Comparison of embedded and added motor imagery training in patients after stroke: results of a randomised controlled pilot trial Determinants of improvement in walking capacity among individuals with chronic stroke following a multi-dimensional exercise program. Effectiveness of community-based ambulation training for walking function of post-stroke hemiparesis: a randomized controlled pilot trial Estimates of quality and reliability with the physiotherapy evidence-based database scale to assess the methodology of randomized controlled trials of pharmacological and nonpharmacological interventions. Poststroke Balance Improves With Yoga: A Pilot Study Multicenter Randomized Clinical Trial Evaluating the Effectiveness of the Lokomat in Subacute Stroke Locomotor imagery training improves gait performance in people with chronic hemiparetic stroke: a controlled clinical trial The effect of a task-oriented walking intervention on improving balance self-efficacy poststroke: a randomized, controlled trial. Effect of Stroke on Fall Rate, Location and Predictors: A Prospective Comparison of Older Adults with and without Stroke Exercise leads to faster postural reflexes, improved balance and mobility, and fewer falls in older persons with chronic stroke. Psychometric evaluation of the original and Canadian French version of the activities-specific balance confidence scale among people with stroke. Effects of integrated motor imagery practice on gait of individuals with chronic stroke: a half-crossover randomized study. Implementation, Process, and Preliminary Outcome Evaluation of Two Community Programs for Persons with Stroke and Their Care Partners How feasible is the attainment of community ambulation after stroke? A pilot randomized controlled trial to evaluate community-based physiotherapy in subacute stroke Falls and fear of falling: which comes first? A longitudinal prediction model suggests strategies for primary and secondary prevention. Balance self-efficacy and its relevance to physical function and perceived health status after stroke. Chronic Stroke Survivors Benefit From High-Intensity Aerobic Treadmill Exercise Body awareness therapy in persons with stroke: a pilot randomized controlled trial Balance and balance self-efficacy are associated with activity and participation after stroke: a cross-sectional study in people with chronic stroke. Virtual reality-based training improves community ambulation in individuals with stroke: a randomized controlled trial. Randomized comparison trial of balance training by using exergaming and conventional weight-shift therapy in patients with chronic stroke. Circuit-based rehabilitation improves gait endurance but not usual walking activity in chronic stroke: a randomized controlled trial. Whole-body vibration has no effect on neuromotor function and falls in chronic stroke. Community-Based Adaptive Physical Activity Program for Chronic Stroke: Feasibility, Safety, and Efficacy of the Empoli Model Longitudinal Analysis of Balance Confidence in Individuals With Stroke Using a Multilevel Model for Change
Background Motor imagery ( MI ) when combined with physiotherapy can offer functional benefits after stroke . Two MI integration strategies exist : added and embedded MI . Both approaches were compared when learning a complex motor task ( MT ) : ' Going down , laying on the floor , and getting up again ' . Methods Out patients after first stroke participated in a single-blinded , r and omised controlled trial with MI embedded into physiotherapy ( EG1 ) , MI added to physiotherapy ( EG2 ) , and a control group ( CG ) . All groups participated in six physiotherapy sessions . Primary study outcome was time ( sec ) to perform the motor task at pre and post-intervention . Secondary outcomes : level of help needed , stages of MT-completion , independence , balance , fear of falling ( FOF ) , MI ability . Data were collected four times : twice during one week baseline phase ( BL , T0 ) , following the two week intervention ( T1 ) , after a two week follow-up ( FU ) . Analysis of variance was performed . Results Thirty nine out patients were included ( 12 females , age : 63.4 ± 10 years ; time since stroke : 3.5 ± 2 years ; 29 with an ischemic event ) . All were able to complete the motor task using the st and ardised 7-step procedure and reduced FOF at T0 , T1 , and FU . Times to perform the MT at baseline were 44.2 ± 22s , 64.6 ± 50s , and 118.3 ± 93s for EG1 ( N = 13 ) , EG2 ( N = 12 ) , and CG ( N = 14 ) . All groups showed significant improvement in time to complete the MT ( p < 0.001 ) and degree of help needed to perform the task : minimal assistance to supervision ( CG ) and independent performance ( EG1 + 2 ) . No between group differences were found . Only EG1 demonstrated changes in MI ability over time with the visual indicator increasing from T0 to T1 and decreasing from T1 to FU . The kinaesthetic indicator increased from T1 to FU . Patients indicated to value the MI training and continued using MI for other difficult-to-perform tasks . Conclusions Embedded or added MI training combined with physiotherapy seem to be feasible and benefi-cial to learn the MT with emphasis on getting up independently . Based on their baseline level CG had the highest potential to improve outcomes . A patient study with 35 patients per group could give a conclusive answer of a superior MI integration strategy .Trial Registration Clinical Trials.gov : OBJECTIVE To identify the determinants of improvement in walking capacity following therapeutic exercise in chronic stroke survivors . DESIGN A secondary analysis of data obtained from a prospect i ve , single-blind , r and omized controlled intervention trial . SUBJECTS Sixty-three community-dwelling individuals ( mean age = 65 years , age range = 50 - 87 years ) with a chronic stroke ( post-stroke duration : mean = 5.5 years , range = 1 - 28 years ) . METHODS Subjects were r and omized into a leg exercise group ( n = 32 ) or an arm exercise group ( n = 31 ) . Subjects in each group underwent 3 1-hour exercise sessions per week for 19 weeks . Walking capacity , cardiorespiratory fitness , isometric knee extensor muscle strength , balance ability , and balance confidence were evaluated before and after the interventions . Multiple regression analysis was performed to identify the determinants of improvement in walking capacity . RESULTS After controlling for age , gender , post-stroke duration , and baseline walking capacity , gain in paretic leg muscle strength and peak oxygen consumption remained independently associated with gain in walking capacity ( R2 = 0.229 ) . CONCLUSION Enhancement of cardiorespiratory fitness and paretic leg muscle strength are both significant determinants in improving walking capacity among chronic stroke survivors . However , the rather weak relationship ( R2 = 0.229 ) indicates that other factors not measured in this study may also contribute to the improvement in walking capacity Objective : To investigate the effect of community-based ambulation training on walking function of patients with post-stroke hemiparesis . Design : R and omized , single-blind , controlled pilot study . Setting : Inpatient rehabilitation hospital . Subjects : Twenty-five subjects were r and omly assigned to either the experimental group or the control group , with 13 and 12 subjects , respectively . Interventions : All subjects received a routine physical therapy . The subjects in the experimental group also received community-based ambulation training , which was performed for an hour , once a day , three times a week for a four-week period . Main measures : Ten-metre walk test , 6-minute walk test , community walk test , walking ability question naire and activities-specific balance confidence scale before and after the intervention . Results : The change values of the 10-m walk test ( 0.21 ± 0.12 m/s versus 0.07 ± 0.10 m/s ) , community walk test ( −13.61 ± 10.31 minutes versus −3.27 ± 11.99 minutes ) , walking ability question naire ( 6.15 ± 3.60 score versus 2.75 ± 2.38 score ) and activities-specific balance confidence scale ( 17.45 ± 11.55 score versus 2.55 ± 10.14 score ) were significantly higher in the experimental group than in the control group ( P < 0.05 ) . At post-test , the 10-m walk test was significantly higher in the experimental group than in the control group ( 0.72 ± 0.24 m/s versus 0.50 ± 0.23 m/s ) ( P < 0.05 ) . In the experimental group , there were significant differences for all variables between pre-test and post-test ( P < 0.01 ) , whereas the subjects of the control group showed a significant difference in only the walking ability question naire ( P < 0.01 ) . Conclusions : The findings demonstrate that community-based ambulation training can be helpful in improving walking ability of patients with post-stroke hemiparesis and may be used as a practical adjunct to routine rehabilitation therapy BACKGROUND AND PURPOSE Systematic review s and meta-analyses often include an evaluation of the method ological quality of the individual studies that have been included , and are usually conducted by at least 2 individuals . The objective of this study was to assess the method ological quality and reliability of a series of r and omized controlled trials ( RCTs ) of both pharmacological and nonpharmacological interventions by use of the 10-item Physiotherapy Evidence -Based Data base ( PEDro ) Scale . METHODS Two abstract ors independently review ed 81 RCTs assessing a variety of interventions . The Cohen kappa statistic and the intraclass correlation coefficient ( ICC ) were used to assess agreement between abstract ors . RESULTS The average total PEDro scores were 5.94 ( SD=1.43 ) for all studies combined , 6.88 ( SD=1.2 ) for pharmacological studies , and 5.29 ( SD=1.26 ) for nonpharmacological studies . The median score for pharmacological studies was significantly higher than that for nonpharmacological studies ( 7 versus 5 ) . Pair-wise kappa scores ranged from a low of .452 for concealed allocation among drug trials to perfect agreement ( 1.00 ) for r and omization and reporting of results from between-group comparisons . The ICCs associated with the cumulative PEDro score were .91 ( 95 % confidence interval [CI]=.83-.94 ) for all studies , .89 ( 95 % CI=.78-.95 ) for pharmacological studies , and .91 ( 95 % CI=.84-.952 ) for nonpharmacological studies . DISCUSSION AND CONCLUSION The method ological quality for pharmacological interventions was significantly higher than that for nonpharmacological interventions . There was good agreement between raters at an individual item level and in total PEDro scores . A lack of reporting clarity , poor organization of the report , or the failure to include salient details contributed to less-than-perfect agreement between raters Background and Purpose — Balance impairment is common after stroke ; modified yoga may be able to improve balance and other important poststroke variables . Scientific- evidence is needed to support such treatment interventions . The purpose of this study was to assess the impact of a yoga-based rehabilitation intervention on balance , balance self-efficacy , fear of falling ( FoF ) , and quality of life after stroke . Methods — This was a prospect i ve , r and omized , pilot study of yoga-based rehabilitation for people with chronic stroke . All yoga sessions were taught by a registered yoga therapist , occurred twice per week for 8 weeks and included seated , st and ing , and floor postures with relaxation and meditation .  