Research Report Abstracts - Gesundheit

WPT2011, Research Report Abstracts eS1019
Research Report Poster Display
Number: RR-PO-208-18-Wed Wednesday 22 June 13:00
RAI: Exhibit Halls 2&3
INFLUENCE OF REACH TRAINING WITH ARM
SUPPORT ON UNSUPPORTED ARM MOVEMENTS
IN CHRONIC STROKE
Prange G. 1 , Krabben T. 1 , Stienen A. 2,3 , Jannink M. 1,3 ,
Hermens H. 1,4
1Roessingh Research and Development, Enschede,
Netherlands, 2Northwestern University, Physical Therapy
and Human Movement Sciences, Chicago, United
States, 3University of Twente, Engineering Technology,
Enschede, Netherlands, 4University of Twente, Electrical
Engineering, Mathematics and Computer Science, Enschede,
Netherlands
Purpose: After stroke, involuntary coupling of shoulder
abduction and elbow flexion is often observed. This can
be reduced instantaneously by application of arm support,
which increases range of motion. Along these lines, it is
expected that application of arm support as training intervention
improves unsupported reach. The purpose of this pilot
study is to examine whether arm function and reach performance
improve after training with arm support, and to obtain
insight into underlying mechanisms.
Relevance: Information about the influence of arm support
during reach training after stroke gives insight in the
effect of several approaches of exercise therapy, including
both conventional practice and newly developed rehabilitation
technology, such as robotics.
Participants: Eight persons were selected from the local
rehabilitation center and included when they: were at least
6 months post-stroke; could move shoulder and elbow partly
against gravity without shoulder pain; could understand and
follow instructions; had provided written informed consent
(approved by the medical ethics committee of Medisch Spectrum
Twente, Enschede).
Methods: The pre-post intervention design involved 6 weeks
of reach training (18 30-minute sessions per week) with arm
support by the Freebal device (compensating for the weight
of the arm), combined with a rehabilitation game. Arm function
(by Fugl-Meyer (FM) upper extremity assessment) and
unsupported reach (involving maximal reach distance, joint
angles and muscle activity of 8 shoulder and elbow muscles)
were assessed before and after training.
Analysis: Pre-post differences were calculated for all
outcome measures and evaluated using 90% confidence intervals.
Results: After training, FM scores had increased in 7 of
8 persons (group average +3.3 points). In 3, the increase
was at least 6.5 points. Maximal unsupported reach distance
improved in all persons but 1 (mean +3.6% of arm length),
together with increased elbow extension (mean +9.2 ◦ ) and
shoulder elevation (mean +4.6 ◦ ). These improvements were
accompanied by increased levels of muscle activity of mainly
agonist muscles by at least +20% with respect to pre-training
levels.
Conclusions: Reach training with arm support has led to
improvements in unsupported arm movements in persons
with a range of mild to severe hemiparesis. Improved unsupported
reach distance mainly involved an increased activation
of agonist muscles at the shoulder and elbow. Future work
involves examining the added value of arm support training
to conventional therapy.
Implications: The present findings indicate that use of prime
movers for active reaching is stimulated through arm support.
The facilitating influence of arm support implies start
of active reaching exercises at an early phase of rehabilitation.
Through integration of a game, independent training is
possible using a relatively simple device, allowing intensification
of active reach training without additional deployment
of therapists.
Keywords: Stroke rehabilitation; Arm support
Funding acknowledgements: This work is supported by
SenterNovem, The Netherlands, grant TSGE2050, and the
Ministry of Economic Affairs (Pieken in de Delta), Overijssel
and Gelderland, The Netherlands, grant 1-5160. We
would also like to thank GJ Renzenbrink, MD, and J de
Boer, PT, of Rehabilitation Centre ‘Het Roessingh’ for their
valuable contributions with inclusion and clinical training of
participants.
Ethics approval: This study was approved by the medical
ethics committee of Medisch Spectrum Twente, Enschede,
The Netherlands.
Research Report Poster Display
Number: RR-PO-305-11-Tue Tuesday 21 June 13:00
RAI: Exhibit Halls2&3
SYMPTOMS AND RISK FACTORS FOR KNEE
OSTEOARTHRITIS, STROKE AND LOW BACK
PAIN: WHAT DO WE KNOW ABOUT THE
PUBLIC’S KNOWLEDGE?
Prasanna S. 1,2 , Korner-Bitensky N. 1,2
1McGill University, School of Physical and Occupational
Therapy, Montreal, Canada, 2Centre for Interdisciplinary
Research in Rehabilitation of Greater Montreal, Montreal,
Canada
Purpose: An informed, involved patient may play a key role
in bridging the knowledge-care gap. This is especially important
when recognizing symptoms and accessing health care
early. As physical therapists we need to put more of our
efforts in to knowledge translation strategies to inform the
public, especially those at higher risk, about chronic conditions
and means to control or stop the progression. In
preparing to create such strategies, it is necessary to understand
the public’s knowledge about different conditions. This
paper hence examines the evidence regarding the public’s