Responsiveness of Section GG Scores in Tracking Post-Stroke Functional Recovery From Inpatient Rehabilitation Admission to 90-Day Follow-Up.

OBJECTIVE: To evaluate the responsiveness and scale-to-sample targeting of Section GG of the Inpatient Rehabilitation Facility-Patient Assessment Instrument in measuring the trajectory of functional recovery in patients with stroke from inpatient rehabilitation admission to 90 days after discharge. DESIGN: Retrospective cohort study. SETTING: 150-bed inpatient rehabilitation facility. PARTICIPANTS: Patients with stroke (N=1087) discharged between December 2019 to April 2021. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Admission and discharge self-care and mobility scores from Section GG were analyzed for the Inpatient Only group (n= 817). Admission, discharge and 90-day post-discharge Section GG scores from telephone interviews with patients or caregivers were analyzed for the Follow-Up group (n=270). Standardized response means (SRM) determined responsiveness of the tool for each group and time interval. Score means, standard deviations, and floor/ceiling effects illustrated scale-to-sample targeting of the tool. RESULTS: Self-care and mobility scores improved significantly from admission to discharge (P<.001) for both groups and from discharge to 90 days (P<.001) for the Follow-Up group. Large SRM existed from admission to discharge for self-care and mobility scores in both groups. ​A small-to-moderate SRM was seen from discharge to 90 days for self-care (0.46) and a moderate SRM was observed for mobility (0.68). Overall floor effects were minor at admission for self-care (9.8%) and mobility (7.2.%). Overall ceiling effects were minor at discharge for self-care (11.2%) and mobility (4.6%)​ and significant at follow-up for both self-care (45.2%) and mobility (32.2%). CONCLUSIONS: Section GG is responsive to change and appropriately measures patients' functional ability during inpatient rehabilitation. More study is required for telephone follow-up after discharge from inpatient rehabilitation.

Clinical practice recommendations for management of lateropulsion after stroke determined by a Delphi expert panel.

OBJECTIVE: People exhibiting post-stroke lateropulsion actively push their body across the midline to the more affected side and/or resist weight shift toward the less affected side. Despite its prevalence and associated negative rehabilitation outcomes, no clinical practice guidelines exist for the rehabilitation of post-stroke lateropulsion. We aimed to develop consensus-based clinical practice recommendations for managing post-stroke lateropulsion using an international expert panel. DESIGN: This Delphi panel process conformed with Guidance on Conducting and Reporting Delphi Studies recommendations. PARTICIPANTS: Panel members had demonstrated clinical and/or scientific background in the rehabilitation of people with post-stroke lateropulsion. MAIN MEASURES: The process consisted of four electronic survey rounds. Round One consisted of 13 open questions. Subsequent rounds ascertained levels of agreement with statements derived from Round One. Consensus was defined a priori as ≥75% agreement (agree or strongly agree), or ≥70% agreement after excluding 'unsure' responses. RESULTS: Twenty participants completed all four rounds. Consensus was achieved regarding a total of 119 recommendations for rehabilitation approaches and considerations for rehabilitation delivery, positioning, managing fear of falling and fatigue, optimal therapy dose, and discharge planning. Statements for which 'some agreement' (50%-74% agreement) was achieved and those for which recommendations remain to be clarified were recorded. CONCLUSIONS: These recommendations build on existing evidence to guide the selection of interventions for post-stroke lateropulsion. Future research is required to elaborate specific rehabilitation strategies, consider the impact of additional cognitive and perceptual impairments, describe positioning options, and detail optimal therapy dose for people with lateropulsion.

Lesion Localization of Poststroke Lateropulsion.

