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1.  Goal Priorities Identified through Client-Centred Measurement in Individuals with Chronic Stroke 
Purpose
The purpose of this study was to identify goal priorities in a sample of individuals with chronic stroke.
Method
In this descriptive study involving 19 community-dwelling individuals with stroke, participants were interviewed on the Canadian Occupational Performance Measure (COPM) to ascertain problem areas experienced after hospital discharge. Once problems were identified, they were classified under the three dimensions of the COPM: self-care, productivity, and leisure.
Results
The mean time since stroke was 6.8 (±2.9) years. Eighty-four problems were identified within the three dimensions of the COPM. The most frequently cited problems in each dimension were bathing (self-care) by 42% of participants, household maintenance (productivity) by 32% of participants, and walking outdoors (leisure) by 32% of participants. Overall, participants rated their performance of identified problems and satisfaction with their abilities as low and rated each dimension as equally important for problem priority.
Conclusion
Long after hospital discharge, individuals with chronic stroke were able to identify issues of concern that could benefit from involvement of rehabilitation professionals. Clinicians should be aware that issues of bathing, walking, household maintenance, and recreational activities are of particular importance to people with chronic stroke living in the community. A client-centred approach to problem generation (ie, use of the COPM) may assist in enhancing client involvement and motivation towards rehabilitation.
PMCID: PMC3557500  PMID: 23372280 CAMSID: cams2666
cerebrovascular accident; client-centred goals; client-centred measures; community; rehabilitation
2.  Individuals with the dominant hand affected following stroke demonstrate less impairment than those with the non-dominant hand affected 
Objective
The purpose was to determine if upper extremity impairment and function in individuals with chronic stroke is dependent upon whether the dominant or non-dominant hand is affected.
Methods
Ninety-three community-dwelling individuals with stroke. The Modified Ashworth Scale (tone), hand held dynamometry (isometric strength), monofilaments (sensation), Brief Pain Inventory (pain), Chedoke Arm and Hand Activity Inventory and Motor Activity Log (paretic arm use), and Reintegration to Normal Living Index (participation) were used to form impairment and function models.
Results
MANOVA models (DOMINANCE x SEVERITY) were created for impairment and function variables. There was a significant interaction and main effect of DOMINANCE for the impairment model (p=0.01) but not the function model (p=0.75). The dependent variables of tone, grip strength and pain were all significantly affected by DOMINANCE, indicating less impairment if the dominant hand was affected. All dependent variables except pain were affected by SEVERITY.
Conclusion
This study looked at the effect of the dominant hand being affected versus the non-dominant in individuals with chronic stroke. Individuals with the dominant hand affected demonstrated less impairment than those with the non-dominant hand affected. However, there was no effect of dominance on paretic arm use or performance in activities of daily living. Prospective studies to further explore the issue of hand dominance and post stroke function are suggested.
doi:10.1177/1545968305284528
PMCID: PMC3432641  PMID: 16885424 CAMSID: cams2217
Stroke; Upper extremity; Laterality; Rehabilitation
3.  A Community-based Fitness and Mobility Exercise (FAME) Program for Older Adults with Chronic Stroke: a Randomized Controlled Trial 
OBJECTIVES
To examine the effects of a community-based group exercise program for older individuals with chronic stroke.
DESIGN
Prospective, single-blind, randomized controlled intervention trial.
SETTING
Intervention was community-based. Data collection was performed in a research laboratory located in a rehabilitation hospital.
PARTICIPANTS
Sixty-three older individuals (≥50 years) with a chronic stroke (post-stroke duration ≥ 1 year) who were living in the community.
INTERVENTION
Participants were randomized into intervention group (n=32) or control group (n=31). The intervention group underwent a Fitness and Mobility Exercise (FAME) program designed to improve cardiorespiratory fitness, mobility, leg muscle strength, balance and hip bone mineral density (BMD) (1-hour sessions, 3 sessions/week, for 19 weeks). The control group underwent a seated upper extremity program.
