Posts Tagged intensity

[Abstract] High Intensity Exercise for Walking Competency in Individuals with Stroke: A Systematic Review and Meta-Analysis

Abstract

OBJECTIVE:

To assess the effects of high intensity exercise on walking competency in individuals with stroke.

DATA SOURCES:

A systematic electronic searching of the PubMed, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL (EBSCOhost), and SPORTSDiscus (EBSCOhost) was initially performed up to June 25, 2019.

STUDY SELECTION:

Randomized controlled trials or clinical controlled trials comparing any walking or gait parameters of the high intensity exercise to lower intensity exercise or usual physical activities were included. The risk of bias of included studies was assessed by the Cochrane risk of bias tool. The quality of evidence was assessed using GRADE (Grading of Recommendations, Assessment, Development and Evaluation) system.

DATA EXTRACTION:

Data were extracted by 2 independent coders. The mean and standard deviation of the baseline and endpoint scores after training for walking distance, comfortable gait speed, gait analysis (cadence, stride length, and the gait symmetry), cost of walking, Berg Balance Scale , Time Up&Go (TUG) Test and adverse events were extracted.

DATA SYNTHESIS:

A total of 22 (n = 952) studies were included. Standardized mean difference (SMD), weighted mean difference (WMD), and odds ratios (ORs) were used to compute effect size and subgroup analysis was conducted to test the consistency of results with different characteristics of exercise and time since stroke. Sensitivity analysis was used to assess the robustness of the results, which revealed significant differences on walking distance (SMD = .32, 95% CI, .17-.46, P < .01, I2 = 39%; WMD = 21.76 m), comfortable gait speed (SMD = .28, 95% CI, .06-.49, P = .01, I2 = 47%; WMD = .04 m/s), stride length (SMD = .51, 95% CI, .13-.88, P < .01, I2 = 0%; WMD = .12 m) and TUG (SMD = -.36, 95% CI, -.72 to .01, P = .05, I2 = 9%; WMD = -1.89 s) in favor of high intensity exercise versus control group. No significant differences were found between the high intensity exercise and control group in adverse events, including falls (OR = 1.40, 95% CI, .69-2.85, P = .35, I2 = 11%), pain (OR = 3.34, 95% CI, .82-13.51, P = .09, I2 = 0%), and skin injuries (OR = 1.08, 95% CI, .30-3.90, P = .90, I2 = 0%).

CONCLUSIONS:

This systematic review suggests that high intensity exercise could be safe and more potent stimulus in enhancing walking competency in stroke survivors, with a capacity to improve walking distance, comfortable gait speed, stride length, and TUG compared with low to moderate intensity exercise or usual physical activities.

 

via High Intensity Exercise for Walking Competency in Individuals with Stroke: A Systematic Review and Meta-Analysis. – PubMed – NCBI

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[Abstract] The Effects of Timing and Intensity of Neurorehabilitation on Functional Outcome after Traumatic Brain Injury: a Systematic Review & Meta-Analysis

Abstract

Objective

To systematically review evidence on the effects of timing and intensity of neurorehabilitation on the functional recovery of patients with moderate to severe traumatic brain injury (TBI) and aggregate the available evidence using meta-analytic methods.

Data sources

Pubmed, Embase, PsycINFO and Cochrane Database.

Data selection

Electronic databases were searched for prospective controlled clinical trials assessing the effect of timing or intensity of multidisciplinary neurorehabilitation programs on functional outcome of patients with moderate or severe TBI. A total of 5,961 unique records were screened for relevance, of which 58 full-text articles were assessed for eligibility by two independent authors. Eleven articles were included for systematic review and meta-analysis.

Data extraction

Two independent authors performed data extraction and risk of bias analysis using the Cochrane Collaboration Tool. Discrepancies between authors were resolved by consensus.

Data synthesis

Systematic review of a total of six randomized controlled trials, one quasi-randomized trails and four controlled trials revealed consistent evidence for a beneficial effect of early onset neurorehabilitation in the trauma center and intensive neurorehabilitation in the rehabilitation facility on functional outcome, as compared to usual care. Meta-analytic quantification revealed a large-sized positive effect for early onset rehabilitation programs (d = 1.02, p < .001, 95%-confidence interval [CI]: 0.56-1.47) and a medium-sized positive effect for intensive neurorehabilitation programs (d = 0.67, p < .001. 95%-CI: 0.38-0.97) as compared to usual care. These effects were replicated based on solely studies with a low overall risk of bias.