Balance was assessed with the Berg Balance Scale , balance self-efficacy with the Activities-specific Balance Confidence Scale , FoF with a dichotomous yes/no question , and quality of life with the Stroke Specific Quality of Life scale . Results — There were no significant differences between wait-list control ( n=10 ) and yoga ( n=37 ) groups in baseline or follow-up scores . However , using within-group comparisons , yoga group data demonstrated significant improvement in balance ( Berg Balance Scale , 41.3±11.7 vs 46.3±9.1 ; P<0.001 ) and FoF ( 51 % vs 46 % with FoF ; P<0.001 ) . Conclusions — A group yoga-based rehabilitation intervention  for people with chronic stroke has potential in improving multiple poststroke variables . Group yoga may be complementary to rehabilitation , may be possible in medical-based and community-based setting s , and may be cost-effective . Further testing of group yoga-based rehabilitation interventions is warranted . Clinical Trial Registration — URL : http:// clinical trials.gov . Unique Identifier : NCT01109602 Objective . To compare the efficacy of robotic-assisted gait training with the Lokomat to conventional gait training in individuals with subacute stroke . Methods . A total of 63 participants < 6 months poststroke with an initial walking speed between 0.1 to 0.6 m/s completed the multicenter , r and omized clinical trial . All participants received twenty-four 1-hour sessions of either Lokomat or conventional gait training . Outcome measures were evaluated prior to training , after 12 and 24 sessions , and at a 3-month follow-up exam . Self-selected overground walking speed and distance walked in 6 minutes were the primary outcome measures , whereas secondary outcome measures included balance , mobility and function , cadence and symmetry , level of disability , and quality of life measures . Results . Participants who received conventional gait training experienced significantly greater gains in walking speed ( P = .002 ) and distance ( P = .03 ) than those trained on the Lokomat . These differences were maintained at the 3-month follow-up evaluation . Secondary measures were not different between the 2 groups , although a 2-fold greater improvement in cadence was observed in the conventional versus Lokomat group . Conclusions . For subacute stroke participants with moderate to severe gait impairments , the diversity of conventional gait training interventions appears to be more effective than robotic-assisted gait training for facilitating returns in walking ability Objective : The purpose of this study was to evaluate whether locomotor imagery training leads to clinical improvements in gait after stroke . Design : Pretest — posttest matched control design . Participants : A total of 24 people with chronic hemiparetic stroke ( 13 for experimental and 11 for control ) were recruited in this study . Interventions : The subjects in the experimental group participated in videotape-based locomotor imagery training five days a week for four weeks . They also conducted regular physical therapy . Outcome measures : Kinematic gait parameters were collected using a three-dimensional motion analysis system . Functional gait performance was assessed using clinical measures : Activities-specific Balance Confidence Scale , Berg Balance Test , Dynamic Gait Index and modified Emory Functional Ambulation Profile . Results : After training , walking velocity increased 0.07 ± 0.06 m/s in the experimental group and 0.01 ± 0.07 m/s in the control group . In the experimental group , the affected and less affected limb stride lengths increased by 0.09 ± 0.12 m and 0.10 ± 0.07 m respectively , whereas in the control group they decreased by 0.00 ± 0.04 m and increased by 0.02 ± 0.06 m , respectively . Kinematic parameters in the lower extremity joints during walking were more improved after the training in the experimental group . Confidence in balance , postural control , dynamic balance and performance time for different environmental walking situations were also improved more in the experimental group . Conclusion : Locomotor imagery training can be considered as a useful option for restoration of ambulation for individuals with chronic hemiparetic stroke who are unable to participate in physical gait training OBJECTIVES To evaluate the efficacy of a task-oriented walking intervention in improving balance self-efficacy in persons with stroke and to determine whether effects were task-specific , influenced by baseline level of self-efficacy and associated with changes in walking and balance capacity . DESIGN Secondary analysis of a two-center , observer-blinded , r and omized , controlled trial . SETTING General community . PARTICIPANTS Ninety-one individuals with a residual walking deficit within 1 year of a first or recurrent stroke . INTERVENTION Task-oriented interventions targeting walking or upper extremity ( UE ) function were provided three times a week for 6 weeks . MEASUREMENTS Activities-specific Balance Confidence Scale , Six-Minute Walk Test , 5-m walk , Berg Balance Scale , and Timed " Up and Go " administered at baseline and postintervention . RESULTS The walking intervention was associated with a significantly greater average proportional change in balance self-efficacy than the UE intervention . Treatment effects were largest in persons with low self-efficacy at baseline and for activities relating to tasks practice d. In the walking group , change in balance self-efficacy correlated with change in functional walking capacity ( correlation coefficient=0.45 , 95 % confidence interval=0.16 - 0.68 ) . Results of multivariable modeling suggested effect modification by the baseline level of depressive symptoms and a prognostic influence of age , sex , comorbidity , time poststroke , and functional mobility on change in self-efficacy . CONCLUSION Task-oriented walking retraining enhances balance self-efficacy in community-dwelling individuals with chronic stroke . Benefits may be partially the result of improvement in walking capacity . The influence of baseline level of self-efficacy , depressive symptoms , and prognostic variables on treatment effects are of clinical importance and must be verified in future studies Background The literature suggests that stroke is a major risk factor for falls , but there is a lack of prospect i ve , controlled studies which quantify fall-risk after stroke . The purpose of this study was to compare the rates , location