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Mark Bayley - One of the best experts on this subject based on the ideXlab platform.
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canadian Stroke best practice recommendations Stroke Rehabilitation practice guidelines update 2015
International Journal of Stroke, 2016Co-Authors: Debbie Hebert, Patrice M Lindsay, Peter Rumney, Mark Bayley, Stephen D Bagg, Amanda Mcintyre, Adam KirtonAbstract:Stroke Rehabilitation is a progressive, dynamic, goal-orientated process aimed at enabling a person with impairment to reach their optimal physical, cognitive, emotional, communicative, social and/or functional activity level. After a Stroke, patients often continue to require Rehabilitation for persistent deficits related to spasticity, upper and lower extremity dysfunction, shoulder and central pain, mobility/gait, dysphagia, vision, and communication. Each year in Canada 62,000 people experience a Stroke. Among Stroke survivors, over 6500 individuals access in-patient Stroke Rehabilitation and stay a median of 30 days (inter-quartile range 19 to 45 days). The 2015 update of the Canadian Stroke Best Practice Recommendations: Stroke Rehabilitation Practice Guidelines is a comprehensive summary of current evidence-based recommendations for all members of multidisciplinary teams working in a range of settings, who provide care to patients following Stroke. These recommendations have been developed to address both the organization of Stroke Rehabilitation within a system of care (i.e., Initial Rehabilitation Assessment; Stroke Rehabilitation Units; Stroke Rehabilitation Teams; Delivery; Outpatient and Community-Based Rehabilitation), and specific interventions and management in Stroke recovery and direct clinical care (i.e., Upper Extremity Dysfunction; Lower Extremity Dysfunction; Dysphagia and Malnutrition; Visual-Perceptual Deficits; Central Pain; Communication; Life Roles). In addition, Stroke happens at any age, and therefore a new section has been added to the 2015 update to highlight components of Stroke Rehabilitation for children who have experienced a Stroke, either prenatally, as a newborn, or during childhood. All recommendations have been assigned a level of evidence which reflects the strength and quality of current research evidence available to support the recommendation. The updated Rehabilitation Clinical Practice Guidelines feature several additions that reflect new research areas and stronger evidence for already existing recommendations. It is anticipated that these guidelines will provide direction and standardization for patients, families/caregiver(s), and clinicians within Canada and internationally.
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effectiveness of virtual reality using wii gaming technology in Stroke Rehabilitation a pilot randomized clinical trial and proof of principle
Stroke, 2010Co-Authors: Gustavo Saposnik, Robert Teasell, Muhammad Mamdani, Judith Hall, William E Mcilroy, Donna Cheung, Kevin E Thorpe, Leonardo G Cohen, Mark BayleyAbstract:Background and Purpose— Hemiparesis resulting in functional limitation of an upper extremity is common among Stroke survivors. Although existing evidence suggests that increasing intensity of Stroke Rehabilitation therapy results in better motor recovery, limited evidence is available on the efficacy of virtual reality for Stroke Rehabilitation. Methods— In this pilot, randomized, single-blinded clinical trial with 2 parallel groups involving Stroke patients within 2 months, we compared the feasibility, safety, and efficacy of virtual reality using the Nintendo Wii gaming system (VRWii) versus recreational therapy (playing cards, bingo, or “Jenga”) among those receiving standard Rehabilitation to evaluate arm motor improvement. The primary feasibility outcome was the total time receiving the intervention. The primary safety outcome was the proportion of patients experiencing intervention-related adverse events during the study period. Efficacy, a secondary outcome measure, was evaluated with the Wolf Moto...