Background and Purpose- Hemispheric stroke studies associating lateropulsion (pusher syndrome) with the location of brain lesions have had mixed results from small, unmatched samples. This study was designed to determine whether lateropulsion localizes to specific brain regions across patients with stroke using a case-control design. Methods- Fifty patients with lateropulsion after stroke were matched with 50 stroke patients without lateropulsion using age, time since onset of stroke, admission motor Functional Independence Measure score, lesion side, and gender. The primary analysis included multivariate lesion symptom mapping using sparse canonical correlations to identify regions most associated with lateropulsion as assessed with the Burke Lateropulsion Scale. Secondary analyses included evaluating paired comparisons for lesion volume, degree of motor impairment, motor and cognitive Functional Independence Measure scores. Results- The lesion symptom mapping analysis of all lesions mapped onto a common hemisphere produced an overall significant model ( P<5×10-5) with a regional peak at the inferior parietal lobe at the junction of the post-central gyrus (Brodmann Area 2) and Brodmann Area 40 as the lesion location most associated with lateropulsion. Lesion volume was larger for patients with lateropulsion. Despite adequate matching, motor performance and total Functional Independence Measure scores differed at a group level between patients with and without lateropulsion. Conclusions- This analysis implicated lesion involvement of the inferior parietal lobe as a key neuroanatomical determinant of developing lateropulsion. A better understanding of the anatomic underpinnings of lateropulsion may improve rehabilitation efforts, including the potential for informing noninvasive neuromodulation approaches.

Sinusoidal Transcranial Direct Current Versus Galvanic Vestibular Stimulation for Treatment of Lateropulsion Poststroke.

OBJECTIVE: To compare the effects of Transcranial Direct Current Stimulation (tDCS) versus Galvanic Vestibular Stimulation (GVS) on Lateropulsion following stroke. METHODS: Patients with Stroke and Burke Lateropulsion Scale (BLS) scores greater than or equal to 2 gave informed consent to receive sinusoidal 1 Hz DC (0-2 mA) anodal stimulation over the affected parietal cortex versus similar GVS with ipsilesional mastoidal anode. Seated haptic center of pressure (COP-X) was measured using an AMTI analog-to-digital forceplate. An inclinometer (Biopac ) measured lateral thoracic tilt. COP-X Power Spectra were analyzed over 3 frequency intervals: 0-.3 Hz, .3-1 Hz, and 1-3 Hz. RESULTS: Six males/4 females age 66 ± 9.5 standard deviation with admission BLS scores of 5.4 ± 3.7 within 8.6 ± 8.1 days poststroke were enrolled. COP-X medial-lateral speed increased for both the tDCS and the GVS protocols compared to sham condition. Fourier Analysis of COP-X velocity for 0-.3 Hz responses showed a significant increase for tDCS stimulation. The .3-1 Hz responses for the tDCS condition were decreased from baseline. Lateral thoracic tilt showed significant improvement for tDCS compared to Sham stimulation at 10 minutes and for GVS versus Sham at 15 minutes. DISCUSSION: Anodal tDCS over the ipsilesional PIVC increases low frequency postural responses usually attributed to visual control with down regulation of median frequency vestibular responses, biasing postural control toward more dependence on visual as opposed to vestibular control. CONCLUSIONS: 2 mA sinusoidal 1 Hz anodal tDCS over the ipsi-lesional PIVC or similar ipsi-lesional anodal GVS improve Lateropulsion following stroke.

Case-Control Study of Impairments Associated with Recovery from "Pusher Syndrome" after Stroke: Logistic Regression Analyses.

BACKGROUND: Comparing cohorts with similar functional and motor status at admission to inpatient rehabilitation may delineate demographics or impairments associated with recovery from lateropulsion, also known as "pusher syndrome," after stroke based on lesion side. The aim of this case-control study was to determine how demographics and severity of stroke impairments at admission to inpatient rehabilitation distinguish patients who recover from lateropulsion from those who do not. METHODS: Patients with admission motor Functional Independence Measure (FIM) scores less than 31 and contralesional lower extremity Fugl-Meyer motor scores less than 19 out of 34 were included. Burke Lateropulsion Scales score of 2 or higher at the time of discharge from inpatient rehabilitation indicated persistent lateropulsion; a score of 0 or 1 indicated resolved lateropulsion. Logistic regression tests included age, gender, admission Motricity Index score, limb placement error, and cognitive FIM score. χ2 analyses compared groups for neglect. RESULTS: For patients with left brain lesion, older age and worse admission motor status distinguished those with persistent lateropulsion at discharge. For right brain lesion, related factors were older age, greater admission limb placement error, and lower cognitive FIM scores. Visuospatial neglect did not influence recovery from lateropulsion. CONCLUSIONS: Older age and severe impairments were associated with delayed recovery from lateropulsion in a manner specific to lesion side in a sample with motor and functional deficits. The study provides evidence that lesion side and admission characteristics are useful in early decision making for the duration of rehabilitation, selection of interventions, and discharge planning.

