The effect of two physiotherapy approaches on physical and cognitive functions and independent coping at home in stroke rehabilitation. A preliminary follow-up study.

PURPOSE: Activating physiotherapy was used to support the principle of post stroke functional recovery as a learning process which requires both cognitive and physical actions. The purpose of the present preliminary study was to examine the influence of activating physiotherapy on stroke patients' cognitive and physical functions and independent living at home compared with traditional treatment over a 12-month follow-up. METHODS: The 40 patients who received activating physiotherapy were compared with 40 patients receiving traditional therapy. Patients' physical functional capacity was measured one week and 12 months post stroke with the Barthel Index (BI), 10-m gait speed, the Postural Control and Balance for Stroke (PCBS) test, walking distances and patients' abilities to cope without outside help. Cognitive capacity was measured with specific neuropsychological tests: language, visuospatial functions, visual inattention and memory. RESULTS: Physical functional capacity improved significantly (p = 0.001) in both groups at the 12-month follow-up, but no significant differences were found between groups. However, the patients in the activating therapy group coped better without outside help (p = 0.042) and covered longer distances outdoors (p = 0.012). At follow-up all the measured cognitive functions had improved significantly in the activating therapy group and the change in memory in the same group differed significantly from that in the traditional therapy group (p < 0.001), where no significant improvement was observed. CONCLUSIONS: Activating therapy advanced stroke patients' cognitive and physical functional recovery and supported their return to independent life at home more than did traditional physiotherapy. In this respect activating therapy seems to have a beneficial influence on long-term stroke rehabilitation.

Validity of the Postural Control and Balance for Stroke test.

BACKGROUND AND PURPOSE: To determine the construct and predictive validity and sensitivity of the sub-scale items for postural changes, sitting balance and standing balance of the Postural Control and Balance for Stroke (PCBS) test over a 90-day follow-up. METHOD: In the initial phase of stroke the PCBS test scores were compared with values obtained for the Barthel Index (BI) and the four neuropsychological domains most widely studied in the literature: memory; language; visuo-spatial functions; and visual inattention. The ability of the PCBS test at an early stage to predict functional status, as measured by the BI, and tendency to falls at 90 days after stroke was studied. The sensitivity of the PCBS test in evaluating postural control was studied by comparing the changes between the initial and 90 days' measures, and by examining the ability of the test to discriminate between healthy people and stroke patients. Forty stroke patients (aged 51-89 years), measured 7 and 90 days post-stroke, and 35 healthy control subjects (aged 50-90 years) participated in the study. RESULTS: Moderate correlations were found between the initial PCBS test and the BI (Spearman's r = 0.56-0.79) and a negative correlation between the sum variables for visual inattention and postural changes (Spearman's r = -0.39) and sitting balance (Spearman's r = -0.55). The score for postural changes predicted functional capacity (p < 0.002) and standing balance predicted falls at the three-month follow-up (p < 0.007). The PCBS test proved to be sensitive to change: the median change in the PCBS test scores during the three-month follow-up was 6.06. The control subjects mostly obtained maximum scores, indicating that the PCBS test was able to discriminate between healthy individuals and those with stroke. CONCLUSIONS: The results confirm that the PCBS test has good construct validity, good ability to predict functional capacity and safe moving, and it is sensitive to changes in balance control after stroke.

Individualised home-based rehabilitation after stroke in eastern Finland--the client's perspective.

Reintegration into society is one of the main purposes of post-stroke rehabilitation. The experiences of clients returning home after a stroke have been studied before. There is, however, little knowledge about activities carried out during home-based rehabilitation interventions and about the involvement of clients in the process. This study focused on clients' experiences of a 3-month individualised, home-based rehabilitation programme supervised by a multidisciplinary team. The data were collected in 2009-2010, and it was based on interviews with 14 clients (48-83 years of age) conducted approximately 7 months after stroke. In the thematic analysis, five main topics describing the goals and functions of the home-based rehabilitation were identified as follows: (i) learning strategies for solving problems in daily activities at home and in the community; (ii) receiving exercise coaching; (iii) exploring community services and facilities; (iv) having a dialogue with professionals; and (v) engaging in activities aimed at returning to work. Implementing rehabilitation activities in the home environment seemed to enhance the participants' active involvement and their ability to evaluate themselves and to set goals for their recovery. Work was an important goal for clients of working age, but work-related tasks were not sufficiently integrated with home-based rehabilitation. A challenge for local communities is to provide health promotion and recreation services that are also suitable for persons with limited functioning.

