The MOST Important Leg Stability Exercise Often Skipped for Standing & Walking After Stroke by Tracy L. Markley Fitness & Author

 10.5 minute video, did you get this from your therapist?

The MOST Important Leg Stability Exercise Often Skipped for Standing & Walking After Stroke

Why You Should Get a Body Mechanics Review by Super Age

 Why You Should Get a Body Mechanics Review

Small asymmetries (leg-length differences, collapsed arches, shoulders) can snowball over time, changing how you move and loading knees, hips, and low back. Super Age Advisor Michelle MacDonald says you should book a quick movement screen or gait/posture check with a trainer or physical therapist, (My physical therapists DID NOTHING to objectively identify my walking problems and correct them. As a result, my left bad knee and my good right knee are slowly being destroyed along with my left hip.)

“Check yourself before you wreck yourself,” she says. “Check your leg length. Look at your pelvis. Look at your foot pressure.” Getting a clear view of how your body is moving and how to correct imbalances will help you keep moving, she says. Do a monthly self-audit: stand barefoot and check arches, balance on one leg for 30 seconds, film a squat from the side, and note what drifts. Adjust your plan before pain shows up. Here’s how to build strength that lasts.

Check out our guide to building strength and power →

 

Physical therapists use different motivational strategies for stroke rehabilitation tailored to an individual’s condition: A qualitative study

Motivation is extremely easy to understand and implement. 

Write up 100% recovery protocols on this and survivors will do the millions of reps needed, no external motivation required. You don't understand one goddamn thing about stroke survivors, DO YOU? The problem is stroke researchers are not motivated to solve stroke. What the fuck is your solution to that failure? We still don't know how to motivate stroke medical 'professionals' to solve stroke to 100% recovery!

 Physical therapists use different motivational strategies for stroke rehabilitation tailored to an individual’s condition: A qualitative study

Physical Therapy. Volume 103(6), Pgs. pzad034.

NARIC Accession Number: J92601. What's this?
Author(s): Oyake, Kazuaki, Sue, Keita, Sumiya, Motofumi, Tanaka, Satoshi.
Publication Year: 2023.
Abstract: Study explored how physical therapists use different motivational strategies for individuals in stroke rehabilitation programs. Fifteen physical therapists who have worked in rehabilitation for over 10 years and were interested in an individual’s motivation participated in one-on-one semi-structured online interviews. The interviews explored their perspectives and experiences regarding the motivational strategies used depending on each individual’s condition. The collected data were analyzed with thematic analysis. Participants used different strategies to encourage individuals’ active participation in physical therapy depending on their mental health, physical difficulties, level of cognitive function, personality, activities and participation, age, and human environment, and the type of rehabilitation service where the individual underwent treatment. For example, in cases where an individual lost self-confidence, participants offered practice tasks that the individual could achieve with little effort to make them experience success. The interviews also revealed motivational strategies used regardless of the individual’s condition. For instance, patient-centered communication was used to build rapport with individuals, irrespective of their condition. Results suggest that physical therapists use different strategies depending on the individual’s mental health conditions, physical problems, level of cognitive function, personality, activities and participation, age, human environment, and the type of rehabilitation service where the individual undergoes treatment to motivate individuals with stroke during physical therapy. The findings of this study can provide experience-based recommendations regarding the selection of motivational strategies for stroke rehabilitation.
Descriptor Terms: CLIENT CHARACTERISTICS, MOTIVATION, PHYSICAL THERAPY, PSYCHOTHERAPY, QUALITATIVE ANALYSIS, REHABILITATION, STROKE.


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Citation: Oyake, Kazuaki, Sue, Keita, Sumiya, Motofumi, Tanaka, Satoshi. (2023.) Physical therapists use different motivational strategies for stroke rehabilitation tailored to an individual’s condition: A qualitative study. Physical Therapy., 103(6), Pgs. pzad034. Retrieved 11/30/2023, from REHABDATA database.

Challenges and Experiences Faced by Physiotherapists in Stroke Rehabilitation

 Really your research should have been to document the challenges survivors face in getting recovered. Therapist problems are only peripheral to solving stroke survivors problems. Do things in the correct order. 100% recovery protocols for survivors first.