Randomized controlled trial of the effectiveness of continuous passive motion after total knee replacement.

OBJECTIVE: To determine the effects of using a continuous passive motion (CPM) device for individuals with poor range of motion (ROM) after a total knee replacement (TKR) admitted for postacute rehabilitation. DESIGN: Randomized controlled trial. SETTING: Inpatient rehabilitation facility (IRF). PARTICIPANTS: Adults (N=141) after TKR with initial active knee flexion <75° on admission to the IRF. INTERVENTION: Two randomized groups: group 1 (n=71) received the conventional 3 hours of therapy per day, and group 2 (n=70) received the addition of daily CPM use for 2 hours throughout their length of stay. MAIN OUTCOME MEASURES: The primary outcome measure was active knee flexion ROM. Secondary outcome measures included active knee extension ROM length of stay, estimate of function using the FIM and Timed Up and Go test, girth measurement, and self-reported Western Ontario and McMaster Universities Osteoarthritis Index scores. RESULTS: All subjects significantly improved from admission to discharge in all outcome measures. However, there were no statistically significant differences in any of the discharge outcome measures of the CPM group compared with the non-CPM group. CONCLUSIONS: CPM does not provide an additional benefit over the conventional interventions used in an IRF for patient after TKR, specifically in patients with poor initial knee flexion ROM after surgery.

Prediction of Discharge Destination After Inpatient Rehabilitation for Stroke Using Mobility and Self-Care Assessment in Section GG of the Inpatient Rehabilitation Facility - Patient Assessment Instrument.

Objective: To determine the ability of Section GG of the Inpatient Rehabilitation Facility - Patient Assessment Inventory (Section GG)'s quantification of mobility and self-care to predict discharge destination for persons with stroke after inpatient rehabilitation. Design: Retrospective, observational cohort study. Setting: 150-bed inpatient rehabilitation facility within a metropolitan health system. Participants: Consecutive sample of adults and older adults with stroke admitted for inpatient rehabilitation from January 2020 to June 2021 (N=1051). Subjects were excluded for discharge to acute care or hospice or if they had COVID-19. Intervention: None. Main Outcome Measures: Section GG self-care and mobility scores used in reimbursement formulation by Centers for Medicare and Medicaid at admission to inpatient rehabilitation; age; sex; prior living situation; discharge setting. Logistic regression examined binary comparisons of discharge destinations. Receiver operating characteristic (ROC) curves determined cut-off admission Section GG scores for binary comparisons. Results: Logistic regression demonstrated that presence of a caregiver in the home was consistently the strongest predictor (P<.001) and admission Section GG scores were significant secondary factors in determining the discharge destination. An admission Section GG cut-off score of 33.5 determined home with homecare vs skilled nursing facility and a cut-off of 36.5 determined discharge to home with outpatient care vs skilled nursing facility. Conclusion: Clinicians responsible for discharge decisions for patients with stroke after inpatient rehabilitation might start by determining the presence of a caregiver in the home and then use Section GG cut-off scores to guide decisions about home (with or without homecare) vs SNF destinations. Such guidance is not advised for the home with outpatient services vs home with homecare decision; clinical judgment is needed to determine the best discharge plan because this ROC had a less robust area under the curve. Sex and race/ethnicity were not determining factors for binary choices of discharge destinations.

Electromyographic Analyses of Trunk Musculature after Stroke: An Integrative Review.