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issues for selection of outcome measures in Stroke Rehabilitation icf activity
Disability and Rehabilitation, 2005Co-Authors: Katherine Salter, Robert Teasell, Norine Foley, Jeffrey W Jutai, Jamie Bitensky, Mark BayleyAbstract:Purpose. To evaluate the psychometric and administrative properties of outcome measures in the ICF Participation category, which are used in Stroke Rehabilitation research and reported in the published literature.Method. Critical review and synthesis of measurement properties for six commonly reported instruments in the Stroke Rehabilitation literature. Each instrument was rated using the eight evaluation criteria proposed by the UK Health Technology Assessment (HTA) programme. The instruments were also assessed for the rigour with which their reliability, validity and responsiveness were reported in the published literature.Results. Validity has been well reported for at least half of the measures reviewed. However, methods for reporting specific measurement qualities of outcome instruments were inconsistent. Responsiveness of measures has not been well documented. Of the three ICF categories, Participation seems to be most problematic with respect to: (a) lack of consensus on the range of domains requir...
Pamela W. Duncan - One of the best experts on this subject based on the ideXlab platform.
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effects of task specific and impairment based training compared with usual care on functional walking ability after inpatient Stroke Rehabilitation leaps trial
Neurorehabilitation and Neural Repair, 2013Co-Authors: Stephen E Nadeau, Dorian K Rose, Bruce H Dobkin, Stanley P Azen, Julie K Tilson, Steven Cen, Pamela W. DuncanAbstract:Background. After inpatient Stroke Rehabilitation, many people still cannot participate in community activities because of limited walking ability. Objective. To compare the effectiveness of 2 conc...
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feasibility and effectiveness of circuit training in acute Stroke Rehabilitation
Neurorehabilitation and Neural Repair, 2011Co-Authors: Dorian K Rose, Trevor Paris, Erin Crews, Anqi Sun, Andrea L Behrman, Pamela W. DuncanAbstract:Background: Task-specificity, repetition and progression are key variables in the acquisition of motor skill however they have not been consistently implemented in post-Stroke Rehabilitation. Objective: To evaluate the effectiveness of a Stroke Rehabilitation plan of care that incorporated task-specific practice, repetition and progression to facilitate functional gain compared to standard physical therapy for individuals admitted to an inpatient Stroke unit. Methods: Individuals participated in either a circuit training (CTPT) model (n = 72) or a standard (SPT) model (n = 108) of physical therapy, 5 days/week. Each 60 minute circuit training session, delivered according to severity level, consisted of four functional mobility tasks. Daily exercise logs documented both task repetition and progression. Results: The CTPT model was successfully implemented in an acute Rehabilitation setting. The CTPT group showed a significantly greater improved change in gait speed from hospital admission to discharge than ...
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Management of Adult Stroke Rehabilitation Care: a clinical practice guideline.
Stroke, 2005Co-Authors: Pamela W. Duncan, Richard D. Zorowitz, Barbara E. Bates, John Y. Choi, Jonathan J. Glasberg, Glenn D. Graham, Richard C. Katz, Kerri Lamberty, Dean M. RekerAbstract:Stroke is a leading cause of disability in the United States.1 The Veterans Health Administration (VHA) of the Department of Veterans Affairs (VA) estimates that 15 000 veterans are hospitalized for Stroke each year (VA HSR&D, 1997). Forty percent of Stroke patients are left with moderate functional impairments and 15% to 30% with severe disability.2 Effective Rehabilitation interventions initiated early after Stroke can enhance the recovery process and minimize functional disability. Improved functional outcomes for patients also contribute to patient satisfaction and reduce potential costly long-term care expenditures. There are only 45 Rehabilitation bed units (RBUs) in the VA today. Many veterans who have a Stroke and are admitted to a VA Medical Center will find themselves in a facility that does not offer comprehensive, integrated, multidisciplinary