Modified constraint-induced therapy for the lower extremity in elderly persons with chronic stroke: single-subject experimental design study.

BACKGROUND: Studies have demonstrated improvements in arm motor function after constraint-induced (CI) therapy. Few studies of CI therapy for lower extremity conditions have been done. Our purpose was to evaluate the effect of modified CI therapy for the lower extremity in terms of motor control in elderly persons with chronic stroke. METHOD: A single-subject experimental AB design was used, with 3 months of follow-up. The A phase consisted of a baseline period of 2 weeks with 6 measurements, and the B phase was a 4-week intervention with 8 measurements. Two men and 1 woman were included. The intervention consisted of intensive rehabilitation of the affected leg for 2 hours each weekday. A whole-leg orthosis was used to immobilize the nonaffected leg. The following tests were conducted: a step test for dynamic balance, Fugl-Meyer assessment for lower-extremity motor function, the Timed Up and Go test for mobility, and the 6-minute and 10-meter walk tests for walking ability. Statistical significance was analyzed by using Shewhart charts with a 2-standard deviation band method. RESULTS: A positive change was observed in 14 of 18 variables. Significant improvements existed in 7 of the 14 positively changed variables. Positive changes remained in 13 of 14 variables at the 3-month follow-up evaluation. CONCLUSION: Modified CI therapy may result in positive changes in balance and motor function in elderly persons with chronic stroke.

Changes in perceived health between one and five years after stroke: a randomized controlled trial of early supported discharge with continued rehabilitation at home versus conventional rehabilitation.

BACKGROUND: Early supported discharge with continued rehabilitation at home (ESD) for patients with mild to moderate impairments has been compared to conventional rehabilitation in a randomized controlled trial. The aim of this study was to explore changes over time in perceived health status over the five years after stroke onset. METHODS: Of 83 patients enrolled in a randomized controlled trial of ESD compared to conventional rehabilitation, 50 (home rehabilitation group, n=28, conventional rehabilitation group, n=22) were followed up at one and five years after stroke with regard to perceived health using the Sickness Impact Profile. The Mann Whitney U-test was employed for statistical analysis of differences between the groups at one and five years, and the Wilcoxon sign test for differences within each group between one and five years. RESULTS: There was no difference in perceived health between the groups at one or five years after stroke with regard to SIP total and the physical and psychosocial dimensions. Perceived health did not change significantly between one and five years in the home rehabilitation group whereas it had deteriorated significantly in the conventional rehabilitation group (p=0.05). CONCLUSIONS: We conclude that the long term outcome with regard to perceived health status is more favourable after ESD than after conventional rehabilitation. Our results suggest that the environment is a key component to be considered in the rehabilitation process of stroke patients.

Early supported discharge and continued rehabilitation at home after stroke: 5-year follow-up of resource use.

BACKGROUND: Early supported discharge (ESD) with continued rehabilitation at home has shown a beneficial effect on extended activities of daily living 5 years after stroke. The long-term effect of ESD on resource use has not been explored. METHODS: At 5 years, 54 patients with mild to moderate disability, enrolled in a randomized controlled trial of ESD, were followed up. Data were collected from a county register and by interviewing the patient or the patient's spouse. RESULTS: There were differences in mean length of hospitalization, 51 versus 32 days (P = .02). There was no significant difference between the groups in regard to total outpatient rehabilitation, ESD visits included, but there was a difference in where the services were obtained. The ESD group had more rehabilitation at home (ESD service) and the control group had more outpatient rehabilitation (P = .04), including physiotherapy in primary care (P = .05). There were no other differences. CONCLUSION: We conclude that, 5 years after stroke, our ESD service was favorable with regard to resource use.

A randomized controlled trial of early supported discharge and continued rehabilitation at home after stroke: five-year follow-up of patient outcome.

BACKGROUND AND PURPOSE: The optimal organization of rehabilitation services after discharge from a stroke unit has not been determined. This study sought to evaluate the effect of early supported discharge and continued rehabilitation at home (ESD), in terms of patient outcome 5 years after stroke and changes in selected data over time. METHODS: Eighty-three patients from Southwest Stockholm, mildly or moderately impaired 5 to 7 days after acute stroke, were enrolled in a randomized controlled trial. The core components of the ESD service were initial treatment in a stroke unit and the involvement of an outreach team to deliver and coordinate home-based rehabilitation in partnership with the patient. At the 5-year follow-up, measures used to assess patient outcome included survival, motor capacity, dysphasia, activities of daily living (ADL), social activities, subjective dysfunction, and self-reported falls. RESULTS: Fifty-four patients (30 in the intervention group and 24 in the control group) were evaluated 5 years after stroke, at which time a significantly larger proportion of patients in the intervention group were independent in extended ADL and active in household activities. CONCLUSIONS: This ESD service has a beneficial effect on extended ADL 5 years after stroke for mildly to moderately impaired patients.