Approaches for treating post-stroke language impairments (aphasia) based upon Constraint-Induced (CI) principles were first introduced in 2001. CI principles as previously applied to upper extremity and locomotor retraining in stroke survivors were derived from basic neuroscience. They comprise forced-use of the affected modality, a gradual rebuilding of targeted functions using a highly intensive treatment protocol, administered in a behaviorally-relevant context.

CI-based approaches have stimulated considerable neurorehabilitation research interest in the past decade. The original CI aphasia treatment protocol was tailored to improve functional communication in chronic aphasia (i.e., 6–12 months after stroke) and more recently, it has been adapted to treat language impairments in acute stroke survivors as well. Moreover, CI therapy applied to aphasia has been used as a model to assess language network plasticity in response to treatment using functional imaging techniques.

In the following paper, we review the first 10 years of behavioral and functional brain imaging research on CI-based approaches for aphasia rehabilitation.

Objective

To examine the applicability of marital resource (marriage has substantial benefits for well being over not being married) or marital crisis models (marital dissolution leads to poorer well being) to the spinal cord injury (SCI) population by studying the effects of gender, marital status and marital transitions on well-being.

Design

Prospective cohort from the SCI Model Systems National Database.

Setting

Community.

Participants

4,864 men and 1,277 women who sustained traumatic SCI and completed a minimum of one follow-up interview beginning at one year through 15 years post-injury.

Interventions

None.

Main outcomes measures

Life satisfaction, depressive symptomatology, and self-perceived health status using linear mixed models for longitudinal data.

Results

In general, well being improved over time since injury. Hypothesis testing supported the marital crisis model as marital loss through being or becoming separated or divorced and being or becoming widowed had the most consistent and negative impact across well-being outcomes, while being or becoming married only had an advantage for lower depression symptomatology over time. However, marital dissolution or loss did not have a uniformly adverse impact on well-being outcomes and this effect was often moderated by gender such that widows had higher depressive symptomatology and poorer self-perceived health than widowers, but separated or divorced women had higher life satisfaction and self-perceived health than men. Irrespective of gender, being separated or divorced vs. being single was associated with higher depression over time.

Conclusions

The results support the marital crisis model and that women and men can experience marital dissolution differently. Nor does all marital loss result in compromised well-being or marriage enhance well-being, highlighting complex dynamics worthy of further investigation in this population.

Objective

To evaluate the psychometric properties of the Fatigue Severity Scale (FSS) in persons with spinal cord injury (SCI).

Design

A two week methodological study was conducted to assess the internal consistency, reliability and the construct validity of the FSS.

Setting

A tertiary spinal cord rehabilitation facility.

Participants

48 community living individuals at least one year post SCI with ASIA A or B SCI and no medical conditions causing fatigue.

Main Outcome Measures

The ASIA Impairment Scale; the FSS; a Visual Analogue Scale for Fatigue (VAS-F), the SF-36 vitality scale, and the Centre for Epidemiological Studies Depression – Scale (CES-D)

Results

Our sample was predominantly male (n=31, 65%) with tetraplegia (n=26, 54%) and ASIA A injuries (n=30, 63%). The mean FSS score at baseline was 4.4 (SD=1.4) with 54% (N=26) scoring greater than 4. The internal consistency of the FSS was Cronbach’s alpha = 0.89. Two-week test-retest reliability was ICC=0.84 (95% CI 0.74 – 0.90). The magnitude of the relationship was as hypothesized for the VAS-F(r=.67) and CES-D (r=.58) and lower than hypothesized for the vitality subscore (r=−.48) of the SF-36.

Conclusions

The FSS has acceptable reliability with regard to internal consistency, test-retest reliability, and validity in persons with motor complete SCI.

Repetitive transcranial magnetic stimulation (rTMS) has been reported to improve naming in chronic stroke patients with nonfluent aphasia since 2005. In Part 1, we review the rationale for applying slow, 1 Hz, rTMS to the undamaged right hemisphere in chronic nonfluent aphasia patients following a left hemisphere stroke; and present a TMS protocol used with these patients that is associated with long-term, improved naming post- TMS. In Part, 2 we present results from a case study with chronic nonfluent aphasia where TMS treatments were followed immediately by speech therapy (constraint-induced language therapy). In Part 3, some possible mechanisms associated with improvement following a series of TMS treatments in stroke patients with aphasia are discussed.