Challenges and Experiences Faced by Physiotherapists in Stroke Rehabilitation

Thakur, Kavita; Sohkhlet, Gracia; David, Sudeep¹; Gangurde, Shweta; Borah, Nirankush; N, Sandeep; Jadav, Vallari; Verma, Prerna; S, Johnson; Palal, Deepu

Author Information

Medical Journal of Dr. D.Y. Patil Vidyapeeth ():, June 02, 2023. | DOI: 10.4103/mjdrdypu.mjdrdypu_965_22

• Open
• PAP

Abstract

Introduction 

Stroke is one of the leading causes of death and disability in India and rehabilitation therapy is underdeveloped. Neurorehabilitation is a program that caters to people who have disabilities to help them attain and maintain optimal performance. The majority of people with disabilities are economically underprivileged and have trouble getting access to basic health care (including rehabilitation). Physiotherapists also face limitations in providing services to stroke survivors and this study is to identify those challenges.

Objective 

The objective of this study is to identify the limitations faced by physiotherapists during stroke rehabilitation.

Material and Method 

In November 2022, a focus group discussion was held with a sample size of 12 physiotherapy residents from neurorehabilitation and community rehabilitation working in a tertiary hospital. After consent was taken, audiovideography was recorded, transcripted, and documented. Data were thoroughly transcribed, and thematic analysis and characteristics were established.

Results 

After extraction of codes and themes, the following results were found. General categories of themes are lack of awareness on stroke and physiotherapy, infrastructure, financial constraints, family dynamic, social health, amotivation and mental health, collaboration limitations, problems in-home services, and the impact of COVID-19 pandemic on rehabilitation. Recommendations given by the participants were creating a stroke community, availability of more insurance companies to support and provide relief for financial stress, early education and awareness on stroke from school level, active participation of caregivers and family members to assist the patient in home-based therapy, and availability of NGOs that cater specifically to physiotherapy.

Conclusion 

It was concluded that neurorehabilitation in India needs to attend to the given categories. Policymakers must be aware of the financial and social issues that stroke survivors experience and enact legislation that will decrease mental and financial stress.

© 2023 Medical Journal of Dr. D.Y. Patil Vidyapeeth | Published by Wolters Kluwer – Medknow

Physical Therapists Use Different Motivational Strategies for Stroke Rehabilitation Tailored to an Individual’s Condition: A Qualitative Study

 

You have motivation wrong. Write up 100% recovery protocols on this and survivors will do the millions of reps needed, no external motivation required. You don't understand one goddamn thing about stroke survivors, DO YOU? The problem is stroke researchers are not motivated to solve stroke. What the fuck is your solution to that failure?

Physical Therapists Use Different Motivational Strategies for Stroke Rehabilitation Tailored to an Individual’s Condition: A Qualitative Study

Kazuaki Oyake, PT, PhD, Keita Sue, PT, MSc, Motofumi Sumiya, PhD, Satoshi Tanaka, PhD

Physical Therapy, pzad034, https://doi.org/10.1093/ptj/pzad034

Published:

05 April 2023

Article history

Abstract

Objective

Various strategies are used to motivate individuals with stroke during rehabilitation. However, how physical therapists select the motivational strategies that they use for each individual is yet to be established. Therefore, this study aimed to explore how physical therapists use different motivational strategies for individuals in stroke rehabilitation programs.

Methods

A criterion sample of 15 physical therapists who have worked in rehabilitation for over 10 years and were interested in an individual’s motivation participated in one-on-one semi-structured online interviews. The interviews explored their perspectives and experiences regarding the motivational strategies used depending on each individual’s condition. The collected data were analyzed with thematic analysis.

Results

A total of 9 themes emerged from the data upon thematic analysis and inductive coding. Participants used different strategies to encourage individuals’ active participation in physical therapy depending on (1) their mental health, (2) their physical difficulties, (3) their level of cognitive function, (4) their personality, (5) their activities and participation, (6) their age, (7) their human environment, and (8) the type of rehabilitation service where the individual underwent treatment. For example, in cases where an individual lost self-confidence, participants offered practice tasks that the individual could achieve with little effort to make them experience success. The interviews also revealed (9) motivational strategies used regardless of the individual’s condition. For instance, patient-centered communication was used to build rapport with individuals, irrespective of their condition.

Conclusions

This qualitative study suggests that physical therapists use different strategies depending on the individual’s mental health conditions, physical problems, level of cognitive function, personality, activities and participation, age, human environment, and the type of rehabilitation service where the individual undergoes treatment to motivate individuals with stroke during physical therapy.

Impact

The findings of this study can provide experience-based recommendations regarding the selection of motivational strategies for stroke rehabilitation.

The impact of physical therapy on functional outcomes after stroke: what's the evidence?

Without pointing to or creating stroke rehab protocols this is useless for survivors. There is absolutely nothing here that any survivor can take to their therapists and have them use it as is to recover from their stroke. 

The impact of physical therapy on functional outcomes after stroke: what's the evidence?