and predictors among individuals recently discharged home from stroke rehabilitation to age and sex matched controls . Methodology /Principal Findings A sample of 80 people with stroke and 90 controls received baseline assessment s of  balance , mobility and balance confidence . Falls were recorded prospect ively over 13 months for both groups . Group differences in fall rates and contribution of clinical measures to falls were determined using negative binomial regression . Fall location was compared between groups using χ2 statistics . The rate of falls for individuals with stroke was 1.77 times the rate for the control group . People with stroke were more likely to fall at home . Poorer balance ( Berg Balance Scale ) was associated with greater falls for both stroke and control groups ( incidence rate ratio [ IRR ] : 0.908 and IRR : 0.877 respectively ) . A faster Timed Up and Go Test was associated with greater falls for the stroke group ( IRR : 0.955 ) while better walking endurance ( Six Minute Walk Test ) was associated with greater falls for the controls ( IRR : 1.004 ) . Balance confidence was not an independent predictor in either group . Conclusions Individuals recently discharged home are at greater risk of falling than individuals without stroke . Attention to home environment is warranted . Balance function can predict falls for both people with stroke and age and sex matched controls . Increased mobility may increase exposure to fall opportunities OBJECTIVES To determine the effect of two different community-based group exercise programs on functional balance , mobility , postural reflexes , and falls in older adults with chronic stroke . DESIGN A r and omized , clinical trial . SETTING Community center . PARTICIPANTS Sixty-one community-dwelling older adults with chronic stroke . INTERVENTION Participants were r and omly assigned to an agility ( n=30 ) or stretching/weight-shifting ( n=31 ) exercise group . Both groups exercised three times a week for 10 weeks . MEASUREMENTS Participants were assessed before , immediately after , and 1 month after the intervention for Berg Balance , Timed Up and Go , step reaction time , Activities-specific Balance Confidence , and Nottingham Health Profile . Testing of st and ing postural reflexes and induced falls evoked by a translating platform was also performed . In addition , falls in the community were tracked for 1 year from the start of the interventions . RESULTS Although exercise led to improvements in all clinical outcome measures for both groups , the agility group demonstrated greater improvement in step reaction time and paretic rectus femoris postural reflex onset latency than the stretching/weight-shifting group . In addition , the agility group experienced fewer induced falls on the platform . CONCLUSION Group exercise programs that include agility or stretching/weight shifting exercises improve postural reflexes , functional balance , and mobility and may lead to a reduction of falls in older adults with stroke OBJECTIVE To evaluate the internal and absolute reliability and construct validity of the Activities-Specific Balance Confidence ( ABC ) scale and a new Canadian French version ( ABC-CF ) of it among people with stroke . DESIGN Cross-sectional data from a r and omized controlled trial . SETTING Community . PARTICIPANTS Ninety-one people with a residual walking deficit between 57 and 386 days poststroke . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES The ABC and ABC-CF scales , Berg Balance Scale ( BBS ) , comfortable and maximum gait speeds , Timed Up & Go ( TUG ) test , 6-minute walk test ( 6MWT ) , Barthel Index , physical function scale of the Medical Outcomes Study 36-Item Short-Form Health Survey , Geriatric Depression Scale ( GDS ) , and the EQ-5D visual analog scale ( EQ VAS ) . RESULTS Internal consistency ( Cronbach alpha ) was .94 and .93 and the st and ard error of measurement was 5.05 and 5.13 for the ABC ( n=51 ) and the ABC-CF ( n=35 ) scales , respectively . Spearman rho values ranged from .30 to .60 for the ABC scale and from .45 to .68 on the ABC-CF scale for associations with scores on the BBS , comfortable and maximum gait speeds , TUG , 6MWT , Barthel Index , physical function scale , GDS , and EQ VAS . CONCLUSIONS Evidence of internal and absolute reliability and of construct validity of the ABC and the ABC-CF scales supports their use for cross-sectional measurements of balance self-efficacy among community-dwelling people in the first year poststroke OBJECTIVES To test the effects of a new motor imagery practice approach , in which motor and motivational contents were integrated in order to improve gait in subjects with chronic poststroke hemiparesis . DESIGN A half-crossover study composed of 2 phases . In phase 1 , subjects were r and omly assigned to receive either the experimental or the control treatment . In phase 2 , the subjects who had initially received the control treatment " crossed over " to receive the experimental intervention . SETTING The experimental and the control intervention were delivered in the subjects ' homes ; assessment s were performed in a hospital laboratory . PARTICIPANTS Community-dwelling individuals ( N=23 ) with chronic poststroke hemiparesis whose gait was impaired . INTERVENTIONS The experimental intervention , called integrated motor imagery practice , consisted of imagery scripts aim ed at improving home and community walking as well as fall-related self-efficacy . The control treatment consisted of executed exercises to improve the function of the involved upper extremity . MAIN OUTCOME MEASURES In-home walking , indoor and outdoor community ambulation , and fall-related self-efficacy . These were assessed before and after the intervention as well as at a 2-week follow-up . RESULTS In-home walking was significantly improved after application of the experimental intervention ( P≤.003 ) , but not after the control treatment ( P≤.68 ) . Community ambulation did not improve . Fall-related