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1.
J Bodyw Mov Ther ; 28: 341-347, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34776162

RESUMO

BACKGROUND: Despite proven health benefits of regular participation in physical activities (PA), adults with stroke fail to achieve recommended levels of PA. Sports being an enjoyable activity is more likely to encourage participation. Therefore, the objectives of the present study are i) to develop and test the feasibility of adaptive sports for promoting PA and Quality of Life (QoL) in community-dwelling adults with stroke, and ii) to explore the participants perception and experiences of playing adaptive sports. METHODS: Two focus groups were conducted among the eight experts and a person with stroke to develop adaptive sports. To test the feasibility of these adaptive sports, in a multi methods study eighteen community dwelling adults with stroke were recruited. Participants played adaptive sports twice a week for two months in a community center. Participants pre and post intervention PA levels and QoL were measured. Participants were also interviewed at the end of the program to explore their experiences of participation in adaptive sports. RESULTS: At the end of the program retention rate of the participants was 83.33% and there was a significant improvement in PA levels, while the improvement in QoL was not statistically significant. Participants expressed positive experience with the program. There were no adverse events during or after the participation. Health benefits, fitness, and fun were reported as facilitators, while lack of access to the sporting facility and lack of caregiver support were reported as barriers to participation. CONCLUSION: Adaptive sports appear to be safe, feasible, and well accepted by the adults with stroke.

2.
Physiother Res Int ; 26(4): e1918, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34228383

RESUMO

BACKGROUND: Low physical activity levels in people with stroke may contribute to higher risk of cardiovascular disease morbidity and mortality. Differences in economic status, culture and the built environment may influence the applicability of interventions developed in high income countries (HIC) for stroke survivors in low to middle-income countries (LMIC). PURPOSE: To compare physical activity levels of stroke survivors in HIC and LMIC and to explore the influence of lower limb impairment on physical activity levels. METHODS AND MATERIALS: An exploratory secondary analysis of observational data on physical activity levels of stroke survivors from Australia (HIC) and India (LMIC). Physical activity variables (step count, light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA)) were measured by accelerometery. Comparisons of physical activity levels between (a) Australian and Indian stroke survivors and (b) participants with and without lower limb impairments were performed using independent t-tests or Mann-Whitney U tests. RESULTS: There were no significant differences in physical activity levels between (i) Australian and Indian stroke survivors (step count mean difference 201 steps [-1375 to 974], LPA mean difference -24 min [-22 to 69], MVPA mean difference 2 min [-8 to 3]), and (ii) stroke survivors with and without lower limb impairments in either country. CONCLUSION: Stroke survivors were highly inactive in both countries. Despite differences in economic status, cultural influences and the built environment, the physical activity of stroke survivors in Australia and India did not differ. People with and without lower limb impairment also had similar physical activity levels.


Assuntos
Países em Desenvolvimento , Acidente Vascular Cerebral , Austrália , Países Desenvolvidos , Exercício Físico , Humanos , Sobreviventes
3.
Ann Indian Acad Neurol ; 24(2): 138-141, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34220054

RESUMO

The COVID19 pandemic in India is causing significant morbidity and disruptions of healthcare delivery. The rapidly escalating contagion is straining our public health system, which is already under pressure due to a shortage of infrastructure and inadequate workforce. Neuro rehabilitation services that are still in its infancy in our country have been significantly interrupted in the last six months. An expert group from Indian Federation of Neurorehabilitation (IFNR) have formulated the guidelines and consensus recommendations for Neurologists, Physiatrists, and Therapists managing neurological disabilities during COVID 19. The aim of this consensus paper is to sensitize the clinicians and therapists about maintaining the continuum of care and rehabilitation needs of Covid patients as well as non Covid patients with neurological disorders during the ongoing COVID 19 pandemic.