The impact of physical therapy on functionaloutcomes after stroke: what’s the evidence?
RPS Van Peppen
 Department of Physical Therapy, VU University Medical Center, Amsterdam,
 G Kwakkel
 Department ofPhysical Therapy, VU University Medical Center, Amsterdam and Center of Excellence for Rehabilitation Medicine ‘deHoogstraat’, Utrecht, The Netherlands,
 S Wood-Dauphinee
 School of Physical and Occupational Therapy, Department ofEpidemiology and Biostatistics, McGill University, Montreal, Canada,
HJM Hendriks
Dutch Institute of Allied Health Care (Npi),Amersfoort and Maastricht University, Department of Epidemiology, Maastricht,
 PhJ Van der Wees
 Royal Dutch Society forPhysical Therapy (KNGF), Amersfoort and
 J Dekker
 Institute for Research in Extramural Medicine (EMGO Institute),Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The NetherlandsReceived 23rd March 2004; returned for revisions 10th June 2004; revised manuscript accepted 25th July 2004.
Objective
: To determine the evidence for physical therapy interventions aimed at improving functional outcome after stroke.(You can't improve outcomes until you write protocols. Are you that fucking stupid? The stupid - it burns)
Methods
: MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials,Cochrane Database of Systematic Reviews, DARE, PEDro, EMBASE and DocOnlinewere searched for controlled studies. Physical therapy was divided into 10intervention categories, which were analysed separately. If statistical pooling(weighted summary effect sizes) was not possible due to lack of comparabilitybetween interventions, patient characteristics and measures of outcome, a best-research synthesis was performed. This best-research synthesis was based onmethodological quality (PEDro score).
Results
: In total, 151 studies were included in this systematic review; 123 were randomized controlled trials (RCTs) and 28 controlled clinical trials (CCTs).  Methodological quality of all RCTs had a median of 5 points on the 10-point PEDroscale (range 2 /8 points). Based on high-quality RCTs strong evidence was found in favour of task-oriented exercise training to restore balance and gait, and for strengthening the lower paretic limb. Summary effect sizes (SES) for functional outcomes ranged from 0.13 (95% CI 0.03/0.23) for effects of high intensity of exercise training to 0.92 (95% CI 0.54/1.29) for improving symmetry when moving from sitting to standing. Strong evidence was also found for therapies that were focused on functional training of the upper limb such as constraint-induced movement therapy (SES 0.46; 95% CI 0.07/0.91), treadmill training with or without body weight support, respectively 0.70 (95% CI 0.29/1.10) and 1.09 (95% CI 0.56/1.61), aerobics (SES 0.39; 95% CI 0.05/0.74), external auditory rhythms during gait (SES 0.91; 95% CI 0.40/1.42) and neuromuscular stimulation for glenohumeral subluxation (SES 1.41; 95% CI 0.76/2.06). No or insufficient evidence in terms of functional outcome was found for: traditional neurological treatment approaches;exercises for the upper limb; biofeedback; functional and neuromuscular electrical stimulation aimed at improving dexterity or gait performance; orthotics and assistive
Address for correspondence: Gert Kwakkel, Department of Physical Therapy, VU University Medical Center, PO Box 7057,1007 MB Amsterdam, The Netherlands.

Outcome measures in physiotherapy management of patients with stroke: a survey into self-reported use, and barriers to and facilitators for use

This is chapter 6 in a 236 page thesis. You can read it yourself and see that PTs in the Netherlands don't follow the Dutch clinical practice guidelines. So even if we were to get actual protocols we would be lucky to get someone who actually implements them. 

Outcome measures in physiotherapy management of patients with stroke: a survey into self-reported use, and barriers to and facilitators for use

Physical therapist’s clinical reasoning in patients with gait impairments from hemiplegia

THIS is the problem, there should be no reasoning involved. 

First you start with objective descriptions of the gait deficits, probably via this;

Pump iron the smart way with a motion-capture coach, repurposed for stroke

Second, based on the specific deficits the protocols to fix those deficits are used.

