The Hospital Anxiety and Depression Scale: a pilot study to examine its latent structure and the link between psychological state and symptom severity in transient ischaemic attack patients.

Transient ischaemic attack (TIA) is often associated with anxiety and depression, which may precipitate secondary stroke and interfere with treatment. The Hospital Anxiety and Depression Scale (HADS) is widely used to assess these states and to inform the management of any associated psychological problems, but there is considerable debate about what it actually measures. The HADS scores from a range of different clinical groups have been reviewed in order to assess its psychometric properties, but so far, no research has examined either its latent structure when used with TIA patients, or the association between symptom severity and the test's validity. The aims of this study, therefore, were to investigate: (a) the underlying structure of the HADS when used with TIA patients; and (b) the impact of symptom severity on the validity of the HADS. The HADS and a functional capacity measure were administered by post to a sample of 542 confirmed TIA patients. Exploratory factor analysis was conducted on the HADS scores to establish its underlying structure for this clinical group, and then, sub-sample correlations were undertaken between the anxiety/depression scores for different levels of functional capacity. Two factors emerged, with 13 of the 14 HADS items loading significantly on both, suggesting there is a common affective state underlying the standard anxiety and depression scales. Further data-exploration indicated that convergence between these affective states increased as functional capacity deteriorated. The results suggest firstly that the HADS measures general subjective distress when used with TIA patients, and secondly that the higher reported symptom severity in this clinical group may be associated with reduced affective differentiation. As the ability to retain clear affective discrimination is associated with health and well-being, this could provide a focus for post-TIA rehabilitation.

Effectiveness of physiotherapy exercise following total knee replacement: systematic review and meta-analysis.

BACKGROUND: Rehabilitation, with an emphasis on physiotherapy and exercise, is widely promoted after total knee replacement. However, provision of services varies in content and duration. The aim of this study is to update the review of Minns Lowe and colleagues 2007 using systematic review and meta-analysis to evaluate the effectiveness of post-discharge physiotherapy exercise in patients with primary total knee replacement. METHODS: We searched MEDLINE, Embase, PsycInfo, CINAHL and Cochrane CENTRAL to October 4(th) 2013 for randomised evaluations of physiotherapy exercise in adults with recent primary knee replacement. Outcomes were: patient-reported pain and function, knee range of motion, and functional performance. Authors were contacted for missing data and outcomes. Risk of bias and heterogeneity were assessed. Data was combined using random effects meta-analysis and reported as standardised mean differences (SMD) or mean differences (MD). RESULTS: Searches identified 18 randomised trials including 1,739 patients with total knee replacement. Interventions compared: physiotherapy exercise and no provision; home and outpatient provision; pool and gym-based provision; walking skills and more general physiotherapy; and general physiotherapy exercise with and without additional balance exercises or ergometer cycling. Compared with controls receiving minimal physiotherapy, patients receiving physiotherapy exercise had improved physical function at 3-4 months, SMD -0.37 (95% CI -0.62, -0.12), and pain, SMD -0.45 (95% CI -0.85, -0.06). Benefit up to 6 months was apparent when considering only higher quality studies. There were no differences for outpatient physiotherapy exercise compared with home-based provision in physical function or pain outcomes. There was a short-term benefit favouring home-based physiotherapy exercise for range of motion flexion. There were no differences in outcomes when the comparator was hydrotherapy, or when additional balancing or cycling components were included. In one study, a walking skills intervention was associated with a long-term improvement in walking performance. However, for all these evaluations studies were under-powered individually and in combination. CONCLUSION: After recent primary total knee replacement, interventions including physiotherapy and exercise show short-term improvements in physical function. However this conclusion is based on meta-analysis of a few small studies and no long-term benefits of physiotherapy exercise interventions were identified. Future research should target improvements to long-term function, pain and performance outcomes in appropriately powered trials.

Recovery of function following hip resurfacing arthroplasty: a randomized controlled trial comparing an accelerated versus standard physiotherapy rehabilitation programme.