Objective

To develop measurement tools for assessing compliance with identifiable processes of inpatient care for children with traumatic brain injury that are reliable, valid, and amenable to implementation.

Design

Literature review and expert panel using the RAND/UCLA Appropriateness Method and a Delphi technique.

Setting

Not applicable

Participants

Children with traumatic brain injury (TBI)

Interventions

Not applicable

Main outcome measures

Quality of care indicators

Results

A total of 119 indicators were developed across the domains of general management; family-centered care; cognitive-communication, speech, language and swallowing impairments; gross and fine motor skill impairments; neuropsychological, social and behavioral impairments; school re-entry; community integration. There was a high degree of agreement on these indicators as valid and feasible quality measures for children with TBI.

Conclusion

These indicators are an important step toward building a better base of evidence about the effectiveness and efficiency of the components of acute inpatient rehabilitation for pediatric patients with TBI.

Objective

To develop evidence-based and expert-driven quality indicators for measuring variations in the structure and organization of acute inpatient rehabilitation for children after traumatic brain injury (TBI) and to survey centers across the United States to determine the degree of variation in care.

Design

Quality indicators were developed using the RAND/UCLA modified Delphi method. Adherence to these indicators was determined from a survey of rehabilitation facilities.

Setting

Inpatient rehabilitation units in the United States.

Participants

A sample of rehabilitation programs identified using data from the National Association of Children’s Hospitals and Related Institutions, Uniform Data System for Medical Rehabilitation, and the Commission on Accreditation of Rehabilitation Facilities yielded 74 inpatient units treating children with TBI. Survey respondents comprised 31 pediatric and 28 all-age units.

Interventions

Not applicable

Main Outcome Measures

Variations in structure and organization of care among institutions providing acute inpatient rehabilitation for children with TBI.

Results

Twelve indicators were developed. Pediatric inpatient rehabilitation units and units with higher volumes of children with TBI were more likely to have: a census of at least one child admitted with a TBI for at least 90% of the time; adequate specialized equipment; a classroom; a pediatric subspecialty trained medical director; and greater than 75% of therapists with pediatric training.

Conclusions

There were clinically and statistically significant variations in the structure and organization of acute pediatric rehabilitation based on the pediatric focus of the unit and volume of children with TBI.

Objective

To determine consistency in motor maps of the abductor pollicis brevis (APB) muscle using transcranial magnetic stimulation (TMS) with conventional and close-spaced surface electrode recording placements.

Design

Nonrandom convenience sample.

Setting

TMS laboratory.

Participants

Eleven participants without any known neurologic disorders.

Interventions

The left hemisphere of right-hand-dominant subjects was mapped using TMS at each of 2 sessions, separated by 1 to 8 weeks.

Main Outcome Measures

Measurements at each session included the resting motor threshold, active site locations and average motor response amplitude for active sites, normalized map volume, and center of gravity (COG) for both electrode array configurations.

Results

The normalized map volume was larger for the conventional electrode placement than for the close electrode placement (4.23cm2 vs 3.44cm2, P=.010). Resting motor threshold was higher for the close-spaced than for the conventional-spaced electrodes (48.36% vs 46.59%, P=.028). No statistical difference was found between sessions and within electrode placements for the normalized map volume, for resting motor threshold, or for the mean motor amplitude of the most active site for each map. No statistical difference was observed for the COG distance between electrode placements.

Conclusions

This study revealed differences between close-spaced and conventional-spaced surface electrode placement for TMS motor map volumes and for resting motor thresholds. The motor maps for the APB muscle were reliably reproducible between sessions for each electrode array.

Objective

To determine the prevalence of anatomic impediments to interlaminar lumbar epidural steroid injection (LESI) in a community-based population.

Design

Cross-sectional observational study.

Setting

Community-based.

Participants

Older adults (N=333) sampled irrespective of back pain status.

Interventions

Not applicable.

Main Outcome Measures

Computed tomography evaluation of 5 potential anatomic impediments to interlaminar LESI at the L2-S1 spinal levels, including (1) ligamentum flavum (LF) calcification, (2) interspinous ligament (ISL) calcification, (3) spinous process (SP) contact, (4) the absence of epidural fat in the posterior epidural space, and (5) the presence of fat density superficial to the LF in the midsagittal plane. Independent variables included age, sex, body mass index (BMI), and current smoking.

