A Community-Based Upper-Extremity Group Exercise Program Improves Motor Function and Performance of Functional Activities in Chronic Stroke: A Randomized Controlled Trial

Notice the same benefits as CIMT. Also notice the extreme incompetency of your stroke hospital doing nothing with this for 13 years. 

A Community-Based Upper-Extremity Group Exercise Program Improves Motor Function and Performance of Functional Activities in Chronic Stroke: A Randomized Controlled Trial

Archives of Physical Medicine and Rehabilitation

Volume 87, Issue 1, January 2006, Pages 1-9

Author links open overlay panelMarco Y.PangPhDJocelyn E.HarrisMScJanice J.EngPhD

https://doi.org/10.1016/j.apmr.2005.08.113Get rights and content

Abstract

Pang MY, Harris JE, Eng JJ. A community-based upper-extremity group exercise program improves motor function and performance of functional activities in chronic stroke: a randomized controlled trial.

Objective

To assess the effects of a community-based exercise program on motor recovery and functional abilities of the paretic upper extremity in persons with chronic stroke.

Design

Randomized controlled trial.

Setting

Rehabilitation research laboratory and a community hall.

Participants

A sample of 63 people (≥50y) with chronic deficits resulting from stroke (onset ≥1y).

Interventions

The arm group underwent an exercise program designed to improve upper-extremity function (1h/session, 3 sessions/wk for 19wk). The leg group underwent a lower-extremity exercise program.

Main Outcome Measures

The Wolf Motor Function Test (WMFT), Fugl-Meyer Assessment (FMA), hand-held dynamometry (grip strength), and the Motor Activity Log.

Results

Multivariate analysis showed a significant group by time interaction (Wilks λ=.726, P=.017), indicating that overall, the arm group had significantly more improvement than the leg group. Post hoc analysis demonstrated that gains in WMFT (functional ability) (P=.001) and FMA (P=.001) scores were significantly higher in the arm group. The amount of improvement was comparable to other novel treatment approaches such as constraint-induced movement therapy or robot-aided exercise training previously reported in chronic stroke. Participants with moderate arm impairment benefited more from the program.

Conclusions

The pilot study showed that a community-based exercise program can improve upper-extremity function in persons with chronic stroke. This outcome justifies a larger clinical trial to further assess efficacy and cost effectiveness.

 

A community-based group exercise program for persons with chronic stroke

Has your stroke hospital done ONE DAMN THING  to implement group exercises for survivors in the last 7 years? If not, everyone in the stroke hospital, including the board of directors needs to be fired. 

A community-based group exercise program for persons with chronic stroke

Med Sci Sports Exerc. Author manuscript; available in PMC 2012 Oct 15.

Published in final edited form as:

Med Sci Sports Exerc. 2003 Aug; 35(8): 1271–1278.

doi: 10.1249/01.MSS.0000079079.58477.0B

Janice J Eng, PhD, PT/OT, Professor,^1,2 Kelly S Chu, MSc,^1,2 C Maria Kim, MSc, PT,^1,2 Andrew S Dawson, MD, FRCP(c),³ Anne Carswell, PhD, OT,^1,2 and Katherine E Hepburn, BHK²

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The publisher's final edited version of this article is available at Med Sci Sports Exerc

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Abstract

PURPOSE

The purpose of this study was to evaluate the physical and psychosocial effects of an 8-week community-based functional exercise program in a group of individuals with chronic stroke.

METHODS

Twenty-five subjects (mean age 63 years) participated in a repeated measures design which evaluated the subjects with two baseline assessments one month apart, one post-intervention assessment, and one retention assessment one month post-intervention. Physical outcome measures assessed were the Berg Balance Test, 12 minute walk test distance, gait speed and stair climbing speed. Psychosocial measures assessed were the Reintegration to Normal Living Index (RNL) and Canadian Occupational Performance Measure (COPM). The 8-week training consisted of a 60 min, 3 times per week group program which focused on balance, mobility, functional strength and functional capacity. The program was designed to be accessible by reducing the need for costly one-on-one supervision, specialized settings and expensive equipment.

RESULTS

Improvements from the exercise program were found for all physical measures and these effects were retained one-month post-intervention. Subjects with lower function improved the most relative to their initial physical status. Significant effects were found for the COPM, but not the RNL Index, however, subjects with lower RNL improved the most relative to their initial RNL score.

CONCLUSION

A short-term community-based exercise program can improve and retain mobility, functional capacity and balance and result in a demonstrable impact upon the performance of activities and abilities that were considered meaningful to the subjects. Implementation of such community-based programs have potential for improving activity tolerance and reducing the risk for secondary complications common to stroke (e.g., falls resulting in fractures and cardiac events).

Keywords: cerebrovascular accident, physical activity, disability, function, walk

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INTRODUCTION

Over fifty thousand Canadians suffer from stroke each year making it the number one cause of neurological disability in Canada today (23) and a leading cause of disability in the community (19). Ninety percent of stroke survivors have some functional disability with mobility being the major impairment (21). Although some individuals with stroke will have received some rehabilitation during the acute and sub-acute phase, rarely does rehabilitation extend beyond one year post-injury due to the belief that functional recovery has plateaued by this time (42). Impairments resulting from stroke, such as muscle weakness, pain, spasticity and poor balance, in addition to the lack of accessible and appropriate community-based exercise programs can lead to reduced tolerance to activity, further sedentary lifestyle, and additional declines in function and disability status (32).

