RehabWire - Volume 7, Number 9, October 2005

 

Rehabilitation from the devastating effects of stroke is the focus of this issue of RehabWire. NIDRR has six new projects focusing on stroke recovery, all featured here. We've also highlighted NIDRR Research articles focusing on stroke and stroke rehabilitation.

Featured NIDRR Grantees: 21st Century Research.

The effects of Diabetes on the Benefits of Exercise After Stroke, Patricia M. Kluding, PT, PhD. (H133F050006). A. Cate Miller, PhD, Project Officer.
Abstract: The purpose of the project is to determine whether the presence of Type II diabetes mellitus attenuates the benefits of aerobic and strengthening exercise for people with chronic stroke. Project goals and objects include: (1) To determine whether people with stroke and diabetes have decreased baseline measures of function, cardio-respiratory fitness, muscle strength, and cognition compared to people with stroke alone; (2) to determine if people with stroke and diabetes show less improvements after a 12 week aerobic and strengthening exercise program than those with stroke alone in the areas of function, cardio-respiratory fitness, and lower extremity muscle strength; and (3) to determine if either people with stroke alone or people with stroke and diabetes show improved cognition after a 12 week aerobic and strengthening exercise program.

Visual Guidance to Improve Stepping Behavior Post-Stroke, Northwestern University (H133G050132) led by David A. Brown, PhD. Thomas Corfman, Project Officer.
Abstract: Impaired walking ability is a major obstacle to quality of life for stroke survivors, and recovery of independent walking is among the most important goals for individuals post-stroke. This project introduces a novel simulated object stepping paradigm to improve walking poststroke by providing the added benefits of visual guidance during body-weight supported treadmill training. Consumers view simulated objects through a pair of goggles and are instructed to step over challenging objects while subjected to body-weight supported treadmill training. The dimensions of the object are adjusted so that successful stepping is associated with an improved and more functional step length and toe clearance leading to improved gait speed and lowered risk for falls.

Driving after Stroke, Wayne State University (H133G050134) led by Lisa J. Rapport, PhD. David W. Keer, Project Officer.
Abstract: The purpose of the study is to evaluate driving after stroke. Cessation of driving is among the most functionally disabling consequences of stroke. Driving is integral to independence, community membership, and activities of daily living such as access to work, shopping, and health care. The objectives of this study are to identify the barriers to driving after stroke and the extent to which these barriers influence driving status (i.e., decision to drive), actual driving risk, and community integration. The project outcomes identify barriers to driving that are unwarranted or remediable and facilitate decision-making based on valid information, both of which are important to improving functional mobility and adaptation to changes associated with stroke.

Black-White Disparities in Stroke Rehabilitation Outcomes, National Rehabilitation Hospital/Medstar Research Institute (H133G050153) led by Gerben DeJong, PhD. Shelley Reeves, Project Officer.
Abstract: This project analyzes a large existing dataset for disparities in stroke rehabilitation care and outcomes among black and white stroke survivors and determines how rehabilitation treatments and outcomes can be optimized for both groups. Investigators then translate study findings into an actionable quality improvement plan that rehabilitation centers can use to enhance care for both groups. Researchers use data on 1063 individuals in the 2 racial groups originally acquired from 6 sites in the Post-Stroke Rehabilitation Outcomes Project. This project used a practice-based evidence (PBE) method that examined the actual practice of care to identify the practices associated with best outcomes. PBE studies are observational cohort studies that require researchers to specify carefully the nature of the rehabilitation treatments and control exhaustively for the patient differences that may otherwise affect the outcomes. To help generalize the findings of the study, investigators compare study participants with stroke survivors included in eRehabdata, a national database to which 180 rehabilitation facilities report. The study is a collaboration between the National Rehabilitation Hospital in Washington, DC and the Institute for Clinical Outcomes Research in Salt Lake City, UT.

Constraint-Induced Movement Therapy Modified for Rehabilitating Arm Function in Stroke Survivors with Plegic Hands, University of Alabama (H133G050222) led by Gitendra Uswatte, PhD. Theresa San Agustin, MD, Project Officer.
Abstract: Based on positive findings from a pilot study, this project conducts a randomized, controlled clinical trial to rigorously test the efficacy of a modification of Constraint-Induced Movement (CI) therapy for rehabilitating arm function in chronic stroke patients with severe upper-extremity impairment. In the modified therapy, participants receive CI therapy, combined with other treatment modalities, for six hours per day. The treatment package includes tone management/movement facilitation, training of more-impaired arm use using shaping, functional task practice, restraint of the less-impaired arm in the laboratory and at home, and a package of behavioral methods for transferring gains from the laboratory to the home situation.

Smart Over-Ground Body-Weight Support Gait Training System, National Rehabilitation Hospital (H133G050259) led by Joseph M. Hidler, PhD. Thomas Corfman, Project Officer.
Abstract: The goal of this project is to build and test a new body-weight support system that allows individuals of different body weight and varying levels of walking ability to safely practice over-ground gait training. To safely practice gait for both the patient and therapist, rehabilitation centers move over-ground gait training to the treadmill where bodyweight support systems can help minimize falls while at the same time raising the intensity of the training. This device allows therapists to train patients early in their recovery stages in a safe, controlled manner, and thus enhance gains in over-ground walking ability.

Please note: These abstracts have been modified. Full, unedited abstracts, as well as any available REHABDATA citations, are available at naric.com.