Results

LF and ISL calcifications were prevalent in 3% to 7% and 2% to 3% of spinal levels, respectively, without significant differences by spinal level. SP contact was most common at the L4-5 level (22%). Absence of posterior epidural fat was very common at L5-S1 (65%), but infrequent at other levels. The presence of midline fat density superficial to LF was most common at L5-S1 (55%). The prevalence of LF calcification, ISL calcification, and SP contact increased with age, but the prevalence of absence of posterior epidural fat and the presence of a midline fat density superficial to LF did not. Sex and smoking status were not associated with the prevalence of anatomic impediments, but higher BMI was associated with a lower prevalence of absence of posterior epidural fat.

Conclusions

Anatomic impediments to interlaminar LESI were common in this community-based population, particularly at the L5-S1 spinal level. Because of the high overall prevalence of anatomic impediments, and differences in prevalence by spinal level, knowledge of the distribution and frequency of these impediments may aid in aspects of decision-making for the interventional spine physician.

Objective

To examine the associations between perceived proximity to neighborhood resources, disability and social participation, and the potential moderating effect of perceived proximity to neighborhood resources on the association between disability and social participation among community-dwelling older women and men.

Design

Cross-sectional.

Setting

Community.

Participants

Older adults (296 women; 258 men).

Interventions

Not applicable.

Main outcome measures

Data on age, education, depressive symptoms, frequency of participation in community activities, perceived proximity to neighborhood resources (services and amenities), and functional autonomy in daily activities (disability) were collected by interviewer-administered questionnaire.

Results

Greater perceived proximity to resources and lower level of disability were associated with greater social participation for both women (R2=0.10; p<0.001) and men (R2=0.05; p<0.01). The association between disability and social participation did not vary as a function of perceived proximity to neighborhood resources among women (no moderating effect; p=0.15). Among men, however, greater perceived proximity to neighborhood resources enhanced social participation (p=0.01), but only among those with minor or no disability.

Conclusions

Future studies should investigate why perceived proximity to services and amenities is associated with social participation among older men with minor or no disabilities and with women overall but has no association among men with moderate disabilities.

Objective

To examine behavioral risk factors in relation to fatigue after spinal cord injury (SCI), specifically cardiovascular related behaviors, prescription medication use, and alcohol and cigarette use.

Design

Cross-sectional.

Setting

A medical university in the Southeastern United States.

Participants

2296 adults at least one year post-SCI from a large specialty hospital in the Southeast responded to a mail-in survey.

Intervention

None

Main Outcomes Measure

The Modified Fatigue Impact Scale-5 item version was used to assess disabling fatigue.

Results

Of participants, 8.3% had disabling fatigue, 45.3% reported fatigue rarely to never impacted their life, and 46.4% reported having some fatigue. Persons who reported having less exercise than others with a similar injury level were 2.49 times as likely to have disabling fatigue as persons who reported more exercise. Those with a fair or poor diet were also more likely to have disabling fatigue. Use of prescription medication to treat pain was associated with disabling fatigue, as was being CAGE positive. Among non-behavioral variables, race and injury severity were significantly associated with disabling fatigue.

Conclusions

We identified several behavioral predictors of disabling fatigue, including cardiovascular risk factors, prescription medication use, and alcohol use. These factors are important as they are able to be modified and could be potential factors for prevention or intervention.

Objective

To determine the effect of a 12-month community-based tango dance program on activity participation among individuals with Parkinson disease (PD).

Design

Randomized controlled trial with assessment at baseline, 3, 6, and 12 months.

Setting

The intervention was administered in the community; assessments were completed in a university laboratory.

Participants

Sixty-two volunteers with PD enrolled in the study and were randomized to treatment group. Ten participants did not receive the allocated intervention, so the final analyzed sample included 52 participants.

Intervention

Participants were randomly assigned to the Tango group, which involved 12 months of twice weekly Argentine tango dance classes, or to the no intervention Control group (n = 26 per group).

Main Outcome Measures

Current, new and retained participation in instrumental, leisure and social activities as measured by the Activity Card Sort (with the “dance” activity removed).

Results

Total Current participation in the Tango group was higher at 3, 6, and 12 months compared to baseline (ps ≤ 0.008), while the Control group did not change (ps ≥ 0.11). Total Activity Retention (since onset of PD) in the Tango group increased from 77% to 90% (p = 0.006) over the course of the study, whereas the Control group remained around 80% (p = 0.60). These patterns were similar in the separate activity domains. The Tango group gained a significant number of New Social activities (p = 0.003), but the Control group did not (p = 0.71).