MEASUREMENTS
(1) cardiorespiratory fitness (maximal oxygen consumption), (2) mobility (Six Minute Walk Test), (3) leg muscle strength (isometric knee extension), (4) balance (Berg Balance Scale), (5) activity and participation (Physical Activity Scale for Individuals with Physical Disabilities) and (6) femoral neck BMD (Dual-energy X-ray absorptiometry).
RESULTS
The intervention group had significantly more gains in cardiorespiratory fitness, mobility, and paretic leg muscle strength than controls. Femoral neck BMD of the paretic leg was maintained in the intervention group whereas a significant decline of the same occurred in controls. There was no significant time × group interaction for balance, activity and participation, non-paretic leg muscle strength and non-paretic femoral neck BMD.
CONCLUSION
The FAME program is feasible and beneficial for improving some of the secondary complications resulting from physical inactivity in older adults living with stroke. It may serve as a good model of community-based fitness program for preventing secondary diseases in older adults living with chronic conditions.
doi:10.1111/j.1532-5415.2005.53521.x
PMCID: PMC3226792  PMID: 16181164 CAMSID: cams1988
cerebrovascular accident; health promotion; osteoporosis; rehabilitation
4.  Exercise Leads to Faster Postural Reflexes, Improved Balance and Mobility, and Reduced Falls in Older Persons with Chronic Stroke 
OBJECTIVES
To determine the effect of two different community-based group exercise programs on functional balance, mobility, postural reflexes, and falls in older adults with stroke.
DESIGN
A randomized, clinical trial.
SETTING
Community centre.
PARTICIPANTS
Total of 61 community-dwelling older adults with chronic stroke.
INTERVENTION
Participants were randomly assigned to an Agility (n = 30) or Stretching/weight-shifting (n = 31) exercise group. Both groups exercised three times a week for 10 weeks.
MEASUREMENTS
Participants were assessed prior to, immediately after, and one-month following the intervention for Berg Balance, Timed Up and Go, step reaction time, Activities-specific Balance Confidence, and Nottingham Health Profile. Testing of standing postural reflexes and induced falls evoked by a translating platform was also performed. In addition, falls in the community were tracked for one year from the start of the interventions.
RESULTS
Although exercise led to improvements in all clinical outcome measures for both groups, the Agility group demonstrated greater improvement in step reaction time and paretic rectus femoris postural reflex onset latency compared to the Stretching/weight-shifting group. Further, induced falls on the platform were reduced in the Agility group.
CONCLUSION
Group exercise programs that include Agility or Stretching/weight shifting exercises improve postural reflexes, functional balance and mobility and may lead to a reduction of falls in older adults with chronic stroke.
doi:10.1111/j.1532-5415.2005.53158.x
PMCID: PMC3226796  PMID: 15743283 CAMSID: cams1987
rehabilitation; cerebrovascular accident; posture; physical fitness; clinical trial
5.  A randomized controlled trial of water-based exercise for cardiovascular fitness in individuals with chronic stroke 
Objective
To evaluate the effect of an 8-week water-based exercise program (experimental group) over an upper extremity function program (control group) to increase cardiovascular fitness within a community setting for individuals with stroke.
Design
Single-blind randomized controlled trial
Setting
Public community centre
Participants
12 community-dwelling individuals who have had a stroke with mild to moderate motor deficits; volunteer sample
Intervention
Experimental and control groups participated in group exercise programs undertaken in one hour sessions, three times per week for 8 weeks. The experimental group undertook chest deep water exercises at targeted heart rates. The control group performed arm and hand exercises while sitting.
Main Outcome Measures
The primary outcome measure was cardiovascular fitness (VO2max). Secondary measures were maximal workload, muscle strength, gait speed, and the Berg Balance Score.
Results
The experimental group attained significant improvements over the control group in cardiovascular fitness, maximal workload, gait speed, and paretic lower extremity muscle strength. The relatively short program (8 weeks) of water-based exercise resulted in a large improvement (22%) in cardiovascular fitness in a small group of individuals with stroke with relatively high function.