Physical therapist’s clinical reasoning in patients with gait impairments from hemiplegia

Jill Seale & Carolyn Utsey

Received 11 May 2017, Accepted 27 Nov 2018, Published online: 24 Jan 2019

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• https://doi.org/10.1080/09593985.2019.1567889

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ABSTRACT

Background: During stroke rehabilitation, physical therapists (PTs) perform gait analysis and design treatments(There should be no design, you chose the EXACT PROTOCOL for the deficit) based on this analysis.
Objectives: To investigate the current trends in PTs clinical reasoning in assessing and managing gait in persons with hemiplegia.
Design: A qualitative study using a phenomenological approach using a semi-structured interview protocol with FG.
Methods: Participants consisted of expert and novice PTs working in a neurologic rehabilitation setting. FG were conducted in person and via web. Constant comparative qualitative analysis was used to analyze the qualitative data.
Results: A total of 22 PTs participated in five FG (2 novice and 3 expert groups). From the analysis of qualitative data, five themes emerged. Novice and experienced clinicians: 1) take a systematic approach to examination and evaluation of persons with hemiplegia; 2) are in agreement in common gait deficits found in persons with hemiplegia; 3) may differ in their approach to treatment based on the amount of experience of the clinician; 4) generally agree on the manner in which orthotics are used in the management of persons with hemiplegia; and 5) demonstrate professional accountability to patients concerning the use of orthotic devices.
Conclusions: This qualitative study provided insight into the variability(There should be no variability) in PTs’ strategies for gait analysis, and their identification and interpretation of common deviations and impairments in persons with hemiplegia following stroke. Reluctance to utilize orthotics for patients with hemiplegia was a consistent theme across FG.

Healthcare Habit: 5 Physical Therapy Myths Debunked

Ask your physical therapist exactly what stroke rehab protocols are being used and their efficacy percentages. The fact is they will give you guidelines but nothing factual about the 100% recovery results you need. 
http://rehab-insider.advanceweb.com/healthcare-habit-5-physical-therapy-myths-debunked/?
As you may already know, October is National Physical Therapy Month! To celebrate physical therapists everywhere, we’re debunking several myths surrounding the profession.
If you’ve never visited a physical therapist before, or have heard some disquieting rumors that have discouraged you to do so, take a look at these 5 common misconceptions about physical therapy.
1. Myth: Physical therapy is extremely painful.
Fact: Yes, some discomfort may be experienced while undergoing physical therapy, but physical therapy is meant to reduce pain and not increase it. “No pain, no gain” is only true in rare cases. Let your physical therapist know when you are in pain, and they can adjust your therapy accordingly. The main objective is to help you heal while working within your pain threshold.
2. Myth: I need a prescription or a referral to see a physical therapist.
Fact: Most people believe that you require a prescription or referral for an evaluation by a physical therapist. Yet in all 50 states, patients can be evaluated by a physical therapist without a physician’s referral. In many states, you may also receive some form of treatment without a referral or prescription. Take a look at APTA’s direct access to physical therapy laws chart before scheduling your physical therapy visit.
3. Myth: Physical therapy isn’t covered by health insurance.
Fact: Actually, most insurance plans cover physical therapy to some degree. In this case, you may need a physician’s prior referral to ensure insurance coverage.
4. Myth: Physical therapy only helps injuries and accidents.
Fact: Physical therapists not only help patients recover from injuries and accidents; they also can diagnose potential problems before they lead to serious or disabling conditions. To name a few, physical therapists can assist with carpal tunnel syndrome, chronic headaches and lower back pain.
5. Myth: I can perform my own physical therapy.(You have to, after your insurance quits paying for rehab)
Fact: While a patient’s participation is essential for recovery, they still require a professional’s guidance and expertise. Only a licensed physical therapist can create an individualized plan for successful treatment.(What a load of bullshit for stroke, 90% failure rate to full recovery).
If you’re experiencing chronic pain or discomfort, it may be time to visit a physical therapist. Physical therapy can transform your life and lead to a healthier you.

APTA Offers Basic Facts for PTs in a Post-Therapy Cap World

You likely will need to know about this for your rehab.
http://rehab-insider.advanceweb.com/apta-offers-basic-facts-for-pts-in-a-post-therapy-cap-world/?

The ruling started a whole new system for how therapy service will be rendered through Medicare

Congress’ approval of the federal spending package earlier this month didn’t just eliminate the hard caps on therapy. It ushered in a new era of payment thresholds, payment rates for physical therapist assistants (PTAs) and occupational therapist assistants (OTAs) and other new structures and guidelines the rehab world will be learning for the rest of 2018.

In response, the American Physical Therapy Association (APTA) compiled a list of five basic aspects of the new ruling that practitioners need to know. Some are clarifications; others are potential roadblocks or detriments to practice. For example, PT and speech-language pathology services are still lumped together under the new ruling, a decision opposed by APTA among others.

The new ruling, retroactive to January 1, 2018, is imperfect in many ways—but the elimination of the therapy caps has been an emphasis of the APTA and other rehab governing bodies for years. The removal of those caps is a he first step, and now begins the ongoing process of making the profession better for practitioners and patients alike.

