Posts Tagged mobility

[WEB SITE] Virtual reality intervention shows promise to repair mobility and motor skills in impaired limb

A combination of traditional physical therapy and technology may improve the motor skills and mobility of an impaired hand by having its partner, more mobile hand lead by example through virtual reality training, new Tel Aviv University research suggests.

“Patients suffering from hemiparesis — the weakness or paralysis of one of two paired limbs — undergo physical therapy, but this therapy is challenging, exhausting, and usually has a fairly limited effect,” said lead investigator Prof. Roy Mukamel of TAU’s School of Psychological Sciences and Sagol School of Neuroscience, who conducted the research with his student Ori Ossmy. “Our results suggest that training with a healthy hand through a virtual reality intervention provides a promising way to repair mobility and motor skills in an impaired limb.” The research was published in Cell Reports.

Does the left hand know what the right hand is doing?

53 healthy participants completed baseline tests to assess the motor skills of their hands, then strapped on virtual reality headsets that showed simulated versions of their hands. The virtual reality technology, however, presented the participants with a “mirror image” of their hands — when they moved their real right hand, their virtual left hand would move.

In the first experiment, participants completed a series of finger movements with their right hands, while the screen showed their “virtual” left hands moving instead. In the next, participants placed motorized gloves on their left hands, which moved their fingers to match the motions of their right hands. Again, the headsets presented the virtual left hands moving instead of their right hands.

The research team found that when subjects practiced finger movements with their right hands while watching their left hands on 3D virtual reality headsets, they could use their left hands more efficiently after the exercise. But the most notable improvements occurred when the virtual reality screen showed the left hand moving while in reality the motorized glove moved the hand.

Tricking the brain

“We effectively tricked the brain,” said Prof. Mukamel.

“Technologically, these experiments were a big challenge,” Prof. Mukamel continued. “We manipulated what people saw and combined it with the passive, mechanical movement of the hand to show that our left hand can learn even when it is not moving under voluntary control.”

The researchers are optimistic that this research could be applied to patients in physical therapy programs who have lost the strength or control of one hand. “We need to show a way to obtain high-performance gains relative to other, more traditional types of therapies,” said Prof. Mukamel. “If we can train one hand without voluntarily moving it and still show significant improvements in the motor skills of that hand, we’ve achieved the ideal.”

The researchers are currently examining the applicability of their novel VR training scheme to stroke patients.

Source: American Friends of Tel Aviv University

Source: Virtual reality intervention shows promise to repair mobility and motor skills in impaired limb

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[Literature Overview] EBRSR – 9 Mobility and the Lower Extremity – 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.

Full Text PDF (175 pages)

 

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[Stroke Rehabilitation Clinician Handbook] 4. Motor Rehabilitation – 4A. Lower Extremity and Mobility – Full Text PDF

4.1 Motor Recovery of the Lower Extremity Post Stroke

Factors that Predict Motor Recovery

Motor deficits post-stroke are the most obvious impairment (Langhorne et al. 2012) and have a disabling impact on valued activities and independence. Motor deficits are defined as “a loss or limitation of function in muscle control or movement or a limitation of movement” (Langhorne et al. 2012; Wade 1992). Given its importance, a large proportion of stroke rehabilitation efforts are directed towards the recovery of movement disorders. Langhorne et al. (2012) notes that motor recovery after stroke is complex with many treatments designed to promote recovery of motor impairment and function.

The two most important factors which predict motor recovery are:

  1. Stroke Severity: The most important predictive factor which reduces the capacity for brain reorganization.
  2. Age: Younger patients demonstrate greater neurological and functional recovery and hence have a better prognosis compared to older stroke patients (Adunsky et al. 1992; Hindfelt & Nilsson 1977; Marini et al. 2001; Nedeltchev et al. 2005).

Changes in walking ability and gait pattern often persist long-term and include increased tone, gait asymmetry, changes in muscle activation and reduced functional abilities (Wooley 2001; Robbins et al. 2006; Pizzi et al. 2007, Pereira et al. 2012). Ambulation post stroke is often less efficient and associated with increased energy expenditure (Pereira et al. 2012). Hemiplegic individuals have been reported to utilize 50-67% more metabolic energy that normal individuals when walking at the same velocity (Wooley et al. 2001).

