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1.
Clin Rehabil ; 26(8): 675-85, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22180445

RESUMO

OBJECTIVE: To investigate two approaches to treating patients with persistent dressing problems and cognitive difficulties following stroke. DESIGN: Pilot randomized controlled trial. SETTING: Inpatient stroke rehabilitation service. SUBJECTS: Seventy consecutive stroke patients with persistent dressing problems and accompanying cognitive difficulties at two weeks after their stroke. INTERVENTIONS: Patients were randomly allocated to six weeks of either a systematic neuropsychological approach, based on analysis of dressing problems and further cognitive testing, or to the control group who received conventional (functional) dressing practice. Both groups received treatment three times a week in accordance with two separately prepared manuals. MAIN MEASURES: Nottingham Stroke Dressing Assessment (NSDA), Line Cancellation, 10-hole peg transfer test, Object Decision, Gesture Imitation. Patients were assessed at six weeks after randomization by an independent assessor masked to group allocation. RESULTS: Both neuropsychological and functional groups improved performance on the NSDA over the treatment period (31% and 22%, respectively) but there was no significant difference between groups at six weeks. However, the neuropsychological group showed a significantly greater improvement on a line cancellation test of visual neglect (t(62) = 2.1, P < 0.05) and a planned subanalysis for those with right hemisphere damage showed a trend towards better dressing outcome (P = 0.07, one-tailed). CONCLUSIONS: Results demonstrate the potential benefits of a systematic neuropsychological approach to dressing therapy, particularly for patients with right hemisphere damage. This study suggests the need for a phase III study evaluating the efficacy of a systematic neuropsychological approach in treating dressing difficulties, targeting patients with right hemisphere stroke and visuospatial impairments.


Assuntos
Atividades Cotidianas , Reabilitação do Acidente Vascular Cerebral , Adulto , Idoso , Idoso de 80 Anos ou mais , Vestuário , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/reabilitação , Estudos de Viabilidade , Feminino , Humanos , Pacientes Internados , Masculino , Pessoa de Meia-Idade , Neuropsicologia , Projetos Piloto , Reabilitação/métodos , Acidente Vascular Cerebral/complicações
2.
Stroke ; 37(11): 2770-5, 2006 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-17008609

RESUMO

BACKGROUND AND PURPOSE: Virtual environments for use in stroke rehabilitation are in development, but there has been little evaluation of their suitability for this purpose. We evaluated a virtual environment developed for the rehabilitation of the task of making a hot drink. METHODS: Fifty stroke patients undergoing rehabilitation in a UK hospital stroke unit were involved. The performance of stroke rehabilitation patients when making a hot drink had the neurological impairments associated with performance of this task, and the errors observed were compared for standardized task performance in the real world and in a virtual environment. Neurological impairments were measured using standardized assessments. Errors in task performance were assessed rating video recordings and classified into error types. RESULTS: Real-world and virtual environment performance scores were not strongly associated (rho=0.30; P<0.05). Performance scores in both settings were associated with age, Barthel ADL score, Mini Mental State Examination score, and tests of visuospatial function. Real-world performance only was associated with arm function and sequencing ability. Virtual environment performance only was associated with language function and praxis. Participants made different errors during task performance in the real world and in the virtual environment. CONCLUSIONS: Although this virtual environment was usable by stroke rehabilitation patients, it posed a different rehabilitation challenge from the task it was intended to simulate, and so it might not be as effective as intended as a rehabilitation tool. Other virtual environments for stroke rehabilitation in development require similar evaluation.


Assuntos
Simulação por Computador/normas , Meio Ambiente , Reabilitação do Acidente Vascular Cerebral , Atividades Cotidianas , Idoso , Feminino , Humanos , Masculino , Estimulação Luminosa/métodos , Desempenho Psicomotor/fisiologia , Acidente Vascular Cerebral/fisiopatologia
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