Proprioceptive neuromuscular facilitation to improve motor outcomes in older adults with chronic stroke.

This case series described changes in motor outcomes across 4 cases of older adults (mean age - 64.75) with chronic stroke (more than 6 months) after implementation of a 6-week proprioceptive neuromuscular facilitation-based program. Findings of this study were compared with a previously reported case. At baseline, all cases presented with motor impairments that increased their fall risk such as impaired balance, lower extremity strength, and mobility. Outcomes were measured using the Mini-BESTest, posturography, 5 times sit-to-stand test, upright motor control test, and 10-meter walk test. All cases completed 1 hour of therapy 3 times a week for 6 consecutive weeks at a university-based outpatient rehabilitation clinic. Positive outcomes in balance, strength, and mobility were seen in all cases. Proprioceptive neuromuscular facilitation can modify motor outcomes to decrease fall risk in older people with chronic stroke. Chronicity of stroke, age, and co-morbidities may influence the degree of improvements expected in these motor outcomes.

Augmentative and alternative communication in the Philippines: a survey of speech-language pathologist competence, training, and practice.

A cross-sectional survey study was undertaken to describe the perceived competence, pre- and post-professional training, and practice of Filipino speech-language pathologists (SLPs) in augmentative and alternative communication (AAC). Printed and electronic questionnaires were distributed to all SLPs in the Philippines with at least 1 year of practice experience. A total of 152 (47%) questionnaires were returned. Based on these data, 108 respondents (71%) practiced AAC, but most (range = 59-89%) did not perceive themselves to be competent in working with various client populations with complex communication needs. A majority (range = 70-93%) of the respondents reported limited pre-professional training in all AAC content areas, and at least 82% strongly desired continuing education in almost all areas of AAC. Almost 90% of respondents only occasionally (53%) or rarely (36%) recommended AAC, and 82% considered it as a last resort. Major practice challenges reported were families' negative attitudes toward AAC and lack of AAC-specific interdisciplinary collaboration. Infrequent use of high-tech AAC was also reported. The findings suggest various ways through which AAC education and services in the Philippines may be enhanced. They also imply the need for further research on alternative service delivery models, as well as additional members of the AAC team.

Hold-relax and contract-relax stretching for hamstrings flexibility: A systematic review with meta-analysis.

OBJECTIVE: To synthesize evidence on the effects of hold-relax and contract-relax stretching (HR and CR) on hamstrings flexibility compared with no intervention and other stretching techniques. DESIGN: Electronic databases (PubMed, PEDro, Cochrane CENTRAL, Scopus, LILACS) were searched from inception until March 31, 2014 and updated until May 31, 2017. Randomized controlled trials involving HR and CR to improve hamstrings flexibility in adults (aged ≥18 years old) with or without a pathological condition were included. Two reviewers independently searched literature, assessed risk of bias, and extracted data, while a third reviewer settled disagreements. RESULTS: Thirty-nine trials (n = 1770 healthy adults; median PEDro score = 4/10) were included. Meta-analysis showed large effects compared to control immediately after 1 session (6 trials, SMD = 1.02, 95% CI = 0.69 to 1.35, I2 = 2%) and multiple sessions (4 trials, SMD = 1.02, 95% CI = 0.64 to 1.40, I2 = 0%). Meta-analysis showed conflicting results compared to static stretching, while individual trials demonstrated conflicting results compared to other techniques. CONCLUSIONS: The immediate effects of HR and CR on hamstrings flexibility in adults are better against control. The long-term effects against other stretching types, and optimal exercise prescription parameters require further research.

Measurement properties of the upright motor control test in adults with subacute stroke.

BACKGROUND: Previous studies have distilled the Upright Motor Control Test Knee Extension and Knee Flexion subscales (UMCT-KE and UMCT-KF, respectively) from the original 6-item instrument and examined these as stand-alone rapid tests of voluntary movement control in the standing position. Systematic review evidence suggests that the UMCT-KE and UMCT-KF may have value in predicting walking ability after stroke. OBJECTIVE: To examine the interrater and intrarater reliability, and concurrent validity of the UMCT-KE and UMCT-KF, and associations with walking ability in adults with subacute stroke. METHODS: A prospective repeated assessments design was implemented in a rehabilitation department in a public teaching hospital. A consecutive sample of patients with subacute first-time stroke (N = 50; mean age = 51 ± 12 years; 20 females; mean time post-stroke = 68 ± 48 days) completed the study. Three physical therapists independently administered the UMCT-KE and UMCT-KF on two testing occasions 2 days apart (t1 and t2). On t2, a fourth rater administered the Leg subscale of the Motricity Index (MI-Leg) as criterion standard. RESULTS: The UMCT-KE and UMCT-KF demonstrated substantial to almost perfect interrater and intrarater reliability (W = 0.77-0.95), with lower limits of 95% confidence intervals extending to no lower than the substantial level. Both the UMCT-KE and UMCT-KF showed high correlations with the MI-Leg (ρ = 0.747-0.775) and significant associations with walking ability. p Values for all tests were <0.001. CONCLUSIONS: The UMCT-KE and UMCT-KF are reliable and valid tests for rapidly estimating voluntary movement control of the lower limbs in adults with subacute stroke.