For mobility outcome, trunk balance is an additional predictor of recovery (Veerbeek et al. 2011). Nonambulant patients who regained sitting balance and some voluntary movement of the hip, knee and/or ankle within the first 72 hours post stroke predicted 98% chance of regaining independent gait within 6 months. In contrast, those who were unable to sit independently for 30 seconds and could not contract the paretic lower limb within the first 72 hours post stroke had a 27% probability of achieving independent gait.

Full Text PDF

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[WEB SITE] Overcome loss of Hand Function and Foot Drop. – Bioness FES – Inquiries

Regain Independence, Function, and Mobility.


Regain function with Bioness’ innovative solutions designed to help those living with Foot Drop or Hand Paralysis due to conditions such as Stroke, Multiple Sclerosis, Cerebral Palsy, Traumatic Brain Injury, or Incomplete Spinal Cord Injury.
Visit Site —> Bioness FES | Inquiries

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[BLOG POST] Disability-Friendly Homes: Easy Modifications You Can Make Today

If you’re living with a disability that makes it challenging to carry out normal activities in the typical home, it can be overwhelming to tackle the necessary modifications. There are many types of disabilities, and each has its own set of helpful home modifications. Of course, these recommendations will not work for everyone, but many can be helpful to a number of common disabilities. If you’re looking at disability-friendly home alterations, here are some good projects to start with.

Accessible Home Security

If you have a mobility issue, keeping yourself safe in your home can be a challenge. Door chains are often placed too high for some people to comfortably reach. Install a door security measure such as a chain at a lower level so that you can easily open the door and talk to someone without putting yourself at risk for forced entry.

Deadbolts are also an ideal home security measure. If your deadbolt is difficult to twist, have someone help you adjust the hardware so that the bolt can glide more smoothly.

Organize for Accessibility

Certain areas can be more expensive to modify for accessibility. The kitchen, for example, has a number of places that should ideally be adjusted such as the stove, sink, and countertops. However, remodeling a kitchen is no easy feat. Instead, you may want to consider organizing it for maximum accessibility.

Place all heavy items, including food items, on lower shelves. Lesser used items such as holiday serving platters can go in harder to reach areas. For deep cabinets or even refrigerators, lazy susans can be a great way to ensure that things in the back are within reach. You might also purchase a grasping tool that extends to reach things that are up high or farther away.

Bathrooms are the Riskiest Room in the House

There are many hazards in the average bathroom. Some disabilities increase the risk of slips and falls. Fortunately, modifying the bathroom can be affordable in many cases. Handrails beside the toilet are a great first step, making it easier to sit and rise from the toilet. A shower seat is another excellent precaution.

Slipping in a shower or tub can be fatal or at least seriously damaging. Furthermore, standing for a shower can be difficult for people with chronic fatigue. The ability to sit makes personal hygiene much simpler.

Dim Lighting Should Be Corrected

Dim lighting can make traversing your own home dangerous. Mobility or vision problems can lead to tripping or other accidents. On top of decluttering your home, improving the lighting can vastly improve your safety and mobility. Take care to light areas that do not receive much natural light and add fixtures where necessary to light main areas of the house.

Altering your home to make it more disability-friendly can vary widely in cost depending on your needs. If you’re struggling to find the money you need to upgrade your house, you can always begin with simpler projects such as reorganizing for convenience or placing smaller safety measures. Every small step can make your life easier.

Image via Pixabay by midascode

This post was written by Paul Denikin, who runs dadknowsdiy.com. On his blog, Paul shares his knowledge with home improvement novices, and connects with other people seeking to modify their homes for a loved one with a disability.

Source: Disability-Friendly Homes: Easy Modifications You Can Make Today – Assistive Technology Blog

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[Abstract] Pilot study of intensive exercise on endurance, advanced mobility and gait speed in adults with chronic severe acquired brain injury – CNS

Brain Inj. 2016 Jul 28:1-7. [Epub ahead of print]

BACKGROUND AND PURPOSE: Effects of high-intensity exercise on endurance, mobility and gait speed of adults with chronic moderate-to-severe acquired brain injury (ABI) were investigated. It was hypothesized that intensive exercise would be associated with improvements in impairment and activity limitation measures.

PARTICIPANTS: Fourteen adults with chronic ABI in supported independent living who could stand with minimal or no assist and walk with or without ambulation device were studied. Eight presented with low ambulatory status.