4.
Top Stroke Rehabil ; : 1-11, 2021 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-34180370

RESUMO

Background: Adherence to prescribed exercises is essential for home-based programs to be effective, but evidence for strategies to enhance exercise adherence in people with stroke is lacking.Objectives: To determine the effect of adherence strategies on the proportion of people with stroke who adhere to prescribed home-based exercises and their level of adherence at 6 and 12 weeks of intervention. Our secondary objective was to determine the effect of the combined intervention on mobility and quality of life post-stroke.Methods: We conducted an RCT among people with stroke (Exp = 27, Con = 25) living in semi-urban India. Both groups received standard hospital care and a home exercise program. The experimental group also received adherence strategies delivered over five sessions. Adherence was measured using the Stroke-Specific Measure of Adherence to Home-based Exercises (SS-MAHE) , mobility using Mobility Disability Scale, and quality of life using the Stroke Impact Scale.Results: The experimental group had better exercise adherence compared to the control group both at six (mean difference [MD] 45, 95% CI 40, 64, p < .001) and 12 weeks (MD 51, 95% CI 39, 63, p < .001). The experimental group also had better mobility at 12 weeks (median (IQR), experimental 42 (57), median (IQR), control 95 (50), p = .002). There was no difference in the quality of life scores between groups at six or 12 weeks.Conclusion: The adherence strategies were effective in improving exercise adherence and mobility post-stroke but did not improve quality of life.Trial registration: CTRI/2018/08/015212.

5.
Artigo em Inglês | MEDLINE | ID: mdl-34001840

RESUMO

OBJECTIVE: This study examines the effect of core stability exercises on trunk control, core muscle strength, standing weight-bearing symmetry and balance confidence of people with chronic stroke. DESIGN: This was an assessor-blinded randomized controlled trial involving 84 ambulatory patients with middle cerebral artery stroke, randomly assigned to three training groups. Two experimental groups practiced core stability exercises either on stable or unstable support surfaces. In contrast, the control group received standard physiotherapy. All the participants an hour-long training session a day, thrice a week over a six-week duration, and followed-up after 12 months. Trunk Impairment Scale, core muscle strength, weight-bearing asymmetry in standing and Activities-specific Balance Confidence scale were the outcome measures. RESULTS: Compared to the control group, the two experimental groups demonstrated a significant improvement on all the outcome measures from baseline to post-training and from baseline to 12-month follow-up (P < 0.001). The two experimental groups demonstrated no significant difference between them on all the measures (P > 0.05). CONCLUSION: Core stability exercises on stable and unstable support surfaces are equally beneficial in improving trunk control, core muscle strength, standing weight-bearing symmetry and balance confidence of ambulatory patients with chronic stroke than the standard physiotherapy.

6.
NeuroRehabilitation ; 48(4): 505-512, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33967067

RESUMO

BACKGROUND: Independent mobility is the most important determinant of quality of life after stroke and it is vital that training aimed at restoration of gait is based on contemporary evidence. Despite several practice guidelines for gait rehabilitation after stroke existing globally, their feasibility of application in low-resource settings is often questionable. OBJECTIVE: To investigate the current practices in gait training among Indian physiotherapists involved in the rehabilitation of stroke survivors. METHODS: A questionnaire on the various aspects of gait training was developed and the content was validated by experts. The survey was made available online and distributed among Indian physiotherapists working in the field of stroke rehabilitation, using snowball sampling. Frequency distribution was used to summarize responses to each component of the questionnaire. RESULTS: Responses were obtained from 250 practicing physiotherapists. The majority of the respondents (55%) reported that they initiate gait training within seven days after stroke. Gait training sessions ranged from 15-30 minutes (55%), once every day (44%), and the majority (89%) reported use of subjective outcome measures to evaluate gait. Although most respondents agreed on the use of assistive aids, 24% indicated that their use may deter gait, rather than improve it. Nearly 86% of the respondents reported that they do not follow standard guidelines pertaining to gait rehabilitation for stroke survivors. CONCLUSION: The findings of the study point toward a lack of evidence-based practice among Indian physiotherapists while training gait after stroke. This implied the urgent need for development and implementation of country specific guidelines for stroke rehabilitation.