care. In a VA Rehabilitation field survey published in December 2000, more than half of the respondents reported that the “rehabilitative care of Stroke patients was incomplete, fragmented, and not well coordinated” at sites lacking a RBU (VA Stroke Medical Rehabilitation Questionnaire Results, 2000). In Department of Defense (DoD) medical treatment facilities, approximately 20 000 active-duty personnel and dependents were seen in 2002 for Stroke and Stroke-related diagnoses according to ICD-9 coding.3 Comprehensive treatment for Stroke patients in DoD medical facilities is given primarily at medical centers. Smaller DoD community hospitals may have limited resources to see both inpatients and outpatients, relying more on the TRICARE network for ongoing Stroke Rehabilitation services. A growing body of evidence indicates that patients do better with a well-organized, multidisciplinary approach to post-acute Rehabilitation after a Stroke.4–6 The VA/DoD Stroke Rehabilitation Working Group only focused on the post–acute Stroke Rehabilitation care. Duncan and colleagues7 found that greater adherence to post-acute Stroke Rehabilitation guidelines was associated with improved patient outcomes and concluded “compliance …
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a taxonomy for classification of Stroke Rehabilitation services
Archives of Physical Medicine and Rehabilitation, 2000Co-Authors: Helen Hoenig, Pamela W. Duncan, Richard Sloane, Ronnie D Horner, M Zolkewitz, Byron B HamiltonAbstract:Abstract Hoenig H, Sloane R, Horner RD, Zolkewitz M, Duncan PW, Hamilton BB. A taxonomy for classification of Stroke Rehabilitation services. Arch Phys Med Rehabil 2000;81:853-62. Objective: To develop a taxonomy for use in measuring Stroke Rehabilitation services. Design: A cross-sectional study using facility-level survey data and extant data files. Setting: Veterans Administration medical centers (VAMCs). Variables: (1) A list of Rehabilitation characteristics, including personnel, physical facilities, coordination of care, and hospital characteristics; and (2) a classification or typology of VAMCs according to the type of postacute Stroke care on-site. Main Outcome Measures: Data sources included extant Veterans Administration (VA) computerized databases, VA central office administrative files, and 2 mailed surveys to VA Rehabilitation medicine services and Stroke acute care services. The Rehabilitation taxonomy was derived using 2 methods that assess face and construct validity, respectively: (1) an expert panel rating, using a modified Delphi process, of the clinical importance of each of the Rehabilitation characteristics; and (2) a comparison of Rehabilitation characteristics across the different types of VAMCs. Variables were included in the final taxonomy if the expert panel reached consensus that the variable was clinically important, or if there were statistically significant differences in these characteristics across the different types of medical centers. Results: Of 67 possible Rehabilitation characteristics, a multidisciplinary expert panel reached consensus about the likely clinical importance of 21 Rehabilitation characteristics, 11 of which showed statistically significant differences across different types of VAMCs. An additional 9 variables that lacked expert panel consensus differed significantly among the different medical centers. These 30 variables represent a preliminary taxonomy of key Rehabilitation characteristics. Among the 20 variables that varied significantly across the different types of medical centers, 18 showed a pattern with the greatest amount of resources and organizational sophistication being found in VAMCs with Rehabilitation units, followed by medical centers with geriatric units, and the least amount of resources and organizational sophistication was seen in medical centers whose postacute care services were limited to nursing home or intermediate care. Conclusion: Thirty Rehabilitation characteristics had face validity and/or construct validity, and can be considered to represent a preliminary taxonomy for measuring Stroke Rehabilitation services. This study also shows that there are significant differences among hospitals in resources and organization of care deemed to be important for Stroke patients. © 2000 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation
Michelle J Johnson - One of the best experts on this subject based on the ideXlab platform.