METHODS: This was a single group pre- and post-intervention study. Participants received a 6-week exercise intervention for 60-90 minutes, 3 days/week assisted by personal trainers under physical therapist supervision. Measures (6MWT, HiMAT and 10MWT) were collected at baseline, post-intervention and 6 weeks later. Repeated measures T-test and Wilcoxon Signed Ranks test were used.

RESULTS: Post-intervention improvements were achieved on average on all three measures, greater than minimal detectable change (MDC) for this population. Three participants transitioned from low-to-high ambulatory status and maintained the change 6 weeks later.

DISCUSSION AND CONCLUSION: People with chronic ABI can improve endurance, demonstrate the ability to do advanced gait and improve ambulatory status with 6 weeks of intensive exercise. Challenges to sustainability of exercise programmes for this population remain.

Source: Traumatic Brain Injury Resource Guide – Research Reports – Pilot study of intensive exercise on endurance, advanced mobility and gait speed in adults with chronic severe acquired brain injury

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[ARTICLE] Effectiveness of botulinum toxin type A on gait and quality of life in adult post-stroke patients with lower limb spasticity: a systematic review protocol – Full Text

Abstract

Review question/objective: The objective of this review is to examine the current best available evidence on the effectiveness of botulinum toxin type A on gait (velocity and distance) and quality of life (QoL) in adult post-stroke patients with lower limb spasticity.

More specifically, this review aims to determine the effectiveness of botulinum toxin type A on adult post-stroke patients with lower limb spasticity in relation to:

* Gait velocity

* Walking distance

* QoL.

Background

Stroke is a leading cause of mortality and morbidity globally. It is the third most common cause of disability globally among people over 65 years of age.1 Post-stroke spasticity is one of the important impairments following stroke along with cognitive and other sensory motor problems. Prevalence post-stroke spasticity ranges from 4% to 42.6%.2

Spasticity is one of the upper motor neuron symptoms experienced by the stroke survivors and defined as a motor disorder characterized by a velocity-dependent increase in tonic stretch reflex (muscle tone) with exaggerated tendon jerks, resulting from hyperexcitability of the stretch reflex (muscle tone) as one component of the upper motor neuron syndrome.1

Post-stroke spasticity typically affects one-half of the body, usually the upper and the lower limb, giving rise to spastic hemiparesis. Spasticity can significantly impair functions, such as mobility and activities of daily living of stroke survivors. In the lower limb, post-stroke spasticity manifests as adducted hip, stiff knee and most commonly equinovarus foot.3 Equinovarus deformity in the ankle and foot is caused by spastic or overactive gastrocnemius, soleus and/or tibialis posterior muscles. Other foot muscles, such as flexor hallucis longus and flexor digitorum longus can also be involved causing clawing of toes. The other spastic lower limb muscles, such as the quadriceps, can cause stiff knee gait,4 hamstrings knee flexion and the hip adductors (adductor magnus, brevis and longus) adduction of the hip. Spastic lower limb gives rise to the characteristic hemiplegic or circumducting gait.

Lower limb muscles are important for transferring from bed to chair, standing from a sitting position and maintaining standing balance before taking steps to walk. The deformities caused by the spastic lower limb muscles in isolation or with other impairments can potentially impede all aspects of mobility as outlined. Post-stroke spasticity can also result in spasm, pain and contracture (permanent deformity), further compounding mobility. Inability to move and lack of independence give rise to activity limitation and participation restriction, leading to poor quality of life (QoL). In some cases, spasticity associated with weakness and lack of voluntary control can lead to adverse health outcomes such as falls and fractures.5 The burden of post-stroke spasticity is high on the stroke survivor’s active function, QoL and also on the carer. Besides the human cost, there is a significant economic cost associated with post-stroke spasticity.6

Spasticity is managed by multidisciplinary rehabilitation team and by oral antispasticity medications such as baclofen, dantrolene, diazepam and clonidine and by blocking nerves with phenol or alcohol. The evidence on the efficacy of oral medications is marginal and their use is associated with adverse effects.7 Botulinum toxin type A is an important adjunctive treatment along with stretching, strengthening exercise and bracing intervention for spasticity.

