Robotic task specific training for upper limb neurorehabilitation: a mixed methods feasibility trial reporting achievable dose.

PURPOSE: Robotic devices for upper-limb neurorehabilitation allow an increase in intensity of practice, often relying on video game-based training strategies with limited capacity to individualise training and integrate functional training. This study shows the development of a robotic Task Specific Training (TST) protocol and evaluate the achieved dose. MATERIALS AND METHODS: Mixed-method study. A 3D robotic device for the upper limb, was made available to therapists for use during neurorehabilitation sessions. A first phase allowed clinicians to define a dedicated session protocol for TST. In a second phase the protocol was applied and the achieved dose was measured. RESULTS: First phase (N = 5): a specific protocol, using deweighting for assessment, followed by customised passive movements and then active movement practice was developed. Second phase: the protocol was successfully applied with all participants (N = 10). Intervention duration: 4.5 ± 0.8 weeks, session frequency: 1.4 ± 0.2sessions/week, session length: 42 ± 9mins, session density: 39 ± 13%, intensity: 214 ± 84 movements/session, difficulty: dn = 0.77 ± 0.1 (normalised reaching distance) and Ɵ = 6.3 ± 23° (transverse reaching angle). Sessions' density and intensity were consistent across participants but clear differences of difficulty were observed. No changes in metrics were observed over the intervention. CONCLUSIONS: Robotic systems can support TST with high therapy intensity by modulating the practice difficulty to participants' needs and capabilities.

Few robotics devices allow for Task Specific Training (TST) of the upper-limb post stroke.Robotic TST was shown to be feasible in a clinicians supervised setting.In supervised robotic TST sessions, clinicians can modulate task difficulty while preserving similar sessions' density and intensity to adjust to the patient impairment.Robotic TST might be used for upper-limb neurorehabilitation without compromising the training intensity.

Home-based motorised cycling in Non-ambulant adults with cerebral palsy: a feasibility study.

PURPOSE: The primary aim was to establish feasibility of a home-based motorised cycling intervention in non-ambulant adults with cerebral palsy (CP). The secondary aim was to investigate perceived outcomes on pain, sleep, fatigue, and muscle stiffness. MATERIALS AND METHOD: Non-ambulant adults with CP were recruited from a specialist clinic. Feasibility encompassing recruitment, retention, adherence, acceptability, practicality, and safety, was the primary outcome., Cycling frequency and duration data were downloaded from the device and augmented by a usage diary and participant survey. Participant satisfaction was rated using a 5-point Likert scale where 1 = very satisfied. Quantitative data and open-ended survey responses were analysed using descriptive statistics and content analysis, respectively. RESULTS: Ten non-ambulant adults with CP (5 female), 18 to 32 years, participated. The median (IQR) days cycled per week was 4 (3,5) with no serious adverse events recorded. The median (IQR) time cycled per session was 13.9 min, (10.2,19.8), per day. Participant satisfaction was high, median (IQR) 2 (1,2.5). Perceived benefits in pain, sleep, fatigue, stiffness, leg function, mood, behaviour, and social interactions were reported alongside occasional problems with spasms and foot placement. CONCLUSION: This study provides preliminary data to support the feasibility of motorised cycling for non-ambulant adults with CP.

Motorised cycling appears a safe form of physical activity for non-ambulant adults with cerebral palsy.Home based motorised cycling was an acceptable form of physical activity for non-ambulant adults with cerebral palsy.Pain, sleep, fatigue, spasticity, and mood may be positively influenced in non-ambulant adults with cerebral palsy through a home-based motorised cycling intervention.

Six-month outcomes and patterns of recovery for people with lateropulsion following stroke.