Assuntos
Atitude do Pessoal de Saúde , Custos e Análise de Custo , Prática Clínica Baseada em Evidências/métodos , Terapia por Exercício/métodos , Marcha , Reabilitação do Acidente Vascular Cerebral/métodos , Prática Clínica Baseada em Evidências/economia , Terapia por Exercício/economia , Humanos , Índia , Fisioterapeutas/psicologia , Qualidade de Vida , Reabilitação do Acidente Vascular Cerebral/economia , Inquéritos e Questionários
7.
J Neuroeng Rehabil ; 18(1): 81, 2021 05 13.
Artigo em Inglês | MEDLINE | ID: mdl-33985543

RESUMO

BACKGROUND: Hemiparesis following stroke is often accompanied by spasticity. Spasticity is one factor among the multiple components of the upper motor neuron syndrome that contributes to movement impairment. However, the specific contribution of spasticity is difficult to isolate and quantify. We propose a new method of quantification and evaluation of the impact of spasticity on the quality of movement following stroke. METHODS: Spasticity was assessed using the Tonic Stretch Reflex Threshold (TSRT). TSRT was analyzed in relation to stochastic models of motion to quantify the deviation of the hemiparetic upper limb motion from the normal motion patterns during a reaching task. Specifically, we assessed the impact of spasticity in the elbow flexors on reaching motion patterns using two distinct measures of the 'distance' between pathological and normal movement, (a) the bidirectional Kullback-Liebler divergence (BKLD) and (b) Hellinger's distance (HD). These measures differ in their sensitivity to different confounding variables. Motor impairment was assessed clinically by the Fugl-Meyer assessment scale for the upper extremity (FMA-UE). Forty-two first-event stroke patients in the subacute phase and 13 healthy controls of similar age participated in the study. Elbow motion was analyzed in the context of repeated reach-to-grasp movements towards four differently located targets. Log-BKLD and HD along with movement time, final elbow extension angle, mean elbow velocity, peak elbow velocity, and the number of velocity peaks of the elbow motion were computed. RESULTS: Upper limb kinematics in patients with lower FMA-UE scores (greater impairment) showed greater deviation from normality when the distance between impaired and normal elbow motion was analyzed either with the BKLD or HD measures. The severity of spasticity, reflected by the TSRT, was related to the distance between impaired and normal elbow motion analyzed with either distance measure. Mean elbow velocity differed between targets, however HD was not sensitive to target location. This may point at effects of spasticity on motion quality that go beyond effects on velocity. CONCLUSIONS: The two methods for analyzing pathological movement post-stroke provide new options for studying the relationship between spasticity and movement quality under different spatiotemporal constraints.


Assuntos
Atividade Motora/fisiologia , Espasticidade Muscular/fisiopatologia , Exame Neurológico/métodos , Acidente Vascular Cerebral/complicações , Adulto , Idoso , Fenômenos Biomecânicos , Articulação do Cotovelo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Movimento/fisiologia , Espasticidade Muscular/etiologia , Paresia/etiologia , Reflexo de Estiramento/fisiologia , Extremidade Superior
8.
Clin Neurophysiol ; 132(6): 1226-1233, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33867256

RESUMO

OBJECTIVE: To determine inter-rater reliability, minimal detectable change and responsiveness of Tonic Stretch Reflex Threshold (TSRT) as a quantitative measure of elbow flexor spasticity. METHODS: Elbow flexor spasticity was assessed in 55 patients with sub-acute stroke by determining TSRT, the angle of spasticity onset at rest (velocity = 0°/s). Elbow flexor muscles were stretched 20 times at different velocities. Dynamic stretch-reflex thresholds, the elbow angles corresponding to the onset of elbow flexor EMG at each velocity, were used for TSRT calculation. Spasticity was also measured with the Modified Ashworth Scale (MAS). In a sub-group of 44 subjects, TSRT and MAS were measured before and after two weeks of an upper-limb intervention. RESULTS: The intraclass correlation coefficient was 0.65 and the 95% minimal detectable change was 32.4°. In the treated sub-group, TSRT, but not MAS significantly changed. TSRT effect size and standardized response mean were 0.40 and 0.35, respectively. Detection of clinically meaningful improvements in upper-limb motor impairment by TSRT change scores ranged from poor to excellent. CONCLUSIONS: Evaluation of stroke-related elbow flexor spasticity by TSRT has good inter-rater reliability. Test responsiveness is low, but better than that of the MAS. SIGNIFICANCE: TSRT may be used to complement current scales of spasticity quantification.