Botulinum toxin (BT) is a neurotoxin and works by blocking the acetylcholine at the neuromuscular junction weakens the muscle. This is a reversible action which lasts for two to four months8, and the injection has to be repeated. There are three varieties of botulinum toxin type A – onabotulinum toxin or Botox (by Allergan), abobotulinum toxin or Dysport (Ipsen) and incobotulinum toxin or Xeomin (Merz), the first two of which are used widely. A number of studies have shown that the botulinum toxin is safe and effective in reducing focal spasticity.8,9 It has been argued that the botulinum toxin should be the first-line treatment for post-stroke spasticity.10

Botulinum toxin is expensive and the licensed indication in many countries is often restricted to the post-stroke upper limb spasticity.11 There is a number of studies demonstrating a reduction of upper limb spasticity measured by the Modified Ashworth Scale and associated disability with botulinum toxin.12 The effectiveness of the toxin in improving function is less certain – more so in the lower limbs.8 Studies have revealed strong evidence that the BT in the lower limb reduces spasticity. There have not been many randomized controlled trials (RCTs) in the lower limb showing improvement in lower limb functioning such as gait (velocity and/or distance) and improving the QoL. This may be the reason the toxin is still not approved by the pharmaceutical benefit scheme for use in the lower limb in many countries including Australia. A systematic review and meta-analysis revealed that use of BT was associated with a small but statistically significant increase in gait velocity.3 Since then, some RCTs have been carried out with BT in lower limb. From a stroke survivor’s perspective, the ability to walk remains one of the most important goals. Botulinum toxin is also useful for passive functions such as hygiene, preventing contracture and lessening the carer’s burden and in combination with physiotherapy is found to reduce the economic cost in patients with post-stroke spasticity.6 There is a recent systematic review and meta-analysis using on the efficacy of botulinum toxin type A for improving activity restriction and QoL of patients using the GRADE approach.13 This systematic review included RCTs comprising a heterogeneous group of patients with spasticity in upper or lower limb from different causes and was not specific to post stroke lower limb spasticity. Currently, no systematic review is available synthesizing evidence from RCTs focusing on the efficacy of botulinum toxin in improving gait and walking distance and QoL among post-stroke patients with lower limb spasticity.

Hence, the present systematic review aims to synthesize and evaluate the current best available evidence, drawn from RCTs, on the effectiveness of botulinum toxin type A therapy on gait velocity, walking distance and QoL, specifically in adult post-stroke patients with lower limb spasticity. The studies to be included in this review will not be restrictive of the injection technique or dosage of botulinum toxin A used to enable a comprehensive assessment of the effectiveness of the treatment. Findings from the present review will serve to inform the usefulness of botulinum toxin type A in improving the functional outcomes of patients with post-stroke lower limb spasticity over the course of rehabilitation.

Continue —> Effectiveness of botulinum toxin type A on gait and quality… : JBI Database of Systematic Reviews and Implementation Reports

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[Abstract] Hydrotherapy vs. conventional land-based exercise for improving walking and balance after stroke: a randomized controlled trial.

Abstract

Objective: To investigate the effects of hydrotherapy on walking ability and balance in patients with chronic stroke.

Design: Single-blind, randomized controlled pilot trial.

Setting: Outpatient rehabilitation clinic at a tertiary neurological hospital in China.

Subjects: A total of 28 participants with impairments in walking and controlling balance more than six months post-stroke.

Intervention: After baseline evaluations, participants were randomly assigned to a land-based therapy (control group, n = 14) or hydrotherapy (study group, n = 14). Participants underwent individual sessions for four weeks, five days a week, for 45 minutes per session.

Main measures: After four weeks of rehabilitation, all participants were evaluated by a blinded assessor. Functional assessments included the Functional Reach Test, Berg Balance Scale, 2-minute walk test, and Timed Up and Go Test.

Results: After four weeks of treatment, the Berg Balance Scale, functional reach test, 2-minute walk test, and the Timed Up and Go Test scores had improved significantly in each group (P < 0.05). The mean improvement of the functional reach test and 2-minute walk test were significantly higher in the aquatic group than in the control group (P < 0.01). The differences in the mean values of the improvements in the Berg Balance Scale and the Timed Up and Go Test were not statistically significant.

Conclusion: The results of this study suggest that a relatively short programme (four weeks) of hydrotherapy exercise resulted in a large improvement in a small group (n = 14) of individuals with relatively high balance and walking function following a stroke.

