Physiospot Neurology

A measure of early physical functioning (EPF) post-stroke.

Finch LE, Higgins J, Wood-Dauphinee S, Mayo NE

This study developed a comprehensive measure of Early Physical Functioning (EPF) post-stroke quantified through Rasch analysis and conceptualized using the International Classification of Functioning Disability and Health (ICF). Functional assessments were made in 262 subjects within 3 days of stroke with items from valid and reliable indices commonly utilized to evaluate stroke survivors. A 38-item unidimensional measure of the EPF met all Rasch model requirements. The item difficulty matched the person ability, reliability of the person-item-hierarchy was excellent. Initial validity was adequate.

The 38-item EPF measure was developed. It expands the range of assessment post acute stroke; it covers a broad spectrum of difficulty with good initial psychometric properties that, once revalidated, can assist in planning and evaluating early interventions.

Journal of Rehabilitation Medicine, 2008, 40(7), 508-17

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Modified Total-Body Recumbent Stepper Exercise Test for Assessing Peak Oxygen Consumption in People With Chronic Stroke

Billinger, S. A, Tseng, B. Y, Kluding, P. M

The purpose of this study was to quantitatively assess the validity and feasibility of a modified exercise test using a total-body recumbent stepper (mTBRS-XT) in individuals after stroke.  11 participants performed 2 maximal-effort graded exercise tests on separate days using the mTBRS-XT and a cycle ergometer exercise protocol to assess cardiorespiratory fitness.   A strong relationship existed between the mTBRS-XT and the cycle ergometer exercise test for Vo₂peak and peak HR . Mean VO₂peak was significantly higher for the mTBRS-XT compared with the cycle ergometer exercise protocol.

The mTBRS-XT may be a safe, feasible, and valid exercise test to obtain measurements of Vo₂peak in people with stroke. Health care professionals may use the mTBRS-XT to prescribe aerobic exercise based on Vo₂peak values for individuals with mild to severe deficits after stroke.

Physical Therapy, 4 Sept 2008, online article ahead of print

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Contemporary Interventions in Neurological Rehabilitation at Sheffield Hallam University

This course investigates and critically evaluates interventions currently used or being researched in neurological rehabilitation. The module will enable a new approach to examining practice in neurology, starting with researched interventions and making implications from these into our day-to-day practice. This module will compliment the approaches dominant in other neurological therapy modules and is highly recommended as a "starter module" for experienced physiotherapists and occupational therapists new to level 7 study.  Successful completion of this module will earn you 15 level 7 credits which may be put towards the MSc Advancing Physiotherapy.

The module will include
• upper limb rehabilitation interventions such as assistive splints, constraint induced movement therapy, sensory training and trunk restraint therapy
• robotics
• functional electric stimulation
• treadmill training and
• stretching and strengthening

Provisional Timetable
Mon 10th Nov, Tues 11th Nov, Mon 8th Dec, Tues 9th Dec, Thurs 22nd Jan, Fri 23rd Jan

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Tai Chi improves balance and mobility in people with Parkinson disease

Madeleine E. Hackney, Gammon M. Earhart

This pilot study examines the effects of Tai Chi on balance, gait and mobility in people with Parkinson disease (PD). Thirty-three people with PD were randomly assigned to either a Tai Chi group or a control group. The Tai Chi group participated in 20 1-h long training sessions completed within 10–13 weeks; whereas, the control group had two testing sessions between 10 and 13 weeks apart without interposed training. The Tai Chi group improved more than the control group on the Berg Balance Scale, UPDRS, Timed Up and Go, tandem stance test, six-minute walk, and backward walking. Neither group improved in forward walking or the one leg stance test. All Tai Chi participants reported satisfaction with the program and improvements in well-being.

Tai Chi appears to be an appropriate, safe and effective form of exercise for some individuals with mild–moderately severe PD.

Gait & Posture, 2008, 28(3), 456-460

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Dependence in Prestroke Mobility Predicts Adverse Outcomes Among Patients With Acute Ischemic Stroke

Dallas M, Rone-Adams S, Echternach J, Brass L, Bravata D

This study primarily aimed to explore the link between pre-stroke levels of mobility and specific post-stroke outcomes. Associations between pre-stroke mobility impairment and plans for physiotherapy were also studied. The method used to explore these issues was secondary data analysis from results of the National Stroke Project.