APTA’s guidelines and explanations are below:

1. It boils down to a threshold for using KX modifiers and a trigger for possible medical review.
The basic idea is this: outpatient therapy under Medicare now has a $2,010 threshold; services delivered beyond that require a KX modifier indicating that the service meets the criteria for a payment exception. When therapy reaches $3,000, it’s subject to possible targeted medical review—although CMS didn’t receive any additional funding to conduct these reviews.

2. Physical therapy and speech-language pathology still are lumped together in the thresholds.
Just as in the previous payment system that included a hard cap and exceptions process, the new system doesn’t separate physical therapy from speech-language pathology in establishing thresholds. Those $2,010 and $3,000 limits are for physical therapy and speech-language pathology therapy combined—another element opposed by APTA.

3. The thresholds apply to all part B outpatient therapy services—including services provided by hospital outpatient departments.
For the brief time beginning in January when the therapy cap was in place, hospital outpatient facilities were not subject to the cap. That changed with the adoption of the budget package, and now these departments or clinics are subject to the thresholds: $2,010 for use of the KX modifier and $3,000 for potential targeted medical review.

4. The PTA payment differential will start in 2022—along with a special claims designation.
In the post-cap payment system, outpatient therapy services performed by physical therapist assistants (PTAs) and occupational therapy assistants (OTAs) will be reimbursed at 85% of the Medicare physician fee schedule—a change opposed by APTA. However, that’s not set to happen until 2022.
For now, claims do not include a way to designate whether a service was delivered by a PTA, but that too will change by 2022, when CMS will develop a modifier to make that distinction. Between now and then, look for opportunities to comment on proposed rules around this process, along with guidance and more details as they develop.

5. Home health also will be subject to the PTA payment differential, absent a plan of care.
The 85% payment differential for services provided by a PTA or OTA will apply to home health care provided to Medicare part B beneficiaries—but only when a home health plan of care is not in effect. The budget deal that resulted in the end to the hard cap also established other new rules for home health

SPSC17: Physios should embrace technology in stroke rehab, says biomechanics lecturer

You wouldn't need to try to fix the appalling rate of 10% full recovery via physiotherapy if your doctors were stopping the neuronal cascade of death by these 5 causes in the first week resulting in fewer dead and damaged neurons.
http://www.csp.org.uk/news/2017/10/30/spsc17-physios-should-embrace-technology-stroke-rehab-says-biomechanics-lecturer

Many physiotherapy students are anxious about the use of biomechanics in rehab, according to a lecturer in biomedical engineering.

1 Comment 0

_{Biomechanical engineering lecturer Andy Kerr spoke about technology and stroke rehab}
Andy Kerr, who is also a researcher at the University of Strathclyde, spoke about the issue during a keynote speech at the Scottish Physiotherapy Student Conference 2017 (SPSC17) in Edinburgh on 28 October.
Dr Kerr has worked on several projects associated with stroke rehabilitation and the use of technology to support its delivery and evaluation.
And his primary research interest is the study of human movement, shaped from many years as both a clinical and teaching physiotherapist.
He asked the conference whether the solution to delivering rehabilitation is technology and provided details of a study that counted the number of sit to stand movements performed during the rehab of older people who have had a stroke.
Some participants were fitted with sensors, he explained, and an avatar on a screen moved in time and told them when to push up.
Dr Kerr said: ‘There are too many barriers to the use of technology: cost, dogma, complexity, access, NHS firewalls that stop apps and staff fear of being replaced by therapy robots.
‘There are not enough physios and the technology cannot replace your skills and knowledge. My aim is greater integration of technology and more use. Next year there will be a master’s level course in technology and health.’
Virtual reality treadmill training
Dr Kerr’s research into gait and recovery of walking function suggests that, although 80 per cent of stroke survivors do recover some walking ability, they are too slow and unskilled for the challenges of walking outdoors.
He has also been involved in a study that combined virtual reality with treadmill training for stroke survivors. People taking part followed virtual 'road and forest paths' and the treadmill slowed when users stepped over ‘objects’.
This feasibility study found treadmill walking (with and without virtual reality) to be similar enough to overground walking to justify it as a training modality for chronic stroke patients, who had already attained some independence in walking.
Installation of the equipment currently costs £600,000 to £1 million, but work is ongoing to use cheaper TV screens.