PURPOSE: This study investigated the (1) six-month outcomes of individuals with lateropulsion; (2) the relationship between baseline measures (from in-patient hospitalisation) and six-month functional abilities; and (3) recovery patterns for lateropulsion in stroke survivors. MATERIALS AND METHODS: Forty-one individuals with lateropulsion participated in this study. Measures of lateropulsion, postural function, and weight-bearing asymmetry in standing were taken initially and fortnightly over eight weeks. Functional independence and walking abilities were assessed at six months post-stroke. RESULTS: Compared to individuals with moderate to severe lateropulsion, those with mild lateropulsion achieved higher levels of functional outcome at six months. However, there were a wide range of scores. Baseline lateropulsion severity explained 26% of the variation in functional outcome. A stronger correlation with functional outcome was observed for lateropulsion (-0.526) than function independence at baseline (0.384). For the task of standing with arm support, patterns of asymmetry were divergent at baseline, favouring either the paretic or non-paretic leg. Over the eight-week period, asymmetry moved towards the non-paretic leg and lateropulsion reduced consistently. CONCLUSIONS: Individuals with lateropulsion can recover from lateropulsion and make meaningful functional gains, including some individuals with more severe lateropulsion. Lateropulsion severity is a key indicator of functional outcome post-stroke.IMPLICATIONS FOR REHABILITATIONIndividuals with lateropulsion can make significant gains in terms of mobility and functional abilities by six months post-stroke, learning to compensate for their verticality impairment in standing by loading their non-paretic leg.It is important that stroke survivors with lateropulsion, including those with moderate and severe lateropulsion, are provided with adequate rehabilitation to optimise their longer-term mobility and functional abilities.Routine screening of acute stroke survivors for lateropulsion is recommended, given lateropulsion may negatively impact longer-term functional outcomes in stroke survivors.Therapists should carefully analyse the weight-bearing pattern which an individual with lateropulsion adopts in standing and subsequently tailor treatment to target this.

Application of the extended technology acceptance model to explore clinician likelihood to use robotics in rehabilitation.

PURPOSE: Evidence suggests that patients with upper limb impairment following a stroke do not receive recommended amounts of motor practice. Robotics provide a potential solution to address this gap, but clinical adoption is low. The aim of this study was to utilize the technology acceptance model as a framework to identify factors influencing clinician adoption of robotic devices into practice. MATERIALS AND METHOD: Mixed methods including survey data and focus group discussions with allied health clinicians whose primary caseload was rehabilitation of the neurologically impaired upper limb. Surveys based on the technology acceptance measure were completed pre/post exposure to and use of a robotic device. Focus groups discussions based on the theory of planned behaviour were conducted at the conclusion of the study. RESULTS: A total of 34 rehabilitation clinicians completed the surveys with pre-implementation data indicating that rehabilitation clinicians perceive robotic devices as complex to use, which influenced intention to use such devices in practice. The focus groups found that lack of experience and time to learn influenced confidence to implement robotic devices into practice. CONCLUSION: This study found that perceived usefulness and perceived ease of use of a robotic device in clinical rehabilitation can be improved through experience, training and embedded technological support. However, training and embedded support are not routinely offered, suggesting there is a discordance between current implementation and the learning needs of rehabilitation clinicians.IMPLICATIONS FOR REHABILITATIONPatients do not receive adequate amounts of upper limb motor practice following a stroke, and although robotic devices have the potential to address this gap, clinical adoption is low.The technology acceptance model identified that clinicians perceive robotic devices to be complex to use with current implementation efforts failing to consider their training needs.Implementation adoption of robotic devices in rehabilitation should be supported with adequate training and technological support if sustainable practice change is to be achieved.

Promoting clinical best practice in a user-centred design study of an upper limb rehabilitation robot.

