Journal of Neurologic Physical Therapy最新文献

Background and purpose: Poststroke fatigue (PSF) is prevalent and often manifests as high perceived effort during activities. Little is known about how PSF influences goal-directed reaching after stroke. The purpose of this study was 2-fold (1) to evaluate how perceived effort changed when individuals with stroke performed a reaching task with various demands and (2) to determine whether PSF was associated with perceived effort during reaching and reach performance.

Methods: Thirty-six individuals with chronic stroke performed 2-dimensional reach actions under varied conditions with the more and less affected arms. Perceived effort during reaching was assessed using rating of perceived exertion (RPE) and Paas Mental Effort Rating Scale (MERS). Derived reach kinematics were used to quantify reach performance. The Fatigue Severity Scale (FSS) was administered to assess fatigue severity.

Results: Perceived effort was higher when participants reached with the more affected arm, reached toward far and small targets, and performed memory-guided reaching. Both RPE and MERS significantly correlated with the FSS score ( r = 0.50 and 0.35, respectively, P < 0.05). Further, FSS correlated with movement time during the more affected arm reaching (ρ = 0.40, p < 0.05) and reach performance discrepancy between the fast and self-selected speed conditions when participants performed with the less affected arm (ρ = 0.36, P < 0.05). Exploratory analysis revealed that the relationship between fatigue and reach control appeared to be modulated by task demand.

Discussion and conclusions: PSF is associated with perceived effort during reaching and reach performance after stroke. These relationships might offer insights into arm performance in the real world after stroke.

Video abstract: for more insights from the authors Supplemental Digital Content available at http://links.lww.com/JNPT/A476.

Background and purpose: Telerehabilitation represents an alternative for individuals who have difficulty accessing services to receive care. Therefore, telerehabilitation measures must be studied for their reliability and validity. This study evaluated the validity and reliability of the videoconference-based Berg Balance Scale assessment in stroke survivors.

Methods: Thirty-one stroke survivors were assessed. Rater A conducted in-person and remote assessments via videoconferencing at 2 different times (test-retest), and rater B conducted an assessment using the second recording made remotely. The validity and agreement between the in-person and remote assessments were analyzed using the Pearson's correlation coefficient and the Bland-Altman plots limits of agreement (LoA), respectively. Test-retest and inter-rater reliability were analyzed using the intraclass correlation coefficient (ICC) with a 95% confidence interval (95% CI), and individual item reliability was assessed by weighted Kappa. The standard error of measurement and minimal detectable change were computed. Cronbach's alpha was used for the analysis of internal consistency, and the ceiling effect was investigated.

Results: In-person and remote assessments showed a strong positive correlation ( r = 0.96) and less than a 1-point difference between the 2 assessments. Both the test-retest (ICC = 0.96; 95% CI, 0.93-0.98) and inter-rater (ICC = 0.93; 95% CI, 0.87-0.97) reliability were excellent. The standard error of measurement and minimal detectable change were 1.8 and 5.1 points, respectively. Results showed adequate internal consistency and no ceiling effect.

Discussion and conclusions: The Tele-Berg demonstrated validity, excellent test-retest and inter-rater reliability, low measurement error, adequate internal consistency, and lack of ceiling effect. These findings suggest that the Tele-Berg is comparable to in-person Berg Balance Scale in stroke survivors.

Video abstract available for more insights from the authors (see Supplemental Digital Content, available at: http://links.lww.com/JNPT/A509 ).

Background and purpose: Even though Benign Paroxysmal Positioning Vertigo (BPPV) is one of the most reported vestibular disorders, its interaction with frailty and postural control in older adults is hardly or not investigated.

Methods: Thirty-seven older adults (≥65 years) with a diagnosis of BPPV (oaBPPV) (mean age 73.13 (4.8)) were compared to 22 age-, weight-, and height-matched controls (mean age 73.5 (4.5)). Modified Fried criteria were used to assess frailty. Postural control was assessed with the timed chair stand test, mini Balance Systems Evaluation test (mini-BESTest), a Clinical Test of Sensory Interaction on Balance (CTSIB), and 10-m walk test. Falls were inquired. The Dizziness Handicap Inventory, Falls Efficacy Scale, and 15-item Geriatric Depression Scale assessed dizziness-related handicap, fear of falling, and feelings of depression, respectively. To assess the importance of frailty, all variables were also compared between frail oaBPPV, robust oaBPPV, and robust controls in a sub-analysis. The significance level was set at α = 0.05.

Results: oaBPPV reported significantly more multiple falls ( P = 0.05) and difficulties to remain standing with increasing task difficulty of the CTSIB ( P = 0.004). They were significantly more (pre-)frail compared to controls ( P < 0.001). Moreover, frail oaBPPV had a significantly decreased reactive postural control ( P < 0.001) and dynamic gait ( P < 0.001). Their fear of falling ( P < 0.001) and dizziness-related handicap ( P < 0.001) were significantly higher compared to robust oaBPPV.