Reported use of technology in stroke rehabilitation by physical and occupational therapists

Lack of objective feedback to patients is a huge concern. With nothing objective you can't correlate interventions to recovery. 
https://tandf.figshare.com/articles/Reported_use_of_technology_in_stroke_rehabilitation_by_physical_and_occupational_therapists/5314591

16.08.2017, 06:07 byJeanne LanganHeamchand SubryanIfeoma NwoguLora Cavuoto

Purpose: With the patient care experience being a healthcare priority, it is concerning that patients with stroke reported boredom and a desire for greater fostering of autonomy, when evaluating their rehabilitation experience. Technology has the potential to reduce these shortcomings by engaging patients through entertainment and objective feedback. Providing objective feedback has resulted in improved outcomes and may assist the patient in learning how to self-manage rehabilitation. Our goal was to examine the extent to which physical and occupational therapists use technology in clinical stroke rehabilitation home exercise programs.
Materials and methods: Surveys were sent via mail, email and online postings to over 500 therapists, 107 responded.
Results: Conventional equipment such as stopwatches are more frequently used compared to newer technology like Wii and Kinect games. Still, less than 25% of therapists’ report using a stopwatch five or more times per week. Notably, feedback to patients is based upon objective data less than 50% of the time by most therapists. At the end of clinical rehabilitation, patients typically receive a written home exercise program and non-technological equipment, like theraband and/or theraputty to continue rehabilitation efforts independently.
Conclusions: The use of technology is not pervasive in the continuum of stroke rehabilitation.Implications for Rehabilitation
The patient care experience is a priority in healthcare, so when patients report feeling bored and desiring greater fostering of autonomy in stroke rehabilitation, it is troubling.
Research examining the use of technology has shown positive results for improving motor performance and engaging patients through entertainment and use of objective feedback.
Physical and occupational therapists do not widely use technology in stroke rehabilitation.
Therapists should consider using technology in stroke rehabilitation to better meet the needs of the patient.
The patient care experience is a priority in healthcare, so when patients report feeling bored and desiring greater fostering of autonomy in stroke rehabilitation, it is troubling.
Research examining the use of technology has shown positive results for improving motor performance and engaging patients through entertainment and use of objective feedback.
Physical and occupational therapists do not widely use technology in stroke rehabilitation.
Therapists should consider using technology in stroke rehabilitation to better meet the needs of the patient.

Videos for Walking After Stroke

Never heard of these two most famous physical therapists on the net. Brad Heineck and Bob Schrup.  The worst part of this is using normal persons as examples, reminds me of one of my PTs saying, 'walk this way'. Fuck you, if I could walk that way I wouldn't need you. 

How to Make Amazing Progress in Walking After Stroke

After Stroke: 3 Exercises for a Weak Leg. (Strengthening of Leg) 

Absolute Best Walking Exercise for Stroke Rehab at Home

10 Exercises for Foot Drop after Stroke, Nerve, or Muscle Damage (Weak Ankle & Foot).

 

 

Hip Abductor Muscle Strength Associations with Gait Speed and Gait Independence Level of Hemiparetic Stroke Patients

Measurement only, NO mention of what protocol would increase hip abductor strength to get to gait independence. I expect your physical therapist to know exactly what exercises can do that.  

Hip Abductor Muscle Strength Associations with Gait Speed and Gait Independence Level of Hemiparetic Stroke Patients

Rigakuryoho Kagaku , Volume 31(5) , Pgs. 723-727.

NARIC Accession Number: I243365.  What's this?
Author(s): YOSUKE SHIMIZU.
Publication Year: 2016.
Abstract: The purpose of this study was to determine the relationships of hip abductor muscle strength with 10-meter maximum walking speed (10MWS) and level of gait independence, and to calculate the cutoff value for gait independence in stroke patients with hemiparesis. Participants were 31 hemiparetic stroke patients. Their 10MWS and gait independence level were determined, and hip abductor muscle strength was measured using a hand-held dynamometer. A significant correlation (r=0.74) was found between 10MWS and the paretic-side hip abductor strength. In the search for factors affecting gait independence level, only hip abductor strength of the paretic side was identified [odds ratio (OR) 11.92, OR 95% confidence level 2.19􀃴65.15], and the cutoff value for gait independence was 0.23 kgf/kg. The results suggest there is a high possibility that the paretic side hip abductor muscle strength is an important factor of gait speed and gait independence.
Descriptor Terms: Gait, Hip, Muscles, Paraparesis, Stroke.
Language: Japanese
Geographic Location(s): Japan, East & Southeast Asia.

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Citation: YOSUKE SHIMIZU. (2016). Hip Abductor Muscle Strength Associations with Gait Speed and Gait Independence Level of Hemiparetic Stroke Patients.  脳卒中片麻痺患者の股関節外転筋力と 歩行速度および歩行自立度との関連性.  Rigakuryoho Kagaku , 31(5), Pgs. 723-727. Retrieved 8/10/2017, from REHABDATA database.