Conclusions

The available evidence indicates that early onset neurorehabilitation in the trauma center and more intensive neurorehabilitation in the rehabilitation facility promote functional recovery of patients with moderate to severe TBI as compared to usual care. These findings support the integration of early onset and more intensive neurorehabilitation in the chain of care for patients with TBI.

via The Effects of Timing and Intensity of Neurorehabilitation on Functional Outcome after Traumatic Brain Injury: a Systematic Review & Meta-Analysis – Archives of Physical Medicine and Rehabilitation

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[ARTICLE] Walking: What say the scientist and what is best practice – Full Text PDF

Abstract

In this part we try to listen to the science, that has and still do over the whole world investigation by stroke patients over the walking aspect and the best way to get the best recovery or compensation. Recovery is only for an group possible, that had an “minor” stroke and there we see that the old system is not too much damaged and recovery is possible. But with greater damage of the brain individual after an stroke must go another way to get his independently and that is compensation. That compensation start with the first movement in bed and will also affect the diagonal. The science has reported that the walking pattern on the EMG don’t change very much after an short period and they said that this pattern are fixed within in certain period. We have our doubt and have search to other forms of training and learning and see that changes is well possible but to be sure the science must investigated that. Here is an problem because science gives another interpretation of the word intensity. For the scientist this is “more time” to do the exercises and in our view, it is the heaviness of the exercises and that can be done by an individual with an stroke an certain time before he is fatigue.

In the treatment we start with the individual with an severe stroke that need all assistance to get him on his feet and will have need of an splint on his knee because the power in the knee muscle is to limited, to hold the knee. Regrettable an individual after an stroke that the scientist never investigate because this is too difficult. From this starting point we walk through all the steps, we must make to get independent walking individual when possible and what the problem were when that goal cannot fully reached.

And we discuss other forms, approach or new development to get walking possible with the use of the diagonals. Part 8 will discuss other casus with an severe stroke. (Jan van de Rakt, Steve McCarthy-Grunwald -Diagonals Part 7 Stroke 5 Walking: What say the scientist and what is best practice. Ita. J. Sports Reh. Po. 2018; 5; 2 ; 1013 – 1062 ; ISSN 2385-1988 [online] IBSN 007-111-19-55 ; CGI J OAJI :0,101 )

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[Abstract] Tele-health, wearable sensors and the Internet. Will they improve stroke outcomes through increased intensity of therapy, motivation and adherence to rehabilitation programs?

Provisional Abstract
Background and Purpose
Stroke, predominantly a condition of older age, is a major cause of acquired disability in the global population and puts an increasing burden on healthcare resources. Clear evidence for the importance of intensity of therapy in optimizing functional outcomes is founded in animal models, supported by neuroimaging and behavioral research, and strengthened by recent meta-analyses from multiple clinical trials. However, providing intensive therapy using conventional treatment paradigms is expensive and sometimes not feasible due to patients’ environmental factors. This paper addresses the need for cost-effective increased intensity of practice and suggests potential benefits of telehealth (TH) as an innovative model of care in physical therapy.

Summary of Key Points
We provide an overview of TH and present evidence that a web-supported program used in conjunction with Constraint Induced Therapy (CIT), can increase intensity and adherence to a rehabilitation regimen. The design and feasibility testing of this web-based program, ‘LifeCIT’ is presented. We describe how wearable sensors can monitor activity and provide feedback to patients and therapists. The methodology for the development of a wearable device with embedded inertial measurement units and mechanomyography sensors, algorithms to classify functional movement, and a graphical user interface to present meaningful data to patients to support a home exercise program is explained.

Recommendations for Clinical Practice
We propose that wearable sensor technologies and TH programs have the potential to provide cost-effective, intensive, home-based stroke rehabilitation.

Source: JUST ACCEPTED: “Tele-health, wearable sensors and the Internet. Will they improve stroke outcomes through increased intensity of therapy, motivation and adherence to rehabilitation programs?” |

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[REVIEW] Mobility and the Lower Extremity | EBRSR – Evidence-Based Review of Stroke Rehabilitation – Full Text PDF

Chapter 9

Mobility and the Lower Extremity

Rehabilitation techniques of sensorimotor complications post stroke fall loosely into one of two categories; the compensatory approach or the restorative approach. While some overlap exists, the underlying philosophies of care are what set them apart. The goal of the compensatory approach towards treatment is not necessarily on improving motor recovery or reducing impairments but rather on teaching patients a new skill, even if it only involves pragmatically using the non-involved side (Gresham et al. 1995). The restorative approach focuses on traditional physical therapy exercises and neuromuscular facilitation, which involves sensorimotor stimulation, exercises and resistance training, designed to enhance motor recovery and maximize brain recovery of the neurological impairment (Gresham et al. 1995).In this review, rehabilitation of mobility and lower extremity complications is assessed. An overview of literature pertaining to the compensatory approach and the restorative approach is provided. Treatment targets discussed include balance retraining, gait retraining, strength training, cardiovascular conditioning and treatment of contractures in the lower extremities. Technologies used to aid rehabilitation include assistive devices, electrical stimulation, and splints.