Caregiver-Provided Physical Therapy Home Programs for Children with Motor Delay: A Scoping Review.

Background: Caregiver-provided physical therapy home programs (PTHP) play an important role in enhancing motor outcomes in pediatric patient populations. Purpose: This scoping review systematically mapped clinical trials of caregiver-provided PTHP that were aimed at enhancing motor outcomes in children who have or who are at risk for motor delay, with the purpose of (1) describing trial characteristics; (2) assessing methodologic quality; and (3) examining the reporting of caregiver-related components. Data Sources: Physiotherapy Evidence Database (PEDro), Cochrane CENTRAL, PubMed, Scopus, ScienceDirect, ProQuest Central, CINAHL, LILACS, and OTseeker were searched up to July 31, 2017. Study Selection: Two reviewers independently assessed study eligibility. Randomized or quasi-randomized controlled trials on PTHP administered by parents, other family members, friends, or informal caregivers to children who had or who were at risk for motor delay were included. Data Extraction: Two reviewers independently appraised trial quality on the PEDro scale and extracted data. Data Synthesis: Twenty-four articles representing 17 individual trials were identified. Populations and interventions investigated were heterogeneous. Most of the trials had important research design limitations and methodological issues that could limit usefulness in ascertaining the effectiveness of caregiver-provided PTHP. Few (4 of 17) trials indicated involvement of caregivers in the PTHP planning, assessed how the caregivers learned from the training or instructions provided, or carried out both. Limitations: Included studies were heterogeneous, and unpublished data were excluded. Conclusions: Although caregiver-provided PTHP are important in addressing motor outcomes in this population, there is a lack of evidence at the level of clinical trials to guide practice. More research is urgently needed to determine the effectiveness of care-giver-provided PTHP. Future studies should address the many important issues identified in this scoping review to improve the usefulness of the trial results.

Clinimetrics of the Upright Motor Control Test in chronic stroke.

INTRODUCTION: Insufficient literature exists regarding the clinimetric properties of the Upright Motor Control Test Knee Extension and Flexion subtests (UMCT-KE and UMCT-KF, respectively). This study examined the interrater and test-retest reliability of these subtests, and determined the relationship between the UMCT-KE and a clinical measure of muscle function in a sample of adults with chronic stroke. METHODS: Three raters independently administered the UMCT-KE and UMCT-KF on adults with chronic stroke with spasticity/abnormal movement patterns. Testing of each participant occurred on two occasions (T1 and T2) separated by a two-week interval. A fourth rater independently administered the Five Times Sit to Stand Test (FTSST), a measure of lower extremity muscle function (power), on T2. RESULTS: Twenty-nine adults aged 55 ± 8 years, comprising 21 men (72%), and who were 9 ± 5 years poststroke, completed the study. Most of the participants (66%, 19/29) did not require an assistive device during walking. The UMCT-KE and UMCT-KF demonstrated substantial interrater reliability (W = 0.63-0.67 and 0.72-0.75, respectively) and substantial to almost perfect test-retest reliability across the raters (W = 0.75-0.82 and 0.85-0.87, respectively). The UMCT-KE showed positive inverse correlation with the FTSST (ρ = -0.52, p = .003). CONCLUSIONS: Scores on both subtests are reproducible within raters and across different raters. The relationship of UMCT-KE scores with FTSST scores implies that the UMCT-KE can provide information that relates with the construct of muscle function in a weight-bearing position.

Effects of proprioceptive neuromuscular facilitation on balance, strength, and mobility of an older adult with chronic stroke: A case report.

