1,721,104 research outputs found
Investigating the internal validity of the Trunk Impairment Scale (TIS) using Rasch analysis: the TIS 2.0
No full textTrunk impairment after stroke. Development of a clinical tool to predict functional outcome and determine recovery patterns
No full textThis study focussed on three major issues: (1) can we develop a clinical tool to measure trunk performance which takes into account the assessment of selective trunk movements, evaluation of quality of trunk movement and is a valid instrument for measuring rehabilitation outcome? (2) What is the importance of trunk function in relation to motor and functional recovery after stroke? And (3) what is the pattern of recovery of the trunk and is it comparable to the pattern of recovery of arm, leg and functional activity after stroke?<br/
Validity of the trunk impairment scale as a measure of trunk performance in people with Parkinson’s disease
No full textOBJECTIVE: To evaluate construct validity of the Trunk Impairment Scale (TIS) as a measure of trunk performance in Parkinson's disease (PD). DESIGN: A cross-sectional study of PD patients and healthy subjects. SETTING: University rehabilitation research unit. PARTICIPANTS: Twenty-six PD patients (Hoehn and Yahr stages 2-4) and 26 healthy subjects. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The TIS and its subscales; static and dynamic sitting balance and trunk coordination. RESULTS: Compared with healthy controls, PD patients showed significantly lower scores on the total TIS, static sitting balance, and coordination subscale. Healthy subjects scored significantly better on the total TIS and coordination subscale compared with patients in the early stage of PD. Patients with PD in the early stage scored significantly higher for the total TIS as well as static and dynamic sitting balance in comparison with PD patients in a later stage. Forward stepwise multiple linear regression analysis showed that trunk impairment in PD patients was significantly related to a combination of older age and a higher score on part III of the Unified Parkinson's Disease Rating Scale, which assesses motor impairments. CONCLUSIONS: Early detection of trunk deficits and the significant relation with PD severity advocates further evaluation and use of the TIS in PD
A narrative review of turning deficits in people with Parkinson’s disease
No full textPurpose: Clinically, people with Parkinson’s disease (PD) demonstrate a loss of axial rotation of the spine often described as moving “enbloc”, with little dissociation between the head, trunk and lower limbs whilst turning. The purpose of this narrative review is to explore the behaviour and relationship of the reported deficits during whole body turning in people with PD, compared to controls. Better understanding of the relationship and impact of the deficits will permit the development of tailored and novel intervention strategies to improve functional performance in turning for people with PD. Methods: Four electronic databases with the search terms: Parkinson* and turn* were used. Results: Seventy-seven papers were reviewed. Turning deficits in people with PD were identified as originating from two hypothetical body segments – perpendicular (i.e. legs) or axial (i.e. head, trunk and pelvis) segments and the relationship between them discussed. Conclusion: Specific movement deficits in turning in people with PD can be categorised into axial and perpendicular deficits. Synthesis of the literature suggests the possibility of axial deficits driving secondary responses in the perpendicular segments. This should be explored when designing rehabilitation aimed at improving turning performance, as current therapy guidelines focus on exercises emphasising perpendicular aspects
Additional exercises improve trunk performance after stroke: an assessor-blinded randomised controlled trial
No full textSequence of onset latency of body segments when turning on-the-spot in people with stroke
No full textBackgroundTurning around is a common activity of daily living. The location of a target may be known or unknown while angle and direction may vary prior to turning. A stroke can compromise coordination of body movement during turning.ObjectivesTo investigate the effect of target predictability, turn angle and turn direction on the kinematic sequence of rotation of body segments in people with stroke and healthy controls when turning on-the-spot.MethodsTen people with stroke (age: 66 ± 10 years; 8 males) and 10 age-matched controls (age: 65 ± 8 years; 6 males) were asked to either turn to a specific light (predictable condition) or locate and turn to a random light (unpredictable condition) placed at 45°, 90° or 135° to the right or left when a light in front extinguished.ResultsPeople with stroke initiated movement of the segments significantly later than the controls (p = 0.014). The sequence of onset of rotation of the segments was not different between both groups. Target predictability affected the sequence of the segments; the eyes, head and shoulder started moving simultaneously when turning to unpredictable targets while the head and shoulder started moving before the eyes when turning to predictable targets. The sequence was also different across the three turn angles for each predictability condition. However, the sequence remained the same when turning to both sides in each group.Conclusion Similarities between the groups may be because the time since the stroke was long and therefore some recovery of function may have occurred. Slowness of movement in people with stroke may predispose them to falls.<br/
Dance for Parkinson’s—The effects on whole body co-ordination during turning around