For evidence tables, please click here.

Source: Mobility and the Lower Extremity | EBRSR – Evidence-Based Review of Stroke Rehabilitation

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[WEB SITE] Neuroplasticity: 10 Things Stroke Survivors Need to Know

Neuroplasticity is a big word getting a lot of buzz. It means the brain (“neuro”) can change (“plastic”). We hear a lot about it in stroke and brain injury rehab because it gives hope to survivors that their brains can heal, adapt, and rewire after they have been damaged. We also hear the word in advertisements for new treatments or programs. What exactly is neuroplasticity, and how does it work?

Intuitively, we know that we get better at the things we practice, and we are shaped by our experiences. Therapy for a damaged brain is essentially no different. The best therapies exploit how neuroplasticity works by using repetitive positive experiences to forge and strengthen pathways in the brain. To better understand how this works, we look to the research published by Kleim & Jones that outlines the 10 principles of experience-dependent neuroplasticity.

Neuroplasticity - What it Means for Stroke Survivors

1) Use it or lose it

The skills we don’t practice often get weaker.

2) Use it and improve it

The skills we practice get better.

3) Specificity

We must skillfully practice the exact tasks we want to improve.

4) Repetition matters

We must do a task over and over again once we’ve got it right to actually change the brain.

5) Intensity matters

More repetitions in a shorter time are necessary for creating new connections.

6) Time matters

Neuroplasticity is a process rather than a single event, with windows of opportunity opening for different skills at different times. In rehabilitation, starting earlier is usually better than starting later.

Recent research shows that even 5+ years post-stroke, people with aphasia made significant progress in language skills using Language Therapy daily.

7) Salience matters

To change the brain, the skill we’re practicing must have some meaning, relevance, or importance to us.

8) Age matters

Younger brains tend to change faster than older brains, but improvement is possible at any age.

9) Transference

Practicing one skill can result in improvement of a related skill.

10) Interference

Learning an “easier way” of doing something (i.e. a bad habit or compensation) may make it harder to learn the proper way.

 

Whether you’re learning a new skill or re-learning a lost one, it’s clear we must practice the thing we want to get better at. Unfortunately, many stroke survivors, recovering but not yet ready to return to work, sit at home alone between therapy sessions. They turn to TV to pass the time, despite being willing to do the exercises they need to improve their skills. Fortunately, there are new technologies (such as an app that helps you practice talking or a video game that guides you through meaningful movements) that can help provide intense, meaningful, and skilled stimulation that will change their brains for the better. Understanding how neuroplasticity works can help you evaluate which methods can truly help you reach your goal.

Regrettably, there are some people who are exploiting the term neuroplasticity to give brain injury survivors false hope that they can get better with unproven treatments that require little to no effort. If the therapy does not have you directly practicing the skill it claims to improve, please be cautious. There are no quick-fixes (remember: intensity and repetition matter), and there is no one-size-fits-all solution (remember: specificity and relevance matter). Anyone who tells you otherwise, using brain-brandingneuro-marketing, or brain-training terminology while charging you for a service or product, is banking on you not knowing the difference. But now you do.

 

Further Reading on Neuroplasticity:

 


Tactus Therapy apps are an affordable and accessible way to get some of the mental stimulation needed for recovery. You can personalize Language Therapy, Answering Therapy, and Conversation Therapy with your own questions or photos, helping you use repetition & personal relevance to your advantage.

Source: Neuroplasticity: 10 Things Stroke Survivors Need to Know

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[WEB SITE] Neuroplasticity: 10 Things Stroke Survivors Need to Know

Neuroplasticity is a big word getting a lot of buzz. It means the brain (“neuro”) can change (“plastic”). We hear a lot about it in stroke and brain injury rehab because it gives hope to survivors that their brains can heal, adapt, and rewire after they have been damaged. We also hear the word in advertisements for new treatments or programs. What exactly is neuroplasticity, and how does it work?Intuitively, we know that we get better at the things we practice, and we are shaped by our experiences. Therapy for a damaged brain is essentially no different. The best therapies exploit how neuroplasticity works by using repetitive positive experiences to forge and strengthen pathways in the brain. To better understand how this works, we look to the research published by Kleim & Jones that outlines the 10 principles of experience-dependent neuroplasticity.