OBJECTIVE: To identify if a tailored rehabilitation programme is more effective than standard practice at improving function in patients undergoing metal-on-metal hip resurfacing arthroplasty. DESIGN: Randomized controlled trial. SETTING: Specialist orthopaedic hospital. SUBJECTS: 80 men with a median age of 56 years. INTERVENTIONS: Tailored post-operative physiotherapy programme compared with standard physiotherapy. MAIN OUTCOMES: Primary outcome - Oxford Hip Score (OHS), Secondary outcomes: Hip disability and Osteoarthritis Outcome Score (HOOS), EuroQol (EQ-5D-3L) and UCLA activity score. Hip range of motion, hip muscle strength and patient selected goals were also assessed. RESULTS: At one year the mean (SD) Oxford Hip Score of the intervention group was higher, 45.1 (5.3), than the control group, 39.6 (8.8). This was supported by a linear regression model, which detected a 5.8 unit change in Oxford Hip Score (p < 0.001), effect size 0.76. There was a statistically significant increase in Hip disability and Osteoarthritis Outcome Score of 12.4% (p < 0.0005), effect size 0.76; UCLA activity score differed by 0.66 points (p < 0.019), effect size 0.43; EQ 5D showed an improvement of 0.85 (p < 0.0005), effect size 0.76. A total of 80% (32 of 40) of the intervention group fully met their self-selected goal compared with 55% (22 of 40) of the control group. Hip range of motion increased significantly; hip flexion by a mean difference 17.9 degrees (p < 0.0005), hip extension by 5.7 degrees (p < 0.004) and abduction by 4 degrees (p < 0.05). Muscle strength improved more in the intervention group but was not statistically significant. CONCLUSIONS: A tailored physiotherapy programme improved self-reported functional outcomes and hip range of motion in patients undergoing hip resurfacing.

Barriers and facilitators in providing home-based rehabilitation for stroke survivors with severe disability in the UK: an online focus group study with multidisciplinary rehabilitation teams.

OBJECTIVES: In the UK, over 20% of stroke survivors leave hospital with severe disability. Limited evidence-based clinical guidance is available to support the rehabilitation of these individuals. Our previous research has focused on establishing consensus regarding the core components of home-based rehabilitation for this under investigated group. This study explores the barriers of providing rehabilitation and identifies strategies to overcome them. DESIGN: Three focus group interviews were conducted with n=20. The context coding framework was employed to organise the transcribed data and to facilitate inductive and deductive analysis and synthesis. SETTING: Online, MSTeams, UK. PARTICIPANTS: A purposive sample of 20 National Health Service clinical staff participants, from 3 multidisciplinary teams providing home-based stroke rehabilitation for this population (n=7, 6 and 7). RESULTS: High levels of need were reported across multiple domains for survivors including continence, communication and physical function. Interventions often required multiagency collaboration in order to optimise the available resources and specialist skills. There was lack of clarity regarding who was ultimately responsible for providing components of rehabilitation for stroke survivors with severe disability. Teams provide rehabilitation for this population but are insufficiently commissioned or resourced to fully meet their needs. In-complete and disjointed pathways with resultant healthcare inequalities were commonly reported. Teams used a variety of strategies to overcome these barriers and optimise rehabilitation opportunities. These included upskilling a diverse range of partners to capitalise on the skills and resources across health, social care and voluntary sector boundaries employing multiagency collaboration. Teams established and engaged networks of stakeholders in order to advocate on behalf of stroke survivors. CONCLUSIONS: Collaboration and partnership working is important in the delivery of rehabilitation for stroke survivors with severe disability. Commissioners need to be aware that cross-agency multidisciplinary expertise is required, if rehabilitation opportunities are to be realised and existing health inequalities addressed.

Weekly exercise does not improve fatigue levels in Parkinson's disease.