Assuntos
Cotovelo/fisiopatologia , Espasticidade Muscular/diagnóstico , Reflexo de Estiramento/fisiologia , Acidente Vascular Cerebral/complicações , Adulto , Idoso , Eletromiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Espasticidade Muscular/etiologia , Espasticidade Muscular/fisiopatologia , Músculo Esquelético/fisiopatologia , Reprodutibilidade dos Testes , Acidente Vascular Cerebral/fisiopatologia
9.
Disabil Rehabil ; : 1-8, 2021 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-33849357

RESUMO

PURPOSE: The context of implementation plays an important role in the delivery of optimal treatments in stroke recovery and rehabilitation. Considering that stroke systems of care vary widely across the globe, the goal of the present paper is to compare healthcare providers' priority of key areas in translating stroke research to clinical practice among High Income Countries, Upper Middle- and Lower Middle-Income Countries (HICs, UMICs, LMICs). We also aimed to compare perceptions regarding the key areas' feasibility of implementation, and formulate recommendations specific to each socioeconomic region. METHODS: Data related to recommendations for knowledge translation in stroke, from a primary survey from the second Stroke Recovery and Rehabilitation Roundtable were segregated based on socioeconomic region. Frequency distribution was used to compare the key areas for practice change and examine the perceived feasibility of implementation of the same across HIC, UMIC and LMICs. RESULTS: A total of 632 responses from healthcare providers across 28 countries were received. Interdisciplinary care and access to services were high priorities across the three groups. Transitions in Care and Intensity of Practice were high priority areas in HICs, whereas Clinical Practice Guidelines were a high priority in LMICs. Interventions specific to clinical discipline, screening and assessment were among the most feasible areas in HICs, whereas Intensity of practice and Clinical Practice Guidelines were perceived as most feasible to implement in LMICs. CONCLUSION: We have identified healthcare providers' priorities for addressing international practice change across socioeconomic regions. By focusing on the most feasible key areas, we can aid the channeling of appropriate resources to bridge the disparities in stroke outcomes across HICs, UMICs and LMICs.IMPLICATIONS FOR REHABILITATIONIt is pertinent to examine the differences in priorities of stroke rehabilitation professionals and the feasibility of implementing evidence-based practice across socioeconomic regions.There is an urgent necessity for the development of clinical practice guidelines for stroke rehabilitation in Low-Middle Income Countries, taking into consideration the cultural, economic and geographical constraints.In upper-middle income countries, encouraging family support and timely screening and assessment for aphasia, cognition and depression appear to be the low hanging fruits to enhance quality of life after stroke.Innovative ways to increase intensity of practice and channelling of resources to improve transitions in care may prove to be the most beneficial in advancing stroke rehabilitation in high income countries.