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affordable robotics for upper limb Stroke Rehabilitation in developing countries a systematic review
IEEE Transactions on Medical Robotics and Bionics, 2021Co-Authors: Andrea Demofonti, Giorgio Carpino, Loredana Zollo, Michelle J JohnsonAbstract:Stroke incidence is increasing more rapidly in Low- and Middle-Income Countries (LMICs) than in High-Income Countries (HICs), but LMICs are not well organized to provide adequate post-Stroke Rehabilitation because of physical, financial and personal barriers. The use of Rehabilitation robotics can help bridge in healthcare disparities but they are available in LMICs in limited number due to their high cost and this limits the number of patients that can benefit from them. This article presents a literature review on the affordable robots for upper limb Stroke Rehabilitation that could be suitable in low-resources clinical settings with a focus on the different techniques implemented to reduce production costs. Different approaches can be carried out: i) developing end-effector and exoskeleton robots for the Rehabilitation of proximal and distal joints respectively; ii) reducing the number of degrees of freedom of the robots at minimum (one or two) allowing the Rehabilitation in a planar workspace; iii) avoiding the use of conventional materials that could make the robot bulky, expensive and difficult to transport. According to the mechanical properties required by the task, stell or metal alloys could be substituted for wood, aluminum, plastic, 3D-printed materials and by the adaptation of off-the-shelf elements.
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technology assisted Stroke Rehabilitation in mexico a pilot randomized trial comparing traditional therapy to circuit training in a robot technology assisted therapy gym
Journal of Neuroengineering and Rehabilitation, 2016Co-Authors: Karla Bustamante D Valles, Sandra Montes, Maria De Jesus Madrigal, Adan Burciaga, Maria Elena Martinez, Michelle J JohnsonAbstract:Background Stroke Rehabilitation in low- and middle-income countries, such as Mexico, is often hampered by lack of clinical resources and funding. To provide a cost-effective solution for comprehensive post-Stroke Rehabilitation that can alleviate the need for one-on-one physical or occupational therapy, in lower and upper extremities, we proposed and implemented a technology-assisted Rehabilitation gymnasium in Chihuahua, Mexico. The Gymnasium for Robotic Rehabilitation (Robot Gym) consisted of low- and high-tech systems for upper and lower limb Rehabilitation. Our hypothesis is that the Robot Gym can provide a cost- and labor-efficient alternative for post-Stroke Rehabilitation, while being more or as effective as traditional physical and occupational therapy approaches.
Robert Teasell - One of the best experts on this subject based on the ideXlab platform.
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the Stroke impact scale performance as a quality of life measure in a community based Stroke Rehabilitation setting
Disability and Rehabilitation, 2016Co-Authors: Marina Richardson, Laura Allen, Matthew Meyer, Nerissa Campbell, Robert TeasellAbstract:AbstractPurpose: The objective of this study was to assess the psychometric properties of the Stroke Impact Scale (SIS). Methods: Data was derived from a study assessing a community-based Stroke Rehabilitation program. Patients were administered the SIS and Euroqol-5D (EQ-5D-5L) on admission to the study, and at six month and 12 month follow-up. The psychometric performance of each domain of the SIS was assessed at each time point. Results: A total of 164 patients completed outcome measures at baseline, 108 patients at six months and 37 patients at 12 months. Correlation of the SIS domains with the EQ-5D-5L suggested that the dimensions of health contributing to a patient’s perception of health-related quality of life changes over time. Conclusion: The SIS performed well in a sample of patients undergoing Stroke Rehabilitation in the community. Our findings suggest that the multidimensionality of the SIS may allow health professionals to track patient progress and tailor Rehabilitation interventions to ta...
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community Stroke Rehabilitation teams providing home based Stroke Rehabilitation in ontario canada
Canadian Journal of Neurological Sciences, 2014Co-Authors: Laura Allen, Amanda Mcintyre, Marina Richardson, Shannon Janzen, Matthew Meyer, Deborah Willems, Robert TeasellAbstract:Background: Community Stroke Rehabilitation teams (CSRTs) provide a community-based, interdisciplinary approach to Stroke Rehabilitation. Our objective was to assess the effectiveness of these teams with respect to client outcomes. Methods: Functional, psychosocial, and caregiver outcome data. were available at intake, discharge from the program, and six-month follow-up. Repeated measures analysis of covariance was performed to assess patient changes between time points for each outcome measure. Results: A total of 794 clients met the inclusion criteria for analysis (54.4% male, mean age 68.5±13.0 years). Significant changes were found between intake and discharge on the Hospital Anxiety and Depression Scale total score (p=0.017), Hospital Anxiety and Depression Scale Anxiety subscale (p Conclusions: Results indicate that the community Stroke Rehabilitation teams were effective at improving the functional and psychosocial recovery of patients after Stroke. Importantly, these gains were maintained at 6 months postdischarge from the program. A home-based, Stroke-specific multidisciplinary Rehabilitation program should be considered when accessibility to outpatient services is limited.