BACKGROUND: Fatigue is one of the most disabling non-motor symptoms for people with Parkinson's disease. Exercise may modify fatigue. This study examines prescribed exercise effects on physical activity levels, well-being, and fatigue in Parkinson's disease. METHODS: In this single-blinded trial, participants were randomly assigned to either a 12 week community exercise program or control group. Primary outcome measures were fatigue (Fatigue Severity Scale) and physical activity. RESULTS: Thirty-nine people with Parkinson's disease were included: 20 in exercise and 19 in control. Sixty-five percent of the study group were fatigued (n = 24, mean 4.02, SD 1.48). Increased fatigue was associated with lower mobility and activity (P < .05). Individuals participated in a mean of 15 (SD 10) exercise sessions with no significant change in fatigue, mobility, well-being, or physical activity after exercise (P ≥ .05). CONCLUSION: Participation in weekly exercise did not improve fatigue in people with Parkinson's Disease.

A cluster randomised controlled trial of an occupational therapy intervention for residents with stroke living in UK care homes (OTCH): study protocol.

BACKGROUND: The occupational therapy (OT) in care homes study (OTCH) aims to investigate the effect of a targeted course of individual OT (with task training, provision of adaptive equipment, minor environmental adaptations and staff education) for stroke survivors living in care homes, compared to usual care. METHODS/DESIGN: A cluster randomised controlled trial of United Kingdom (UK) care homes (n = 90) with residents (n = 900) who have suffered a stroke or transient ischaemic attack (TIA), and who are not receiving end-of-life care. Homes will be stratified by centre and by type of care provided and randomised (50:50) using computer generated blocked randomisation within strata to receive either the OT intervention (3 months intervention from an occupational therapist) or control (usual care). Staff training on facilitating independence and mobility and the use of adaptive equipment, will be delivered to every home, with control homes receiving this after the 12 month follow-up.Allocation will be concealed from the independent assessors, but the treating therapists, and residents will not be masked to the intervention. Measurements are taken at baseline prior to randomisation and at 3, 6 and 12 months post randomisation. The primary outcome measure is independence in self-care activities of daily living (Barthel Activities of Daily Living Index). Secondary outcome measures are mobility (Rivermead Mobility Index), mood (Geriatric Depression Scale), preference based quality of life measured from EQ-5D and costs associated with each intervention group. Quality adjusted life years (QALYs) will be derived based on the EQ-5D scores. Cost effectiveness analysis will be estimated and measured by incremental cost effectiveness ratio. Adverse events will be recorded. DISCUSSION: This study will be the largest cluster randomised controlled trial of OT in care homes to date and will clarify the currently inconclusive literature on the efficacy of OT for stroke and TIA survivors residing in care homes. TRIAL REGISTRATION: ISRCTN00757750.

Exercise for multiple sclerosis: a single-blind randomized trial comparing three exercise intensities.

BACKGROUND: The most effective exercise dose has yet to be established for multiple sclerosis (MS). OBJECTIVE: The aim of this study was to investigate the effect of different exercise intensities in people with MS. METHODS: We completed a randomized comparator study of three cycling exercise intensities, with blinded assessment, was carried out in Oxford. Sixty-one adults with MS who fulfilled inclusion criteria were randomized at entry into the study, using a computer-generated list held by an exercise professional, into either: continuous (at 45% peak power, n=20), intermittent (30 sec on, 30 sec off at 90% peak power, n=21) or combined (10 min intermittent at 90% peak power then 10 min continuous at 45% peak power, n=20) exercise for 20 min twice a week for 12 weeks in a leisure facility. Groups were assessed at: baseline, halfway (6 weeks), end intervention (12 weeks) and follow-up (24 weeks). Primary outcome measure was 2 min walk. RESULTS: Fifty-five participants were included in the analysis (n=continuous 20, intermittent 18, combined 17). No differences were found between groups. After 6 weeks, considering all participants, 2 min walk distance increased by 6.96±2.56 m (95% CI: 1.81 to 12.10, effect size (es): 0.25, p<0.01). The continuous group increased by 4.71±4.24 m (95% CI: -3.80 to 13.22, es: 0.06), intermittent by 12.94±4.71 m (95% CI: 3.97 to 21.92, es: 0.28) and combined by 3.22±4.60 m (95% CI: -6.01 to 12.46, es: 0.04). Two minute walk did not significantly change between further assessments. Between 6 and 12 weeks there was a drop in attendance that seemed to be associated with the intermittent and combined groups; these groups also had a greater number of adverse events (leg pain during cycling most common) and dropouts (n=continuous 1, intermittent 5, combined 10). Considering all participants, 6 weeks of cycling exercise produced benefits in mobility that were maintained with further sessions. CONCLUSION: While no differences were found between groups, greater benefit may be associated with higher-intensity exercise, but this may be less well tolerated. CONSORT-trial registration number (ISRCTN89009719).