PURPOSE: Despite their promise to increase therapy intensity in neurorehabilitation, robotic devices have not yet seen mainstream adoption. Whilst there are a number of contributing factors, it is obvious that the treating clinician should have a clear understanding of the objectives and limitations of robotic device use. This study sought to explore how devices can be developed to support a clinician in providing clinical best practice. METHODS AND MATERIALS: A user-centred design study of a robotic device was conducted, involving build-then-use iterations, where successive iterations are built based on feedback from the use cycle. This work reports results of an analysis of qualitative and quantitative data describing the use of the robotic device in the clinical sessions, and from a focus group with the treating clinicians. RESULTS AND CONCLUSIONS: The data indicated that use of the device did not result in patient goal-setting and may have resulted in poor movement quality. Therapists expected a higher level of autonomy from the robotic device, and this may have contributed to the above problems. These problems can and should be addressed through modification of both the study design and device to provide more explicit instructions to promote clinical best practice.IMPLICATIONS FOR REHABILITATIONEncouraging clinical best practice when using evaluating prototype devices within a clinical setting is important to ensure that best practice is maintained - and can be achieved through both study and device designSupport from device developers can significantly improve the confidence of therapists during the use of that device in rehabilitation, particularly with new or prototype devicesEnd effector-based robotic devices for rehabilitation show potential for a wide variety of patient presentations and capabilities.

The utility of short-term goal achievement as an early indicator of discharge destination in people admitted to neurological rehabilitation with severe functional deficits.

PURPOSE: This study investigates whether short-term goal achievement in the early phase of neurological rehabilitation is an accurate indicator of discharge destination in patients with severe disability in comparison to change in scores in the motor domain of the Functional Independence Measure (FIM motor). METHOD: A prospective observational cohort study. PARTICIPANTS: A consecutive sample of 53 patients admitted to rehabilitation with a neurological diagnosis and FIM motor score below 47.Measures: Short-term goal achievement and FIM motor change in the first 2 weeks following admission and discharge destination. RESULTS: Short-term goal achievement showed good prognostic utility [area under the curve (AUC) of 0.75; 95% confidence intervals (CI) 0.6, 0.89] for discharge destination, dichotomized as home or semi-independent living versus nursing home care, similar to that demonstrated by change in FIM motor scores (AUC of 0.69; 95% CI 0.55, 0.84), p = 0.55. A cut-off was established for short-term goal achievement at more than half of goals achieved, with an AUC of 0.73 (95% CI 0.58, 0.87); sensitivity 71.4% and specificity 74.4%. CONCLUSIONS: Short-term goal achievement in the early phase post-admission is a good indicator of the person's potential to return home.Implications for RehabilitationShort-term goal setting should be a key practice feature of neurological rehabilitation.Goal achievement is an indicator of a person's potential to return home or to semi-independent living in people with severe neurological deficits.Evaluation of short-term goal achievement may inform the ongoing rehabilitation program and discharge planning.

The Ankle Lunge Test for measurement of dorsiflexion in individuals following stroke; reliability, validity and evaluation of change following intervention for spasticity of the lower limb.

INTRODUCTION: The Ankle Lunge Test (ALT) is a reliable method of measuring weight bearing ankle dorsiflexion range, a key component of gait, in healthy ankles and a range of musculoskeletal conditions. The aim of this study is to evaluate the reliability and concurrent validity of the ALT in people with stroke and investigate whether change in ALT is observed following treatment of spasticity with Botulinum Toxin. METHODOLOGY: Repeated Measure Design: Forty stroke survivors were recruited for reliability testing. Twenty three stroke survivors were evaluated with the ALT before and after treatment of the lower limb with Botulinum Toxin. Measurement with the ALT was performed for all participants. For the reliability group, two physiotherapists evaluated the ALT on Day 1 and one therapist re-evaluated the ALT one to 5 days later. For the change evaluation group, the ALT was tested prior to and six to eight weeks after intervention. Other measures evaluated were velocity, the Functional Ambulation Category, Timed Up and Go and the Modified Tardieu Scale. RESULTS: Intra-rater, inter-rater and test-retest reliability yielded intra-class correlation coefficients at or above 0.92. Moderate correlations were found between the ALT and velocity r = 0.605 (p < 0.01), the Timed Up and Go r = -0.598 (p < 0.01) and the Functional Ambulation Category r = 0.380 (p < 0.05). Following intervention with Botulinum Toxin, there was significant (p < 0.02) improvement in the ALT; pre-median 20 mm (IQR -25 to 35) to post-median 21 mm (IQR 0 to 40) and the Timed Up and Go; pre-median 21.40 s (IQR 13.43 to 28.82) to post-median 20.08 s (IQR 14.06 to 28.47). CONCLUSION/SIGNIFICANCE: The ALT is a reliable and valid measure which may be applied in clinical practice to evaluate change in weight bearing ankle dorsiflexion in people with stroke.