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community Stroke Rehabilitation teams providing home based Stroke Rehabilitation in ontario canada
Canadian Journal of Neurological Sciences, 2014Co-Authors: Laura Allen, Amanda Mcintyre, Marina Richardson, Shannon Janzen, Matthew Meyer, Deborah Willems, Robert TeasellAbstract:BACKGROUND: Community Stroke Rehabilitation teams (CSRTs) provide a community-based, interdisciplinary approach to Stroke Rehabilitation. Our objective was to assess the effectiveness of these teams with respect to client outcomes. METHODS: Functional, psychosocial, and caregiver outcome data. were available at intake, discharge from the program, and six-month follow-up. Repeated measures analysis of covariance was performed to assess patient changes between time points for each outcome measure. RESULTS: A total of 794 clients met the inclusion criteria for analysis (54.4% male, mean age 68.5±13.0 years). Significant changes were found between intake and discharge on the Hospital Anxiety and Depression Scale total score (p=0.017), Hospital Anxiety and Depression Scale Anxiety subscale (p<0.001), Functional Independence Measure (p<0.001), Reintegration to Normal Living Index (p=0.01), Bakas Caregiver Outcomes Scale (p<0.001), and Caregiver Assistance and Confidence Scale assistance subscale (p=0.005). Significant gains were observed on the strength, communication, activities of daily living, social participation, memory, and physical domains of the Stroke Impact Scale (all p<0.001). These improvements were maintained at the 6-month follow-up. No significant improvements were observed upon discharge on the memory and thinking domain of the Stroke Impact Scale; however, there was a significant improvement between admission and follow-up (p=0.002). All significant improvements were maintained at the 6-month follow-up. CONCLUSIONS: Results indicate that the community Stroke Rehabilitation teams were effective at improving the functional and psychosocial recovery of patients after Stroke. Importantly, these gains were maintained at 6 months postdischarge from the program. A home-based, Stroke-specific multidisciplinary Rehabilitation program should be considered when accessibility to outpatient services is limited.
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effectiveness of virtual reality using wii gaming technology in Stroke Rehabilitation a pilot randomized clinical trial and proof of principle
Stroke, 2010Co-Authors: Gustavo Saposnik, Robert Teasell, Muhammad Mamdani, Judith Hall, William E Mcilroy, Donna Cheung, Kevin E Thorpe, Leonardo G Cohen, Mark BayleyAbstract:Background and Purpose— Hemiparesis resulting in functional limitation of an upper extremity is common among Stroke survivors. Although existing evidence suggests that increasing intensity of Stroke Rehabilitation therapy results in better motor recovery, limited evidence is available on the efficacy of virtual reality for Stroke Rehabilitation. Methods— In this pilot, randomized, single-blinded clinical trial with 2 parallel groups involving Stroke patients within 2 months, we compared the feasibility, safety, and efficacy of virtual reality using the Nintendo Wii gaming system (VRWii) versus recreational therapy (playing cards, bingo, or “Jenga”) among those receiving standard Rehabilitation to evaluate arm motor improvement. The primary feasibility outcome was the total time receiving the intervention. The primary safety outcome was the proportion of patients experiencing intervention-related adverse events during the study period. Efficacy, a secondary outcome measure, was evaluated with the Wolf Moto...