Conclusions

Individuals with PD who participated in a community-based Argentine tango class reported increased participation in complex daily activities, recovery of activities lost since the onset of PD, and engagement in new activities. Incorporating dance into the clinical management of PD may benefit participation and subsequently quality of life for this population.

Objective

To investigate whether use of physical therapy (PT) and occupational therapy (OT) services decreased after the passage of the 1997 Balanced Budget Act (BBA).

Design

Data from the nationally representative Medicare Current Beneficiary Survey (MCBS) were merged with Medicare claims data. We conducted cross-sectional analyses of data from 1995 (n=7978), 1999 (n=7863), and 2001 (n=7973). All analyses used MCBS sampling weights to provide estimates that can be generalized to the Medicare population with 5 common conditions.

Settings

Skilled nursing facilities (SNFs), home health agencies, inpatient rehabilitation facilities (IRFs), and outpatient rehabilitation settings.

Participants

Medicare beneficiaries who participated in the MCBS survey in each of the study years and had 1 or more of the following conditions: acute stroke, acute myocardial infarction, chronic obstructive pulmonary disease, arthritis or degenerative joint disease, or mobility problems.

Interventions

Not applicable.

Main Outcome Measures

Percentage of persons meeting our inclusion criteria who received PT or OT in each setting, and total units of PT and OT received in each setting.

Results

Multivariable logistic regression revealed no statistically significantly differences in the proportion of people who met our inclusion criteria who used PT or OT from home health agencies across the 3 time points. For SNFs, an increase in the odds of receiving PT was statistically significant from 1995 to 1999 (odds ratio [OR]=1.42; 95% confidence interval [CI], 1.19–1.69) and 1995 to 2001 (OR=1.69; 95% CI, 1.39–2.05). For IRF and outpatient settings, a significant increase was observed between 1995 and 2001 (OR=1.71, OR=1.27, respectively). For OT, a statistically significant increase was observed for IRF and outpatient rehabilitation settings from 1995 to 2001. For SNF, the increase was statistically significant from 1995 to 1999 and 1995 to 2001. Mean total PT and OT units received also increased across all settings from 1995 to 2001 except for IRFs.

Conclusions

Despite BBA mandates restricting postacute care expenditures, this nationally representative study showed no decreases in the percentage of Medicare beneficiaries with 5 common diagnoses receiving PT and/or OT across all settings and no decreases in units of PT and/or OT services received between 1995 and 2001 except for those in IRFs. This study suggests that the delivery of PT and OT services did not decline among persons with conditions where rehabilitation services are often clinically indicated.

Objective

To explore shortened response formats for use with the Activities-specific Balance Confidence scale and then: 1) evaluate the unidimensionality of the scale; 2) evaluate the item difficulty; 3) evaluate the scale for redundancy and content gaps; and 4) evaluate the item standard error of measurement (SEM) and internal consistency reliability among aging individuals (≥50 years) with a lower-limb amputation living in the community.

Design

Secondary analysis of cross-sectional survey and chart review data.

Setting

Out-patient amputee clinics, Ontario, Canada.

Participants

Four hundred forty eight community living adults, at least 50 years old (mean = 68 years), who have used a prosthesis for at least 6 months for a major unilateral lower limb amputation. Three hundred twenty five (72.5%) were men.

Intervention

N/a

Main Outcome Measure(s)

Activities-specific Balance Confidence Scale.

Results

A 5-option response format outperformed 4- and 6-option formats. Factor analyses confirmed a unidimensional scale. The distance between response options is not the same for all items on the scale, evident by the Partial Credit Model (PCM) having a better fit to the data than the Rating Scale Model. Two items, however, did not fit the PCM within statistical reason. Revising the wording of the two items may resolve the misfit, and improve the construct validity and lower the SEM. Overall, the difficulty of the scale’s items is appropriate for use with aging individuals with lower-limb amputation, and is most reliable (Cronbach ∝ = 0.94) for use with individuals with moderately low balance confidence levels.

Conclusions

The ABC-scale with a simplified 5-option response format is a valid and reliable measure of balance confidence for use with individuals aging with a lower limb amputation.

