Canadian Stroke Best Practice Recommendations: Rehabilitation, Recovery, and Community Participation following Stroke. Part Two: Transitions and Community Participation Following Stroke.

The sixth update of the Canadian Stroke Best Practice Recommendations for Transitions and Community Participation following Stroke is a comprehensive set of evidence-based guidelines addressing issues faced by people following an acute stroke event. Establishing a coordinated and seamless system of care that supports progress achieved during the initial recovery stages throughout the transition to the community is more essential than ever as the medical complexity of people with stroke is also on the rise. All members of the health-care team engaged with people with stroke, their families, and caregivers are responsible for partnerships and collaborations to ensure successful transitions and return to the community following stroke. These guidelines reinforce the growing and changing body of research evidence available to guide ongoing screening, assessment, and management of individuals following stroke as they move from one phase and stage of care to the next without "falling through the cracks." It also recognizes the growing role of family and informal caregivers in providing significant hours of support that disrupt their own lives and responsibilities and addresses their support and educational needs. According to Statistics Canada, in 2012, eight million Canadians provided care to family members or friends with a long-term health condition, disability, or problems associated with aging. These recommendations incorporate aspects that were previously in the rehabilitation module for the purposes of streamlining, and both modules should be reviewed in order to provide comprehensive care addressing recovery and community reintegration and participation. These recommendations cover topics related to support and education of people with stroke, families, and caregivers during transitions and community reintegration. They include interprofessional planning and communication, return to driving, vocational roles, leisure activities and relationships and sexuality, and transition to long-term care.

Orthotic and therapeutic effect of functional electrical stimulation on fatigue induced gait patterns in people with multiple sclerosis.

PURPOSE: To assess the orthotic and therapeutic effects of prolonged use of functional electrical stimulation (FES) on fatigue induced gait patterns in people with Multiple Sclerosis (MS). METHOD: Thirteen people with MS completed 3D gait analysis with FES off and on, before and after a fatiguing 6-minute walk, at baseline and after 8 weeks of use of FES. RESULTS: Eleven participants completed all testing. An orthotic effect on gait was not evident on first use of FES. However, therapeutic effects on gait after 8 weeks use were generally positive, including increases in walking speed due to improved neuromuscular control and power generated at the hip and ankle of the more affected limb. The action of FES alone was not sufficient to overcome all fatigue related deficits in gait but there was evidence 8 weeks use of FES can ameliorate some fatigue effects on lower limb kinetics, including benefits to ankle mechanics involved in generating power around push-off during stance. CONCLUSIONS: Eight-weeks of FES can benefit the gait pattern of people with MS under non-fatigued and fatigued conditions. Implications for rehabilitation In some people with MS prolonged use of FES may be necessary before observing positive orthotic effects. Improvements in the neuromuscular control of the more affected lower limb may develop with prolonged use of FES in people with MS. Only some therapeutic benefits of FES are maintained during fatigued walking in people with MS. FES may be considered as a gait retraining device as well as an orthotic intervention for people with MS.

Cognitive and personality factors associated with assaultive and domestic offenders.

An evaluation of domestic assaultive (n=46), general assaultive (n= 23) and nonassaultive (19 property offenders) groups was performed to compare cognitive (Test of Nonverbal Intelligence), personality (Minnesota Multiphasic Personality Inventory), aggression (Buss-Durkee Hostility Inventory), and criminal sentiments (Carlson Psychological Survey). Analysis showed minimal significant differences amongst the groups. A significant difference was found for the Verbal Hostility subscale of the Buss-Durkee Hostility Inventory. The domestic assaultive offenders were similar to the general assaultive and nonviolent offenders, with a greater disparity for the control group. Furthermore, a significant difference was noted for the Hypochondriasis scale of the Minnesota Multiphasic Personality Inventory. The general assaultive and control (n = 15) groups had similar scores, with the greatest difference found for nonviolent offenders who were least anxious. Discriminant analysis showed group membership could be identified for 89.1% of the domestic assaultive group.