No full textObjectiveTo investigate the effects of ballroom and Latin American dancing classes on turning in people with Parkinson’s.DesignThis study employed a randomised, controlled, experimental design.SettingDance classes were performed in a community dance centre in Southern England and all assessments took place a gait laboratory.ParticipantsTwenty-seven people with mild-moderate Parkinson’s participated.InterventionParticipants were randomly allocated to receive either 20, 1-h dancing classes over 10 weeks (n = 15), or a ‘usual care’ control group (n = 12).Main outcome measureTwelve, 180° on-the-spot turns to the predicted/un-predicted and preferred/un-preferred direction were analysed for each participant, using 3-dimensional motion analysis before and after the intervention period, alongside clinical measures.ResultsMovement of the head, pelvis, and feet during turning in people with Parkinson’s are affected by dancing with tighter coupling of body segments. Significant 4-way interactions between the groups, over time and turn style, with longer latency of the head (p = 0.008) and greater rotation in the pelvis (p = 0.036), alongside a trend of slower movement of the first (p = 0.063) and second (p = 0.081) foot in controls were shown, with minimal change in dancers. All interactions were affected by the type of turn. No significant differences were found in the centre of mass displacement, turn time or clinical measures.ConclusionThose who danced were better able to coordinate their axial and perpendicular segments and surprisingly became more ‘en bloc’ in their turning behaviour, suggesting this may be a beneficial adaptation, rather than a maladaptive result of Parkinson’s, as previously suggested.<br/
Instrumented Trunk Impairment Scale (iTIS): a reliable measure of trunk impairment in the stroke population
No full textBackground: the Trunk Impairment Scale (TIS) is recommended for use in clinical research to assess trunk impairment post-stroke. However, it is observer dependent and does not consider the quality of trunk movement. To address these challenges, this study proposes an instrumented TIS (iTIS).Objective: this study aims to investigate the intra-rater and inter-rater reliability of the iTIS in chronic stroke patients.Method: trunk impairment was assessed in 20 patients with stroke using the iTIS Valedo system; three sensors were fixed to the skin on the sternum, L1 and S1 levels. Interclass correlation coefficients were used to assess the inter-rater and intra-rater reliability (between days) with 95% CI.Results: reliability for the dynamic subscale parameters was good to excellent (intra-rater ICC = 0.60–0.95; inter-rater ICC = 0.59–0.93); however, reliability for the coordination parameters was poor to good (intra-rater ICC = 0.05–0.72) and poor to excellent (inter-rater ICC = 0.04–0.78).Conclusion: the iTIS demonstrates an acceptable level of reliability for dynamic subscale measurement in research and clinical practice. Further studies could use larger sample sizes and improve the iTIS methodology by employing additional sensors on the limbs to detect compensatory movements.<br/
Clinical tools to measure trunk performance after stroke: a systematic review of the literature
No full textObjective : To give a systematic review of clinical measurement scales used to assess trunk performance after stroke.Data sources : The databases CINAHL, Cochrane, Pedro and PubMed were searched with the terms 'sitting balance' plus 'stroke' and `trunk' plus 'stroke' mentioned in the title or abstract. Databases were searched from inception to January 2006.Review methods : All articles were selected which reported or included a clinical measure of trunk performance used in an adult stroke population. Reference lists were searched as secondary sources of articles.Results : A total of 458 articles resulted from the database search. Thirty-two articles were eligible for inclusion. Earlier studies mentioned ordinal single items or a combination of items which are part of a larger scale used to assess sitting balance as a derived measure of trunk performance. Three clinical tools were available which specifically evaluated trunk performance after stroke; the Trunk Control Test and two Trunk Impairment Scales.Conclusion : Ordinal single items or subscales of existing larger scales lack a systematic evaluation of psychometric characteristics. Both Trunk Impairment Scales have been extensively examined. A comparative study assessing psychometric properties of the Trunk Control Test and two Trunk Impairment Scales could determine which should be the measure of choice when assessing trunk performance after stroke
TMS Summer School, Oxford UK
No full textIntroduction: About 65 percent of stroke survivors cannot involve their affected upper limb (UL) into their activities of daily living (Bruce & Dobkin 2005). Robot Therapy (RT) is one technique that can increase the intensity of rehabilitation and evidence shows that robot-assisted arm training results in reduction of UL motor impairments (Lo et al. 2010). Recently, RT has also been combined with a non-invasive method of brain stimulation, transcranial Direct Current Stimulation (tDCS) (Hesse et al. 2011). When comparing real to sham tDCS in addition with RT, non- significant differences in UL motor recovery of people with sub-acute stroke were demonstrated. A possible reason for this was that the robot used in the study was a one-dimensional wrist robot which did not allow the impaired UL to move in different dimensions. Thus, the main objective of this research is to explore whether combining tDCS with unilateral three-dimensional robot therapy for people with stroke leads to better outcomes in impairment, function and corticospinal neurophysiology measures than robot therapy alone.Methods: A systematic literature review was conducted to investigate different methodologies used for applying tDCS and RT. The evidence was synthesized to generate the final protocol.Results: A pilot, double-blinded randomised controlled trial is underway using a three-dimensional Armeo® robot with tDCS. The trial involves two groups of participants with sub-acute stroke: 1) Armeo RT and real tDCS, and 2) Armeo RT and sham tDCS. Each participant will receive an intervention programme involving 18 sessions over 8 weeks. Each session will consist of twenty minutes of real or sham tDCS during 1 hour of RT. Clinical and neurophysiological measures using Transcranial Magnetic Stimulation will be utilised pre- and post- intervention and at the 3 month follow-up. Conclusions: Research into non-invasive brain stimulation and RT seems promising but to translate research findings into clinical stroke practice, further research is needed. This study will add to the body of knowledge of neurorehabilitation research
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