1) Use it or lose it: The skills we don’t practice often get weaker.

2) Use it and improve it: The skills we practice get better.

3) Specificity: We must skillfully practice the exact tasks we want to improve.

4) Repetition matters: We must do a task over and over again once we’ve got it right to actually change the brain.

5) Intensity matters: More repetitions in a shorter time are necessary for creating new connections.

6) Time matters: Neuroplasticity is a process rather than a single event, with windows of opportunity opening for different skills at different times. In rehabilitation, starting earlier is usually better than starting later.Recent research shows that even 5+ years post-stroke, people with aphasia made significant progress in language skills using Language Therapy daily.

7) Salience matters: To change the brain, the skill we’re practicing must have some meaning, relevance, or importance to us.

8) Age matters: Younger brains tend to change faster than older brains, but improvement is possible at any age.

9) Transference: Practicing one skill can result in improvement of a related skill.

10) Interference: Learning an “easier way” of doing something (i.e. a bad habit or compensation) may make it harder to learn the proper way.

Whether you’re learning a new skill or re-learning a lost one, it’s clear we must practice the thing we want to get better at. Unfortunately, many stroke survivors, recovering but not yet ready to return to work, sit at home alone between therapy sessions. They turn to TV to pass the time, despite being willing to do the exercises they need to improve their skills. Fortunately, there are new technologies (such as an app that helps you practice talking or a video game that guides you through meaningful movements) that can help provide intense, meaningful, and skilled stimulation that will change their brains for the better. Understanding how neuroplasticity works can help you evaluate which methods can truly help you reach your goal.

Regrettably, there are some people who are exploiting the term neuroplasticity to give brain injury survivors false hope that they can get better with unproven treatments that require little to no effort. If the therapy does not have you directly practicing the skill it claims to improve, please be cautious. There are no quick-fixes (remember: intensity and repetition matter), and there is no one-size-fits-all solution (remember: specificity and relevance matter). Anyone who tells you otherwise, using brain-branding, neuro-marketing, or brain-training terminology while charging you for a service or product, is banking on you not knowing the difference. But now you do.

Source: Neuroplasticity: 10 Things Stroke Survivors Need to Know

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[REVIEW] Mobility and the Lower Extremity | EBRSR – Evidence-Based Review of Stroke Rehabilitation – Full Text PDF

Abstract

Rehabilitation techniques of sensorimotor complications post stroke fall loosely into one of two categories; the compensatory approach or the restorative approach. While some overlap exists, the underlying philosophies of care are what set them apart. The goal of the compensatory approach towards treatment is not necessarily on improving motor recovery or reducing impairments but rather on teaching patients a new skill, even if it only involves pragmatically using the non-involved side (Gresham et al. 1995). The restorative approach focuses on traditional physical therapy exercises and neuromuscular facilitation, which involves sensorimotor stimulation, exercises and resistance training, designed to enhance motor recovery and maximize brain recovery of the neurological impairment (Gresham et al. 1995). In this review, rehabilitation of mobility and lower extremity complications is assessed. An overview of literature pertaining to the compensatory approach and the restorative approach is provided. Treatment targets discussed include balance retraining, gait retraining, strength training, cardiovascular conditioning and treatment of contractures in the lower extremities. Technologies used to aid rehabilitation include assistive devices, electrical stimulation, and splints.

Get Full Text PDF

via Mobility and the Lower Extremity | EBRSR – Evidence-Based Review of Stroke Rehabilitation.

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[REVIEW] The Elements of Stroke Rehabilitation | EBRSR – Evidence-Based Review of Stroke Rehabilitation – Full Text PDF

 

Abstract

The primary concern of stroke rehabilitation is to foster functional improvement and neurological recovery. Intensity, duration and timing of therapy are important factors during stroke rehabilitation to maximize effectiveness. As well, identifying and employing the most applicable treatments for each stroke patient’s specific deficits is also necessary. This review examines the role of intensity in occupational, physical and speech therapy. Elements of stroke rehabilitation that have evidence-based results for improved outcomes are also reviewed.

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via The Elements of Stroke Rehabilitation | EBRSR – Evidence-Based Review of Stroke Rehabilitation.

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