self-efficacy was slightly improved by the integrated motor imagery intervention ; however , the findings were not unequivocal . CONCLUSIONS Home delivery of integrated motor imagery practice was feasible and exerted a positive effect on walking in the home . However , it was ineffective for improving gait in public domains . We speculate that the addition of physical practice to imagery practice may be essential for achieving that end Abstract Purpose : This evaluation compared a new self-management program with l and and water exercise ( Moving On after STroke or MOST ) to a st and ard education program ( Living with Stroke or LWS ) . Participants : Of 30 persons with stroke ( average age 68 and 2 years post stroke ) , 18 selected MOST and 12 chose LWS . Sixteen care partners participated . Method : Assessment s at baseline , program completion , and 3-month follow-up included the Reintegration to Normal Living ( RNL ) Index , Activity-specific Balance Confidence ( ABC ) scale , exercise participation , and goal attainment ( for the MOST group ) . Program delivery costs were calculated and focus groups conducted to examine participant expectations and experiences . Results : Social support was an important benefit of both programs , but only MOST participants improved significantly on the RNL ( p < .05 ) and ABC ( p < .001 ) . Seventy-eight percent of all short-term personal goals in MOST were achieved , and overall goal attainment was above the expected level . At follow-up , a higher percentage of MOST participants were enrolled in exercise programs ( p < .05 ) . Conclusion : Although self-management programs with exercise are more costly to deliver than st and ard educational programs , these preliminary results indicate that such programs may be more effective in helping persons with stroke and care partners deal with the challenges of living with stroke Objective : This pilot r and omized controlled trial evaluated an assistant-led , community-based intervention to improve community mobility and participation after stroke , and examined the potential for independent community ambulation in people with subacute stroke who present with moderate gait deficit . Design : A multicentre , pilot r and omized controlled trial . Setting : Three hospitals and three community setting s in New Zeal and . Subjects : Thirty post-acute , home-dwelling stroke survivors were r and omly allocated to receive intervention in the community ( n = 14 ) or as hospital out patients ( n = 16 ) twice a week for seven weeks . Interventions : The community intervention involved practice of functional gait activities in community environments relevant to each participant . Hospital-based physiotherapy was based upon a Motor Relearning approach . Main measures : The primary outcome measure was gait speed ( m/min ) . Secondary outcomes included endurance ( six-minute walk time ) , Activities-specific Confidence Balance Scale , and the Subjective Index of Physical and Social Outcomes measured at baseline , post intervention and six months . Results : Large gains in gait speed were obtained for participants in both groups : community group mean ( SD ) 16 ( 16.1 ) m/min ; physiotherapy group mean ( SD ) 15.9 ( 16.1 ) m/min , maintained at six months . There were no significant differences between groups for primary and secondary outcomes after treatment ( P = 0.86 ANOVA ) or at six months ( P = 0.83 ANOVA ) . Only 11 participants reported independent community ambulation . Levels of social integration were low to moderate . Conclusions : A community-based gait recovery programme appears a practicable alternative to routine physiotherapy , however independent community ambulation is a challenging rehabilitation goal OBJECTIVES Previous cross-sectional studies have shown a correlation between falls and fear of falling , but it is unclear which comes first . Our objectives were to determine the temporal relationship between falls and fear of falling , and to see whether these two outcomes share predictors . DESIGN A 20-month , population -based , prospect i ve , observational study . SETTING Salisbury , Maryl and . Each evaluation consisted of a home-administered question naire , followed by a 4- to 5-hour clinic evaluation . PARTICIPANTS The 2,212 participants in the Salisbury Eye Evaluation project who had baseline and 20-month follow-up clinic evaluations . At baseline , subjects were aged 65 to 84 and community dwelling and had a Mini-Mental State Examination score of 18 or higher . MEASUREMENTS Demographics , visual function , comorbidities , neuropsychiatric status , medication use , and physical performance-based measures were assessed . Stepwise logistic regression analyses were performed to evaluate independent predictors of falls and fear of falling at the follow-up evaluation , first predicting incident outcomes and then predicting fall or fear-of-falling status at 20 months with baseline falling and fear of falling as predictors . RESULTS Falls at baseline were an independent predictor of developing fear of falling 20 months later ( odds ratio ( OR ) = 1.75 ; P < .0005 ) , and fear of falling at baseline was a predictor of falling at 20 months ( OR = 1.79 ; P < .0005 ) . Women with a history of stroke were at risk of falls and fear of falling at follow-up . In addition , Parkinson 's disease , comorbidity , and white race predicted falls , whereas General Health Question naire score , age , and taking four or more medications predicted fear of falling . CONCLUSION Individuals who develop one of these outcomes are at risk for developing the other , with a result ing spiraling risk of falls , fear of falling , and functional decline . Because falls and fear of falling share predictors , individuals who are at a high risk of developing these endpoints can be identified OBJECTIVES To estimate the level of balance self-efficacy among community-dwelling subjects with stroke and to determine the relative importance of balance self-efficacy compared with functional walking capacity in predicting physical function and perceived health status . DESIGN Secondary analysis of baseline , postintervention , and 6-month follow-up data from a r and omized trial . SETTING General community . PARTICIPANTS Ninety-one subjects with a first or recurrent stroke , discharged from rehabilitation therapy with a residual walking deficit . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES The Activities-Specific Balance Confidence ( ABC ) Scale , Medical Outcomes Study 36-Item Short-Form Health Survey physical function scale , and the EQ-5D visual analog scale of perceived health status . RESULTS Average balance self-efficacy was 59 out of 100 points on the ABC scale ( 95 % confidence interval , 55 - 64 ; n=89 ) . After adjusting for age and sex , functional walking capacity explained 32 % and 0 % of the respective variability in physical function and perceived health status scores obtained 6 months later . After adjustment for age , sex , and functional walking capacity , balance self-efficacy explained 3 % and 19 % of variation in 6-month physical function and perceived health status scores , respectively . CONCLUSIONS Subjects living in the community after stroke experience impaired balance self-efficacy . Enhancing balance self-efficacy in addition to functional walking capacity may lead to greater improvement , primarily in perceived health status , but also in physical function , than the enhancement of functional walking capacity alone Background and objective . Ambulatory subjects after stroke may benefit from gait-oriented cardiovascular fitness training , but trials to date have not primarily assessed older persons . Methods . Thirty-eight subjects ( age > 60 years ) with residual hemiparetic gait were enrolled > 6 months after stroke . Participants were r and omized to receive 3 months ( 3 × /week ) progressive grade d , high-intensity aerobic treadmill exercise ( TAEX ) or conventional care physiotherapy . Primary outcome measures were peak exercise capacity ( Vo2peak ) and sustained walking capacity in 6-minute walks ( 6MW ) . Secondary measures were gait velocity in 10-m walks , Berg Balance Scale , functional leg strength ( 5 chair-rise ) , self-rated mobility ( Rivermead Mobility Index ) , and quality of life ( SF-12 ) . Results . Thirty-six participants completed the study ( 18 TAEX , 18 controls ) .  TAEX but not conventional care  improved Vo2peak ( difference 6.4 mL/kg/min , P < .001 ) and 6MW ( 53 m , P < .001 ) . Likewise , maximum walking speed ( 0.13 m/s , P = .01 ) , balance ( P < .05 ) , and the mental subscore of the SF-12 ( P < .01 ) improved more after TAEX . Gains in Vo2peak correlated with the degree at which training intensity could be progressed in the individual participant ( P < .01 ) . Better walking was related to progression in treadmill velocity and training duration ( P < .001 ) . Vo2peak and 6MW performances were still higher 1 year after the end of training when compared with the baseline , although endurance walking ( 6MW ) at 1 year was lower than immediately after training ( P < .01 ) . Conclusion . This trial demonstrates that TAEX effectively improves cardiovascular fitness and gait in persons with chronic stroke Objective : To investigate the effects of body awareness therapy on balance , mobility , balance confidence , and subjective health status in persons with stroke . Design : A pilot r and omized controlled study with follow-up at one and 4–6 weeks after the intervention period . Setting : Four primary healthcare centres in Örebro County Council . Subjects : Persons more than six months post stroke , with walking ability of 100 metres . Intervention : The experimental intervention was body awareness therapy in groups once a week for eight weeks . The controls were instructed to continue their usual daily activities . Main measures : Berg Balance Scale , Timed Up and Go Test , Timed Up and Go Test with a cognitive component , 6-minute walk test , and Timed-St and s Test . Self-rated balance confidence was assessed using the Activities-specific Balance Confidence Scale , and subjective health status using the Short Form 36 ( SF-36 ) question naire . Results : A total of 46 participants were included ( mean age 64 years ) ; 24 in the experimental intervention group and 22 in the control group . No significant differences in changed scores over time were found between the groups . Within the experimental intervention group , significant improvements over time was found for the tests Berg Balance Scale , Timed Up and Go cognitive , and 6-minute walk test . Within the control group , significant improvements over time were found for the Timed Up and Go Cognitive , and the Timed-St and s Test . Conclusion : In comparison to no intervention , no effects were seen on balance , mobility , balance confidence , and subjective health status after eight weeks of body awareness therapy OBJECTIVES To ( 1 ) examine the relationships between multiple poststroke mobility variables ( gait speed , walking capacity , balance , balance self-efficacy , and falls self-efficacy ) and activity and participation ; and ( 2 ) determine which poststroke mobility variables are independently associated with activity and participation . DESIGN This is the primary analysis of a prospect i ve cross-sectional study completed to underst and the impact of mobility on activity and participation in people with chronic stroke . SETTING University-based research laboratory , hospitals , and stroke support groups . PARTICIPANTS People ( N=77 ) with stroke greater than 6 months ago were included in the study if they were referred to occupational or physical therapy for physical deficits as a result of the stroke , completed all stroke related inpatient rehabilitation , had residual functional disability , scored a ≥4 out of 6 on the short , 6-item Mini-Mental State Examination , and were between the ages of 50 and 85 . INTERVENTIONS Not applicable , this is a cross-sectional data