A systematic review of the incidence and prevalence of long-term neurological conditions in the UK.

BACKGROUND: Updated, robust estimates of the incidence and prevalence of rare long-term neurological conditions in the UK are not available. Global estimates may be misrepresentative as disease aetiology may vary by location. OBJECTIVES: To systematically review the incidence and prevalence of long-term neurological conditions in the UK since 1988. SEARCH STRATEGY: Medline (January 1988 to January 2009), Embase (January 1988 to January 2009), CINAHL (January 1988 to January 2009) and Cochrane CENTRAL databases. SELECTION CRITERIA: UK population-based incidence/prevalence studies of long-term neurological conditions since 1988. Exclusion criteria included inappropriate diagnoses and incomprehensive case ascertainment. DATA COLLECTION AND ANALYSIS: Articles were included based on the selection criteria. Data were extracted from articles with ranges of incidence and prevalence reported. MAIN RESULTS: Eight studies met the criteria (3 on motor neurone disease; 4 on Huntington's disease; 1 on progressive supranuclear palsy). The incidence of motor neurone disease ranged from 1.06 to 2.4/100,000 person-years. The prevalence ranged from 4.02 to 4.91/100,000. The prevalence of Huntington's disease ranged from 4.0 to 9.94/100,000. The prevalence of progressive supranuclear palsy ranged from 3.1 to 6.5/100,000. CONCLUSIONS: The review updates the incidence/prevalence of long-term neurological conditions. Future epidemiological studies must incorporate comprehensive case ascertainment methods and strict diagnostic criteria.

Supported community exercise in people with long-term neurological conditions: a phase II randomized controlled trial.

OBJECTIVE: Adults with long-term neurological conditions have low levels of participation in physical activities and report many barriers to participation in exercise. This study examines the feasibility and safety of supporting community exercise for people with long-term neurological conditions using a physical activity support system. DESIGN: A phase II randomized controlled trial using computer-generated block randomization, allocation concealment and single blind outcome assessment. SETTING: Oxfordshire and Birmingham community Inclusive Fitness Initiative gyms. SUBJECTS: Patients with a long-term neurological condition. INTERVENTIONS: The intervention group (n = 51) received a 12-week, supported exercise programme. The control group (n = 48) participants received standard care for 12 weeks and were then offered the intervention. MAIN MEASURES: Physical activity, adherence to exercise, measures of mobility, health and well-being. RESULTS: Forty-eight patients (n = 51) completed the intervention, achieving 14 gym attendances (range 0-39) over the 12 weeks. Overall activity did not increase as measured by the Physical Activity Scale for the Elderly (change score mean 14.31; 95% confidence interval (CI) −8.27 to 36.89) and there were no statistically significant changes in body function and health and well-being measures. CONCLUSIONS: People with long-term neurological conditions can safely exercise in community gyms when supported and achieve similar attendance to standard exercise referral schemes, but may reduce other life activities in order to participate at a gym.

Nominal group technique to establish the core components of home-based rehabilitation for survivors of stroke with severe disability.

In the UK, over 20% of patients leaving hospital after a stroke will be severely disabled. Despite this, limited clinical guidance is available to teams tasked with providing support for this complex population at home. Additionally, many areas across the UK are not commissioned to treat this patient cohort, leaving them with no specialist support on discharge. OBJECTIVES: To establish core components of home-based rehabilitation for survivors of stroke with severe disability, based on expert panel consensus. SETTING: Virtual nominal group technique (vNGT) across the UK. PARTICIPANTS: Experts in the field of stroke rehabilitation (n=14) including researchers, clinicians and those with lived experience. METHODS: Two vNGT were completed using a freely available online platform, Microsoft Teams. The technique's five stages were completed virtually; introduction, silent idea generation, round robin, clarifications and scoring. Statements were analysed for consensus, those achieving consensus underwent content analysis to form rich overarching consensus statements. RESULTS: A combined total of 421 statements achieved positive consensus (>75% in agreement), which formed 11 overarching consensus statements. These outline key components of home-based rehabilitation for survivors of stroke with severe disability including the structure and members of the team, as well as the skills and knowledge required. CONCLUSION: The consensus statements highlight the complexity of managing patients with severe stroke disability following discharge from hospital. This study has the potential to support the provision of services for this patient group, providing a benchmark for commissioners and clinicians as well as setting expectations for stroke survivors and their carers. What remains unknown is how many services currently offer this service to patients with severe disability.