Standing weight-bearing asymmetry in adults with lateropulsion following stroke.

BACKGROUND: Weight-bearing asymmetry biasing the non-paretic leg is common following stroke. However, little is known as to how lateropulsion impacts on the weight-bearing patterns adopted in standing by individuals following stroke. RESEARCH QUESTIONS: (1) Are there differences in weight-bearing asymmetry patterns observed in standing in people with lateropulsion relative to healthy controls; (2) What is the relationship between weight-bearing asymmetry and clinical measures of lateropulsion and postural function; and (3) Are measures of weight-bearing asymmetry reliable between test occasions. METHODS: Thirty-three individuals with lateropulsion and 35 healthy controls participated in this study. For the participants with lateropulsion, weight-bearing asymmetry during standing tasks (measured using two Wii Balance Boards) and clinical measures of lateropulsion (Burke Lateropulsion Scale) and postural function (Postural Assessment Scale for Stroke) were assessed initially and fortnightly over eight weeks. RESULTS: Individuals with lateropulsion displayed marked weight-bearing asymmetry in standing compared to healthy controls. This asymmetry was predominantly towards their non-paretic leg when standing unsupported, and mixed presentation of weight-bearing asymmetry directions when standing with arm support. No significant correlations were observed between directional weight-bearing asymmetry and the Burke Lateropulsion Scale. A moderate correlation was found between absolute weight-bearing asymmetry for the stand with arm support task and the Postural Assessment Scale for Stroke (r = -0.608). The weight-bearing asymmetry variables for the standing with arm support task were found to be highly reliable between test occasions (ICC 0.915-0.972) and the standard error of measurement was 8.2%-9.3% body weight. SIGNIFICANCE: Individuals with lateropulsion following stroke demonstrate marked and varied patterns of asymmetry in standing. Weight-bearing asymmetry when standing with arm support may be an appropriate outcome measure for use with patients with lower functional abilities, including those with lateropulsion.

Progression of Postural Asymmetry in Young Adults With Cerebral Palsy Who Are Not Walking: An Exploratory Study.

PURPOSE: Young adults with cerebral palsy (CP) who are not walking are at risk of developing or increasing musculoskeletal asymmetries affecting the rib cage, spine, pelvis, and hips. This longitudinal study aimed to explore postural change using the Goldsmith Indices of Body Symmetry (GIofBS) over an 18-month period in adults with CP who are not walking. METHODS: Demographic and medical data were accessed from participant's history. Posture was recorded using the GIofBS to collect data during an 18-month period following skeletal maturity. RESULTS: All participants had postural asymmetry at study onset with evidence of minimal change in some GIofBS outcome measures and fluctuations in other outcomes over 18 months. CONCLUSIONS: Physical therapists may use the GIofBS across the lifespan to screen for deterioration in musculoskeletal status or in assessing longer-term outcomes of interventions impacting posture in this complex population. VIDEO ABSTRACT: For more insights from the authors, see Supplemental Digital Content 1, available at: http://links.lww.com/PPT/A314.

Pain and its relationship with postural asymmetry in adults with cerebral palsy: A preliminary exploratory study.

