Functional profiles derived from the ICF Generic set and the responsiveness and validity of the Generic-6 set's Functioning score among persons after stroke.

BACKGROUND: The International Classification of Functioning, Disability and Health (ICF) parsimonious Generic set can provide identification of functional profiles and recovery after rehabilitation in persons post stroke. AIM: To explore concurrent validity of the ICF Generic-6_Functioning score with the Barthel Index (BI) and responsiveness after rehabilitation in persons post stroke. Further, the feasibility of applying the ICF Brief Stroke Core set in routine rehabilitation recovery was evaluated. DESIGN: Prospective study. SETTING: Inpatient rehabilitation setting. POPULATION: Persons post stroke. METHODS: The study included 71 persons post stroke (mean age 66.8 [standard deviation 14.5], mean onset 199.3 [565.3] days, BI score improvement: 17/100), N.=44 acute stroke (<3 months, stroke subacute [SA]_group) and N.=27 chronic stroke (>3 months, Stroke chronic [SC]_group). The Brief Stroke core set, including the Generic set, was used for classification at admission and at discharge using the five grade qualifiers. The median value of the groups' qualifiers on the Generic set (excluding item 850) was used to form a Functioning score (Generic-6 FS). Responsiveness was assessed with effect sizes (ES) and confidence intervals (CI). The concurrent validity of the Generic-6 FS was explored with the BI as a gold standard using Spearman's correlation coefficient. P was set at 0.05. RESULTS: The Generic-6 FS proved responsive with ES being moderate for the Generic-6 FS and the BI for the whole group (0.48, CI 0.14-0.82 and 0.67, CI -1.02--0.32 respectively). ES of the Generic-6 FS was significant only for the SA_group (0.62, CI 0.27-0.96. Correlation between the Generic-6 FS and the BI at baseline and discharge were respectively r=-0.59 and r=0.60, while correlation between change values was lower (r=0.44). The Generic-6 FS did not distinguish between the SA_group and the SC_group. Classification with the ICF brief stroke core set was feasible with 89% of the persons being classified both at admission and discharge. CONCLUSIONS: ICF classification of persons post stroke during rehabilitation recovery was feasible. The Generic-6 FS detected changes in functioning and health in persons recovered for rehabilitation after stroke and distinguished between different recovery rates of persons in the acute and chronic phase after stroke.

Task-oriented biofeedback to improve gait in individuals with chronic stroke: motor learning approach.

BACKGROUND: Electromyographic biofeedback (EMG-BFB) has shown equivocal benefits on gait retraining after stroke. OBJECTIVE: The authors evaluated the efficacy of EMG-BFB applied in a task-oriented approach based on principles of motor learning to increase peak ankle power of the affected leg and gait velocity in patients with chronic mild to moderate hemiparesis. METHODS: They assigned 20 participants randomly to the EMG-BFB group or a control group that received conventional therapy for the same duration. Quantitative gait analysis was performed before and after treatment. The EMG-BFB involved the triceps surae during functional gait activities. Treatment was administered with a fading frequency of BFB application and an increasing variability in gait activities. Both groups had 20 treatment sessions of 45 minutes each, including at least 15 minutes of walking-related therapy for the control group. Follow-up (FU) gait analysis was obtained 6 weeks after training. RESULTS: BFB treatment led to significant increases (P < .01) in peak ankle power at push-off (from 0.63 W/kg to 1.04 W/kg) in conjunction with significant increases in velocity (from 28.3 %h/s--normalized to percentage height per second--to 39.6 %h/s) and stride length (from 44.5 %h--normalized to percentage height--to 57.6 %h). Increases remained significant at FU. There were no changes in any gait variable in the control group. CONCLUSION: A task-oriented BFB treatment was effective in increasing peak ankle power, gait velocity, and stride length in a population with hemiparesis. Further studies should compare the combination intervention with either of its components in more impaired patients.

Concepts of motor learning applied to a rehabilitation protocol using biofeedback to improve gait in a chronic stroke patient: an A-B system study with multiple gait analyses.

OBJECTIVE: The impact of electromyographic biofeedback (EMG BFB) applied during functional gait activities and employed in accord with theories on motor learning was investigated in a chronic hemiplegic patient. METHODS: A single-subject A-B design was used. EMG BFB was applied to the triceps surae during gait. A rehabilitation program with a fading frequency of BFB application and an increasing variability in the task training was implemented. Responses to the rehabilitation program were documented via multiple quantitative gait analyses, performed during a baseline, treatment, and at follow-up 6 weeks after the end of treatment. RESULTS: From baseline to end of treatment, there were significant changes in ankle power at push-off, both in amplitude and timing, as well as onset of ankle power at push-off relative to heel strike of the healthy leg. There was a significant increase in gait velocity, step length of the healthy side, stride length, and stride frequency. At follow-up, changes were still significantly different from baseline and the patient had reduced the use of the cane in activities of daily living. CONCLUSIONS: BFB appears to have been effective in promoting positive changes in gait in this pilot study. The rehabilitation protocol also appeared to be effective in promoting learning and the incorporation of trained activities into daily activities.

Head control: volitional aspects of rehabilitation training in patients with multiple sclerosis compared with healthy subjects.

OBJECTIVE: To investigate the role of voluntary mechanisms and motor learning in head stability and the impact of longitudinal biofeedback training in head control. DESIGN: Crossover trial and single-subject research design. SETTING: Neurorehabilitation research institute. PARTICIPANTS: Head stability during treadmill gait was measured in healthy subjects and patients with multiple sclerosis (MS). INTERVENTION: The experimental condition in which subjects walked on the treadmill was compared with that in which the head was voluntarily stabilized. In another experimental condition, augmented feedback of head displacement was provided by means of a laser mounted on the head that projected a laser beam on a screen. The motor learning was investigated with biofeedback training sessions. Positional feedback was represented by the laser beam, with subjects having to stabilize the beam while walking on the treadmill. MAIN OUTCOME MEASURE: Head angular oscillation in the sagittal and frontal planes. RESULTS: Results showed that on verbal request, healthy subjects and patients further stabilized the head during gait, especially in the sagittal plane. Short-term feedback of head displacement was no better than self-stabilization at improving head control. Conversely, the motor learning was evident in the rehabilitation protocol: after 10 to 15 training sessions, patients with MS showed a clinically relevant decrease of head angular oscillations. CONCLUSIONS: Voluntary mechanisms play a role in head stabilization during gait. Augmented biofeedback of head displacement may be effective in reducing head oscillations.