipation exercise testing (36.1%) and for monitoring patients from higher-risk populations, specifically people with diabetes at risk for hypoglycemia (78.8%) and hypertension (36.6%). Of programs conducting preparticipation exercise testing, 91% did not monitor electrocardiography.

Discussion and Conclusions: Most stroke rehabilitation programs across Canada include AT. People with severe physical impairment and those with cardiac, metabolic, and hemodynamic comorbidities may be excluded or not appropriately monitored during exercise. More detailed guidelines and training practices are needed to address these challenges.

Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A233).

via Aerobic Training in Canadian Stroke Rehabilitation Programs : Journal of Neurologic Physical Therapy

[ARTICLE] Therapists’ Perspective on Virtual Reality Training in Patients after Stroke: A Qualitative Study Reporting Focus Group Results from Three Hospitals – Full Text

Abstract

Background. During the past decade, virtual reality (VR) has become a new component in the treatment of patients after stroke. Therefore aims of the study were (a) to get an insight into experiences and expectations of physiotherapists and occupational therapists in using a VR training system and (b) to investigate relevant facilitators, barriers, and risks for implementing VR training in clinical practice.

Methods. Three focus groups were conducted with occupational therapists and physiotherapists, specialised in rehabilitation of patients after stroke. All data were audio-recorded and transcribed verbatim. The study was analysed based on a phenomenological approach using qualitative content analysis.

Results. After code refinements, a total number of 1289 codes emerged out of 1626 statements. Intercoder reliability increased from 53% to 91% until the last focus group. The final coding scheme included categories on a four-level hierarchy: first-level categories are (a) therapists and VR, (b) VR device, (c) patients and VR, and (d) future prospects and potential of VR developments.

Conclusions. Results indicate that interprofessional collaboration is needed to develop future VR technology and to devise VR implementation strategies in clinical practice. In principal, VR technology devices were seen as supportive for a general health service model.

1. Background

Stroke is a frequent cause of livelong disability in adulthood and is one of the most expensive diseases regarding patient-centred care [1]. To reduce the burden of upper limb limitations and to improve patients’ outcomes and independence, new treatment concepts have to be developed and effectiveness of patient outcomes has to be investigated, respectively [2]. Virtual reality (VR) is a novel computer technology that was adapted for rehabilitation over the past decade [3]. It is a computer technology that simulates real-life learning while providing augmented feedback and a high intensity of massed practiced tasks [4]. VR can be differentiated into immersive and nonimmersive gaming systems. Immersive systems enable players to move an avatar in a simulated environment. Nonimmersive systems often focus on arm or leg movements in simulated 3D environments [5]. VR provides a safe environment for patients to explore functional capability without interference from their physical or cognitive limitations [6]. As an example of a therapeutic VR system, YouGrabber (YG, YouRehab© Ltd.) will be explored in this study: it is a training system for upper limb training in stroke rehabilitation (Figure 1). It provides training of bimanual reaching and grasping in combination with different game options on a computer or television screen. Patients’ movements are captured by two size-adjustable data gloves and infrared arm tracking [7]. As Saposnik and Levin reported in their meta-analysis, there are beneficial effects for upper limb rehabilitation using VR in combination with conventional treatment approaches [8]. Analysed studies evaluated different aspects of VR including number of repetitions and exercise intensity. While rehabilitation targets are functional skills, most of VR implementation is working with simulations that are playful but not directly relevant to patients’ daily life [4]. To maximise benefits, the therapeutic application of VR should be compatible with the therapeutic goal setting [9]. Moreover, patients’ motivation and attention are important factors stimulating motor relearning after stroke [10].

Continue —> Therapists’ Perspective on Virtual Reality Training in Patients after Stroke: A Qualitative Study Reporting Focus Group Results from Three Hospitals

[ARTICLE] Integrative Cognitive Rehabilitation Program: An Innovative, Multidisciplinary Approach

…To develop a comprehensive, patient centered and multidisciplinary cognitive rehabilitation program, using the theoretical foundations of distributed cognition, neural plasticity, activity theory, and ICF (WHO, 2001). Incorporate technology as cognitive prosthetics.Develop and reinforce compensatory strategies to optimize cognitive functioning…

via Integrative Cognitive Rehabilitation Program: An Innovative, Multidisciplinary Approach – Archives of Physical Medicine and Rehabilitation.