BACKGROUND: Pain in adults with cerebral palsy (CP) is commonly reported, with muscular and skeletal dysfunction resulting in postural asymmetry as potential contributors to multifactorial causes of pain. The relationship between pain and postural asymmetry of the thoracic cage, pelvis and hips in non-ambulatory adults with CP however is unknown, particularly in those with cognitive and communication limitations. OBJECTIVE: The primary aim of this study was to describe and quantify day and night pain in non-ambulatory adults with CP. Secondary aims were to investigate any relationship between pain and postural asymmetry and to describe current pain management strategies utilised. METHODS: Pain was measured using the Non Communicating Adult Pain Checklist (NCAPC). Posture was measured using the Goldsmith Indices of Body Symmetry (GIofBS) and radiographs. Correlations between pain scores and posture (GIofBS and radiographs) were assessed using non-parametric analysis. Information regarding pain management strategies was gained from medical records and carer interviews. RESULTS: Seventeen non-ambulatory adults with CP were recruited. High levels of day pain were experienced by ≥ 50% of participants with a high incidence of prescribed medications targeting pain. Strong positive correlations between day and night NCAPC scores, chest right left ratio and night pain, Cobb angle and day pain and between Cobb angle and night pain were evident. CONCLUSION: The incidence and severity of pain in non-ambulatory adults with CP is high with postural asymmetry a potential contributor. Pain remains difficult to assess and manage in adults with significant cognitive and communication impairments and warrants further investigation.

The Association Between Sarcopenia and Functional Improvement in Older and Younger Patients Who Completed Inpatient Rehabilitation: A Prospective Cohort Study.

Objective: To investigate the association between sarcopenia and functional improvement in patients older and younger than 65 years upon completion of an inpatient rehabilitation program. Design: Prospective cohort study. Participants: Adult consecutive patients who completed the inpatient rehabilitation program at a metropolitan tertiary referral hospital general inpatient rehabilitation unit. Methods: Sarcopenia status was determined using the European Working Group on Sarcopenia in Older People 2 algorithm, using muscle mass measured by BioImpedance Analysis and grip strength. Progress in rehabilitation was measured using change in the Functional Independence Measure and Goal Attainment Scaling score. To investigate the age group by sarcopenia status interaction we used quantile regression models with bootstrapped standard error estimation for functional improvement and linear regression model with robust standard error estimation for GAS score. Results: 257 participants [128 (50%) male, median age 63 years (IQR: 52-72)], 33(13%) with sarcopenia, completed inpatient rehabilitation [median length of stay 16 days (IQR: 11-27.5)]. Participants' median Functional Independence Measure change was 24 (IQR 15-33.5) and mean total Goal Attainment Scaling score was 57.6 (SD 10.2). Adjusting for admission Functional Independence Measure score, the median difference in Functional Independence Measure change between participants with and without sarcopenia was: -4.3 (95% CI: -10.6, 1.9); p = 0.17 in participants 65 years and younger, and 4.6 (95% CI: 1.0, 8.2); p = 0.01 in participants older than 65; age-by-sarcopenia interaction p = 0.02. Conclusions: Unlike younger people, older people with sarcopenia have greater functional improvement in inpatient rehabilitation than those without sarcopenia.

The intra- and inter-rater reliability of the Goldsmith indices of body symmetry in non-ambulant adults with cerebral palsy.

PURPOSE: Non-ambulant adults with cerebral palsy are at risk of developing asymmetry affecting thoracic cage, pelvis and hips. The primary aim of this study was to establish intra-rater and inter-rater reliability of the Goldsmith Indices of Body Symmetry in non-ambulant adults with cerebral palsy. The secondary aim was to establish comparative data for the Goldsmith Indices of Body Symmetry in healthy adults. MATERIALS AND METHOD: Thirty non-ambulant young adults with cerebral palsy (17 males), and 48 young healthy controls (19 males), were recruited. Thoracic shape and symmetry, pelvic orientation and hip range, was measured using the Goldsmith Indices of Body Symmetry. Intra-rater reliability was established by repeated measurement within a single session. Inter-rater reliability was established having two raters measure each participant on two sequential sessions. Analysis utilised intraclass correlation coefficients. RESULTS: The Goldsmith Indices of Body Symmetry has excellent intra-rater reliability (intraclass correlation coefficients ≥0.97). Inter-rater reliability for all Goldsmith Indices of Body Symmetry measures was good to excellent (intraclass correlation coefficients ≥0.85). Range and variability of results was greater for participants with cerebral palsy compared to comparative data. CONCLUSION: The Goldsmith Indices of Body Symmetry has good inter and intra-rater reliability for measurement of thoracic shape and symmetry, pelvic orientation and hip range, allowing accurate tracking of postural changes over time in non-ambulant adults with cerebral palsy.Implications for rehabilitationThe Goldsmith Indices of Body Symmetry is a reliable clinical measurement tool to enable measurement of the thoracic shape and symmetry, pelvic and hip orientation in adults with cerebral palsy.The Goldsmith Indices of Body Symmetry, with an impairment focus, is a useful adjunct to the assessment and management of postural asymmetry in adults with cerebral palsy.

