Posts Tagged Gait disorders

[A CLINICAL PRACTICE GUIDELINE] A Core Set of Outcome Measures for Adults With Neurologic Conditions Undergoing Rehabilitation

Background: Use of outcome measures (OMs) in adult neurologic physical therapy is essential for monitoring changes in a patient’s status over time, quantifying observations and patient-reported function, enhancing communication, and increasing the efficiency of patient care. OMs also provide a mechanism to compare patient and organizational outcomes, examine intervention effectiveness, and generate new knowledge. This clinical practice guideline (CPG) examined the literature related to OMs of balance, gait, transfers, and patient-stated goals to identify a core set of OMs for use across adults with neurologic conditions and practice settings.

Methods: To determine the scope of this CPG, surveys were conducted to assess the needs and priorities of consumers and physical therapists. OMs were identified through recommendations of the Academy of Neurologic Physical Therapy’s Evidence Database to Guide Effectiveness task forces. A systematic review of the literature on the OMs was conducted and additional OMs were identified; the literature search was repeated on these measures. Articles meeting the inclusion criteria were critically appraised by 2 reviewers using a modified version of the COnsensus-based Standards for the selection of health Measurement INstruments. (COSMIN) checklist. Methodological quality and the strength of statistical results were determined. To be recommended for the core set, the OMs needed to demonstrate excellent psychometric properties in high-quality studies across neurologic conditions.

Results/Discussion: Based on survey results, the CPG focuses on OMs that have acceptable clinical utility and can be used to assess change over time in a patient’s balance, gait, transfers, and patient-stated goals. Strong, level I evidence supports the use of the Berg Balance Scale to assess changes in static and dynamic sitting and standing balance and the Activities-specific Balance Confidence Scale to assess changes in balance confidence. Strong to moderate evidence supports the use of the Functional Gait Assessment to assess changes in dynamic balance while walking, the 10 meter Walk Test to assess changes in gait speed, and the 6-Minute Walk Test to assess changes in walking distance. Best practice evidence supports the use of the 5 Times Sit-to-Stand to assess sit to standing transfers. Evidence was insufficient to support use of a specific OM to assess patient-stated goals across adult neurologic conditions. Physical therapists should discuss the OM results with patients and collaboratively decide how the results should inform the plan of care.

Disclaimer: The recommendations included in this CPG are intended as a guide for clinicians, patients, educators, and researchers to improve rehabilitation care and its impact on adults with neurologic conditions. The contents of this CPG were developed with support from the APTA and the Academy of Neurologic Physical Therapy (ANPT). The Guideline Development Group (GDG) used a rigorous review process and was able to freely express its findings and recommendations without influence from the APTA or the ANPT. The authors declare no competing interest.

Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A214.

TABLE OF CONTENTS

  • INTRODUCTION AND METHODS
  • Levels of Evidence and Grades of Recommendations ………………………………………………..178
  • Summary of Action Statements ………………………………………………..179
  • Introduction ………………………………………………..181
  • Methods ………………………………………………..182
  • OUTCOME MEASURE RECOMMENDATIONS
  • The Core Set of Outcome Measures for Neurologic Physical Therapy ………………………………………………..191
  • Action Statement 1: Static and Dynamic Sitting and Standing Balance Assessment ………………………………………………..191
  • Action Statement 2: Walking Balance Assessment ………………………………………………..195
  • Action Statement 3: Balance Confidence Assessment ………………………………………………..197
  • Action Statement 4: Walking Speed Assessment ………………………………………………..199
  • Action Statement 5: Walking Distance Assessment ………………………………………………..203
  • Action Statement 6: Transfer Assessment ………………………………………………..207
  • Action Statement 7: Documentation of Patient Goals ………………………………………………..208
  • Action Statement 8: Use of the Core Set of Outcome Measures ………………………………………………..209
  • Action Statement 9: Discuss Outcome Measure Results and Use
  • Collaborative/Shared Decision-Making With Patients ………………………………………………..211
  • Guideline Implementation Recommendations ………………………………………………..212
  • Summary of Research Recommendations ………………………………………………..215
  • ACKNOWLEDGMENTS AND REFERENCES
  • Acknowledgments ………………………………………………..217
  • References ………………………………………………..217
  • TABLES
  • Table 1: Levels of Evidence ………………………………………………..178
  • Table 2: Grades of Recommendations ………………………………………………..178
  • Table 3: Outline of the CPG Process ………………………………………………..183
  • Table 4: Inclusion and Exclusion Criteria for Article Review ………………………………………………..187
  • Table 5: COSMIN Ratings for Strength of Statistics ………………………………………………..189
  • Table 6: Process Used to Make Recommendations ………………………………………………..190
  • Table 7: Evidence Table, Berg Balance Scale ………………………………………………..192
  • Table 8: Evidence Table, Functional Gait Assessment ………………………………………………..196
  • Table 9: Evidence Table, Activities-specific Balance Confidence ………………………………………………..198
  • Table 10: Evidence Table, 10 meter Walk Test ………………………………………………..201
  • Table 11: Evidence Table, 6-Minute Walk Test ………………………………………………..205
  • Table 12: Evidence Table, 5 Times Sit-to-Stand ………………………………………………..208

