Physical and Functional Ability Recovery Patterns and Quality of Life after Immediate Autologous Latissimus Dorsi Breast Reconstruction: A 1-Year Prospective Observational Study.

BACKGROUND: The authors evaluated arm and shoulder function and quality of life prospectively after breast reconstruction with the latissimus dorsi flap. METHODS: Muscle strength was checked by manual muscle test and range of motion preoperatively and then at five postoperative time points: week 2, week 6, month 3, month 6, and month 12. Functional disability and quality of life were also measured by the Disabilities of the Arm, Shoulder and Hand questionnaire and the 36-Item Short-Form Health Survey. The assessments were performed preoperatively and then at three postoperative time-points (i.e., months 3, 6, and 12). Statistical analysis was performed by repeated-measures analysis of variance. RESULTS: Thirty-one patients were included for analysis. All manual muscle test and range-of-motion scale scores at postoperative week 2 decreased significantly compared with preoperative scores. After postoperative month 3, scores for both manual muscle test and range of motion nearly recovered to preoperative status. However, functional disability, according to the Disabilities of the Arm, Shoulder and Hand instrument, was increased considerably after latissimus dorsi flap surgery, and a substantial amount of disability remained 1 year postoperatively. The mental component of the 36-Item Short-Form Health Survey improved consistently for 1 year postoperatively, whereas the physical component decreased significantly until the sixth month postoperatively and was still lower than the preoperative score at postoperative month 12. CONCLUSIONS: One year after latissimus dorsi flap surgery, shoulder strength and range of motion returned to baseline. However, functional disability and deteriorated physical aspects of quality of life persisted.

Effects of Balance Control Training on Functional Outcomes in Subacute Hemiparetic Stroke Patients.

OBJECTIVE: To investigate the efficacy of balance control training using a newly developed balance control trainer (BalPro) on the balance and gait of patients with subacute hemiparetic stroke. METHODS: Forty-three subacute stroke patients were assigned to either a balance control training (BCT) group or a control group. The BCT group (n=23) was trained with BalPro for 30 minutes a day, 5 days a week for 2 weeks, and received one daily session of conventional physical therapy. The control group (n=20) received two sessions of conventional physical therapy every day for 2 weeks. The primary outcome was assessment with the Berg Balance Scale (BBS). Secondary outcomes were Functional Ambulation Category (FAC), the 6-minute walking test (6mWT), Timed Up and Go (TUG), the Korean version of Modified Barthel Index (K-MBI), and the manual muscle test (MMT) of the knee extensor. All outcome measures were evaluated before and after 2 weeks of training in both groups. RESULTS: There were statistically significant improvements in all parameters except MMT and FAC after 2 weeks of treatment in both groups. After training, the BCT group showed greater improvements in the BBS and the 6mWT than did the control group. CONCLUSION: Balance control training using BalPro could be a useful treatment for improving balance and gait in subacute hemiparetic stroke patients.

Effect of dominant hand paralysis on quality of life in patients with subacute stroke.

OBJECTIVE: To evaluate the degree to which the paralysis of a dominant hand affects quality of life (QOL) in patients with subacute stroke. METHODS: We recruited 75 patients with subacute hemiplegic stroke. Patients were divided into two groups according to the location of the lesion and the side of the dominant hand. Group 1 consisted of patients whose strokes affected the dominant hand (i.e., right hemiplegia and right dominant hand or left hemiplegia and left dominant hand). Group 2 consisted of patients whose strokes affected the non-dominant hand (i.e., left hemiplegia and right dominant hand or right hemiplegia and left dominant hand). The primary outcome measure was the Short-Form 36-Item Health Survey (SF-36), which was used to evaluate health-related QOL. Secondary outcomes were scores on the Modified Barthel Index (MBI) and Beck Depression Inventory (BDI). RESULTS: We did not find any statistically significant differences between the groups in any SF-36 domain including the summaries of physical and mental component. Similarly, the MBI and BDI scores were not significantly different between the groups. CONCLUSION: The effect of paralysis on the dominant hand and QOL in patients with subacute stroke was not significantly different from the effect of paralysis on the non-dominant hand.

Feasibility and effects of newly developed balance control trainer for mobility and balance in chronic stroke patients: a randomized controlled trial.

OBJECTIVE: To investigate the feasibility and effects of balance training with a newly developed Balance Control Trainer (BCT) that applied the concept of vertical movement for the improvements of mobility and balance in chronic stroke patients. METHOD: Forty chronic stroke patients were randomly assigned to an experimental or a control group. The experimental group (n=20) underwent training with a BCT for 20 minutes a day, 5 days a week for 4 weeks, in addition to concurrent conventional physical therapy. The control group (n=20) underwent only conventional therapy for 4 weeks. All participants were assessed by: the Functional Ambulation Categories (FAC), 10-meter Walking Test (10mWT), Timed Up and Go test (TUG), Berg Balance Scale (BBS), Korean Modified Barthel Index (MBI), and Manual Muscle Test (MMT) before training, and at 2 and 4 weeks of training. RESULTS: There were statistically significant improvements in all parameters except knee extensor power at 2 weeks of treatment, and in all parameters except MBI which showed further statistically significant progress in the experimental group over the next two weeks (p<0.05). Statistically significant improvements on all measurements were observed in the experimental group after 4 weeks total. Comparing the two groups at 2 and 4 weeks of training respectively, 10mWT, TUG, and BBS showed statistically more significant improvements in the experimental group (p<0.05). CONCLUSION: Balance training with a newly developed BCT is feasible and may be an effective tool to improve balance and gait in ambulatory chronic stroke patients. Furthermore, it may provide additional benefits when used in conjunction with conventional therapies.