Objective

To analyze change over 6 months in accelerometer-measured physical activity for participants with arthritis in a physical activity promotion trial. We tested the hypothesis that participants with the highest baseline functional capacity, regardless of their intervention status, experienced the greatest increases in physical activity levels at 6-month follow-up.

Design

At baseline, participants were interviewed in person, completed a 5-minute timed walk, and wore a biaxial accelerometer for 1 week, with a subsequent week of accelerometer wear at 6 months. We present data on the changes in accelerometermeasured physical activity across baseline function quartiles derived from participants’ walking speed. Analyses were controlled for sociodemographic, health status, and seasonal covariates as well as exposure to the study’s behavioral intervention.

Setting

A Midwest academic medical center.

Participants

Participants (N=226) with knee osteoarthritis or rheumatoid arthritis currently enrolled in the Improving Motivation for Physical Activity in Persons With Arthritis Clinical Trial.

Intervention

Counseling by physical activity coaches versus control group physician advice to exercise.

Main Outcome Measure

Change in average daily counts between baseline and 6-month follow-up.

Results

Contrary to our hypothesis, and after controlling for other predictors of change, the lowest quartile function participants had the largest mean absolute and relative physical improvement over baseline, regardless of intervention group status.

Conclusions

Participants at a higher risk of immanent mobility loss may have been more committed to improve lifestyle physical activity, reflecting the wisdom of targeting older adults at risk of mobility loss for physical activity behavior change interventions.

Objective

Spatial neglect is a failure or slowness to respond, orient, or initiate action towards contra-lesional stimuli, associated with functional disability that impedes stroke recovery. Early identification of specific neglect deficits may identify patients likely to experience chronic disability. However, psychometric evaluation of assessments has focused on subacute/chronic populations. We addressed this gap by assessing two neglect measures – the Behavioral Inattention Test (BIT) and the Catherine Bergego Scale (CBS) – in acute neglect.

Design

Correlational/Psychometric study.

Setting

Inpatient rehabilitation hospital.

Participants

Screening identified 51 consecutive right-hemisphere stroke patients with left neglect (BIT conventional score < 129 or CBS > 11) that tested an average of 22.3 days post-stroke.

Interventions

Not applicable.

Main Outcome Measures

We obtained BIT, CBS, and Barthel assessments for each participant, and clinical and laboratory measures of perceptual-attentional and motor-intentional deficits.

Results

The BIT demonstrated good reliability and loaded onto a single factor. Consistent with our theoretical prediction, principal components analysis of the CBS identified two underlying factors: “Where” perceptual-attentional items (CBS-PA) and embodied, motor exploratory items (CBS-ME). The CBS-ME uniquely predicted ADL deficits (Barthel Index), but did not predict clinical and laboratory assessments of motor-intentional bias. More severe neglect on CBS-PA correlated with greater “Where” perceptual-attentional bias on clinical and laboratory tests, but did not uniquely predict deficits in activities of daily living (ADLs).

Conclusions

Our results indicate that assessments of spatial neglect may be used to detect specific motor-exploratory deficits in spatial neglect. Obtaining CBS-ME scores routinely might improve detection of acute stage patients with spatial action deficits requiring increased assistance that may persist to the chronic stage.

There is a need for time-efficient, valid measures of distal paretic upper extremity (UE) movement. The purposes of this study were to: (a) determine the psychometric properties of the wrist stability and mobility and hand items of the upper extremity scale of the Fugl-Meyer (w/h UE FM) as a “stand alone” measure of distal UE movement; and (b) provide detailed instructions on w/h UE FM administration and scoring. The UE FM and Action Research Arm Test (ARAT) were administered on 2 separate occasions to each of 29 subjects exhibiting stable, mild, UE hemiparesis (23 males; age (mean (sd)) 60.8 (12.3) years; mean time since stroke onset for subjects in the sample: 36.0 months). Fifty-eight observations were collected on each measure. w/h UE FM internal consistency levels (measured by Cronbach’s alpha) were high (0.90 and 0.88 for first and second testing sessions, respectively). The intraclass correlation coefficients for the UE FM was 0.98, while the intraclass correlation coefficient for the w/h UE FM was 0.97. Concurrent validity measured by Spearman’s correlation was moderately high between the w/h UE FM and ARAT (.72 p < .0001). From these data, it appears that the w/h UE FM is a promising tool to measure distal UE movement in minimally impaired stroke, although more research with a larger sample is needed. A standardized approach to UE test administration is critical to accurate score interpretation across patients and trials. Thus, the article also provides instructions and pictures for w/h UE FM administration and scoring.