This study described the effects of a proprioceptive neuromuscular facilitation (PNF) program on balance, strength, and mobility in an older adult with chronic stroke. The patient was male, aged 69 years, with right hemiplegia for 17 years, and had diminished balance, balance confidence, lower extremity (LE) strength, and gait velocity. He received 1 h of PNF-based therapy thrice a week for six weeks. Outcome measures were: Mini-BESTest, limits of stability (LOS), Activities-Specific Balance Confidence Scale (ABC), Five Time Sit-to-Stand Test (FTSST), Upright Motor Control Test (UMCT), and 10 Meter Walk Test (10 MWT). The patient improved on the Mini-BESTest (25/28, from 21/28), FTSST (27.47 s, from 30.27 s), UMCT knee extension (moderate, from weak), and 10 MWT (0.82 m/s, from 0.67 m/s); and positive changes in LOS dimensions. PNF was effective in enhancing balance, strength, and mobility in an older adult with chronic stroke and may mitigate falls risk in this population. More research is needed to determine its impact in a larger sample of older people with chronic stroke.

Intensive task-oriented training for mobility and balance in a patient with multiple strokes: A case report

@#<p style="text-align: justify;">Patients with multiple strokes are often excluded from studies due to poor outcomes. This case report described change in mobility and balance in a 54-year-old male with four strokes following intensive physical therapy (PT) based on the Task oriented Approach. Outcome assessment demonstrated clinically meaningful change in balance and mobility, and no adverse events. Intensive task-oriented PT is safe and feasible, and may contribute toward positive outcomes in severe disability related to multiple strokes.</p>

Measurement properties of the upright motor control test for adults with stroke: a systematic review.

BACKGROUND: The Upright Motor Control Test (UMCT) has been used in clinical practice and research to assess functional strength of the hemiparetic lower limb in adults with stroke. It is unclear if evidence is sufficient to warrant its use. The purpose of this systematic review was to synthesize available evidence on the measurement properties of the UMCT for stroke rehabilitation. METHODS: Electronic databases that indexed biomedical literature were systematically searched from inception until October 2015 (week 4): Embase, PubMed, Web of Science, CINAHL, PEDro, Cochrane Library, Scopus, ScienceDirect, SPORTDiscus, LILACS, DOAJ, and Google Scholar. All studies that had used the UMCT in the time period covered underwent hand searching for any additional study. Observational studies involving adults with stroke that explored any measurement property of the UMCT were included. The COnsensus-based Standards for the selection of health Measurement INstruments was used to assess the methodological quality of included studies. The CanChild Outcome Measures Rating Form was used for extracting data on measurement properties and clinical utility. RESULTS: The search yielded three methodologic studies that addressed criterion-related validity and contruct validity. Two studies of fair methodological quality demonstrated moderate-level evidence that Knee Extension and Knee Flexion subtest scores were predictive of community-level and household-level ambulation. One study of fair methodological quality provided limited-level evidence for the correlation of Knee Extension subtest scores with a laboratory measure of ground reaction forces. No published studies formally assessed reliability, responsiveness, or clinical utility. Limited information on responsiveness and clinical utility dimensions could be inferred from the included studies. CONCLUSIONS: The UMCT is a practical assessment tool for voluntary control or functional strength of the hemiparetic lower limb in standing in adults with stroke. Although different levels of evidence suggest that the Knee Extension and Knee Flexion subtests may possess criterion and construct validity, the lack of published literature examining content validity, reliability, and responsiveness raises questions regarding the use of the UMCT in routine clinical practice. These key findings highlight the need to further investigate the UMCT's measurement properties toward enhancing its standardization.

Reliability and validity of the Four Square Step Test in children with cerebral palsy and Down syndrome.

Little is known about the measurement properties of clinical tests of stepping in different directions for children with cerebral palsy (CP) and Down syndrome (DS). The ability to step in various directions is an important balance skill for daily life. Standardized testing of this skill can yield important information for therapy planning. This observational methodological study was aimed at defining the relative and absolute reliability, minimal detectable difference, and concurrent validity with the Timed Up-&-Go (TUG) of the Four Square Step Test (FSST) for children with CP and DS. Thirty children, 16 with CP and 14 with DS, underwent repeat testing 2 weeks apart on the FSST by 3 raters. TUG was administered on the second test occasion. Intraclass correlation coefficients (ICC [1,1] and [3,1]) with 95% confidence intervals, standard error of measurement (SEM), minimal detectable difference (MDD) and the Spearman rank correlation coefficient were computed. The FSST demonstrated excellent interrater reliability (ICC=.79; 95% CI: .66, .89) and high positive correlation with the TUG (r=.74). Test-retest reliability estimates varied from moderate to excellent among the 3 raters (.54, .78 and .89 for raters 1, 2 and 3, respectively). SEM and MDD were calculated at 1.91s and 5.29s, respectively. Scores on the FSST of children with CP and DS between 5 and 12 years of age are reliable and valid.

Clinimetric properties of sitting balance measures for children with cerebral palsy: a systematic review.