 

Source: Hydrotherapy vs. conventional land-based exercise for improving walking and balance after stroke: a randomized controlled trial

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[ARTICLE] Effects of physical therapy delivery via home video telerehabilitation on functional and health-related quality of life outcomes – Full Text HTML

Abstract 

This study examined functional outcomes, health-related quality of life (HRQoL), and satisfaction in a group of Veterans who received physical therapy via an in-home video telerehabilitation program, the Rural Veterans TeleRehabilitation Initiative (RVTRI). A retrospective, pre–post study design was used. Measures obtained from 26 Veterans who received physical therapy in the RVTRI program between February 22, 2010, and April 1, 2011, were analyzed. Outcomes were the Functional Independence Measure (FIM); Quick Disabilities of the Arm, Shoulder, and Hand measure; Montreal Cognitive Assessment (MoCA); and the 2-minute walk test (2MWT). HRQoL was assessed using the Veterans RAND 12-Item Health Survey (VR-12), and program satisfaction was evaluated using a telehealth satisfaction scale. Average length of participation was 99.2 +/– 43.3 d and Veterans, on average, received 15.2 +/– 6.0 therapeutic sessions. Significant improvement was shown in the participants’ FIM (p < 0.001, r = 0.63), MoCA (p = 0.01, r= 0.44), 2MWT (p = 0.006, r = 0.73), and VR-12 (p = 0.02, r = 0.42). All Veterans reported satisfaction with their telerehabilitation experiences. Those enrolled in the RVTRI program avoided an average of 2,774.7 +/– 3,197.4 travel miles, 46.3 +/– 53.3 hr of driving time, and $1,151.50 +/– $1,326.90 in travel reimbursement. RVTRI provided an effective real-time, home-based, physical therapy.

INTRODUCTION

The mission of the Veterans Health Administration (VHA) of the Department of Veterans Affairs (VA) is to deliver uniform high-quality care to all Veterans, regardless of geography, distance, or economic circumstances. To meet this mission, the VHA must reach Veterans regardless of barriers to care provision, including long travel times and distances and expense. These barriers are magnified for rural Veterans with disabilities who require rehabilitation services. These individuals must invest additional time, thought, and resources in order to reach distant medical centers. Many rehabilitation protocols involve repeated therapy sessions, often two to five times weekly over weeks or months, resulting in additional physical, financial, and logistical hardships. In order to fulfill its promise, the VHA is actively attempting to address the gap in services for Veterans with limited access to traditional modes of treatment.

The VHA presently serves 3.3 million Veterans residing in rural localities. These individuals represent 41 percent of all Veterans enrolled in the VHA. Nearly 43 percent (2.27 million) of Veterans served by the VHA with a service-­connected disability live in rural or highly rural areas [1]. Therefore, the VHA is looking to new technologies to facilitate access to healthcare for these individuals. As stated by W. Scott Gould, the former U.S. Deputy Secretary of Veterans Affairs, “We are investing more in telehealth technologies to make VA healthcare available to Veterans wherever they live. In FY [fiscal year] 2010, we invested $121 million in telehealth. In FY2011, those investments will grow to $163 million. By the end of FY2012, we expect to have doubled our present use of telehealth” [2]. Robert A. Petzel, the former Under Secretary for Health of the VA, has explicitly endorsed home telehealth technologies. In testimony before the House Committee on Veterans’ Health on February 23, 2010, he stated, “Our increasing reliance on noninstitutional long-term care includes an investment in 2011 of $163 million in home telehealth. Taking greater advantage of the latest technological advancements in healthcare delivery will allow us to more closely monitor the health status of Veterans and will greatly improve access to care. Telehealth will place specialized healthcare professionals in direct contact with patients using modern IT [information technology] tools” [3].

Telerehabilitation refers to the clinical application of consultative, preventative, diagnostic, and therapeutic services via two-way interactive telecommunication technologies [4–5]. Telerehabilitation is an alternative to usual-care outpatient rehabilitation services. It can also serve as an alternative to “homecare” rehabilitation, which requires the treating therapist or clinician to travel to the patient’s home. By reducing or eliminating barriers relating to travel time and travel-related costs, telerehabilitation has the potential to improve access to rehabilitative care for stroke survivors [6–7]. Improving access to rehabilitative care may reduce disparities for stroke survivors and caregivers facing financial or transportation-related challenges. While research on telerehabilitation is limited, there is increasing evidence supporting the need for telerehabilitation services, the development of telerehabilitation interventions, and support for people with disabling conditions that potentially limit access to rehabilitation services [6–14].