Objective

To develop and test a prototype dyspnea computer adaptive test.

Design

Prospective study.

Setting

Two outpatient medical facilities.

Participants

A convenience sample of 292 adults with COPD.

Interventions

Not applicable

Main Outcome Measure

We developed a modified and expanded item bank and computer adaptive test (CAT) for the Dyspnea Management Questionnaire (DMQ), an outcome measure consisting of four dyspnea dimensions: dyspnea intensity, dyspnea anxiety, activity avoidance, and activity self-efficacy.

Results

Factor analyses supported a four-dimensional model underlying the 71 DMQ items. The DMQ item bank achieved acceptable Rasch model fit statistics, good measurement breadth with minimal floor and ceiling effects, and evidence of high internal consistency reliability (α = 0.92 to 0.98). Using CAT simulation analyses, the DMQ-CAT showed high measurement accuracy compared to the total item pool (r = .83 to .97, p < .0001) and evidence of good to excellent concurrent (r = −.61 to −0.80, p < .0001) validity. All DMQ-CAT domains showed evidence for known-groups validity (p ≤ 0.001).

Conclusions

The DMQ-CAT reliably and validly captured four distinct dyspnea domains. Multidimensional dyspnea assessment in COPD is needed to better measure the effectiveness of pharmacologic, pulmonary rehabilitation, and psychosocial interventions in not only alleviating the somatic sensation of dyspnea but also reducing dysfunctional emotions, cognitions, and behaviors associated with dyspnea, especially for anxious patients.

Objective

To exercise testing in AD and possible disease-related change over time. Though physical activity and fitness are receiving increased attention as a possible adjunct treatment for Alzheimer’s disease (AD), relatively little work has been done characterizing their physiologic response to exercise

Design

Retrospective assessment of a 2-year, observational study

Setting

University medical center

Participants

50 nondemented individuals and 31 with AD

Interventions

None

Main Outcome Measures

Participants underwent a clinical dementia evaluation and performed an incremental exercise test using a treadmill and the modified Bruce protocol at baseline and at a two year follow-up. We examined oxygen consumption, minute ventilation, heart rate and ventilatory equivalents for oxygen and carbon dioxide at submaximal and peak exercise intensities to determine if the measures were different between groups or over time.

Results

AD and nondemented participants performed similarly at submaximal effort and both groups showed similar change in exercise response over 2 years. However, nondemented individuals had consistently higher values of oxygen consumption (p≤0.02) and minute ventilation at peak effort at baseline (p=0.003).

Conclusions

Individuals with AD demonstrate physiologic responses to submaximal exercise effort that are not significantly different than individuals without dementia. However, differences are apparent at the extreme of effort.

Objective

To establish reference values for stair ascent and descent times in community dwelling ambulatory older adults, and to examine their predictive validity for functional decline.

Design

Longitudinal cohort study. Mean follow-up time was 1.8 year (maximum 3.2 y, total 857.9 person-years).

Setting

Community sample.

Participants

Older adults age 70 and older (N=513; mean age, 80.8±5.1y), without disability or dementia.

Interventions

Not applicable.

Main Outcome Measures

Time to ascend and descend 3 steps measured at baseline. 14 point Disability scale assessed functional status at baseline and at follow-up interviews every 2–3 months. Functional decline was defined as an increase in the disability score by 1-point during the follow-up period.

Results

The mean ± standard deviation (SD) stair ascent and descent time for three steps was 2.78 ±1.49 and 2.83 ±1.61 sec respectively. The proportion of self-reported and objective difficulty was higher with longer stair ascent and descent times (P<.001 for trend for both stair ascent and descent). Of the 472 participants with at least one follow-up interview, 315 developed functional decline with a 12-month cumulative incidence of 56.6% (95% confidence interval, CI, 52.1–61.3%). The stair negotiation time was a significant predictor of functional decline after adjusting for covariates including gait velocity (adjusted hazard ratio per one-second increase, aHR 1.12, 95% CI 1.04–1.21 for stair ascent time, aHR 1.15, 95% CI 1.07–1.24 for stair descent time). Stair descent time was a significant predictor of functional decline among relatively high-functioning older adults reporting no difficulty in stair negotiation (P=.001).