Lee Silverman Voice Treatment versus standard speech and language therapy versus control in Parkinson's disease: preliminary cost-consequence analysis of the PD COMM pilot randomised controlled trial.

BACKGROUND: The PD COMM pilot randomised controlled trial compared Lee Silverman Voice Treatment (LSVT® LOUD) with standard NHS speech and language therapy (SLT) and a control arm in people with Parkinson's disease (PwPD) with self-reported problems with voice or speech. This analysis compares costs and quality of life outcomes between the trial arms, and considers the validity of the alternative outcome measures for economic evaluations. METHODS: A comparison of costs and outcomes was undertaken alongside the PD COMM pilot trial involving three arms: LSVT® LOUD treatment (n = 30); standard NHS SLT (n = 30); and a control arm (n = 29) excluded from receiving therapy for at least 6 months after randomisation unless deemed medically necessary. For all trial arms, resource use and NHS, social care and patient costs and quality of life were collected prospectively at baseline, 3, 6, and 12 months. Total economic costs and outcomes (EQ-5D-3L, ICECAP-O) were considered over the 12-month follow-up period from an NHS payer perspective. Quality of life measures for economic evaluation of SLT for people with Parkinson's disease were compared. RESULTS: Whilst there was no difference between arms in voice or quality of life outcomes at 12 months, there were indications of differences at 3 months in favour of SLT, which need to be confirmed in the main trial. The estimated mean cost of NHS care was £3288 per patient per year for the LSVT® LOUD arm, £2033 for NHS SLT, and £1788 for the control arm. EQ-5D-3L was more strongly correlated to voice impairment than ICECAP-O, and was sensitive to differences in voice impairment between arms. CONCLUSIONS: The pilot did not identify an effect of SLT on disease-specific or economic outcomes for PwPD at 12 months; however, there appeared to be improvements at 3 months. In addition to the sample size not powered to detect difference in cost-consequence analysis, many patients in the control arm started SLT during the 12-month period used for economic analysis, in line with the study protocol. The LSVT® LOUD intervention was more intense and therefore more costly. Early indications suggest that the preferred economic outcome measure for the full trial is EQ-5D-3L; however, the ICECAP-O should still be included to capture a broader measure of wellbeing. TRIAL REGISTRATION: International Standard Randomised Controlled Trial Number Register: ISRCTN75223808. Registered 22 March 2012.

An integrated motor imagery program to improve functional task performance in neurorehabilitation: a single-blind randomized controlled trial.

OBJECTIVE: To investigate the feasibility of a motor imagery program integrated into physiotherapy and occupational therapy. DESIGN: A parallel-group, phase II, assessor-blind randomized controlled trial comparing motor imagery embedded in usual therapy with usual therapy only. SETTING: A neurologic rehabilitation center (Oxford, United Kingdom). PARTICIPANTS: Inpatients and outpatients diagnosed with stroke, brain injury, or multiple sclerosis, participating in a rehabilitation program with sufficient language skills to undertake the intervention were recruited (N=30) and assessed at baseline, after 6 weeks (postintervention), and after 12 weeks (follow-up). INTERVENTIONS: A motor imagery strategy was developed that could be integrated into usual therapy, tailored to individual goals, and used for any activity. The control group received standard care. MAIN OUTCOME MEASURES: Goal attainment scaling was used as the primary outcome measure. Other measures included the Barthel activities of daily living index and the Rivermead Mobility Index. RESULTS: Compliance with advised treatment was poor in 85% of the therapists and in 72% of the patients. Goal attainment scaling scores significantly improved at postintervention and follow-up (F(2,27)=45.159; P<.001), but no significant difference was observed between the groups over time (F(1,28)=.039; P=.845). CONCLUSIONS: Therapist and patient compliance with performing the intervention was low, restricting the conclusions regarding the effectiveness of the integrated motor imagery program. Future studies will need to explore barriers and facilitators to uptake of this intervention in clinical practice. Trial recruitment and retention were good. The study demonstrated that imagery could be successfully integrated into usual therapy and tailored for a wide range of functional activities.