collection of 1 timepoint . MAIN OUTCOME MEASURES We measured activity and participation with the vali date d International Classification of Functioning , Disability and Health Measure of Participation and Activities . Other variables included gait speed ( 10-meter walk ) , walking capacity ( 6-minute walk ) , balance ( Berg Balance Scale ) , balance self-efficacy ( Activities Specific Balance Confidence Scale ) , and falls self-efficacy ( Modified Falls Efficacy Scale ) . RESULTS Only balance self-efficacy was found to be independently associated with poststroke activity ( β=-.430 , P<.022 , 95 % confidence interval [ CI ] , -.247 to -.021 ) and participation ( β=-.439 , P<.032 , 95 % CI , -.210 to -.010 ) . CONCLUSIONS Among people with chronic stroke , balance self-efficacy , not physical aspects of gait , was independently associated with activity and participation . While gait training continues to be important , this study indicates a need to further evaluate and address the psychological factors of balance and falls self-efficacy to obtain the best stroke recovery This is a single blind r and omized controlled trial to examine the effect of virtual reality-based training on the community ambulation in individuals with stroke . Twenty subjects with stroke were assigned r and omly to either the control group ( n=9 ) or the experimental group ( n=11 ) . Subjects in the control group received the treadmill training . Subjects in the experimental group underwent the virtual reality-based treadmill training .  Walking speed , community walking time , walking ability question naire ( WAQ ) , and activities-specific balance confidence ( ABC ) scale were evaluated . Subjects in the experimental group improved significantly in walking speed , community walking time , and WAQ score at posttraining and 1-month follow-up periods . Their ABC score also significantly increased at posttraining but did not maintain at follow-up period . Regarding the between-group comparisons , the experimental group improved significantly more than control group in walking speed ( P=0.03 ) and community walking time ( P=0.04 ) at posttraining period and in WAQ score ( P=0.03 ) at follow-up period . Our results support the perceived benefits of gait training programs that incorporate virtual reality to augment the community ambulation of individuals with stroke OBJECTIVE To compare the effects of exergaming with conventional weight-shift training on balance function in patients with chronic stroke . DESIGN Single-blind r and omized controlled trial . SETTING Medical center . PARTICIPANTS Patients ( N=30 ) with chronic stroke and balance deficits . INTERVENTIONS Twelve weeks of Wii Fit training or conventional weight-shift training . MAIN OUTCOME MEASURES Static balance was assessed using posturography . We recorded the stability index and percentage of weight bearing on the affected leg in 8 positions . We also used the timed Up and Go and forward reach tests for dynamic balance evaluation , Falls Efficacy Scale-International for fear of falling assessment , and Physical Activity Enjoyment Scale for estimating the enjoyment of training . RESULTS The exergaming group showed more improvement in stability index than the control group in head straight with eyes open while st and ing on a foam surface , eyes closed while st and ing on a solid surface with head turned 30 ° to the left , and eyes closed while st and ing on a solid surface with head turned up positions ( time-group interaction P=.02 , .04 , and .03 , respectively ) ; however , the effects were not maintained . At 3-month follow-up , the control group showed more improvement in weight-bearing symmetry in the head straight with eyes open while st and ing on a solid surface position than the exergaming group ( time-group interaction P=.03 ) . Both groups showed improvement in the timed Up and Go test , forward reach test , and fear of falling . The improvement in fear of falling was not maintained . The exergaming group enjoyed training more than the control group ( P=.03 ) . CONCLUSIONS Exergaming is enjoyable and effective for patients with chronic stroke UNLABELLED Mudge S , Barber PA , Stott NS . Circuit-based rehabilitation improves gait endurance but not usual walking activity in chronic stroke : a r and omized controlled trial . OBJECTIVE To determine whether circuit-based rehabilitation would increase the amount and rate that individuals with stroke walk in their usual environments . DESIGN Single-blind r and omized controlled trial . SETTING Rehabilitation clinic . PARTICIPANTS Sixty participants with a residual gait deficit at least 6 months after stroke originally enrolled in the study . Two withdrew in the initial phase , leaving 58 participants ( median age , 71.5y ; range , 39.0 - 89.0y ) who were r and omized to the 2 intervention groups . INTERVENTIONS The exercise group had 12 sessions of clinic-based rehabilitation delivered in a circuit class design ed to improve walking . The control group received a comparable duration of group social and educational classes . MAIN OUTCOME MEASURES Usual walking performance was assessed using the StepWatch Activity Monitor . Clinical tests were gait speed ( timed 10-meter walk ) and endurance ( six-minute walk test [ 6MWT ] ) , confidence ( Activities-Based Confidence Scale ) , self-reported mobility ( Rivermead Mobility Index [ RMI ] ) , and self-reported physical activity ( Physical Activity and Disability Scale ) . RESULTS Intention-to-treat analysis revealed that the exercise group showed a significantly greater distance for the 6MWT than the control group immediately after the intervention ( P=.030 ) but that this effect was not retained 3 months later . There were no changes in the StepWatch measures of usual walking performance for either group . The exercise and control groups had significantly different gait speed ( P=.038 ) and scores on the RMI ( P=.025 ) at the 3-month follow-up . These differences represented a greater decline in the