For conferences on stroke and stroke rehabilitation visit the Internet Stroke Center’s Stroke and Neurosciences Conferences at www.strokecenter.org/prof/calendar.htm

New Research: Selections from REHABDATA

Bode, R., Heinemann, A. (2004) Patterns of therapy activities across length of stay and impairment levels: Peering inside the "black box" of inpatient stroke rehabilitation. Archives of Physical Medicine and Rehabilitation, 85(12), 8. NARIC Accession Number: J47628. Project Number: H133B30041, H133G60135.
Abstract: Study describes the type and pattern of therapy activities provided to patients with stroke during inpatient rehabilitation. Researchers examined the timing, intensity, and duration of rehabilitation activities separately by discipline within four lengths-of-stay (LOS) groups (two-, three-, four-, and five-week). Using this classification system, the results indicated differences in total therapy units by discipline, by activity type, and by week of rehabilitation. Regardless of impairment severity, occupational therapists consistently spent more time on impairment-focused activities and physical therapists and speech-language pathologists consistently spent more time on function-based activities. Patterns of time spent in therapy were similar for all LOS groups, but the average number of therapy units provided weekly increased with the LOS.

Brown, D., Nagpal, S. (2005) Limb-loaded cycling program for locomotor intervention following stroke. Physical Therapy, 85(2),10. NARIC Accession Number: J48620. Project Number: H133B980021.
Abstract: Study examined the feasibility and safety of a limb-loaded cycling (LLC) training program as an adjunct to physical therapy in gait training for people in the acute stages of recovery following a stroke. Two people with hemiplegia who were within their first two months following stroke participated in the intervention. Performance of LLC involved cycling while supporting progressive amounts of applied load and weight shifting from one lower extremity to the other. Both patients showed rapid progression with increases in weight bearing and force generation. The patients tolerated all loads without cardiorespiratory distress.

Jette, D., Latham, N. (2005) Physical therapy interventions for patients with stroke in inpatient rehabilitation facilities. Physical Therapy, 85(3), 11. NARIC Accession Number: J48673. Project Number: H133B990005.
Abstract: Study results describe the physical therapy (PT) services provided to 972 patients with stroke in 6 inpatient rehabilitation facilities in the United States. Analysis revealed that the mean length of stay was 18.7 days and patients received PT an average of 13.6 days during an episode of care. The average number of PT sessions per day was 1.5, with each session lasting 38.1 minutes. Gait and prefunctional activities were performed most frequently. The most frequently provided interventions included strengthening exercises, balance training, postural awareness, and motor learning. Eighty-six percent of the patients received evaluation, and 84 percent of patients and families received education.

Beer, R., Dewald, J. (2004) Target-dependent differences between free and constrained arm movements in chronic hemiparesis. Experimental Brain Research, 156(4), 13. NARIC Accession Number: J49200. Project Number: H133G80063.
Abstract: Study compared the kinematic and kinetic characteristics of constrained and free upper limb movements in eight subjects with chronic hemiparesis. Movements of the dominant and non-dominant limbs were also examined in five control subjects. Arm movements performed in the horizontal plane were analyzed with the arm supported against gravity loading provided either by a low-friction air-bearing apparatus (constrained movement) or actively supported by the subject (free movement). Data analysis focused on the peak joint torques generated during the acceleratory phase of movement, and on the net change in joint angles at the elbow and shoulder. Results showed that movement parameters were broadly invariant with support condition for either limb of control subjects, as well as for the nonparetic limb of hemiparetic subjects. In contrast, support condition had a target-dependent effect on movements of the paretic limb.

Luft, A., McCombe-Walke. (2004) Repetitive bilateral arm training and motor cortex activation in chronic stroke: A randomized controlled trial. Journal of the American Medical Association (JAMA), 292(15), 9. NARIC Accession Number: J49203. Project Number: H133G010111. Abstract: Study examined the effect of bilateral arm training with rhythmic auditory cueing (BATRAC) on the reorganization of brain regions involved in motor control in patients with hemiparesis after a stoke. BATRAC is a rehabilitation therapy based on the concept that bilateral movement permits interhemispheric facilitation of the limbs. Patients were randomly assigned to BATRAC or standardized dose-matched therapeutic exercises. Both were conducted for one hour, three times a week, for six weeks. Within two weeks before and after the intervention, patients underwent functional magnetic resonance imaging of the elbows, electromyography of biceps and deltoid muscles during elbow movement, and a battery of arm functioning tests. Results showed that only patients in the BATRAC group increased hemispheric activation during paretic arm movement. Changes in activation were observed in the contralesional cerebrum and ipsilesional cerebellum. Findings suggest the BATRAC induces reorganization in contralesional motor networks. There were no differences in functional outcome between groups.

Craelius, W. (2004) Exploiting residual function after paralysis. NARIC Accession Number: O15886. Project Number: H133F030011.
Abstract: Reports outcomes of a project to develop new ways for people with paralysis to use and improve their residual muscle function through improved human-machine interface, which is the coupling between the human user and his assistive devices. The interface is a myokinetic interface wherein a sensory array is applied to limb muscles and joints in order to register residual kinetic activity that is then used to control an assistive device. Five subjects with hemiparalysis due to stroke performed various physical tasks using a prototype myokinetic orthosis. All five subjects were able to record and visualize their residual muscle activities using the new interface.

Stevens, J. (2004) Motor imagery protocol (MIP) to improve functional recovery from hemiparesis in stroke survivors.. NARIC Accession Number: O16056. Project Number: H133F030015.
Abstract: Report describes the effects of the using of motor imagery protocol (MIP) as a clinical intervention to improve functional recovery from upper extremity hemiparesis following stroke. Author presents evidence of the overlap of processing at the cognitive-behavioral and neural levels during execution.The present study compared the outcomes of people with acute and chronic stage hemiparesis who received either MIP, consisting of imagined wrist movements and mental simulations of reaching and object manipulations, or occupational therapy (OT). Results demonstrated that MIP is just as effective as OT in increasing performance of impaired upper limbs in chronic stage stroke survivors. The results with acute stage stroke survivors are less clear.