Discussion and conclusions: oaBPPV were less healthy and more (pre-)frail compared to controls, impacting their daily functioning. Future research should investigate whether frailty and postural control were already decreased before the BPPV onset and if this recovers after treatment with repositioning maneuvers or if additional rehabilitation is necessary.

Impact statement: Older adults with Benign Paroxysmal Positional Vertigo (BPPV) can present with an impaired sensory orientation, declined cognition, significantly more multiple falls, and (pre-)frailty compared to controls. Moreover, frail older adults with BPPV also had a significantly decreased reactive postural control and dynamic gait, and an increased odds of falling compared to robust controls. BPPV and frailty appear to be linked with each other, which cannot be ignored in future research and clinicians treating older adults with BPPV.

Background and purpose: Individuals with downbeat nystagmus (DBN) syndrome present with DBN, dizziness, blurred vision, and unsteady gait. Pharmacological intervention with 4-aminopyridine (4-AP) may be effective in improving oculomotor function, but there is minimal evidence to date that it improves gait. This suggests the possible benefit of combining pharmacotherapy with physical therapy to maximize outcomes. This case report documents improvements in gait and balance after physical therapy and aminopyridine (AP) in an individual with DBN syndrome.

Case description: The patient was a 70-year-old man with a 4-year history of worsening dizziness and imbalance, diagnosed with DBN syndrome. He demonstrated impaired oculomotor function, dizziness, and imbalance, which resulted in falls and limited community ambulation.

Intervention: The patient completed a customized, tapered course of physical therapy over 6 months. Outcome measures included the 10-meter walk test, the Timed Up and Go (TUG), the Dynamic Gait Index (DGI), and the modified clinical test of sensory integration and balance.

Outcomes: Improvements exceeding minimal detectable change were demonstrated on the TUG and the DGI. Gait speed on the 10-meter walk test did not change significantly, but the patient was able to use a cane to ambulate in the community and reported no further falls.

Discussion: Controlled studies are needed to explore the potential for AP to augment physical therapy in people with DBN syndrome. Physical therapists are encouraged to communicate with referring medical providers about the use of AP as pharmacotherapy along with physical therapy for individuals with DBN syndrome.

Background and purpose: Physical activity has beneficial symptomatic effects for people with Parkinson's disease (PD), but increasing-and sustaining-a physically active lifestyle remains challenging. We investigated the feasibility (ability to increase step counts) and usability of a behavioral intervention using a motivational smartphone application to remotely increase physical activity in PD.

Methods: We performed a 4-week, double-blind pilot trial. Thirty people with PD who were able to walk independently and did not take more than 7000 steps at baseline were randomized to minimal, moderate, or large increases in step counts. Step counts were continuously collected with the participants' own smartphones. Usability was assessed with a translated version of the System Usability Scale. We reported the distribution of clinical characteristics in our participants.

Results: Step counts per day increased over 4 weeks in a dose-dependent pattern (mean ± standard deviation: minimal = 1064 ± 1030, moderate = 1689 ± 2060, large = 2745 ± 3817). The usability of the STEPWISE app (System Usability Scale) was perceived as excellent (mean ± standard deviation: 86.6 ± 12.7).

Discussion and conclusions: Our findings support the notion that a titrated increase in daily step count is feasible over 4 weeks. This motivates and supports further development of a smartphone application to increase physical activity in people with manifest PD. If effective, this behavioral intervention could provide an accessible option for people with PD worldwide.

Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content available at: http://links.lww.com/JNPT/A516 ).

Background and purpose: Studies investigating high-intensity interval exercise (HIIE) in stroke typically emphasize treadmill training. However, a literature review suggested that seated devices such as a recumbent stepper or cycle offer a promising alternative for HIIE since exercise can be prescribed using peak power output (PPO). Therefore, this would give health care professionals the ability to monitor and adapt power output for the target heart rate range. The purpose of this secondary analysis was to examine the feasibility of prescribing short-interval, low-volume HIIE using PPO in chronic stroke.

Methods: We used several methods to test feasibility: (1)Acceptability: Measured by the percentage of participants who completed the entire HIIE protocol; (2) Implementation was assessed by the number of reported cardiac or serious adverse events during submaximal exercise testing and HIIE and the average percentage of participants reaching vigorous intensity, defined by the American College of Sports Medicine as at least 77% of age-predicted maximal heart rate (HR max ).

Results: Data were available for 28 participants who were 32.2 (17.2) months post-stroke and 61.4 (11.9) years of age. Twenty-eight participants completed HIIE per protocol. No cardiac or serious adverse events occurred during the submaximal exercise test or during HIIE. The rapid switching between HIIE and recovery showed no evidence of blood pressure reaching unsafe thresholds. Average intensity during HIIE reached 76.8% HR max , which is slightly below the target of 77.0%.

Discussion and conclusions: A single bout of short-interval, low-volume HIIE, prescribed using PPO, was feasible in chronic stroke.

Video Abstract : Available for more insights from the authors (Supplemental Digital Content, Video, available at: http://links.lww.com/JNPT/A474 ).