BACKGROUND: Observational and intervention studies examining trunk electromyographic (EMG) activity following stroke are underpowered and fail criteria for systematic reviews of randomized control trials. Objective: To systematically evaluate and summarize evidence about trunk muscle activation after stroke during ADL and with diagnostic and therapeutic interventions. METHODS: Search databases were Medline Complete, CINAHL and Health Sources: Nursing Academic Edition. Studies written in English after 1989 included these search terms: stroke, muscle activity, and trunk including abdominal or back muscles. Systematic reviews, single case studies, dissertations, or letters to the editor were excluded. Reviewers used Covidence to screen relevant research and extract information after title, abstract, and full-text screening. Information extracted related to stroke severity, time since onset, specific muscles and EMG analysis technique, and study limitations. Articles were classified as observational, intervention or device-related. RESULTS: The electronic search yielded 188 articles and a hand search found 3. Title and abstract screening yielded 102 articles for full text screening. Ultimately, 45 articles were extracted. Trunk muscle recruitment during function and movement demonstrated significant differences in trunk EMG recruitment timing, magnitude, and symmetry after stroke when compared with healthy participants. Individuals with stroke demonstrated significant differences when comparing paretic to non-paretic side trunk EMG measures. Intervention studies showed some effect on improving trunk muscle activation but they had small sample sizes and methodological issues. CONCLUSIONS: Trunk muscle activation after stroke can be monitored with EMG during rehabilitation programs which challenge functional recovery.

Activity Measure for Post-Acute Care "6-Clicks" Basic Mobility Scores Predict Discharge Destination After Acute Care Hospitalization in Select Patient Groups: A Retrospective, Observational Study.

Objectives: To establish cutoff scores for the Activity Measure for Post-Acute Care "6-Clicks" standardized Basic Mobility scores (sBMSs) for predicting discharge destination after acute care hospitalization for diagnostic subgroups within an acute care population and to evaluate the need for a second score to improve predictive ability. Design: Retrospective, observational design. Setting: Major medical center in metropolitan area. Participants: Electronic medical records of 1696 adult patients (>18 years) admitted to acute care from January to October 2018. Records were stratified by orthopedic, cardiac, pulmonary, stroke, and other neurological diagnoses (N=1696). Interventions: None. Main Outcome Measure: Physical therapists scored patients' sBMSs after referral for physical therapy and prior to discharge. Receiver operating characteristic curves delineated sBMS cutoff scores distinguishing various pairings of home, home with services, inpatient rehabilitation, or skilled nursing facility discharges. First and second sBMSs were compared with percentage change of the area under the curve and inferential statistics. Results: Home vs institution cutoff score was 42.88 for combined sample, pulmonary and neurological cases. The cutoff score for orthopedic diagnoses score was 41.46. Cardiac and stroke model quality invalidated cutoff scores. Home without services vs skilled nursing discharges and home with services vs skilled nursing discharges were predicted with varying cutoff scores per diagnosis. sBMS cutoff scores collected closer to discharge were either the same or higher than first cutoffs, with varying effects on predictive ability. Conclusions: sBMSs can help decide institution vs home discharge and finer distinctions among discharge settings for some diagnostic groups. A single sBMS may provide sufficient assistance with discharge destination decisions but timing of scoring and diagnostic group may influence cutoff score selection.

Post-stroke lateropulsion terminology: pushing for agreement amongst experts.

Post-stroke lateropulsion is prevalent. The global inconsistency in terminology used to describe the condition presents obstacles in accurately comparing research results, reaching consensus on use of measurement tools, agreeing upon a consistent approach to rehabilitation, and translating research to clinical practice. Commencing in 2021, 20 international experts undertook a Delphi Process that aimed to compile clinical practice recommendations for the rehabilitation of lateropulsion. As a part of the process, the panel agreed to aim to reach consensus regarding terminology used to describe the condition. Improved understanding of the condition could lead to improved management, which will enhance patient outcomes after stroke and increase efficiency of healthcare resource utilisation. While consensus was not reached, the panel achieved some agreement that 'lateropulsion' is the preferred term to describe the phenomenon of 'active pushing of the body across the midline toward the more affected side, and / or actively resisting weight shift toward the less affected side'. This group recommends that 'lateropulsion' is used in future research and in clinical practice.

The effect of fatigue on balance performance in Parkinson's disease.