10.
Gait Posture ; 83: 132-140, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33137637

RESUMO

BACKGROUND: Gait is considered to be the most important determinant of functional independence in activities of daily living. The challenges faced by stroke survivors in India differ from the western population due to economic, cultural, and geographical factors and this, in turn, may influence the choice of intervention. Hence, there is a need to understand the current gait training trends for stroke survivors in low resource settings like India. RESEARCH QUESTION: To systematically review the literature on interventional strategies for improving gait among stroke survivors in India. METHODS: Six databases were searched to identify RCTs delivering gait training to stroke survivors having some gait deficits in terms of speed or any other kinematic parameters. Studies of the English language from India were included. Two independent reviewers screened, extracted data, and assessed the study quality. A descriptive synthesis was undertaken and the data was summarized. RESULTS: Of 2112 potentially relevant articles, 12 studies with a total of 412 participants were included after title, abstract and full-text screening. Studies tested the efficacy of interventions such as mirror therapy, motor imagery, transcutaneous electrical nerve stimulation, strengthening, and task-based training. The outcome measures were kinematic gait-analysis, gait velocity, Functional Ambulation Categories, Timed Up and Go, Fugl-Meyer Assessment. From the results of this review, active task-based gait training and strengthening along with motor priming seems to be the most tested interventions. Future studies may need to design interventions targeting both impairment and function to bring about maximum improvement in gait after stroke. SIGNIFICANCE: Reviews addressing gait practices in developing countries for people with stroke are scarce. The present review would assist physiotherapists in developing countries to utilize evidence-based criteria for the selection of gait training approaches post-stroke. Due to the environmental and contextual demands, the effect of interventions for recovery among stroke survivors should be improvised in low resource settings. This review can be a source of recommendation in giving effective strategies for clinical practice.


Assuntos
Atividades Cotidianas/psicologia , Marcha/fisiologia , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/fisiopatologia , Humanos
12.
Complement Ther Clin Pract ; 39: 101110, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32379645

RESUMO

BACKGROUND: The evidence on aquatic therapy (AT) for improving balance and gait deficits post-stroke is unclear. Therefore, this study aimed to determine the effect of AT on balance and gait in stroke survivors. METHODS: We searched CINAHL, PubMed, Web of Science, Aqua4balance, Ewac, Cochrane, and EMBASE databases from inception to 1st November 2019. RESULTS: Eleven studies with 455 participants were included for the review. Meta-analysis showed that AT was effective for improving balance (MD 3.23, 95% CI 1.06, 5.39; p = 0.004; I2 = 61%) and gait speed (MD 0.77, 95% CI 0.25, 1.29; p = 0.004; I2 = 0%) when delivered alone. AT was effective in improving cadence (MD 4.41, 95% CI 0.82, 8.00; p = 0.02; I2 = 68%) when delivered as an adjunct to land-based therapy. CONCLUSION: AT may be used to improve balance and gait after stroke; however, the evidence to support its use is still low.


Assuntos
Terapia por Exercício/métodos , Marcha/fisiologia , Hidroterapia/métodos , Equilíbrio Postural/fisiologia , Reabilitação do Acidente Vascular Cerebral/métodos , Humanos
13.
Disabil Rehabil Assist Technol ; : 1-7, 2020 May 18.
Artigo em Inglês | MEDLINE | ID: mdl-32421460

RESUMO

Purpose: Motor recovery of the upper limb (UL) is related to exercise intensity, defined as movement repetitions divided by minutes in active therapy, and task difficulty. However, the degree to which UL training in virtual reality (VR) applications deliver intense and challenging exercise and whether these factors are considered in different centres for people with different sensorimotor impairment levels is not evidenced. We determined if (1) a VR programme can deliver high UL exercise intensity in people with sub-acute stroke across different environments and (2) exercise intensity and difficulty differed among patients with different levels of UL sensorimotor impairment.Methods: Participants with sub-acute stroke (<6 months) with Fugl-Meyer scores ranging from 14 to 57, completed 10 ∼ 50-min UL training sessions using three unilateral and one bilateral VR activity over 2 weeks in centres located in three countries. Training time, number of movement repetitions, and success rates were extracted from game activity logs. Exercise intensity was calculated for each participant, related to UL impairment, and compared between centres.Results: Exercise intensity was high and was progressed similarly in all centres. Participants had most difficulty with bilateral and lateral reaching activities. Exercise intensity was not, while success rate of only one unilateral activity was related to UL severity.Conclusion: The level of intensity attained with this VR exercise programme was higher than that reported in current stroke therapy practice. Although progression through different activity levels was similar between centres, clearer guidelines for exercise progression should be provided by the VR application.Implications for rehabilitationVR rehabilitation systems can be used to deliver intensive exercise programmes.VR rehabilitation systems need to be designed with measurable progressions through difficulty levels.

