Gait deficits and functional disability are persistent problems for many stroke survivors, even after standard neurorehabilitation. There is little quantified information regarding the trajectories of response to a long-dose, 12-month intervention.
OBJECTIVE:
We quantified treatment response to an intensive neurorehabilitation mobility and fitness program.
METHODS:
The 12-month neurorehabilitation program targeted impairments in balance, limb coordination, gait coordination, and functional mobility, for five chronic stroke survivors. We obtained measures of those variables every two months.
RESULTS:
We found statistically and clinically significant group improvement in measures of impairment and function. There was high variation across individuals in terms of the timing and the gains exhibited.
CONCLUSIONS:
Long-duration neurorehabilitation (12 months) for mobility/fitness produced clinically and/or statistically significant gains in impairment and function. There was unique pattern of change for each individual. Gains exhibited late in the treatment support a 12-month intervention. Some measures for some subjects did not reach a plateau at 12 months, justifying further investigation of a longer program (>12 months) of rehabilitation and/or maintenance care for stroke survivors.
Cinnera,A. M., Bonnì Pellicciari,M. C., Giorg,F., Caltagirone,C., & KochG. (2020). Health-related quality of life (HRQoL) after stroke: Positive relationship between lower extremity and balance recovery. Top Stroke Rehabil, 27(7):534–540. doi: 10.1080/10749357.2020.1726070. Epub 2020 Feb 10.
2.
Andersson,A. G., Kamwendo,K., Seiger,A., & Appelros,P. (2006). How to identify potential fallers in a stroke unit: validity indexes of 4 test methods. Journal of Rehabilitation Medicine, 38(3):186.
3.
Beninato,M., Gill-Body,K. M., Salles,S., et al. (2006). Determination of the minimal clinically important difference in the FIM instrument in patients with stroke. Archives of Physical Medicine and Rehabilitation, 87(1):32–9.
4.
Billinger,S. A., Boyne,P., Coughenour,E., et al. (2015). Does aerobic exercise and the FITT principle fit into stroke recovery?Current Neurology and Neuroscience Reports, 15(2):519.
5.
Carr,J. H., & Shepherd,R. B. (1987). Movement Science: Foundations for Physical Therapy in Rehabilitation. Aspen Publishers, Inc.: Rockville, Maryland, US.
6.
Cramer,S. C. (2020). Issues important to the design of stroke recovery trials. Lancet Neurol, 19(3):197–198. doi: 10.1016/S1474-4422(20)30030-2
7.
Boissoneault,C., Grimes,T., Waters,M., Rose.D., Khanna,A., Datta,S., & Daly,J. J. (2020). Innovative Long-Dose Neurorehabilitation for Balance and Mobility in Chronic Stroke: A Preliminary Case Series. Brain Sci, 10, 555; doi: 10.3390/brainsci10080555.
8.
Cohen,J. (1992). A power primer. Psychological Bulletin, 112(1), 155.
9.
Daly,J. J., McCabe,J. P., Gansen,J., et al. (2012). Gait Coordination Protocol for recovery of coordinated gait, function, and quality of life following stroke. Journal of Rehabilitation Research and Development, 49(8):XIX.
10.
Daly,J. J., & Ruff,R. L. (2007). Construction of efficacious gait and upper limb functional interventions based on brain plasticity evidence and model-based measures for stroke patients. Scientific World J, 7:2031–45.
11.
Daly,J. J., Zimbelman,J., Roenigk,K. L., et al. (2011). Recovery of coordinated gait: randomized controlled stroke trial of functional electrical stimulation (FES) versus no FES, with weight-supported treadmill and over-ground training. Neurorehabilitation and Neural Repair, 25(7):588–96.
12.
Davison,A. C., & Hinkley,D. V. (1997). Bootstrap methods and their application (Vol. 1). Cambridge University Press.
13.
Doğğan,A., MengüllüoĞĞlu,M., & Özgirgin,N. (2011). Evaluation of the effect of ankle-foot orthosis use on balance and mobility in hemiparetic stroke patients. Disability and Rehabilitation, 33(15-16):1433–9.
14.
Duncan,P. W., Goldstein,L. B., Matchar,D., Divine,G. W., & FeussnerJ. Stroke. 1992). 23(8):1084–9. doi: 10.1161/01.str.23.8.1084.
15.
Flansbjer,U. B., Blom,J., & Brogårdh,C. (2012). The reproducibility of Berg Balance Scale and the Single-leg Stance in chronic stroke and the relationship between the two tests. PM&R, 4(3):165–70.
16.
Flansbjer,U. B., Holmbäck,A. M., Downham,D., et al. (2005). Reliability of gait performance tests in men and women with hemiparesis after stroke. Journal of Rehabilitation Medicine, 37(2):75–82.
17.
Fulk,G. D., & He,Y. (2018). Mininal Clinically Important difference of the -minute walk test in people with stroke. J Neurol Phys Ther, 42(4):235–240.
18.