INTRODUCTION: Balance loss and falls are a common and multifactorial finding in persons with Parkinson's Disease (pwPD). Objective fatigability is thought to contribute to falls in other neurologic conditions, but its impact on balance in pwPD is not known. The two-fold purpose of this study was to: 1) establish that a 6-minute walk (6MWFast) is a stimulus to subjective fatigue for pwPD; and, 2) determine if the Mini Balance Evaluation Systems Test (MBT) is sensitive to change that was induced by a fatiguing condition. METHODS: Using a randomized crossover design, 19 research participants performed a Mini Balance Evaluation Systems Test (MBT) before and after either a 'fast' 6-minute walk (6MWFast) to induce fatigue or a 6-minute rest. RESULTS: VASF scores increased after the 6MWFast. Total MBT scores in research participants with Modified Hoehn and Yahr (H&Y) scores of 3.0 and above differed significantly before and after the 'fast' 6-minute walk (p = .007, n = 9) while participants with H&Y scores of 1.5 to 2.5 (p = .084, n = 10) did not, suggesting that more disabled pwPD were more likely to experience fatigability that interfered with balance. CONCLUSIONS: A 6MWFast is a sufficient stimulus to induce subjective fatigue in pwPD and to decrease total MBT scores for more disabled pwPD. Balance evaluations should occur when pwPD are in fatigued and unfatigued states to determine whether fatigue has an impact on balance performance.

A preliminary study of the influence of sagittal plane neck alignment on mylohyoid activity during oropharyngeal swallowing: A surface electromyographic analysis.

OBJECTIVE: Forward head posture lengthens mylohyoid muscles, but its impact on swallowing is unknown. This study determined the effect of sagittal plane neck alignment on surface electromyographic parameters from mylohyoid muscles during oropharyngeal swallowing in healthy, young women. METHODS: Surface EMG over bilateral mylohyoid muscles was recorded in 10 female subjects (22-37 y, Mean = 30 (5.1)) for average peak amplitude (µV). Percent time to peak activity and duration [s] were recorded in three different sitting postures: habitual posture (HP), exaggerated forward head posture (FHP), and optimal posture (OP) with head positioned in alignment with the spine. RESULTS: Paired t-tests revealed that HP produced lower mylohyoid average peak amplitude than the FHP or OP. OP had greater average percent time to peak mylohyoid activity than HP. DISCUSSION: HP yielded the most efficient mylohyoid activity. Muscle activation during swallowing should be addressed when training young women about OP.

Clinical examination tools for lateropulsion or pusher syndrome following stroke: a systematic review of the literature.

OBJECTIVE: To examine the clinimetric properties and clinical applicability of published tools for 'quantifying' the degree of lateropulsion or pusher syndrome following stroke. DATA SOURCES: Search through electronic databases (MEDLINE, EMBASE, CINAHL, Science Citation Index) with the terms lateropulsion, pushing, pusher syndrome, validity, reliability, internal consistency, responsiveness, sensitivity, specificity, posture and stroke. Databases were searched from their inception to October 2008. REVIEW METHODS: Abstracts were selected by one author. A panel of experts then determined which should be included in this review. Five abstracts were reviewed and the panel agreed to omit one abstract because those authors did not write a full manuscript. The panel critiqued manuscripts according to predetermined criteria about clinical and clinimetric properties. RESULTS: Four manuscripts referencing three tools for examining lateropulsion were found. Validity and reliability data support the clinical use of the Scale for Contraversive Pushing, the Modified Scale for Contraversive Pushing and the Burke Lateropulsion Scale. The Scale for Contraversive Pushing has the most extensive testing of clinimetric properties. The other tools show promising preliminary evidence of clinical and research utility. More testing is needed with larger, more diverse samples. REVIEWERS' CONCLUSIONS: The Scale for Contraversive Pushing, the Modified Scale for Contraversive Pushing and the Burke Lateropulsion Scale are reliable and valid measures with good clinical applicability. Larger, more varied samples should be used to better delineate responsiveness and other clinimetric properties of these examination tools.

Outcomes with stroke and lateropulsion: a case-matched controlled study.