14.
Braz J Phys Ther ; 24(1): 61-68, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-30501938

RESUMO

OBJECTIVE: To explore the personal and environmental contextual factors that influence use of affected arm for function among stroke survivors. METHODS: We conducted a qualitative phenomenological study using an interpretivist paradigm among 23 stroke survivors in their late sub-acute and chronic stages and their relatives living in the rural regions of India using maximum variation sampling. Semi-structured interviews were conducted to identify personal and environmental contextual factors relevant to arm use. Their current level of arm use, motor and functional ability were evaluated using Motor Activity Log, AbilHand and Lawton Instrumental Activities of Daily Living scales and the scores were categorized in order to describe and compare the participant's characteristics before analyzing each interview. Differences among the contextual factors of participants with high and low levels of functional arm use and exercise using paretic limb were analyzed using qualitative content analysis. RESULTS: Study participants followed active exercises or passive interventions to improve their arm. Their immediate social environment influenced these decisions. Lack of awareness on how to self-engage or scale down their physical environment to match their abilities demoted active functional task performance. Ability to perceive small gains in arm function helped them sustain their efforts. CONCLUSION: Context influences arm use. Addressing contextual determinants influencing arm use such as facilitating understanding about the need for active functional task engagement; identifying and addressing factors moderating motivation to sustain functional task practice and enriching objects to match their movement abilities can increase arm use and promote upper limb recovery.


Assuntos
Paresia/fisiopatologia , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/fisiopatologia , Atividades Cotidianas , Exercício Físico , Humanos , Vida Independente , Índia , Motivação , Movimento , Sobreviventes , Análise e Desempenho de Tarefas , Extremidade Superior/fisiologia
15.
BMJ Open ; 9(9): e023963, 2019 09 17.
Artigo em Inglês | MEDLINE | ID: mdl-31530586

RESUMO

INTRODUCTION: After a stroke, 55% of survivors do not regain the ability to completely use their arm in daily life functioning. Currently, evidence-based guidelines recommend functional training for improving the affected hand after stroke. However, promoting an optimal quantity and quality of functional training is influenced by personal and environmental contextual factors. Studies that comprehensively target multiple factors regulating arm use are limited. This study compares the effects of functional training to multifactorial context-enhancing functional training program for improving functional arm use and recovery after stroke. METHODS AND ANALYSIS: This is a protocol for an observer-blinded, two parallel groups, randomised controlled trial. A total of 126 community-dwelling subacute and chronic stroke survivors will be included in the study. A tailor-made multifactorial context-enhancing intervention-incorporating education, environmental enrichment and behaviour change techniques to reinforce functional training will be provided to the experimental group. The functional training group will be provided with functional exercises. The intervention will be delivered for 2 months. The primary outcomes of functional arm use and recovery will be measured using Motor Activity Log, Goal Attainment Scale and Rating of Everyday Arm-use in the Community and Home scale. The secondary outcomes of arm motor impairment and function will be measured using Fugl-Meyer upper limb score, Action Research Arm Test, ABILHAND questionnaire and Stroke Impact Scale. These will be measured at three points in time: before, after 2 months and after 1-month follow-up. The outcome measures will be analysed using one-way analysis of variance and regression analysis will be performed to identify factors limiting optimal task practice. ETHICS AND DISSEMINATION: The study has been approved by the Institutional Ethics Committee of Kasturba Hospital, Manipal, India. Participants will sign a written informed consent prior to participation. The results will be published on completion of the trial and communicated to community-dwelling stroke survivors. TRIAL REGISTRATION NUMBER: CTRI/2017/10/010108.