GripBMI - A fast and simple sarcopenia screening tool in post acute inpatient rehabilitation.

BACKGROUND & AIMS: Sarcopenia is prevalent in post acute inpatient rehabilitation. An easy to administer screening test may improve identification of sarcopenia in this population, which may promote its early detection and treatment. THE AIMS OF THIS STUDY WERE: a) To investigate clinical utility of SARC-F as a European Working Group on Sarcopenia in Older People2 (EWGSOP2) recommended tool for sarcopenia case finding in post acute inpatient rehabilitation. b) To develop an easy and pragmatic screening test for sarcopenia in healthcare settings with limited ability to measure the patients' muscle mass for confirmation of the sarcopenia diagnosis. METHODS: This cross-sectional study with prospective data collection recruited patients admitted to a general inpatient rehabilitation unit in a metropolitan tertiary referral hospital in Australia. Participant's true sarcopenia status was ascertained, as per EWGSOP2, from their grip strength and muscle mass. Two SARC-F questionnaires were administered, for participants' current and, by recall, premorbid status. To develop GripBMI screening tool, BMI test positivity cut off was established on training sample and validated in conjunction with the established grip strength cut off on validation sample using area under the Receiver Operating Curve (ROC) analysis. RESULTS: True prevalence of sarcopenia in 277 participants (median age 64 years (IQR 53-72), 52% male) was 14% (95%CI 11%-19%). Screening utility of SARC-F positive status at the time of admission for sarcopenia had ROC of 0.50, and of premorbid SARC-F positive status had ROC of 0.51. Out of 42 participants positive on the GripBMI screen, 33 had sarcopenia, and out of 235 participants negative on the GripBMI screen, 7 participants had sarcopenia, resulting in GripBMI ROC area 0.89, sensitivity 83%, specificity 96%, positive predictive value 79%, negative predictive value 97%, diagnostic odds ratio 119 (95% CI 42-338). CONCLUSIONS: The GripBMI screening tool uses the combination of EWGSOP2 recommended low grip strength cut offs and Body Mass Index of less than 25 as a positive screening test for sarcopenia. It may assist in promoting early detection and management of sarcopenia in post acute inpatient rehabilitation.

Sarcopenia Is Associated With Reduced Function on Admission to Rehabilitation in Patients With Diabetes.

OBJECTIVE: This work aims to estimate the prevalence of sarcopenia and to investigate the association between sarcopenia and functional performance in patients with and without diabetes admitted for inpatient rehabilitation. MATERIALS AND METHODS: Consecutive patients admitted to the subacute inpatient rehabilitation unit at St Vincent's Hospital Melbourne, Australia (November 2016 to March 2020) were prospectively recruited into this cross-sectional study. Sarcopenia was diagnosed using the European Working Group on Sarcopenia in Older People 2018 algorithm. Participants' functional performance was measured by the total Functional Independence Measure, motor Functional Independence Measure, and the Short Physical Performance Battery. The association between sarcopenia and functional performance was investigated using quantile regression. RESULTS: Of 300 participants, 49 (16%) had a history of diabetes and 44 (14.7%) were diagnosed with sarcopenia. No significant difference in the prevalence of sarcopenia between patients with or without diabetes was identified (11/49, 22.5% vs 33/251, 13.2%, P = .12). In patients with diabetes, those with sarcopenia had significantly reduced functional performance compared to those without sarcopenia on Functional Independence Measure, motor Functional Independence Measure, and the Short Physical Performance Battery, whereas in patients without diabetes no significant difference between patients with and without sarcopenia were identified for either functional performance measure (all P values for interaction < .005). CONCLUSIONS: The diagnosis of sarcopenia was associated with a reduced functional performance on admission to inpatient rehabilitation in patients with diabetes, but not in those without diabetes. Further investigation is needed into the progress of patients with dual diagnoses of diabetes and sarcopenia in inpatient rehabilitation.