BACKGROUND AND OBJECTIVE: Lateropulsion after stroke has not been tracked using a case-matched controlled study and a standardized lateropulsion scale. Matched pairs of patients with stroke, with and without lateropulsion, were compared for functional outcomes and discharge destination following inpatient rehabilitation. METHODS: A retrospective chart review of patients with ischemic stroke at an inpatient rehabilitation hospital matched 36 pairs of patients with versus without lateropulsion. Scores of 2 or greater on the Burke Lateropulsion Scale identified lateropulsion. Matching criteria were side of stroke, sex, age, admission motor Functional Independence Measure (FIM), and interval poststroke. FIM efficiency (change in total FIM/length of stay) and discharge destination were analyzed with Wilcoxon signed-ranks tests. RESULTS: FIM efficiency and discharge FIM scores were lower in the lateropulsion group. Groups had similar mean lengths of stay. Post-hoc analyses showed that only patients with lateropulsion and right brain damage had significantly different FIM efficiency and discharge FIM scores. Lower extremity weakness was greater in the lateropulsion group at discharge; patients with right brain damage accounted for this difference. Patients with lateropulsion required more dependent living situations at discharge, especially if they had right brain damage. CONCLUSIONS: Patients with lateropulsion following stroke have a lower FIM efficiency and more dependency at discharge when compared with matched controls with equal functional limitations. Secondary analyses show worse outcomes for the subgroup of patients with right hemisphere stroke; lateropulsion and greater leg weakness may account for differences. Patients with lateropulsion may require longer rehabilitation to reach outcome goals.

Increases in fatigue do not change spasticity scores in persons with multiple sclerosis.

AIM: Fatigue is a common finding in multiple sclerosis (MS) which may result in worsening of gait, function and other MS symptoms, like spasticity. Although the worsening of spasticity with fatigue has been reported by persons with MS, the effect of fatigue on spasticity has not been measured. PURPOSE: The purpose of this study was to compare lower extremity Modified Ashworth Scale (MAS) scores of persons with mild-to-moderate MS symptoms before and after fatigued and unfatigued conditions. METHODS: Using a randomized crossover design, MS subjects underwent 6-min walk to induce fatigue and 6-min supine rests, with lower extremity spasticity measured before and after each condition. Friedman tests gave paired comparisons of MAS before and after each condition. RESULTS: 16 subjects with mild-to-moderate MS completed the study (mean age = 56; standard deviation = 11.7). Friedman tests showed a significant decrease in mean rank for overall average MAS for both lower extremities (p = 0.031) when comparing fatigued to unfatigued conditions. This appeared to be driven by the right lower extremity average MAS (p = 0.002) and, more specifically, in post hoc pre to post-test comparisons for right knee flexor (p = 0.002 fatigued; p = 0.059 unfatigued) and right knee extensor (p = 0.001 fatigued; p = 0.020 unfatigued) MAS mean rank differences. Fatigue did not result in increased spasticity. CONCLUSION: Spasticity in these subjects with MS was not worsened by fatigue suggesting that worsening of gait with fatigue may be due to causes other than spasticity.

Surface electromyography of lumbar paraspinal muscles during seated passive tilting of patients with lateropulsion following stroke.

BACKGROUND: Patients with lateropulsion (pushing) following stroke push toward the contralesional side. Their response to a passive tilt while seated has not been studied with surface electromyography (sEMG) of lumbar paraspinal muscles. OBJECTIVE: To compare onset, response duration, and trends in lumbar paraspinal muscle activity among patients with stroke, patients with stroke and lateropulsion, and healthy controls during seated passive tilting. METHOD: Seated subjects were passively tilted in the frontal plane at slow and fast speeds. Bilateral sEMG electrodes at the level of lumbar vertebrae 3 recorded paraspinal muscle activity. Surface EMG onset, response duration, and type of muscle activity were compared for 15 patients with stroke and lateropulsion, 12 patients with uncomplicated stroke, and 16 healthy, aged controls. Correlations were assessed between the Burke Lateropulsion Scale (BLS) and both sEMG onset and sEMG response duration. RESULTS: Onset of muscle activity was similar in all groups. Patients with lateropulsion showed decreased sEMG response duration in weak-sided paraspinal muscle activity during slow, passive tilting to the strong side. They had more variable muscle activity during fast, passive tilting to the weak side than controls. BLS scores did not correlate with dependent variables. CONCLUSIONS: Patients with lateropulsion activated paraspinal muscles with similar onset time as controls during seated passive tilting. Lateropulsion influences weak-sided paraspinal response duration during passive tilting. Graviceptive neglect may explain some of this difficulty with sustaining contractions, but weakness may also be a contributing factor.

Polarity-Dependent Misperception of Subjective Visual Vertical during and after Transcranial Direct Current Stimulation (tDCS).