Assuntos
Terapia por Exercício/normas , Paresia/reabilitação , Reabilitação do Acidente Vascular Cerebral/normas , Acidente Vascular Cerebral/terapia , Extremidade Superior/fisiopatologia , Atividades Cotidianas , Método Duplo-Cego , Feminino , Humanos , Masculino , Estudos Observacionais como Assunto , Paresia/etiologia , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Recuperação de Função Fisiológica , Acidente Vascular Cerebral/complicações , Sobreviventes
16.
Int J Telemed Appl ; 2019: 5903106, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31186627

RESUMO

Background: Stroke is a leading cause of disability and requires continued care after hospital discharge. Mobile-based interventions are suitable to reduce the cost of stroke rehabilitation and facilitate self-management among stroke survivors. However, before attempting to use mobile-based home exercise program, it is crucial to recognize the readiness of stroke survivors and their caregivers to opt for such interventions. Objective: To assess the acceptability and attitude towards a mobile-based home exercise program among stroke survivors and their primary caregivers. Methods: A cross-sectional study was conducted among 102 participants to understand their attitude and acceptability towards mobile-based home exercise program. A validated 10-item questionnaire was adapted for the study. The questions which assessed the attitude were rated on a three-point Likert scale, with three denoting agree and one denoting disagree. The acceptability was assessed by their willingness to opt for a mobile-based home program services. A Chi-square analysis and cross-tabulation were performed to test differences between caregivers and patients. A logistic regression was performed to determine the effects of age, gender, and mobile phone on acceptability. Results: Ninety-two percent of caregivers and 90% of patients showed willingness to opt for mobile-based intervention. Majority of the participants showed a positive attitude towards this mode of treatment. There was no difference in the attitude noted among caregivers and patients (p>0.05) towards mobile-based intervention. Conclusion: The stroke survivors and caregivers welcomed the concept of mobile-based home exercise program even in a low-resource settings, but further studies to understand treatment and cost-effectiveness of this technology among the stroke survivors would lead to better implementation.

17.
Int J Stroke ; 14(5): 457-459, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30975042

RESUMO

There is an urgent need to improve life after stroke across the world-especially in low-income countries-through methods that are effective, equitable and sustainable. This paper highlights physical activity (PA) as a prime candidate for implementation. PA reduces modifiable risk factors for first and recurrent stroke and improves function and activity during rehabilitation and following discharge. Preliminary evidence also indicates PA is cost-effective. This compelling evidence urgently needs to be translated into seamless pathways to enable stroke survivors across the world to engage in a more active lifestyle. Although more quality research is needed-particularly on how to optimize uptake and maintenance of PA-this should not delay implementation of high-quality evidence already available. This paper shares examples of best practice service models from low-, middle-, and high-income countries around the world. The authors call for a concerted effort to implement high-quality PA services to improve life after stroke for all.


Assuntos
Prática Clínica Baseada em Evidências/métodos , Exercício Físico , Internacionalidade , Qualidade de Vida , Reabilitação do Acidente Vascular Cerebral/métodos , Humanos
18.
Int J Stroke ; 14(4): 337-339, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30806591

RESUMO

Clinical practice guidelines are essential for driving evidence-based clinical care to patients. In an era of ever-increasing research evidence, keeping guidelines up to date is a challenging and resource-intensive process. Advances in technological platforms provide opportunities to develop new models of guideline development that will allow for continuous, rapid updates to recommendations as new evidence emerges. As Australia and other countries begin to develop these models, we have an opportunity to work more closely together to ensure the most efficient use of resources.


Assuntos
Programas Governamentais , Acidente Vascular Cerebral/epidemiologia , Austrália/epidemiologia , Tomada de Decisão Clínica , Medicina Baseada em Evidências , Humanos , Guias de Prática Clínica como Assunto , Pesquisa Médica Translacional
19.
Neurorehabil Neural Repair ; 33(2): 141-152, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30744528