Relationships between standing balance and symmetry measurements in patients following recent strokes (3 weeks or less) or older strokes (6 months or more).

BACKGROUND AND PURPOSE: The Functional Standing Balance (FSB) Scale was designed to obtain measurements of standing balance and to identify the problems typically faced by people with stroke. The purpose of this study was to investigate the validity of measurements obtained with the FSB Scale for use in the acute and chronic phases of stroke by comparing the measurements obtained with the FSB Scale with those obtained for postural sway and lateral symmetry by use of a force platform. SUBJECTS AND METHODS: Measurements were obtained for 26 people with recent strokes (ie, strokes within 3 weeks of data collection) and for 28 people with long-standing strokes (ie, strokes of 6 months' duration or older). The FSB Scale consists of 3 components: weight distribution, balance without movement, and balance with movement. Measurements of balance performance were compared with measurements of anteroposterior and lateral sway velocity obtained on a force platform. The weight distribution on 2 digital scales was compared with the lateral symmetry measured on the force platform. RESULTS: The highest correlations were found between the FSB Scale balance measurements and the measurements of anteroposterior sway velocity obtained on the force platform with feet apart and eyes open. The correlations (r) were -.68 and -.67 for the group with recent strokes and -.74 and -.91 for the group with long-standing strokes. The correlations (r) between weight distribution measured on the digital scales and lateral symmetry measured on the force platform were.44 for the group with recent strokes and.52 for the group with long-standing strokes. DISCUSSION AND CONCLUSION: The subjects whose results on the FSB Scale were poor had higher sway velocities on the force platform than the subjects whose results on the FSB Scale were good. The results of this study suggest that the FSB Scale provides the same kind of information as that obtained for sway velocity and lateral symmetry as measured with the use of force platforms in both patients with recent strokes and patients with long-standing strokes.

Discourse analytic study of counseling sessions in stroke physiotherapy.

Studies on the interaction between physiotherapists and patients during treatment sessions have found low levels of communicative participation by patients and lack of direct influence by patients on the content of their treatment. This article reports the results of 7 counseling sessions in which physiotherapists and patients with stroke and their caregivers discussed the patients' postural control and balance, which had been tested and videotaped at different stages of the rehabilitation process. The physiotherapists' discourses relating to the videotaped test performances were either brief comments on the patient's performance or critical appraisals with references to difficulties encountered during performance. Performances of the easier tasks were treated by the physiotherapists with rhetorical questions. The second type of discourse consisted of the physiotherapists directing the patients' attention to their problems, and of the patients' and caregivers' initiatives leading to conversation about the patients' problems. The patients understood the significance of the test performance for their life at home in varying ways. The results of this study showed that successful counseling calls for physiotherapists to develop dialogic communication skills to help patients in coconstructing their home exercise together with their social network.

The reliability, distribution, and responsiveness of the Postural Control and Balance for Stroke Test.

OBJECTIVES: To determine the inter- and intrarater reliability of the Postural Control and Balance for Stroke (PCBS) test and to assess its distribution and responsiveness to changes during 1-year follow-up. DESIGN: Intrarater reliability of the PCBS test was assessed by comparing the repeat ratings of videotaped test performances by each of the 5 raters. Interrater reliability was assessed by comparing the ratings of the videotaped test performances between the raters. SETTING: Hospital neurologic ward and outpatient department of physiotherapy as well as health centers in Finland. PARTICIPANTS: Fifty stroke patients (age range, 42-89 y) were measured 7, 120, and 360 days poststroke for the study of distribution and responsiveness and 19 patients (age range, 55-85 y) were measured during a period between 7 and 60 days poststroke for the reliability study. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The distributions of the scores of the PCBS test, intraclass correlation coefficient (ICC) and weighted kappa values, and Wilcoxon matched-pairs tests. RESULTS: The PCBS test had limited floor and ceiling effects at 7, 120, and 360 days poststroke. The differences between scores 7 and 120 days poststroke were significant (P<.001). The differences between scores 120 and 360 days poststroke were not significant (P>.05). The Cronbach alpha for all the items combined was .96. The ICC values for the interrater and intrarater reliability of the PCBS test were .94 and .96, respectively. CONCLUSIONS: The PCBS test showed an acceptable level of reliability and the responsiveness results indicated a good level before 120 days but not between 120 and 360 days after stroke.