Results highlighted a strong association between dependence pre-stroke and adverse outcomes. The authors concluded that this demonstrates the importance of screening for pre-stroke mobility in order to identify patients at greatest risk of adverse events.

Stroke 2008, 39, 2298-2303

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Gait festination and freezing in Parkinson's disease: Pathogenesis and rehabilitation.

Morris ME, Iansek R, Galna B

Freezing and festination during gait are common yet poorly understood motor control deficits in people with Parkinson's disease (PD). As a basis for evidence based clinical decision making during rehabilitation, this issue explores the underlying factors associated with freezing of gait in PD. It is argued that disorders of motor set and the sequence effect (festination) are associated with freezing, either in isolation or in combination. The contribution of environmental constraints, task related factors, attention, mental status, and prolonged use of PD medications are also investigated. Strategies to reduce the frequency and severity of freezing episodes for a range of locomotion tasks are proposed.

Movement Disorders, 2008, 23(S2), S451-S460

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What are the therapeutic advances in neurology? Opinions from world experts

For this inaugural issue of Therapeutic Advances in Neurological Disorders, the international editorial board gives their opinion on significant therapeutic advances in their area of neurology, what the future holds, and what needs to be addressed. This article provides a clinical picture of where we are now and where therapeutic advances in neurology should head in the years to come.

Therapeutic Advances in Neurological Disorders, 2008, 1, 5

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Postural Instability in Idiopathic Parkinson's Disease: Discriminating Fallers from Nonfallers Based on Standardized Clinical Measures.

Landers MR, Backlund A, Davenport J, Fortune J, Schuerman S, Altenburger P

Forty-nine participants with a diagnosis of idiopathic PD were included in this study to identify those at risk of falling. Each was assessed using three categories of measurement tools: PD-specific scales (modified Hoehn and Yahr [HY] and Unified Parkinson's Disease Rating Scale [UPDRS]), balance-specific scales (Berg Balance Scale [BBS], Sensory Organization Test [SOT], and Activities-Specific Balance Confidence Scale [ABC]), and functional gait scales (Self-Selected Gait Velocity [SSGV], Dynamic Gait Index [DGI]), and a standardized obstacle course.

Results from this study suggest that the UPDRS-ADL, UPDRS-Overall, and the BBS are the best clinical tests for discriminating falls in persons with PD.

Journal of Neurolgic Physical Therapy, 2008, 32(2), 56-61

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The effect of exercise training in improving motor performance and corticomotor excitability in people with early Parkinson's disease.

Fisher BE, Wu AD, Salem GJ, Song J, Lin CH, Yip J, Cen S, Gordon J, Jakowec M, Petzinger G

The objective of this study was to obtain preliminary data on the effects of high-intensity exercise on functional performance in people with Parkinson's disease (PD) relative to exercise at low and no intensity and to determine whether improved performance is accompanied by alterations in corticomotor excitability as measured through transcranial magnetic stimulation (TMS).  Subjects were randomized to high-intensity exercise using body weight-supported treadmill training, low-intensity exercise, or a zero-intensity education group. A small improvement in total and motor UPDRS was observed in all groups. High-intensity group subjects showed postexercise increases in gait speed, step and stride length, and hip and ankle joint excursion during self-selected and fast gait and improved weight distribution during sit-to-stand tasks. Improvements in gait and sit-to-stand measures were not consistently observed in low- and zero-intensity groups.

The dose-dependent benefits of exercise and high-intensity exercise can normalize corticomotor excitability in early PD.

Archives of Physical Medicine and  Rehabilitation, 2008, 89(7), 1221-9

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Post-stroke exercise rehabilitation: what we know about retraining the motor system and how it may apply to retraining the heart.

Luft A, Macko R, Forrester L, Goldberg A, Hanley DF

A plateau in recovery within the first few months of rehabilitative therapy was assumed to be the norm in stroke survivors. Recent studies examined the effect of 6 months of treadmill exercise training in chronically disabled stroke survivors. Treadmill exercise improves fitness and walking ability in patients when initiated 6 months or more following their index stroke. Functional imaging studies show that such exercise also induces subcortical reorganization in these patients.

Treadmill exercise appears to have motor, cardiac, and daily functional benefits in stroke survivors.

Cleveland Clinic Journal of Medicine, 2008, 75 Suppl 2, S83-6

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