Conclusions

The stair ascent and descent times are simple, quick, and valid clinical measures for assessing the risk of functional decline in community dwelling older adults including high-functioning individuals.

Objective

To compare three different methods of measuring plantarflexor stiffness in children with spastic diplegia cerebral palsy (CP) and children without disability.

Design

Case-control study

Setting

Human Performance Laboratory

Participants

A retrospective analysis was conducted with one hundred twenty-one children (mean age 8.4 years) with spastic diplegia (CP group) and forty-eight children (mean age 9.7 years) with typical development (TD group).

Intervention

Not applicable

Main Outcome Measures

An isokinetic dynamometer was used to measure ankle plantarflexor stiffness at 10°/s using three methods; 1) End-range method which applied a linear slope to the end of the torque-angle curve, 2) Set-range method which applied a linear slope from 30–10º plantarflexion and 3) a Linear method which applied a slope only to the linear portion of the curve.

Results

Two-way ANOVA revealed significant main effects for group and stiffness method. The End-range method showed no significant difference between groups for plantarflexor stiffness (p=.62), the Set-range method showed the CP group with 120% greater stiffness than the TD group (p<.046) and the Linear method showed the CP group with 35% greater stiffness than the TD group (p<.001).

Conclusions

The Linear method appeared to resolve the issues with the previous methods; applying a linear slope to a nonlinear curve or applying a linear slope to the same range of motion for each child regardless of their range limitations. It is clear that children with CP have limited range of motion; therefore stiffness occurs earlier in the range than would be expected for a typically developing child. Using the Linear method, children with CP were 35% stiffer in the ankle plantarflexors than typically developing peers.

Objectives

To determine the test-retest reliability over 2 separate days for weight-bearing ability during standing tasks in individuals with chronic stroke and to compare the weight-bearing ability among five standing tasks for the paretic and non-paretic limbs.

Design

Prospective study using a convenient sample.

Setting

Free-standing tertiary rehabilitation center.

Participants

15 community-dwelling stroke individuals with moderate motor deficits; volunteer sample.

Interventions

Not applicable.

Main Outcome Measures

Weight-bearing ability as measured by the vertical ground reaction force during 5 standing tasks (rising from a chair, quiet standing, weight-shifting forward, backward, laterally).

Results

The weight-bearing ability was less for the paretic limb compared with the nonparetic limb, but the intraclass correlation coefficients were high (0.95–0.99) for both limbs between the 2 sessions for all 5 tasks. The forward weight-shifting ability was particularly low in magnitude on the paretic side compared with the other weight-shifting tasks. In addition, the forward weight-shift ability of the nonparetic limb was also impaired but to a lesser extent. Large asymmetry was evident when rising from a chair, with the paretic limb bearing a mean 296N and the nonparetic side bearing a mean 458N. The weight-bearing ability during all 5 tasks correlated with one another (r range, 0.56–0.94).

Conclusions

Weight-bearing ability can be reliably measured and may serve as a useful outcome measure in individuals with stroke. We suggest that impairments of the hemiparetic side during forward weight shifting and sit-to-stand tasks presents a challenge to the motor systems of individuals with stroke, which may account for the poor balance that is often observed in these individuals.

Objective

To determine the reliability of isokinetic concentric strength measures of both the hemiparetic and non-involved limbs for flexion and extension motions of the hip, knee, and ankle joints in individuals who have had a stroke.

Design

Test-retest, repeated-measures intraobserver reliability design.

Setting

Tertiary rehabilitation center.

Participants

20 community-dwelling individuals who have had a stroke, with motor deficits ranging from 3 to 6 on the Chedoke-McMaster Stroke Assessment; volunteer sample.

Interventions

Not applicable.

Main Outcome Measures

Peak torque and average torque (ie, mean over the range of motion tested) from an ensemble-averaged (three trials) torque-angle curve during isokinetic concentric extension and flexion movements of the ankle, knee, and hip.

Results

Although peak and average torque were significantly less for the hemiparetic limb compared with the non-involved limb, the intraclass correlation coefficients (ICCs) between the two test sessions were high (0.95–0.99 for peak torque, 0.88–0.98 for average torque) for both limbs for all 3 joints. However, there was a learning effect, as observed by the slightly greater values attained from the second test session.

Conclusions

Peak and average isokinetic torque can be used to assess reliably lower extremity strength in persons with chronic stroke. Practice sessions may be required before the actual test to reduce the effect of learning.