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the pedro scale provides a more comprehensive measure of methodological quality than the jadad scale in Stroke Rehabilitation literature
Journal of Clinical Epidemiology, 2005Co-Authors: Sanjit K Bhogal, Robert Teasell, Norine Foley, Mark SpeechleyAbstract:Abstract Objective To systematically compare the PEDro scale and the Jadad scale when applied to the Stroke Rehabilitation literature. Study Design and Setting A literature search of multiple databases was used to identify all trials from 1968 through 2002. Each article was reviewed and assigned quality scores according to PEDro and Jadad criteria. Quality scores for both scales were compared using descriptive statistics. The correlation between the scales was estimated using the Pearson product moment correlation coefficient. Results 272 randomized controlled trials were retrieved and subjected to quality scoring to both the PEDro scale and the Jadad scale. Mean scores (with standard deviation) for the PEDro and Jadad scales were 5.78 (1.4) and 2.46 (1.1), respectively. The Pearson coefficient determined the PEDro and Jadad scales to be significantly correlated ( r =.59, P r =.49, P r =.52, P Conclusion In the Stroke Rehabilitation literature, where double-blinding studies are often not possible due to the nature of the interventions, breaking down the levels of blinding and accounting for concealed allocation, intention-to-treat, and attrition is important. Accordingly, the PEDro scale provides a more comprehensive measure of methodological quality of the Stroke literature.
Lalit Kalra - One of the best experts on this subject based on the ideXlab platform.
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Stroke Rehabilitation 2009 old chestnuts and new insights
Stroke, 2010Co-Authors: Lalit KalraAbstract:The past year has continued to see growth in Stroke Rehabilitation literature, ranging from important insights into the basic science of Stroke recovery to broader multidisciplinary aspects aimed at improving global quality of life in Stroke survivors. The areas that particularly stand out include 1) new evidence on old treatment strategies in clinical Rehabilitation; 2) developments in the treatment of “neglected” impairments, such as hemianopia and sensory loss; 3) evaluation of the use of technology in Stroke Rehabilitation; and 4) advances in neurorestorative treatments after Stroke.
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randomized controlled trial of integrated managed care pathway for Stroke Rehabilitation
Stroke, 2000Co-Authors: David Sulch, Inigo Perez, Anne Melbourn, Lalit KalraAbstract:Background and Purpose—Integrated Care Pathway (ICP) is an organized, goal-defined, and time-managed plan that has the potential of facilitating timely interdisciplinary coordination, improving discharge planning, and reducing length of hospital stay. Methods—An ICP for Stroke Rehabilitation based on evidence of best practice, professional standards, and existing infrastructure was developed. Its effectiveness was tested in 152 Stroke patients undergoing Rehabilitation who were randomized to receive ICP care coordinated by an experienced nurse (n=76) or conventional multidisciplinary care (n=76). Results—The age, sex, premorbid functional ability, and Stroke characteristics of the 2 groups were comparable. There were no differences in mortality rates (10 [13%] versus 6 [8%]), institutionalization (10 [13%] versus 16 [21%]), or length of hospital stay (50±19 versus 45±23 days) between patients receiving ICP or multidisciplinary care. Patients receiving conventional multidisciplinary care improved significa...
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medical complications during Stroke Rehabilitation
Stroke, 1995Co-Authors: Lalit Kalra, Koo Wilson, Pauline RootsAbstract:Background and Purpose We sought to evaluate the effect of setting on the rate of medical complications during Stroke Rehabilitation. Methods A study of the frequency and nature of medical complications in Stroke Rehabilitation was undertaken in 245 patients managed either on a Stroke Rehabilitation unit (n=124) or on general medical wards (n=121). The Stroke unit setting was characterized by established protocols for prevention, early diagnosis, and management of complications (eg, aspiration, infections, thromboembolism, pressure sores, depression, Stroke progression). Similar protocols did not exist on general medical wards except for thromboembolism, pressure sores, and secondary Stroke prevention. Results Medical complications were documented in 147 patients (60%) and were more common in patients with severe Strokes (97%). The frequency of reported complications was similar in both settings. Aspiration (33% versus 20%; P<.01) and musculoskeletal pain (38% versus 23%; P<.05) were more commonly documen...