Activities which promote mobility and fitness are imperative for the prevention of further pathological events (e.g., falls resulting in fracture, recurrent strokes or cardiac events). Stroke is one of the top risk factors for incurring fractures as a result of a fall in older adults; Kanis et al. (24) analyzed 16.3 million hospitalizations due to fractures and reported a 7-fold hip fracture risk for individuals with stroke. In fact, the incidence of falls has been reported to be as high as 73% of individuals with stroke falling within six months following hospital discharge to home with an average of 3.4 falls per person during this six month time period (18). In addition, cardiovascular disease is the leading prospective cause of death in chronic stroke. Inactivity and low cardiovascular fitness, a major occurrence in persons with stroke, is one of the modifiable risk factors associated with cardiovascular disease.

In the past, intensive training in persons with stroke has been controversial due to the belief that strenuous activity would increase spasticity and reinforce abnormal movement (5). However, recent evaluation of intensive exercise programs has not found any evidence of an increase in spasticity (39).

Intensive treadmill protocols (30, 34, 37) are a recent addition to stroke rehabilitation and have resulted in improvements in gait and aerobic capacity, however, Smith et al. (38) found no significant improvements in reactive balance using an endurance treadmill protocol and suggested that functional or task-specific training may be needed to improve balance. Duncan et al. (14) also reported no significant improvements for the Berg Balance score using a randomized controlled home-based individual exercise program (strengthening and walking program). Functional balance may be difficult to improve due to the varied tasks and movements under which balance is required. The one exception was a non-controlled pilot study by Weiss et al. (43) which reported a 12% improvement in the Berg Balance Score for 7 individuals with stroke using a one-to-one high intensity strengthening program. However, Kim et al. (26) recently undertook a double-blind randomized controlled trial of strength training in chronic stroke found no carry-over into functional tasks and these authors emphasized the need for functional task-based practice.

Intensive rehabilitation programs for individuals with stroke have traditionally involved a one-to-one client-therapist ratio due to the close supervision required when challenging balance in these individuals, in addition to the necessary monitoring when taxing their cardiovascular function. However, given the current limited rehabilitation resources, it would be ideal to develop safe and effective community-based group exercise programs which are accessible to larger numbers of individuals. There is a clear and impressive void in the current literature which evaluates community-based group exercise programs for individuals with stroke and only three studies have examined such programs. Rimmer et al. (37) undertook an intensive 12-week community-based group training program (seven staff to 18 clients) which resulted in improvements in peak VO₂, strength, and back flexibility, but did not measure or train balance. A recent controlled pilot study which evaluated an 8-week circuit training program found improvements in walking speed, six minute walk distance, in addition to weight-bearing ability through the affected limb for the five experimental subjects (supervised by two physical therapists) compared to the four control subjects (12). Teixeira-Salmela et al. (39) found improvements in gait and stair climbing speed, in addition to muscle strength from a 10-week muscle strengthening and physical conditioning program for 13 individuals with stroke. No studies to date have assessed the effect of a community-based group exercise program on both balance and functional capacity in individuals with stroke, and in addition, the retention of these effects has never been evaluated.

The purpose of this study was to evaluate a community-based group exercise intervention on both balance and functional capacity, two functions which are severely compromised in persons with stroke and can lead to devastating secondary complications We evaluated the effects of an 8-week group exercise intervention on balance, walking ability and functional capacity and the retention of these effects one month post-intervention. Lastly, the psychosocial effects of exercise are infrequently evaluated in stroke, despite the well-documented high incidence of clinical depression in this population (4, 10) and the knowledge that exercise can have substantial benefits to one’s well-being (11, 25). Therefore, we also evaluated the effect of the exercise intervention on measures of health-related quality of life.

COMPARING MEMORY GROUP TRAINING AND COMPUTERIZED COGNITIVE TRAINING FOR IMPROVING MEMORY FUNCTION FOLLOWING STROKE: A PHASE II RANDOMIZED CONTROLLED TRIAL

Nothing here will make one fucking bit of difference.  Your doctor will do nothing with this. Your stroke hospital will do nothing with this. Neither will even know this exists, they are that fucking incompetent.