Train the Brain: Exploring the Brain-Body Connection in Neurological Rehabilitation

 I can't say I learned anything new.
1 hour 30 minutes, a number of physical therapists giving presentations.
http://youtu.be/vdAHBilcqzo

The effects of object height and visual information on the control of obstacle crossing during locomotion in healthy older adults

Is your physical therapist including this complication in your walking protocols? I had nothing higher than a 2x4, I needed a 18-24 inch high barrier to get over, right now that height and higher I regularly have to do on my walks until I can cut thru the trees
http://www.gaitposture.com/article/S0966-6362(17)30139-X/fulltext?rss=yes

Sho KunimuneCorrespondence information about the author Sho KunimuneEmail the author Sho Kunimune

,

Shuichi Okada

DOI: http://dx.doi.org/10.1016/j.gaitpost.2017.04.016

|Article Info

• Abstract

• Full Text

• Images
• References

Highlights

• •In familiar settings, feedforward visual control is similar in young/older adults.
• •Older adults exhibit increased dependence on vision for postural stability.
• •LTC and TTC are correlated when crossing obstacles ≤ 10 cm high regardless of age.

Abstract

In order to safely avoid obstacles, humans must rely on visual information regarding the position and shape of the object obtained in advance. The present study aimed to reveal the duration of obstacle visibility necessary for appropriate visuomotor control during obstacle avoidance in healthy older adults. Participants included 13 healthy young women (mean age: 21.5 ± 1.4 years) and 15 healthy older women (mean age: 68.5 ± 3.5 years) who were instructed to cross over an obstacle along a pressure-sensitive pathway at a self-selected pace while wearing liquid crystal shutter goggles. Participants were evaluated during three visual occlusion conditions: (i) full visibility, (ii) occlusion at T-1 step (T: time of obstacle crossing), and (iii) occlusion at T-2 steps. Toe clearances of both the lead and trail limb (LTC and TTC) were calculated. LTC in the occlusion at T-2 steps condition was significantly greater than that in other conditions. Furthermore, a significant correlation was observed between LTC and TTC in both groups, regardless of the condition or obstacle height. In the older adult group alone, step width in the occlusion at T-2 steps condition increased relative to that in full visibility conditions. The results of the present study suggest that there is no difference in the characteristics of visuomotor control for appropriate obstacle crossing based on age. However, older adults may exhibit increased dependence on visual information for postural stability; they may also need an increased step width when lacking information regarding their positional relationship to obstacles.

Aerobic Exercise Prescription in Stroke Rehabilitation: A Web-Based Survey of US Physical Therapists

Still just a best practice recommendation, not a protocol. When the fuck will we get protocols? Exact exercise interventions? I'm guessing never since that would involve taking a stand.
http://journals.lww.com/jnpt/Fulltext/2017/04000/Aerobic_Exercise_Prescription_in_Stroke.6.aspx

Boyne, Pierce PT, DPT, NCS; Billinger, Sandra PT, PhD, FAHA; MacKay-Lyons, Marilyn MSPT, PhD; Barney, Brian BS; Khoury, Jane PhD; Dunning, Kari PT, PhD

Journal of Neurologic Physical Therapy: April 2017 - Volume 41 - Issue 2 - p 119–128

doi: 10.1097/NPT.0000000000000177

Research Articles

• Abstract
• Author Information

Background and Purpose: Best practice recommendations indicate that aerobic exercise (AEX) should be incorporated into stroke rehabilitation. However, this may be challenging in clinical settings. The purpose of this study was to assess physical therapist (PT) AEX prescription for patients with stroke, including AEX utilization, barriers to AEX prescription, dosing parameters, and safety considerations.

Methods: A cross-sectional Web-based survey study was conducted. Physical therapists with valid e-mail addresses on file with the state boards of Florida, New Jersey, Ohio, Texas, and Wyoming were eligible to participate. Survey invitations were e-mailed to all licensed PT in these states. Analysis focused on respondents who were currently involved with clinical stroke rehabilitation in common practice settings.

Results: Results from 568 respondents were analyzed. Most respondents (88%) agreed that AEX should be incorporated into stroke rehabilitation, but 84% perceived at least one barrier. Median prescribed AEX volume varied between practice settings from 20- to 30-minute AEX sessions, 3 to 5 days per week for 2 to 8 weeks. Prescribed intensity was most commonly light or moderate; intensity was determined by the general response to AEX and patient feedback. Only 2% of respondents reported that the majority of their patients with stroke had stress tests.

Discussion and Conclusions: Most US PTs appear to recognize the importance of AEX for persons poststroke, but clinical implementation can be challenging. Future studies and consensus are needed to clarify best practices and to develop implementation interventions to optimize AEX utilization in stroke rehabilitation.

Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A167).

Aerobic Exercise Prescription in Stroke Rehabilitation: A Web-Based Survey of US Physical Therapists

 Notice that they don't point to a protocol, just a 'recommendation'. Which means that every one of these therapists is conducting a single person clinical trial with you as the guinea pig.

 http://journals.lww.com/jnpt/Abstract/publishahead/Aerobic_Exercise_Prescription_in_Stroke.99799.aspx

Boyne, Pierce PT, DPT, NCS; Billinger, Sandra PT, PhD, FAHA; MacKay-Lyons, Marilyn MSPT, PhD; Barney, Brian BS; Khoury, Jane PhD; Dunning, Kari PT, PhD

Journal of Neurologic Physical Therapy:

Post Author Corrections: March 03, 2017

doi: 10.1097/NPT.0000000000000177

Research Articles: PDF Only

• Abstract

Abstract

Background and Purpose: Best practice recommendations indicate that aerobic exercise (AEX) should be incorporated into stroke rehabilitation. However, this may be challenging in clinical settings. The purpose of this study was to assess physical therapist (PT) AEX prescription for patients with stroke, including AEX utilization, barriers to AEX prescription, dosing parameters, and safety considerations.

Methods: A cross-sectional Web-based survey study was conducted. Physical therapists with valid e-mail addresses on file with the state boards of Florida, New Jersey, Ohio, Texas, and Wyoming were eligible to participate. Survey invitations were e-mailed to all licensed PT in these states. Analysis focused on respondents who were currently involved with clinical stroke rehabilitation in common practice settings.

Results: Results from 568 respondents were analyzed. Most respondents (88%) agreed that AEX should be incorporated into stroke rehabilitation, but 84% perceived at least one barrier. Median prescribed AEX volume varied between practice settings from 20- to 30-minute AEX sessions, 3 to 5 days per week for 2 to 8 weeks. Prescribed intensity was most commonly light or moderate; intensity was determined by the general response to AEX and patient feedback. Only 2% of respondents reported that the majority of their patients with stroke had stress tests.

Discussion and Conclusions: Most US PTs appear to recognize the importance of AEX for persons poststroke, but clinical implementation can be challenging. Future studies and consensus are needed to clarify best practices and to develop implementation interventions to optimize AEX utilization in stroke rehabilitation.

Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A167).

(C) 2017 Academy of Neurologic Physical Therapy, APTA

Physios urge MPs to prioritise stroke care in England

Totally fucking wrong, wrong, wrong. Wrong focus, this is like shutting the barn door after the horses have already left. You stop a lot of damage in the first place by stopping the neuronal cascade of death by these 5 causes in the first week.
Working on the 90% failure rate of rehab to get you to 100% recovery is not where the focus should be. This is a jobs bill for physios rather than what is best for stroke survivors.
http://www.csp.org.uk/news/2017/01/31/physios-urge-mps-prioritise-stroke-care-england
MPs have heard there is an urgent need for improvements in stroke care in England, after speaking with physiotherapists, stroke survivors and other medical professionals.
The discussions were part of a meeting, hosted by Labour MP Chris Leslie and organised by UK charity the Stroke Association, at the House of Commons on 31 January.
It focused on the future of stroke services and highlighted the charity’s campaign, A New Era for Stroke, which is calling on the government to commit to a new national stroke strategy.
Jakko Brouwers, chair of the Association of Chartered Physiotherapists in Neurology (ACPIN), attended the event and told Frontline: ‘There is a need for continued focus on speedy, efficient and prolonged delivery of care, including the provision of dedicated stroke rehabilitation.
‘Although there is an awareness that physiotherapy provision is needed post stroke, in discussion with MP's and stroke survivors, it was clear that ACPIN and the CSP still have a lot to work on in order to bring the message home that stroke rehabilitation and ongoing care needs specialist neuro physiotherapists who are experienced in stroke.’
Inconsistent provision of care(We only care about results you blithering idiots)
Other delegates warned that stroke services across England are at risk of being deprioritised once the current national stroke strategy, which started in 2007, ends next year.
This is despite a 2016 Stroke Association survey of 1,424 stroke survivors, which showed that

• 45 per cent of stroke survivors feel abandoned after discharge from hospital
  
• only 77 per cent are receiving the rehabilitation they are entitled to while in hospital
  
• 80 per cent have a physical disability but 38 per cent of those who said their disability was severe described their physiotherapy rehab as ‘poor’ or ‘very poor’
  

In addition a CSP audit of stroke services in England, conducted last year, found that patients in different areas of the country were receiving highly inconsistent levels of care after leaving hospital.