[…]

Continue —>  A Core Set of Outcome Measures for Adults With Neurologic Co… : Journal of Neurologic Physical Therapy

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[Abstract] Feasibility Study of a Take-Home Array-Based Functional Electrical Stimulation System With Automated Setup for Current Functional Electrical Stimulation Users With Foot-Drop

Abstract

Objective

To investigate the feasibility of unsupervised community use of an array-based automated setup functional electrical stimulator for current foot-drop functional electrical stimulation (FES) users.

Design

Feasibility study.

Setting

Gait laboratory and community use.

Participants

Participants (N=7) with diagnosis of unilateral foot-drop of central neurologic origin (>6mo) who were regular users of a foot-drop FES system (>3mo).

Intervention

Array-based automated setup FES system for foot-drop (ShefStim).

Main Outcome Measures

Logged usage, logged automated setup times for the array-based automated setup FES system and diary recording of problems experienced, all collected in the community environment. Walking speed, ankle angles at initial contact, foot clearance during swing, and the Quebec User Evaluation of Satisfaction with Assistive Technology version 2.0 (QUEST version 2.0) questionnaire, all collected in the gait laboratory.

Results

All participants were able to use the array-based automated setup FES system. Total setup time took longer than participants’ own FES systems, and automated setup time was longer than in a previous study of a similar system. Some problems were experienced, but overall, participants were as satisfied with this system as their own FES system. The increase in walking speed (N=7) relative to no stimulation was comparable between both systems, and appropriate ankle angles at initial contact (N=7) and foot clearance during swing (n=5) were greater with the array-based automated setup FES system.

Conclusions

This study demonstrates that an array-based automated setup FES system for foot-drop can be successfully used unsupervised. Despite setup’s taking longer and some problems, users are satisfied with the system and it would appear as effective, if not better, at addressing the foot-drop impairment. Further product development of this unique system, followed by a larger-scale and longer-term study, is required before firm conclusions about its efficacy can be reached.

Source: Feasibility Study of a Take-Home Array-Based Functional Electrical Stimulation System With Automated Setup for Current Functional Electrical Stimulation Users With Foot-Drop – Archives of Physical Medicine and Rehabilitation

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[ ARTICLE] Neuroplasticity in post-stroke gait recovery and noninvasive brain stimulation – Full Text PDF

Abstract

Gait disorders drastically affect the quality of life of stroke survivors, making post-stroke rehabilitation an important research focus. Noninvasive brain stimulation has potential in facilitating neuroplasticity and improving post-stroke gait impairment. However, a large inter-individual variability in the response to noninvasive brain stimulation interventions has been increasingly recognized. We first review the neurophysiology of human gait and post-stroke neuroplasticity for gait recovery, and then discuss how noninvasive brain stimulation techniques could be utilized to enhance gait recovery. While post-stroke neuroplasticity for gait recovery is characterized by use-dependent plasticity, it evolves over time, is idiosyncratic, and may develop maladaptive elements. Furthermore, noninvasive brain stimulation has limited reach capability and is facilitative-only in nature. Therefore, we recommend that noninvasive brain stimulation be used adjunctively with rehabilitation training and other concurrent neuroplasticity facilitation techniques. Additionally, when noninvasive brain stimulation is applied for the rehabilitation of gait impairment in stroke survivors, stimulation montages should be customized according to the specific types of neuroplasticity found in each individual. This could be done using multiple mapping techniques.

Introduction

The American Heart Association estimates that approximately 795,000 individuals in the United States have a stroke each year (Go et al., 2014). A lack of mobility is the main obstacle for stroke survivors seeking to regain daily living independence and social integration. Thus, restoring impaired gait is one of the major goals of post-stroke rehabilitation. Recently, traditional rehabilitation techniques have been augmented by the use of a new methodology, noninvasive brain stimulation (NIBS), which facilitates neuroplasticity. To better understand the use of NIBS, this paper reviews literature regarding the neurophysiology of human gait, poststroke neuroplasticity in the motor control system underlying gait, and finally, approaches for using NIBS to enhance gait recovery.