COMPARING MEMORY GROUP TRAINING AND COMPUTERIZED COGNITIVE TRAINING FOR IMPROVING MEMORY FUNCTION FOLLOWING STROKE: A PHASE II RANDOMIZED CONTROLLED TRIAL

Toni D. Withiel, DPsych^1,9, Dana Wong, PhD^1,2,3, Jennie L. Ponsford, PhD^1,3, Dominique A. Cadilhac, PhD^4,5, Peter New, PhD^6,7,8, Tijana Mihaljcic, DPsych¹ and Renerus J. Stolwyk, DPsych^1,3

From the ¹Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, ²School of Psychology and Public Health, La Trobe University, ³Monash-Epworth Rehabilitation Research Centre, Melbourne, ⁴Translational Public Health and Evaluation Division Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, ⁵Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, ⁶Rehabilitation and Aged Care, Medical Program, Monash Health, Melbourne, ⁷Epworth-Monash Rehabilitation Medicine Unit, Southern Medical School, ⁸Department of Epidemiology and Preventive Medicine, Monash University, Victoria, and ⁹Allied Health, Royal Melbourne Hospital, Melbourne, Australia

Abstract

Objectives: Memory deficits are common after stroke, yet remain a high unmet need within the community. The aim of this phase II randomized controlled trial was to determine whether group compensatory or computerized cognitive training approaches were effective in rehabilitating memory following stroke.
Methods: A parallel, 3-group, single-blind, randomized controlled trial was used to compare the effectiveness of a compensatory memory skills group with restorative computerized training on functional goal attainment. Secondary outcomes explored change in neuropsychological measures of memory, subjective ratings of prospective and everyday memory failures and ratings of internal and external strategy use.
Results: A total of 65 community dwelling survivors of stroke were randomized (24: memory group, 22: computerized cognitive training, and 19: wait-list control). Participants allocated to the memory group reported significantly greater attainment of memory goals and internal strategy use at 6-week follow-up relative to participants in computerized training and wait-list control conditions. However, groups did not differ significantly on any subjective or objective secondary outcomes.
Conclusion: Preliminary evidence shows that memory skills groups, but not computerized training, may facilitate achievement of functional memory goals for community dwelling survivors of stroke. These findings require further replication, given the modest sample size, subjective nature of the outcomes and the absence of objective eligibility for inclusion.

Group rehabilitation activities improve walking after stroke

I can only see this as being helpful for survivors fairly similar in disability. High functioning persons would likely get nothing out of it and be resented by the lower functioning. 

Group rehabilitation activities improve walking after stroke

Group-based circuit class therapy (CCT) focused on repetitive mobility, and functional tasks improved walking ability in people after stroke. People walked on average 61m further during six minutes than those receiving comparison interventions. CCT involves stroke survivors practising different activities at workstations in sight of each other.
This Cochrane review identified 17 trials of group-based CCT, given at least weekly for four weeks, compared with other physical therapies or no intervention. Those receiving CCT showed clinically meaningful improvements in walking distance and speed, as well as independence and balance.
Regular multidisciplinary team rehabilitation is a central component of post-stroke care. However, there are no specific recommendations around the format of rehabilitation. Cost effectiveness was not assessed, but it is possible that group-based physical rehabilitation programmes could reduce staff resources and offer cost savings.
Local availability may be an issue. There is also the question of whether it would be practical and appropriate for individuals to attend group sessions, depending on their stroke severit

Motor imagery group practice for gait rehabilitation in individuals with post-stroke hemiparesis: A pilot study

See what your therapist and doctor think of this. 

Motor imagery group practice for gait rehabilitation in individuals with post-stroke hemiparesis: A pilot study

Journal NeuroRehabilitation Publisher IOS Press ISSN 1053-8135 (Print) 1878-6448 (Online) Subject Medicine, Clinical Neurology, Exercise & Occupational Therapy and Rehabilitation & Assistive Technology Pages - DOI 10.3233/NRE-131035 Subject Group Medicine and Health Online Date Tuesday, January 07, 2014 Publisher's Copyright Statement	Add to marked items Add to shopping cart Add to saved items Recommend this article

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Authors

Ruth Dickstein¹, Sandra Levy², Sara Shefi¹, Sarit Holtzman¹, Sara Peleg³, Jean-Jacques Vatine⁴

¹Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
²Stroke Alliance for Europe (SAFE)
³Department of Physical Therapy, Reuth Medical Center, Tel Aviv, Israel
⁴Outpatient and Research Division, Reuth Medical Center, Sackler Faculty of Medicine, Tel Aviv, Israel

Abstract

BACKGROUND: Stroke is the leading cause of adult disability, with walking impairment being a devastating indicator of chronic post-stroke hemiparesis. Limited resources exist for individual treatments; therefore, the delivery of safe group exercise therapy is highly desired. OBJECTIVE: To examine whether the application of group-based motor imagery practice to community-dwelling individuals with chronic hemiparesis improves gait. METHODS: Sixteen individuals with chronic hemiparesis from two community centers participated in the study, with eight from each center. Four participants in each center received five weeks of the experimental intervention, consisting of group-based motor imagery exercises of gait tasks, followed by five weeks of control treatment of motor imagery exercises for the affected upper extremity. Four other subjects in each center received the same treatments in reverse order. Pre- and post intervention measurements included clinical and biomechanical gait parameters. RESULTS: Comparisons within (pre- vs. post) and between treatments (experimental vs. control) indicated no significant change in any gait variable. Nevertheless, the verbal reports of most participants alluded to satisfaction with the intervention and to an increase in self-confidence. CONCLUSIONS: Despite the lack of evidence for the effectiveness of group-based motor imagery practice in improving gait among individuals with chronic hemiparesis, the contrast between the measured negative outcomes and the positive verbal reports merits further inquiry.