Current clinical practice in managing somatosensory impairments and the use of technology in stroke rehabilitation.

Stroke-induced somatosensory impairments seem to be clinically overlooked, despite their prevalence and influence on motor recovery post-stroke. Interest in technology has been gaining traction over the past few decades as a promising method to facilitate stroke rehabilitation. This questionnaire-based cross-sectional study aimed to identify current clinical practice and perspectives on the management of somatosensory impairments post-stroke and the use of technology in assessing outcome measures and providing intervention. Participants were 132 physiotherapists and occupational therapists currently working with stroke patients in public hospitals and rehabilitation centres in Singapore. It was found that the majority (64.4%) of the therapists spent no more than half of the time per week on somatosensory interventions. Functional or task-specific training was the primary form of intervention applied to retrain somatosensory functions in stroke survivors. Standardised assessments (43.2%) were used less frequently than non-standardised assessments (97.7%) in clinical practice, with the sensory subscale of the Fugl-Meyer Assessment being the most popular outcome measure, followed by the Nottingham Sensory Assessment. While the adoption of technology for assessment was relatively scarce, most therapists (87.1%) reported that they have integrated technology into intervention. There was a common agreement that proprioception is an essential component in stroke rehabilitation, and that robotic technology combined with conventional therapy is effective in enhancing stroke rehabilitation, particularly for retraining proprioception. Most therapists identified price, technology usability, and lack of available space as some of the biggest barriers to integrating robotic technology in stroke rehabilitation. Standardised assessments and interventions targeting somatosensory functions should be more clearly delineated in clinical guidelines. Although therapists were positive about technology-based rehabilitation, obstacles that make technology integration challenging ought to be addressed.

Assessing advanced walking ability in people with stroke using the Groningen Meander Walking Test.

OBJECTIVES: (1) To investigate the intrarater, interrater and test-retest reliabilities of the Groningen Meander Walking Test in people with stroke; (2) to compare the performance of the Groningen Meander Walking Test between people with stroke and healthy older adults; (3) to quantify any correlations between the Groningen Meander Walking Test and other stroke-specific impairment measurements; and (4) to determine the cut off time that best discriminates between 30 people with stroke and 30 age-matched healthy elderly. METHOD: Using a cross-sectional design, the Groningen Meander Walking Test was administered along with the Fugl-Meyer Motor Assessment for the lower extremities, measurement of lower limb muscle strength, Berg's Balance Scale, comfortable walking speed, Timed up and Go test and Community Integration Measure-Cantonese version. RESULTS: The Groningen Meander Walking Test completion times showed excellent intrarater, interrater and test-retest reliabilities (ICC = 0.984-1.00). Our study also showed that stroke subjects took three times longer (28.8 s) than the healthy subjects (9.0 s) in completion times. Both Groningen Meander Walking Test completion times and overstep scores significantly correlated with comfortable walking speed and Timed up and Go test. The cut off time for people with stroke was 11.98 seconds (sensitivity = 0.967; specificity = 1.0) to discriminate against healthy elderly. CONCLUSION: The Groningen Meander Walking Test is a highly reliable and valid tool for quantifying the advanced walking abilities of people with stroke. Implications for Rehabilitation The Groningen Meander Walking Test completion times demonstrated excellent intrarater, interrater and test-retest reliabilities. The Groningen Meander Walking Test completion times correlates well with Berg Balance Scale scores, comfortable walking and Timed Up and Go test times. The Groningen Meander Walking Test overstep scores correlates significantly to its completion times, Fugl-Myer Assessment-Lower Extremity scores, comfortable walking speed and Timed Up and Go test times. A cut off time of 11.98s best for Groningen Meander Walking Test completion times discriminates people with stroke from healthy elderly with sensitivity of 97% and specificity of 100%. The Groningen Meander Walking Test is highly reliable and easy to administer in assessing advanced walking abilities in people with stroke.

Effects of cognitive and motor tasks on the walking speed of individuals with chronic stroke.

Walking speed is a measure of gait performance after a stroke and a predictor of community ambulatory competence. Although gait decrements during a cognitive or motor task after stroke are well-documented, the differential effects of motor and cognitive tasks on the comfortable and maximum walking speeds of individuals with chronic stroke have not been investigated. This study aimed to compare the effects of cognitive and motor tasks on the comfortable and maximum walking speeds of individuals with chronic stroke.This is a cross-sectional study. Thirty community-dwelling chronic stroke individuals were included. Time taken to complete the 10-meter Walk Test under various conditions, including walking alone, walking while completing a cognitive task, and walking while completing a motor task, was recorded, with each condition performed at comfortable as well as maximum walking speeds. Accuracy in performing the cognitive tasks was also assessed.The cognitive and motor tasks caused decrements in both comfortable and maximum walking speeds (P ≤ 0.001). The cognitive task had a greater influence than the motor task on maximum walking speed (P < 0.01).Individuals with chronic stroke tend to prioritize task accuracy and completion over maintaining walking speed. This phenomenon was more evident during the cognitive task than the motor task and was especially evident at maximum walking speed.