Rasch analysis of the Burke Lateropulsion Scale (BLS).

BACKGROUND: Lateropulsion is a common problem following stroke. Whilst the Burke Lateropulsion Scale (BLS) is recommended in the literature as the outcome measure of choice for measuring lateropulsion, the internal validity of the BLS has not been investigated. OBJECTIVES: To evaluate the internal validity of the BLS for use in evaluating the effectiveness of therapies aimed at reducing lateropulsion. METHODS: Rasch analysis procedures were undertaken including assessment of overall model fit, item, and person fit, threshold ordering, differential item functioning, internal consistency, targeting, and dimensionality. RESULTS: Data from 132 participants were utilized to perform Rasch analysis of the BLS. In this preliminary study, overall model fit and individual item and person fit were found to be good using fit residual statistics and chi-square probability values. The BLS was found to be unidimensional and have good internal consistency (Person Separation Index 0.867). Thresholds for four of the five items were found to be only marginally disordered and were subsequently not modified. Non-uniform differential item functioning was detected for age for the transfers item; however, this item did not display item misfit and was therefore not removed. CONCLUSIONS: This study identified good psychometric properties of the BLS using Rasch analysis and supports the use of the BLS as a measure of lateropulsion following stroke. Further use of Rasch analysis on the BLS using a larger sample is recommended to confirm these preliminary findings and allow transformation into an interval-level scale.

Goal attainment scaling outcomes in general inpatient rehabilitation: association with functional independence and perceived goal importance and difficulty.

OBJECTIVE: To investigate the association of goal attainment scaling outcomes with change in the Func-tional Independence Measure, and the association between the perceived importance, difficulty and degree of achievement of individual goals in general inpatient rehabilitation. DESIGN: Prospective cohort study. PARTICIPANTS: A total of 208 participants admitted to inpatient rehabilitation in a metropolitan tertiary referral hospital in Melbourne, Australia. METHODS: Participants determined the nature of the goals and their importance, and therapists determined the difficulty of the goals. The associations were investigated using median regression and random effect ordinal regression. RESULTS: An increase of each point in the goal attainment scaling score was associated with an adjusted median increase of 0.34 points (95% confidence interval (CI): 0.18-0.5, p < 0.001) in Functional Independence Measure change. More important goals of similar difficulty (very important vs a little important: adjusted common odds ratio (cOR) = 1.97, 95% CI: 1.01-3.83, p = 0.045) and less difficult goals of similar importance (moderately difficult vs a little difficult cOR = 0.59, 95% CI: 0.04-0.87, p = 0.007; very difficult vs a little difficult cOR = 0.59, 95% CI 0.37-0.94, p = 0.027) were better achieved. CONCLUSION: Rehabilitation progress measured using the goal attainment scaling method is associated with changes in functional outcomes. For goals with similar difficulty, those with higher importance were better achieved, while for goals with similar importance, less difficult goals were better achieved.

Postural asymmetry in non-ambulant adults with cerebral palsy: a scoping review.