Conclusions
A water-based exercise program can be undertaken in the community as a group program and may be an effective means to promote fitness in individuals with stroke.
PMCID: PMC3181213  PMID: 15179638 CAMSID: cams1874
endurance; stroke; randomized trial; exercise; cardiovascular fitness; clinical trial
6.  A community-based group upper extremity 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 (≥ 50 years) with chronic deficits resulting from stroke (onset ≥ 1 year).
Interventions
The arm group underwent an exercise program designed to improve upper extremity function (1 hour per session, 3 sessions per week for 19 weeks). The leg group underwent a lower extremity exercise program.
Main outcome measures
(1) Wolf Motor Function Test (WMFT), (2) Fugl-Meyer Motor Assessment (FMA), (3) hand-held dynamometry (grip strength), and (4) Motor Activity Log.
Results
Multivariate analysis showed a significant group × time interaction (Wilk’s Lambda=0.726, P=0.017), 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=0.001) and FMA (P=0.001) 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.
doi:10.1016/j.apmr.2005.08.113
PMCID: PMC3123334  PMID: 16401430 CAMSID: cams1782
Cerebrovascular accident; rehabilitation; arm; exercise
7.  Gender differences in self reported long term outcomes following moderate to severe traumatic brain injury 
BMC Neurology  2010;10:102.
Background
The majority of research on health outcomes after a traumatic brain injury is focused on male participants. Information examining gender differences in health outcomes post traumatic brain injury is limited. The purpose of this study was to investigate gender differences in symptoms reported after a traumatic brain injury and to examine the degree to which these symptoms are problematic in daily functioning.
Methods
This is a secondary data analysis of a retrospective cohort study of 306 individuals who sustained a moderate to severe traumatic brain injury 8 to 24 years ago. Data were collected using the Problem Checklist (PCL) from the Head Injury Family Interview (HIFI). Using Bonferroni correction, group differences between women and men were explored using Chi-square and Wilcoxon analysis.
Results
Chi-square analysis by gender revealed that significantly more men reported difficulty setting realistic goals and restlessness whereas significantly more women reported headaches, dizziness and loss of confidence. Wilcoxon analysis by gender revealed that men reported sensitivity to noise and sleep disturbances as significantly more problematic than women, whereas for women, lack of initiative and needing supervision were significantly more problematic in daily functioning.
Conclusion
This study provides insight into gender differences on outcomes after traumatic brain injury. There are significant differences between problems reported by men compared to women. This insight may facilitate health service planners and clinicians when developing programs for individuals with brain injury.
doi:10.1186/1471-2377-10-102
PMCID: PMC3006373  PMID: 21029463
8.  The International Classification of Functioning as an explanatory model of health after distal radius fracture: A cohort study 
Background
Distal radius fractures are common injuries that have an increasing impact on health across the lifespan. The purpose of this study was to identify health impacts in body structure/function, activity, and participation at baseline and follow-up, to determine whether they support the ICF model of health.
Methods
This is a prospective cohort study of 790 individuals who were assessed at 1 week, 3 months, and 1 year post injury. The Patient Rated Wrist Evaluation (PRWE), The Wrist Outcome Measure (WOM), and the Medical Outcome Survey Short-Form (SF-36) were used to measure impairment, activity, participation, and health. Multiple regression was used to develop explanatory models of health outcome.
Results
Regression analysis showed that the PRWE explained between 13% (one week) and 33% (three months) of the SF-36 Physical Component Summary Scores with pain, activities and participation subscales showing dominant effects at different stages of recovery. PRWE scores were less related to Mental Component Summary Scores, 10% (three months) and 8% (one year). Wrist impairment scores were less powerful predictors of health status than the PRWE.
Conclusion
The ICF is an informative model for examining distal radius fracture. Difficulty in the domains of activity and participation were able to explain a significant portion of physical health. Post-fracture rehabilitation and outcome assessments should extend beyond physical impairment to insure comprehensive treatment to individuals with distal radius fracture.
doi:10.1186/1477-7525-3-73
PMCID: PMC1310523  PMID: 16288664

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