Anomalous centre of mass energy fluctuations during treadmill walking in healthy individuals.

Motorised treadmills are used to research and rehabilitate gait despite conflicting evidence that treadmill ambulation is equivalent to ground walking. It has been suggested that no mechanical differences should exist between these environments but there is little evidence to support this. During ground walking, the whole body centre of mass (COM) acts like an inverted pendulum recovering energy, thereby reducing the effort of locomotion. The energy recovery has a relationship with speed whereby maximum recovery occurs at intermediate speeds. In order to determine the relationship between energy recovery and speed during treadmill walking, we investigated estimated COM displacement in nine healthy individuals each walking on a treadmill at seven different speeds. In addition, we measured oxygen cost to determine the effort of walking. Our participants formed two distinct groups, those with normal COM energy recovery (N%R) that was similar to ground walking, and those with low COM energy recovery (L%R) that was different from typical ground walking. The low energy recovery in the L%R group was attributed to in-phase potential and kinetic energy fluctuations. Despite the low energy recovery values both groups produced the expected 'U'-shaped oxygen cost speed curve with no significant difference between groups (p<0.05), however, only N%R produced a significant relationship between energy recovery and oxygen cost (p<0.05). Although a useful tool, walking on a treadmill may not be a true representation of ground walking and therefore not the most effective way to research or rehabilitate gait.

A workshop to maintain residents' mobility and activity.

Care homes have poor access to physiotherapy and occupational therapy, and consequently staff can be unaware of basic rehabilitation techniques. A workshop was devised to enable staff to learn simple strategies to improve and maintain residents' mobility and activity. This article describes its design, content and delivery.

Oxygen cost during treadmill walking with hip and knee immobilised.

The aim of this study was to determine the effect of immobilising the knee and hip on the oxygen cost (ml·kg(-1)·min(-1)) to velocity relationship during treadmill walking. The study was a prospective experimental conducted in a Rehabilitation centre. Ten healthy individuals, five men and five women, with no gait abnormality participated. Following familiarisation five men and five women walked on a treadmill and selected their own, free "comfortable walking velocity "(SSWS). Subjects then performed an incremental test at -60 to +60% of SSWS. Individuals later repeated the test with the knee and hip of one limb immobilised. Samples of expired air were measured at each velocity and the oxygen cost (ml·kg(-1)·min(-1)) to Froude number (Fr) relationship plotted (where calculation of Fr normalizes for subjects of differing leg length and acts as an index of velocity). There was a higher oxygen cost, and lower Fr at SSWS during immobilised (0.21 ± 0.03 ml·kg(-1)·min(-1); Fr = 0.12 ± 0. 03) compared with free walking (0.16 ± 0.02 ml·kg(-1)·min(-1); Fr = 0.18 ± 0.04) (p < 0. 01). Statistical analysis demonstrated that during immobilised walking an inverse fit (y = ß0 + ß1/x) and for free walking a cubic fit (y = ß0 + ß1x + ß2x(2) + ß3x(3) ) best fitted the data. Hip and knee immobilisation increased the oxygen cost at SSWS and altered the oxygen cost to Fr relationship. The results have implications in selecting optimal walking velocities in individuals with impairments affecting mobility such as hemiplegic gait. Key PointsWalking with one limb immobilised requires greater energy cost than normal free walking.This has clinical implications when developing rehabilitation strategies for patients who mobility problems such as those with hemi paretic gait.