PURPOSE: Non-ambulant adults with cerebral palsy are vulnerable to development of postural asymmetry and associated complications. The primary aim of this scoping review was to identify postural deformities in non-ambulant adults with cerebral palsy. MATERIALS AND METHODS: Comprehensive searches were undertaken in EMBASE, CINAHL, AMED, Cochrane, Psych INFO, and Joanna Briggs (1986-Jan 2017), supplemented by hand searching. Two reviewers independently extracted data using a customised tool focusing on study design, participant characteristics, postural descriptors, measurement tools, and interventions. RESULTS: From 2546 potential records, 17 studies were included. Variability in populations, reporting methodology, and measurement systems was evident. Data suggest more than 30% of this population have hip migration percentage in excess of 30%, more than 75% experience "scoliosis", and more than 40% demonstrate pelvic obliquity. Estimates ranged from 14% to 100% hip and 32% to 87% knee contracture incidence. Conservative interventions were infrequently and poorly described. CONCLUSION: Many non-ambulant adults with cerebral palsy experience postural asymmetry associated with windswept hips, scoliosis, pelvic obliquity, and limb contracture. Options for non-radiographic monitoring of postural asymmetry should be identified, and conservative interventions formally were evaluated in this population. Implications for rehabilitation The common postural asymmetries of windswept hips, scoliosis, pelvic obliquity, and limb contracture require standardised clinical measurement. Radiography is most commonly used to monitor postural asymmetry in this population, but standardised positioning is not applied and may not be feasible indicating a need for alternate methods and rigorous documentation. The Posture and Postural Ability Scale may be considered for use in the management of body shape in adults with CP.

Determining discharge destination in geriatric evaluation and management units: Is progressive goal attainment a better early indicator of discharge destination than improvement in functional independence measure scores?

AIM: To determine whether progress in goal attainment is a more responsive measure of functional improvement than the Functional Independence Measure, and whether it is a more accurate predictor of discharge destination in the early phase of a Geriatric Evaluation and Management episode. METHODS: The present study was a prospective audit of goal achievement, functional ability and discharge destination. A total of 83 patients were included in this study. Logistic regression was carried out with the outcome variable discharge destination (home vs residential care), and the predictors being goal attainment, age at admission and change in the Functional Independence Measure motor function scale from admission to 2 weeks. RESULTS: Of the predictors, goal attainment was the only significant predictor. The overall amount of variability in the discharge destination explained by the predictors was 25% (Nagelkerke pseudo R2 ). CONCLUSIONS: Progressive goal attainment might be a better predictor of improvement in function and discharge destination than change in the Functional Independence Measure. Geriatr Gerontol Int 2018; 18: 1058-1063.

Comprehensive clinical sitting balance measures for individuals following stroke: a systematic review on the methodological quality.

PURPOSE: The aim of this systematic review was to examine the psychometric properties of published clinical sitting measurement scales containing dynamic tasks in individuals following stroke. METHOD: Databases, including Cumulative Index of Nursing and Allied Health Literature (CINAHL), MEDLINE, EMBASE, Cochrane, PubMed and Allied and Complementary Medicine Database (AMED) were searched from inception to December 2015. The search strategy included terms relating to sitting, balance and postural control. Two reviewers independently selected and extracted data from the identified articles and assessed the methodological quality of the papers using the COnsensus-based Standards for selection of health status Measurement INstruments (COSMIN) checklist. RESULTS: Fourteen clinical sitting measurement scales (39 papers) containing dynamic tasks met the inclusion criteria and various measurement properties were evaluated. The methodological quality of the majority of the included studies was rated as poor to fair using the COSMIN checklist, with common limitations including small sample size and inappropriate use of statistical methods. CONCLUSIONS: This review was unable to identify measures with sufficient psychometric properties to enable recommendation as preferred tools. However, measures were identified that warrant further specific psychometric investigations to fulfil requirements for a high quality measure. Implications for Rehabilitation Fourteen clinical sitting balance scales containing dynamic tasks are available to measure sitting balance with individuals following stroke. No single scale has sufficient psychometric properties to enable recommendation as a preferred tool for measuring sitting balance with stroke survivors. Use of a balance scale or dedicated sitting balance measure containing static and dynamic sitting items should be utilised to monitor progress for individuals following stroke with more severe deficits.