Assessment of sitting balance in children and youth with cerebral palsy (CP) is critical in order to design appropriate interventions to enhance activities and participation. This systematic review synthesized research evidence on the reliability, validity, responsiveness to change, and clinical utility of sitting balance measures for children and youth with CP. A two-tiered search in August 2012 using nine peer-reviewed electronic databases yielded nine articles with relevant information on seven clinical measures. Four of seven clinical measures: the Pediatric Reach Test (PRT), Sitting Assessment for Children with Neuromotor Dysfunction (SACND), Segmental Assessment of Trunk Control (SATCo), and Trunk Control Measurement Scale (TCMS), demonstrate acceptable overall applicability (at least one study supporting clinical utility, reliability, and validity) and are thus recommended for use in practice. Ongoing research on responsiveness to change, however, is warranted to support validity for outcomes measurement.

Teaching evidence based practice in physical therapy in a developing country: a national survey of Philippine schools.

BACKGROUND: Early education on the foundations of evidence based practice (EBP) is advocated as a potent intervention toward enhancing EBP uptake among physical therapists. Little is known about the extent to which EBP is integrated in educational curricula in developing countries where the benefits of EBP are more acutely needed. This study sought to describe EBP education in Philippine physical therapy schools, including the challenges encountered by educators in teaching EBP. METHODS: A national survey of higher education institutions offering an undergraduate degree program in physical therapy was conducted from August 2011 through January 2012. A 35-item questionnaire was developed to gather data on whether or not EBP was taught, specific EBP content covered and courses in which content was covered, teaching and evaluation methods, and challenges in teaching EBP. Data were analyzed descriptively. RESULTS: The study had a response rate of 55.7% (34/61). Majority of the participating educational institutions (82%, 28/34) reported teaching EBP by incorporating EBP content in the professional courses. Among those that did not teach EBP, inadequate educator competence was the leading barrier. Courses commonly used to teach EBP were those on research (78.6%, 22/28), therapy planning (71.4%, 20/28), treatment skills (57.1-64.3%, 16-18/28), and undergraduate thesis (60.7%, 17/28). Various EBP contents were covered, with statistical concepts more frequently taught compared with critical EBP content. Lectures and journal reports were the usual teaching methods (96.4%, 27/28 and 89.3%, 25/28, respectively) while written examinations, completion of an undergraduate thesis, and oral reports (82.1%, 23/28, 78.6%, 22/28, and 78.6%, 22/28, respectively) were often used in evaluation. Students' inadequate knowledge of statistics and lack of curricular structure for EBP were identified as leading challenges to teaching (75%, 21/28 and 50%, 14/28, respectively). CONCLUSIONS: Many physical therapy faculties across the Philippines are incorporating EBP content in teaching. However, there is arbitrary and fragmented coverage of EBP content and inadequate emphasis on clinically oriented teaching-learning and assessment methods. These findings suggest the need to design appropriate entry-level educational programs on EBP. Effective 'educating the educators' strategies are urgently needed and can have far-reaching positive repercussions on EBP uptake in physical therapist practice.

Research evidence uptake in a developing country: a survey of attitudes, education and self-efficacy, engagement, and barriers among physical therapists in the Philippines.

RATIONALE AND OBJECTIVE: Use of evidence from systematic research is critical in evidence-based physical therapy, yet this has not been described well in developing countries where its purported benefits are most needed. This study explored research evidence uptake among physical therapists in the Philippines. METHOD: A probability survey of practitioners in tertiary hospitals in the Philippines' National Capital Region was conducted. RESULTS: Of the 188 questionnaires distributed, 152 were returned for an 81% response rate. Positive attitudes were consistently reported (78-93%), although education and self-efficacy related to key dimensions such as searching, appraising and integrating evidence were varied (53-82%). Less than 50% reported using research evidence routinely in five of six dimensions of clinical practice, except in selecting treatments (53%). Textbooks, own observations and expert opinion were consistently relied upon (74-96%) while average-month approximations of engagement in relevant activities such as searching, reading, appraising and applying research literature were low (10-18%). Participants faced a number of barriers such as lack of time, resources, skills, access to research literature, supporting administrative policies, in-service training and authority in decision making. CONCLUSIONS: The low research evidence uptake and heavy reliance on potentially biased evidence sources strongly indicate the need for effective professional education for practitioners to address current barriers as well as early intensive undergraduate education for students to ensure adequate preparation on being effective research evidence consumers. Given the profile of Filipino physical therapists, alternatives to 'from scratch' evidence searching and appraisal are required if widespread uptake is envisaged.