A comparison of two approaches in the treatment of perceptual problems after stroke.

OBJECTIVE: To compare the effectiveness of the transfer of training and functional approaches in improving perceptual and functional abilities after stroke. DESIGN: Patients identified as having perceptual problems were randomly allocated to either the transfer of training approach or the functional approach for perceptual treatment. On completion of six weeks of treatment, each patient was reassessed for perceptual and functional abilities. SUBJECTS AND SETTING: Eighty inpatients on the Nottingham Stroke Unit. INTERVENTIONS: Perceptual treatment was given for 2.5 hours per week for six weeks. MAIN OUTCOME MEASURES: Rivermead Perceptual Assessment Battery, Barthel ADL Index and Edmans ADL index. RESULTS: There was no significant difference between the treatment groups on patient characteristics or impairments. The results also showed no significant difference between the treatment groups before and after treatment on perceptual ability total scores, individual perceptual subtest scores, or functional ability total scores (Mann-Whitney U 642.5-798.0, p > 0.05). Wilcoxon matched pairs signed ranks tests showed a significant improvement in both groups after treatment on perceptual and functional abilities (perceptual z = 6.02, p < 0.001, functional z = 6.72, p < 0.001). CONCLUSIONS: These results indicated that the improvement in perceptual abilities was equivalent using either of the two approaches. This could be due to spontaneous recovery or the effects of the Stroke Unit.

The Edmans ADL index: validity and reliability.

The Edmans ADL index was developed to assess functional abilities in stroke patients, including the activities necessary to enable a person to live independently at home, and graded to enable staff to monitor patient's progress over time. Content validity was established by comparing the Edmans ADL index with other published ADL assessments. Construct validity was established by comparing the Edmans and Barthel ADL indices, for 60 patients admitted consecutively to the Nottingham stroke unit. This showed a strong association between assessments. Inter-rater reliability was assessed by two occupational therapists, who independently and simultaneously assessed 20 patients individually on the stroke unit. This showed 96% excellent/good agreement between observers. Test-retest reliability was established by assessing 20 patients, 1 year post-stroke, on two separate occasions, 1 month apart. Results showed 85% excellent/good agreement over time. We conclude that the Edmans ADL index has content and construct validity, is sensitive to change over time, and has inter-rater and test-retest reliability.

The accuracy of predictions about progress of patients on a stroke unit.

The aim of the study was to check the accuracy of predictions about the factors which affect the progress, in physical abilities and activities of daily living, of patients admitted to a stroke unit. A series of 60 patients admitted consecutively to a stroke unit were assessed on tests of motor, functional and cognitive abilities at admission. On the basis of these assessments predictions were made about the abilities of the patients at discharge. Patients were assessed for level of motor abilities and activities of daily living at discharge and the accuracy of the predictions checked. Predictions were found to be significantly correlated with outcome but the relationships were not so close as to be useful for the clinical management of individual patients.

A re-validation of the Rivermead ADL scale for elderly patients with stroke.

The Rivermead ADL scale was developed for assessing activities of daily living in stroke patients but was not validated for elderly subjects. This study was designed to validate the scale for patients aged over 64 years. A series of 150 stroke patients was assessed on the scale, of whom 103 were aged over 64 years. The coefficients of reproducibility and 'scalability' were within acceptable limits both for patients aged under 65 and over 64 years. A revised order of assessment is suggested based on the order of difficulty of items. The two original household scales were combined to give an overall household scale which was validated as a unidimensional Guttman scale.

An investigation of factors affecting progress of patients on a stroke unit.

The aim of the study was to identify factors affecting the progress in physical abilities and activities of daily living of patients admitted to a stroke unit. A series of 70 patients admitted consecutively were assessed on a series of tests of motor, functional and cognitive abilities at admission. They were assessed for level of motor abilities and activities of daily living at discharge and 9 months after stroke. Predictive equations were developed which account for between 61% and 33% of the variance in motor abilities and activities of daily living at discharge and at 9 months after stroke. The most important factor influencing outcome was the degree of motor loss.

Treatment of visual perceptual deficits after stroke: four single case studies.

The transfer of training approach to the treatment of visual perceptual deficits was evaluated with three left hemiplegic and one bilateral hemiplegic stroke patients, using single case designs. The results showed little evidence of effective treatment for perceptual deficits, although there was a slight response to treatment for inattention deficits. Overall the changes were minimal. The importance of monitoring treatment is discussed.