Pathologic tilt of subjective visual vertical (SVV) frequently has adverse functional consequences for patients with stroke and vestibular disorders. Repetitive transcranial magnetic stimulation (rTMS) of the supramarginal gyrus can produce a transitory tilt on SVV in healthy subjects. However, the effect of transcranial direct current stimulation (tDCS) on SVV has never been systematically studied. We investigated whether bilateral tDCS over the temporal-parietal region could result in both online and offline SVV misperception in healthy subjects. In a randomized, sham-controlled, single-blind crossover pilot study, thirteen healthy subjects performed tests of SVV before, during and after the tDCS applied over the temporal-parietal region in three conditions used on different days: right anode/left cathode; right cathode/left anode; and sham. Subjects were blind to the tDCS conditions. Montage-specific current flow patterns were investigated using computational models. SVV was significantly displaced towards the anode during both active stimulation conditions when compared to sham condition. Immediately after both active conditions, there were rebound effects. Longer lasting after-effects towards the anode occurred only in the right cathode/left anode condition. Current flow models predicted the stimulation of temporal-parietal regions under the electrodes and deep clusters in the posterior limb of the internal capsule. The present findings indicate that tDCS over the temporal-parietal region can significantly alter human SVV perception. This tDCS approach may be a potential clinical tool for the treatment of SVV misperception in neurological patients.

Time to recovery from lateropulsion dependent on key stroke deficits: a retrospective analysis.

BACKGROUND: Lateropulsion, a postural control disorder, delays recovery following hemispheric stroke. The number of stroke impairments may lead to differential recovery rates, depending on the intact systems available for recovery from lateropulsion. OBJECTIVE: To study the impact of key postural control deficits on lateropulsion rate of recovery following stroke. METHODS: Through retrospective analysis: 169 patients with hemispheric stroke in an in-patient rehabilitation facility were divided into 3 groups: (1) motor deficits only; (2) motor and hemianopic or visual-spatial deficits or motor and proprioceptive deficits; and (3) motor, proprioceptive, and hemianopic or visual-spatial deficits. Kaplan-Meier survival analysis determined if time to recovery from lateropulsion (achieving a score of 0 or 1 on the Burke Lateropulsion Scale) differed by group. RESULTS: Log rank tests showed that time to recovery from lateropulsion differed based on the number of deficits (group, P = .012). Post hoc analyses by lesion side showed that group differences only occurred in right brain lesion (P < .05) as compared with left brain lesions (P = .34). Patients recovered from lateropulsion during in-patient rehabilitation if they had only motor deficits; those with all 3 postural control deficits showed the most protracted recovery. CONCLUSIONS: Rate of recovery from lateropulsion after stroke is dependent on the side of lesion, and number of key motor, proprioceptive, and/or hemianopic or visual-spatial deficits. The more postural control systems affected, the slower the recovery. Our data identify patients likely to need protracted rehabilitation targeting key postural control deficits.

Physical therapy students' self-reports of development of clinical reasoning: a preliminary study.

Reports of student perceptions about the efficacy of educational tools used by academic and clinical instructors to facilitate clinical reasoning are limited. Physical therapist students' (PTSs') perceptions of tools for developing clinical reasoning and problem-solving skills were surveyed to determine the effectiveness of various teaching methods and to identify factors associated with clinical reasoning development. The purposes of this descriptive investigation were to determine (1) if factors, such as learning mode, life experience, and curriculum, influence PTS' perception of their clinical reasoning mastery; (2) the relative roles of academic and clinical instructors and the value of their pedagogic tools in assisting PTS with clinical reasoning development; and (3) how PTS rate their degree of mastery of clinical reasoning as they progress through training. A survey was mailed to 17 physical therapy schools in New York and 2 in New Jersey; 156 PTS near graduation responded, yielding a 22% response rate. The survey instrument had 6 open-ended and 19 multiple-choice questions. Frequency analysis showed (1) PTS' opinion about how they would teach clinical reasoning varied with their preferred learning mode, (2) prior life experiences were associated with clinical reasoning for some individuals, (3) academic and clinical instructors contribute to development of clinical reasoning, (4) the best pedagogic tools involved case study presentations/ assignments using actual patients or videotapes, and (5) PTS gained confidence in their clinical reasoning ability while progressing through clinical education experiences. Results support inclusion of diverse pedagogic tools, such as case studies, and emphasizing a variety of learning modes to facilitate PTS' development of clinical reasoning.