Objective

To evaluate the association of health status, secondary health conditions, hospitalizations, and risk of mortality and life expectancy (LE) after spinal cord injury (SCI).

Design

Prospective cohort study.

Setting

Preliminary data were collected from a specialty hospital in the Southeastern United States, with mortality follow-up and data analysis conducted at a medical university.

Participants

A total of 1361 adults with traumatic SCI, all at least 1 year post-injury at the time of assessment, were enrolled in the study. There were 325 deaths. After elimination of those with missing data on key variables, there were 267 deaths and 12,032 person-years.

Interventions

None

Main Outcome Measures

Mortality status was determined by routine follow-up using the National Death Index through December 31, 2008. A logistic regression model was developed to estimate the probability of dying in any given year using person years.

Results

A history of chronic pressure ulcers, amputations, a depressive disorder, symptoms of infections, and being hospitalized within the past year were all predictive of mortality. LE estimates were generated using the example of a male with non-cervical, non-ambulatory SCI. Using 3 age examples (20, 40, 60), the greatest estimated lost LE was associated with chronic pressure ulcers (50.3%), followed by amputations (35.4%), 1 or more recent hospitalizations (18.5%), and the diagnosis of probable major depression (18%). Symptoms of infections was associated with a 6.7% reduction in LE for a 1 standard deviation increase in infectious symptoms.

Conclusion

Several secondary health conditions represent risk factors for mortality and diminish LE after SCI. The presence of 1 or more of these factors should be taken as an indicator of the need for intervention.

Objective

To compare the mobility status (admission and discharge status, in addition to change in status) between patients with stroke and traumatic brain injury (TBI) during inpatient rehabilitation and to determine the relationship between mobility status and outcome variables including length of stay.

Design

Prospective study using a consecutive sample

Setting

Freestanding tertiary rehabilitation centre

Participants

A total of 210 stroke and traumatic brain injury patients consecutively admitted for inpatient rehabilitation.

Main Outcome Measures

Clinical Outcome Variable Scale, a 13 item scale of mobility status (measured on admission and discharge from inpatient rehabilitation) and rehabilitation length of stay.

Results

With age and time since injury controlled in the model, the TBI group demonstrated a significantly higher mobility status on admission and discharge over the stroke group, but the change (improvement) in mobility status was not different. The admission mobility status accounted for 61% and 60% of variability of the discharge mobility status for the stroke and TBI groups, respectively. The admission mobility status accounted for 40% and 50% of the variability in rehabilitation length of stay for the stroke and TBI groups, respectively. Either the admission mobility status or the physical therapist’s prediction of the discharge status could be used to determine the actual discharge mobility status, although the physical therapist’s predictions were more accurate than using a statistical model.

Conclusions

The TBI group demonstrated a higher mobility status at admission and discharge from inpatient rehabilitation than the stroke group, however, the rate of improvement (improvement in mobility status per day) was not different between groups. Admission mobility status using the Clinical Outcome Variable Scale, was an excellent predictor of discharge mobility status and rehabilitation length of stay in stroke and TBI patients.

Objective

The National Institute of Neurological Disorders and Stroke (NINDS) commissioned the Neurology Quality of Life (Neuro-QOL) project to develop a bilingual (English/Spanish), clinically relevant and psychometrically robust HRQL assessment tool. This paper describes the development and calibration of these banks and scales.

Design

Classical and modern test construction methodologies were used, including input from essential stakeholder groups.

Setting

An online patient panel testing service and eleven academic medical centers and clinics from across the United States and Puerto Rico that treat major neurological disorders.

Participants

Adult and pediatric patients representing different neurological disorders specified in this study, proxy respondents for select conditions (stroke and pediatric conditions), and English and Spanish speaking participants from the general population.

Main Outcome Measures

Multiple generic and condition specific measures used to provide construct validity evidence to new Neuro-QOL tool.

Results

Neuro-QOL has developed 14 generic item banks and 8 targeted scales to assess HRQL in five adult (stroke, multiple sclerosis, Parkinson’s disease, epilepsy, and amyotrophic lateral sclerosis) and two pediatric conditions (epilepsy and muscular dystrophies).

Conclusions

The Neuro-QOL system will continue to evolve, with validation efforts in clinical populations, and new bank development in health domains not currently included. The potential for Neuro-QOL measures in rehabilitation research and clinical settings is discussed.