The emerging field of video-based telerehabilitation allows therapists to deliver rehabilitative care to Veterans with physical, financial, and logistical barriers to healthcare providers and facilities [5]. Telerehabilitation has expanded dramatically in recent years as a result of advances in technology, increases in speed of telecommunication, and decreases in costs of computer hardware and software [6]. The scope of telerehabilitation includes direct therapeutic interventions, disease monitoring, coordination of care, patient and caregiver training and education, patient networking, and multidisciplinary professional consultation [15–16].

Veteran access to healthcare services is a topic of high interest and concern to both providers and researchers [6,17–20]. Numerous factors may interfere with patient access to healthcare, including distance, high travel-related expenses, reduced numbers of healthcare providers within rural areas, transportation barriers, caregiver burden, attitude toward and perception of medical care providers, consumer knowledge, informal caregiver and/or familial supports, and ethnic and cultural differences. Reduced access to healthcare contributes to increased morbidity and mortality, increased cost of treatment, and inappropriate use of emergency services [21–24]. Available technologies allow for rehabilitative services to be provided in real-time from providers’ clinics to various recipients’ locations such as home, community, health facilities, and/or work settings. While popular enthusiasm and capital investment in telerehabilitation continue to grow, very little is known regarding the efficacy of telerehabilitation or patients’ overall evaluation and acceptance of telerehabilitation services [25]. A recent Cochran review concerning telerehabilitation services provided to patients during recovery from stroke concluded that sufficient data do not exist to support the effectiveness of telerehabilitation as a stand-alone replacement for traditional rehabilitative services for the restoration of activities of daily living, mobility, upper-limb function, health-related quality of life (HRQoL), patient satisfaction, or cost savings for patients receiving rehabilitative care following stroke [5]. The purpose of this study was to assess the functional outcomes, HRQoL, and satisfaction of a group of patients who participated in a VA telerehabilitation program.

 

Continue —> Effects of physical therapy delivery via home video telerehabilitation on functional and health-related quality of life outcomes

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[ARTICLE] Caregiver-mediated exercises with e-health support for early supported discharge after stroke (CARE4STROKE): study protocol for a randomized controlled trial – Full Text HTML

Abstract

Background: Several systematic reviews have shown that additional exercise therapy has a positive effect on functional outcome after stroke. However, there is an urgent need for resource-efficient methods to augment rehabilitation services without increasing health care costs. Asking informal caregivers to do exercises with their loved ones, combined with e-health services may be a cost-effective method to promote early supported discharge with increased functional outcome.

The primary aim of the CARE4STROKE study is to evaluate the effects and cost-effectiveness of a caregiver-mediated exercises program combined with e-health services after stroke in terms of self-reported mobility and length of stay.

Methods: An observer-blinded randomized controlled trial, in which 66 stroke-patients admitted to a hospital stroke unit, rehabilitation center or nursing home are randomly assigned to either 8 weeks of the CARE4STROKE program in addition to usual care (i.e., experimental group) or 8 weeks of usual care alone (i.e., control group). The CARE4STROKE program is compiled in consultation with a trained physical therapist. A tablet computer is used to present video-based exercises for gait and gait-related activities in which a caregiver acts as an exercise coach.

Primary outcomes are the mobility domain of the Stroke Impact Scale and length of stay. Secondary outcomes are the other domains of the Stroke Impact Scale, motor impairment, strength, walking ability, balance, mobility, (Extended) Activities of Daily Living, psychosocial functioning, self-efficacy, fatigue, health-related quality of life of the patient as well as the experienced strain, psychosocial functioning and quality of life of the caregiver. An economic evaluation will be conducted from the societal and health care perspective.

Discussion: The main aspects of the CARE4STROKE program are

  1. increasing intensity of training by doing exercises with a caregiver in addition to usual care and
  2. e-health support.

We hypothesize this program leads to better functional outcome and early supported discharge, resulting in reduced costs.

Source: Caregiver-mediated exercises with e-health support for early supported discharge after stroke (CARE4STROKE): study protocol for a randomized controlled trial – Springer

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