Neurophysiology of Human Gait

Involvement of the cerebral cortices: In functional neuroimaging studies of human walking, the premotor cortex (PMC) and the supplementary motor cortex (SMC) are activated prior to step onset (Huppert et al., 2013). However, lesions in these two areas often lead to problems with gait initiation and the negotiation of narrow passages (Jahn et al., 2004), indicating their importance in the initiation and planning of walking. Furthermore, corticospinal inputs significantly facilitate muscular responses in the lower limbs, especially during the swing phase of the step cycle (Pijnappels et al., 1998). These observations suggest that cortical outputs play a critical role in the modulation of lower limb locomotion…

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[ARTICLE] Noninvasive Neuromodulation in Poststroke Gait Disorders

Abstract

Walking rehabilitation is one of the primary goals in stroke survivors because of its great potential for recovery and its functional relevance in daily living activities. Although 70% to 80% of people in the chronic poststroke phases are able to walk, impairment of gait often persists, involving speed, endurance, and stability.

Walking involves several brain regions, such as the sensorimotor cortex, supplementary motor area, cerebellum, and brainstem, which are approachable by the application of noninvasive brain stimulation (NIBS). NIBS techniques, such as repetitive transcranial magnetic stimulation and transcranial direct current stimulation, have been reported to modulate neural activity beyond the period of stimulation, facilitating neuroplasticity. NIBS methods have been largely applied for improving paretic hand motor function and stroke-associated cognitive deficits. Recent studies suggest a possible effectiveness of these techniques also in the recovery of poststroke gait disturbance. This article is a selective review about functional investigations addressing the mechanisms of lower-limb motor system reorganization after stroke and the application of NIBS for neurorehabilitation.

via Noninvasive Neuromodulation in Poststroke Gait Disorders.

 

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[ARTICLE] Feasibility study of a take-home array-based functional stimulation system with automated setup for current functional electrical stimulation users with foot-drop.

Abstract: 

OBJECTIVE: To investigate the feasibility of unsupervised community use of an array-based automated setup functional electrical stimulator for current foot-drop functional electrical stimulation (FES) users.

DESIGN: Feasibility study.

SETTING: Gait laboratory and community use.

PARTICIPANTS: Participants (N=7) with diagnosis of unilateral foot-drop of central neurologic origin (>6mo) who were regular users of a foot-drop FES system (>3mo).

INTERVENTION: Array-based automated setup FES system for foot-drop (ShefStim).

MAIN OUTCOME MEASURES: Logged usage, logged automated setup times for the array-based automated setup FES system and diary recording of problems experienced, all collected in the community environment. Walking speed, ankle angles at initial contact, foot clearance during swing, and the Quebec User Evaluation of Satisfaction with Assistive Technology version 2.0 (QUEST version 2.0) questionnaire, all collected in the gait laboratory.

RESULTS: All participants were able to use the array-based automated setup FES system. Total setup time took longer than participants’ own FES systems, and automated setup time was longer than in a previous study of a similar system. Some problems were experienced, but overall, participants were as satisfied with this system as their own FES system. The increase in walking speed (N=7) relative to no stimulation was comparable between both systems, and appropriate ankle angles at initial contact (N=7) and foot clearance during swing (n=5) were greater with the array-based automated setup FES system.

CONCLUSIONS: This study demonstrates that an array-based automated setup FES system for foot-drop can be successfully used unsupervised. Despite setup’s taking longer and some problems, users are satisfied with the system and it would appear as effective, if not better, at addressing the foot-drop impairment. Further product development of this unique system, followed by a larger-scale and longer-term study, is required before firm conclusions about its efficacy can be reached.

via Feasibility study of a take-home array-based functional electrical … – PubMed – NCBI.

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[ARTICLE] Feasibility Study of a Take-Home Array-Based Functional Electrical Stimulation System With Automated Setup for Current Functional Electrical Stimulation Users With Foot-Drop

…This study demonstrates that an array-based automated setup FES system for foot-drop can be successfully used unsupervised. Despite setup’s taking longer and some problems, users are satisfied with the system and it would appear as effective, if not better, at addressing the foot-drop impairment. Further product development of this unique system, followed by a larger-scale and longer-term study, is required before firm conclusions about its efficacy can be reached…

via Feasibility Study of a Take-Home Array-Based Functional Electrical Stimulation System With Automated Setup for Current Functional Electrical Stimulation Users With Foot-Drop – Archives of Physical Medicine and Rehabilitation.

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