RESUMO

BACKGROUND: Spasticity is common in patients with stroke, yet current quantification methods are insufficient for determining the relationship between spasticity and voluntary movement deficits. This is partly a result of the effects of spasticity on spatiotemporal characteristics of movement and the variability of voluntary movement. These can be captured by Gaussian mixture models (GMMs). OBJECTIVES: To determine the influence of spasticity on upper-limb voluntary motion, as assessed by the bidirectional Kullback-Liebler divergence (BKLD) between motion GMMs. METHODS: A total of 16 individuals with subacute stroke and 13 healthy aged-equivalent controls reached to grasp 4 targets (near-center, contralateral, far-center, and ipsilateral). Two-dimensional GMMs (angle and time) were estimated for elbow extension motion. BKLD was computed for each individual and target, within the control group and between the control and stroke groups. Movement time, final elbow angle, average elbow velocity, and velocity smoothness were computed. RESULTS: Between-group BKLDs were much larger than within control-group BKLDs. Between-group BKLDs for the near-center target were lower than those for the far-center and contralateral targets, but similar to that for the ipsilateral target. For those with stroke, the final angle was lower for the near-center target, and the average velocity was higher. Velocity smoothness was lower for the near-center than for the ipsilateral target. Elbow flexor and extensor passive muscle resistance (Modified Ashworth Scale) strongly explained BKLD values. CONCLUSIONS: Results support the view that individuals with poststroke spasticity have a velocity-dependent reduction in active elbow joint range and that BKLD can be used as an objective measure of the effects of spasticity on reaching kinematics.


Assuntos
Modelos Teóricos , Transtornos dos Movimentos , Espasticidade Muscular , Acidente Vascular Cerebral , Extremidade Superior , Adulto , Idoso , Fenômenos Biomecânicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos dos Movimentos/etiologia , Transtornos dos Movimentos/fisiopatologia , Espasticidade Muscular/etiologia , Espasticidade Muscular/fisiopatologia , Análise Espaço-Temporal , Processos Estocásticos , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/fisiopatologia , Extremidade Superior/fisiopatologia
20.
Arch Phys Med Rehabil ; 100(4): 751-768, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30452892

RESUMO

OBJECTIVES: (1) To determine the effect of transcutaneous electrical nerve stimulation (TENS) on poststroke spasticity. (2) To determine the effect of different parameters (intensity, frequency, duration) of TENS on spasticity reduction in adults with stroke. (3) To determine the influence of time since stroke on the effectiveness of TENS on spasticity. DATA SOURCES: PubMed, PEDro, CINAHL, Web of Science, CENTRAL, and EMBASE databases were searched from inception to March 2017. STUDY SELECTION: Randomized controlled trial (RCT), quasi-RCT, and non-RCT were included if (1) they evaluated the effects of TENS for the management of spasticity in participants with acute or subacute or chronic stroke using clinical and neurophysiological tools; and (2) TENS was delivered either alone or as an adjunct to other treatments. DATA EXTRACTION: Two authors independently screened and extracted data from 15 of the 829 studies retrieved through the search using a pilot tested pro forma. Disagreements were resolved through discussion with other authors. Quality of studies was assessed using Cochrane risk of bias criteria. DATA SYNTHESIS: Meta-analysis was performed using a random-effects model that showed (1) TENS along with other physical therapy treatments was more effective in reducing spasticity in the lower limbs compared to placebo TENS (SMD -0.64; 95% confidence interval [95% CI], -0.98 to -0.31; P=.0001; I2=17%); and (2) TENS, when administered along with other physical therapy treatments, was effective in reducing spasticity when compared to other physical therapy interventions alone (SMD -0.83; 95% CI, -1.51 to -0.15; P=.02; I2=27%). There were limited studies to evaluate the effectiveness of TENS for upper limb spasticity. CONCLUSION: There is strong evidence that TENS as an adjunct is effective in reducing lower limb spasticity when applied for more than 30 minutes over nerve or muscle belly in chronic stroke survivors (review protocol registered at PROSPERO: CRD42015020151).


Assuntos
Espasticidade Muscular/reabilitação , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/complicações , Estimulação Elétrica Nervosa Transcutânea/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Espasticidade Muscular/etiologia , Resultado do Tratamento
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