Gordon,N. F., Gulanick,M., Costa,F., et al. (2004). Physical activity and exercise recommendations for stroke survivors: an American heart association scientific statement from the council on clinical cardiology. Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention; the Council on Cardiovascular Nursing; the Council on Nutrition, Physical Activity, and Metabolism; and the Stroke Council, 109(16):2031–41.
19.
Hendricks,H. T., van Limbeek,J., Geurts,A. C., & Zwarts,M. J. (2002). Motor recovery after stroke: a systematic review of the literature. Arch Phys Med Rehabil, 83(11):1629–37. doi: 10.1053/apmr.2002.35473.
20.
Hessam,M., Salehi,R., Yazdi,M. J. S., Negahban,H., Rafie,S., & Mehravar,M.J. (2018). Relationship between functional balance and walking ability in individuals with chronic stroke. Phys Ther Sci, 30(8):993–996. doi: 10.1589/jpts.30.993. Epub 2018 Jul 24.
21.
Hiengkaew,V., Jitaree,K., & Chaiyawat,P. (2012). Minimal detectable changes of the Berg Balance Scale, Fugl-Meyer Assessment Scale, Timed “Up & Go” Test, gait speeds, and 2-minute walk test in individuals with chronic stroke with different degrees of ankle plantarflexor tone. Archives of Physical Medicine and Rehabilitation, 93(7):1201–8.
22.
Kuptniratsaikul,V., Kovindha,A., Suethanapornkul,S., Massakulpan,P., Permsirivanich,W., & Kuptniratsaikul,P. S. (2017). Motor recovery of stroke patients after rehabilitation: one-year follow-up study. Int J Neurosci, 127(1):37–43. doi: 10.3109/00207454.2016.1138474. Epub 2016 Jan 29.
23.
Nas,K., Gür,A., Çevik,R., & Saraç,A. J. (2004). The relationship between physical impairment and disability during stroke rehabilitation: effect of cognitive status. Int J Rehabil Res, 27(3):181–184.
24.
O’Sullivan,S. B., & Schmitz,T. J. (1994). Physical Rehabilitation Assessment and Treatment. FA Davis Company: Philadelphia.
25.
Perry,J., Garrett,M., Gronley,J. K., & Mulroy,S. J. (1995). Classification of walking handicap in the stroke population. Stroke, 26(6):982.
26.
Price,R., & Choy,N. L. (2019). Investigating the relationship of the functional gait assessment to spatiotemporal parameters of gait and quality of life in individuals with stroke, J Geriatr Phys Ther, 42(4):256–264. doi: 10.1519/JPT.0000000000000173.
27.
Quaney,B. M., Boyd,L. A., McDowd,J. M., Zahner,L. H., He.J., et al. (2009). Aerobic exercise improves cognition and motor function poststroke. Neurorehabilitation and Neural Repair, 23(9):879–85.
28.
R Core Team (2018). R:Alanguage and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. URL https://www.R-project.org/.
29.
Ryerson,S., & Levit,K. (1997). Functional movement Reeducation. Churchill Livingstone (Harcourt Brace and Company): Philadelphia, Pennsylvania.
30.
Siegel,S., CastellanN. J.Jr (1988). Nonparametric statistics for the behavioral sciences. 2nd ed. New York: McGraw-Hill.
31.
Taylor-Piliae,R. E., & Coull,B. M. (2012). Community-based Yang-style Tai Chi is safe and feasible in chronic stroke: a pilot study. Clinical Rehabilitation,26(2):121–31.
32.
Taylor-Piliae,R. E., Hoke,T. M., Hepworth,J. T., et al. (2014). Effect of Tai Chi on physical function, fall rates and quality of life among older stroke survivors. Archives of Physical Medicine and Rehabilitation, 95(5):816–24.
33.
Tilson,J. K., Sullivan,K. J., Cen,S. Y., et al. (2010). Meaningful gait speed improvement during the first 60 days poststroke: minimal clinically important difference. Physical Therapy, 90(2):196–208.
34.
Umphred,D. A., Lazaro,R. T., Roller,M. L., & Burton,G. U. (2013). Neurological Rehabilitation, Sixth Edition. Mobsby (Elsevier): www.elsevier.com
Walker,N., Mellick,D., Brooks,C. A., & Whiteneck,G.G. (2003). Measuring participation across impairment groups using the Craig Handicap Assessment Reporting Technique. American Journal of Physical Medicine & Rehabilitation, 82(12):936–41.
37.
Wee,J. Y. M., & Hopman,W. H. (2005). Stroke impairment predictors of discharge function, length of stay, and discharge destination in stroke rehabilitation. Am J Phys Med Rehabil, 84(8):604–12. doi: 10.1097/01.phm.0000171005.08744.ab. PMID: 16034230.
38.
WHO.World Health Organization (WHO), website accessed July 30 2020, World Health Report. The Global Burden of Disease. ISBN 978 92 4 156371 0 NLM classification: W 74.
39.
Wickham,H. (2016). ggplot2: elegant graphics for data analysis. Springer.
40.
Winstein,C. J., Stein,J., Arena,R., et al. (2016). Guidelines for adult stroke rehabilitation and recovery: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 47(6):e98–169.