control group compared with the exercise group for both outcome measures . CONCLUSIONS Circuit-based rehabilitation leads to improvements in gait endurance but does not change the amount or rate of walking performance in usual environments . Clinical gains made by the exercise group were lost 3 months later . Future studies should consider whether rehabilitation needs to occur in usual environments to improve walking performance PURPOSE Whole-body vibration therapy has gained increasing popularity in enhancing neuromotor function in various patient population s. It remains uncertain , however , whether whole-body vibration is beneficial when used in stroke patients . The aim of this r and omized controlled trial was to examine the efficacy of whole-body vibration in optimizing neuromotor performance and reducing falls in chronic stroke patients . METHODS Eighty-two chronic stroke patients were r and omly assigned to either the experimental group or control group . The experimental group received 9 - 15 min of whole-body vibration ( vertical vibration ; frequency = 20 - 30 Hz . amplitude = 0.44 - 0.60 mm , peak acceleration = 9.5 - 15.8 m·s or 0.97 - 1.61 U of Earth gravitational acceleration ( g ) while performing a variety of dynamic leg exercises on the vibration platform . The control group performed the same exercises without vibration . The subjects underwent their respective training three times a week for 8 wk . Balance ( Berg balance scale ) , mobility ( 10-m walk test and 6-min walk test ) , knee muscle strength ( isokinetic dynamometry ) , and fall-related self-efficacy ( activities-specific balance confidence scale ) were assessed at baseline , immediately after the 8-wk training and at a 1-month follow-up . The incidence of falls was recorded until 6 months after the termination of training . RESULTS Intention-to-treat analysis revealed similar significant improvement in all balance , mobility , muscle strength , and fall-related self-efficacy measures in both groups after the 8-wk treatment period ( P < 0.001 ) , and these were maintained at the 1-month follow-up . The incidence of falls did not differ significantly between the two groups ( P > 0.05 ) . CONCLUSIONS The addition of the presently used whole-body vibration paradigm to a leg exercise protocol was no more effective in improving neuromotor performance and reducing the incidence of falls than leg exercises alone in chronic stroke patients who have mild to moderate motor impairments Objective . To determine whether Adaptive Physical Activity ( APA-stroke ) , a community-based exercise program for participants with hemiparetic stroke , improves function in the community . Methods . Nonr and omized controlled study in Tuscany , Italy , of participants with mild to moderate hemiparesis at least 9 months after stroke . Forty-nine participants in a geographic health authority ( Empoli ) were offered APA-stroke ( 40 completed the study ) . Forty-four control participants in neighboring health authorities ( Florence and Pisa ) received usual care  ( 38 completed the study ) . The APA intervention was a community-based progressive group exercise regimen that included walking , strength , and balance training for 1 hour , thrice a week , in local gyms , supervised by gym instructors . No serious adverse clinical events occurred during the exercise intervention . Outcome measures included the following : 6-month change in gait velocity ( 6-Minute Timed Walk ) , Short Physical Performance Battery ( SPPB ) , Berg Balance Scale , Stroke Impact Scale ( SIS ) , Barthel Index , Hamilton Rating Scale for Depression , and Index of Caregivers Strain . Results . After 6 months , the intervention group improved whereas controls declined in gait velocity , balance , SPPB , and SIS social participation domains . These between-group comparisons were statistically significant at P < .00015 . Individuals with  depressive symptoms at baseline improved whereas controls were unchanged ( P < .003 ) . Oral glucose tolerance tests were performed on a subset of participants in the intervention group . For these individuals , insulin secretion declined 29 % after 6 months ( P = .01 ) . Conclusion . APA-stroke appears to be safe , feasible , and efficacious in a community setting Background . Confidence about balance may be an important factor affecting self-efficacy for daily activities after stroke . Objective . The authors investigated whether confidence changes and the parameters that may predict changes in self-perceived balance within the first year of community reintegration . Methods . In this prospect i ve study , 98 hemiparetic participants who could walk at least 10 m independently were assessed 1 , 3 , 6 , and 12 months postdischarge from rehabilitation  by the  Berg Balance Scale , Timed Up and Go , 6-minute walking distance , and depression and anxiety scales . The 98 age-/sex-matched controls were assessed at enrollment and the same intervals . Multilevel modeling was used to determine if assessed covariates predicted changes in balance confidence by the Activities-Specific Balance Confidence Scale . Results . Stroke subjects had lower initial balance confidence than controls and showed a statistically significant increase in confidence over 1 year at each assessment . Poor balance and high state anxiety were associated with lower balance confidence . Significant interactions were observed between greater depression , along with more impaired walking capacity and balance tests , in predicting lower change trajectories in confidence . Falls predicted a reduced rate of improvement . Conclusions . Balance confidence after stroke remained lower than controls over the first year . Physical therapies and supportive interventions design ed to treat confidence should be initiated at discharge from inpatient rehabilitation
Objective : To conduct a systematic review of clinical trials that examined the effectiveness of interventions on balance self-efficacy among individuals with stroke .