Corrigendum to "Subjective Experiences of Speech and Language Therapy in Patients with Parkinson's Disease: A Pilot Study".

[This corrects the article DOI: 10.1155/2015/839895.].

A pilot study to investigate explosive leg extensor power and walking performance after stroke.

We examined explosive leg extensor power (LEP) and gait in men and women after a stroke using an experimental observational design. A convenience sample of consecutively referred individuals (8 men, 6 women) with chronic stroke mean age ± SD, range, 46.4 ± 8.4, 32 - 57 years, and able to walk for four minutes were recruited. The test re-test reliability and performance of LEP was measured together with walking parameters. LEP (Watts·kg(-1)) and gait measures during a four-minute walk; temporal-spatial gait parameters (GAITRite(®)) and oxygen cost of walking (mL·kg(-1)·m(-1)) were recorded. Percentage Asymmetry LEP (stronger LEP - weaker LEP/stronger LEP x 100) was calculated for each person. LEP was reliable from test to re-test ICC [3, 1] 0.8 - 0.7 (n = 9). Greater Asymmetry LEP correlated strongly with reduced walking velocity, cadence, stance time, and swing time on the weaker leg (n = 14) (p < 0.01). Findings demonstrate explosive LEP, in particular Percentage Asymmetry LEP, can be measured after stroke and is both reliable and related to walking performance. LEP training of the stronger or weaker leg warrants further investigation in this group. Key PointsExplosive leg power (LEP) is a reliable measure in individuals recovering from a stroke.Significant asymmetry occurred in LEP in this group.Greater LEP asymmetry related to reduced walking performance after stroke.

Subjective Experiences of Speech and Language Therapy in Patients with Parkinson's Disease: A Pilot Study.

Purpose. Parkinson's disease can produce a range of speech-language pathologies, which may require intervention. While evaluations of speech-language therapy have been undertaken, no work has been undertaken to capture patients' experiences of therapy. This was the aim of the present study. Methods. Semistructured interviews, using themes derived from the literature, were conducted with nine Parkinson's disease patients, all of whom had undergone speech-language therapy. Participants' responses were analysed in accordance with Thematic Network Analysis. Results. Four themes emerged: emotional reactions (frustration, embarrassment, lack of confidence, disappointment, and anxiety); physical impact (fatigue, breathing and swallowing, and word production); practical aspects (cost of treatment, waiting times, and the actual clinical experience); and expectations about treatment (met versus unmet). Conclusions. While many benefits of speech-language therapy were reported, several negative issues emerged which could impact adversely on rehabilitation. Parkinson's disease is associated with a range of psychological and physical sequelae, such as fatigue and depression; recognising any individual experiences which could exacerbate the existing condition and incorporating these into treatment planning may improve rehabilitation outcomes.

Measuring oxygen cost during level walking in individuals with acquired brain injury in the clinical setting.

This study examined the test-retest reliability of oxygen cost (ml·kg(-1)·min(-1)) during level walking in individuals with acquired brain injury (ABI). Ten individuals with ABI (5 men, 5 women) (Traumatic brain injury, 1, central pontine myelinolysis, 1, stroke 8) and 21 healthy controls (11 men, 10 women). Measurements of gross and net (walking minus resting) oxygen consumption (ml·kg(-1)·min(-1)), and oxygen cost (ml·kg(-1)·min(-1)) during level walking at self-selected speeds. Measurements were taken on two occasions within one week. Oxygen cost was significantly lower (p < 0.05) in individuals with ABI on the second test versus the first test. Percentage variability in oxygen cost from test to re-test ranged from 14.7 to 17.3% in the control group and from 17.4 to 20.8% in the brain injury group. Clinical populations may demonstrate a significant decrease in oxygen cost between testing occasions. Individuals require at least one period of familiarisation if oxygen cost is used as an outcome measure during level walking in clinical groups. The amount of familiarisation has yet to be investigated in individuals with ABI. Key PointsIndividuals with brain injury during level walkingMay demonstrate a significant decrease in oxygen cost between testing occasions.May require at least one period of familiarisation if oxygen cost is used as an outcome measureThe degree of familiarisation required in this clinical group needs further investigation.