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BACKGROUND: Accurate prediction of recovery is essential to determine whether a knee-ankle-foot orthosis (KAFO) is required in the subacute phase of stroke. However, there are currently no reliable methods to predict such recovery. OBJECTIVE: This study aimed to determine whether muscle strength of the affected lower limb (affected side LL strength) in stroke patients in the subacute phase who cannot walk without a KAFO can be used to predict the continuous need for a KAFO, using a hand-held dynamometer. METHODS: We enrolled patients with severe hemiplegia (n = 51) who were unable to walk without a KAFO for 10 days after stroke onset. They were divided into two groups depending on the continuous need for a KAFO at 1 month after onset; the KAFO and non-KAFO groups. Logistic regression analysis was used to investigate whether the affected side LL strength was a predictor of the continuous need for a KAFO at 1 month after onset. In addition, significant predictors were analyzed using receiver operating characteristic (ROC) curves. RESULTS: The KAFO and non-KAFO groups included 23 (45.10%) and 28 (54.90%) patients, respectively. The affected side LL strength and pusher syndrome severity were identified as predictors of the continuous need for a KAFO. The predictor with the highest predictive ability was the affected side LL strength, with an area under the ROC curve of 0.80 (95% CI, 0.68–0.93). CONCLUSIONS: Affected side LL strength may be a highly accurate predictor of the need for a KAFO in the subacute phase of stroke. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to explore the use of Complete Vocal Technique (CVT) voice therapy in acquired brain injury (ABI) patients Study: This study is an exploratory retrospective study. Method: Five ABI patients (two female and three male) with an average age of 20.6 years (SD = 3.5) received CVT voice therapy from an authorized CVT teacher at a neurorehabilitation facility in conjunction with physical rehabilitation therapy and speech and language therapy. Pre- and postmeasures included Voice Handicap Index, Maximum Phonation Time, electroglottography, and acoustic measures. Results: All voice measures improved for all five patients after receiving CVT voice therapy. Voice Handicap Index scores decreased from an average of 48.4 to 22.8. Maximum Phonation Time improved while the electroglottography and acoustic data showed improved phonation stability in jitter and shimmer measures. Overall, following the intervention, patients demonstrated improved loudness range, improved range in contact quotient for different sound conditions, faster-paced speech, extended functional pitch range, and decrease in unwanted creaking and breathiness. Conclusions: The findings suggest that CVT may be used as therapy in ABI populations with promising results. Both patient self-assessment and objective voice measures demonstrate improved voice function. Given the longitudinal nature of recovery in ABI patients, more studies are needed to qualify at which stage(s) of recovery the CVT interventions are most effective and beneficial. Randomized controlled trials for specific patient populations of ABI are needed to assess the interventions' effectiveness in specific ABI diagnoses. [ABSTRACT FROM AUTHOR]

Patients with Ehlers-Danlos Syndrome (EDS) frequently suffer from severe chronic pain. We carried out an observational cohort study to assess the effectiveness of compression garments (CGs) for reducing this pain. Patients with non-vascular EDS were given custom-made Cerecare® CGs during a visit to a specialist clinic (visit V0). They were followed up over 2 years with visits every 6 months (V1–V4). At each visit, pain was assessed for the joints treated with CGs using a visual analogue scale (VAS; 0–100 mm). Additional measures were obtained to assess neuropathic pain (painDETECT questionnaire), proprioception/balance (Berg Balance Scale), and functional independence, amongst others. Data were analyzed for 67 patients with EDS (hypermobile: 91%; classical: 6%; kyphoscoliotic: 3%). For the most painful joint, the mean VAS rating was 71.5 ± 22.8 mm at V0; this decreased to 53.5 ± 25.5 mm at V1 and 45.7 ± 29 mm at V4 (t-tests: p < 0.0001). From V0 to V4, improvements were also seen for pain at the other joints, neuropathic pain, functional independence, proprioception/balance, and the incidence of sprains and dislocations/subluxations, although not all comparisons were statistically significant (p < 0.05 level). These results indicate that CGs may effectively reduce the pain and joint instability in non-vascular EDS patients. [ABSTRACT FROM AUTHOR]

Engagement in leisure is difficult for many communitydwelling adults post-stroke, resulting in increased sedentary and solitary leisure activity, and reduced leisure engagement and satisfaction. This, in turn, impacts long-term recovery, health, and quality of life. The aim of this study was to review the efficacy of in-home and community-based leisure education and leisure counseling on meaningful activity engagement and health outcomes for this population. A systematic review of the literature from 2005-2020 resulted in 2,017 references of which three met the inclusion criteria. Findings indicate that leisure education and leisure counseling improved quality of life, leisure satisfaction, autonomous leisure engagement, and leisure competence, as well as reduced depression and perceived barriers. Clinical implications and future research recommendations are provided. [ABSTRACT FROM AUTHOR]

BACKGROUND: Patients exhibit considerable variations in gait patterns especially in knee hyperextension in the stance phase after stroke. If knee hyperextension is untreated it may lead to pain, reduced independence in activities of daily living, deformities and instability. OBJECTIVE: The aim of this study was to investigate the immediate effects of a buffered knee orthosis on gait of stroke patients with knee hyperextension. METHODS: A total of nine patients with knee hyperextension after stroke were selected to wear buffered knee orthosis developed by Zhongshan Traditional Chinese Medicine Hospital and Ruike Medical Technology (Shanghai) Co., Ltd during walking training and daily walking. Then the gait analysis system of Motionanalysis was used to analyze and evaluate kinematic and spatiotemporal parameters of the gait in patients with independent walking or walking with a buffered knee orthosis. RESULTS: After wearing the buffered knee brace, initial contact, maximum and minimum angles of support phase, the toe off the ground, maximum and minimum angles of swing phase on the injured side of knee and ankle increased. Minimum angle of support phase and maximum angle of swing phase on the uninjured side of ankle decreased, while the toe off the ground and minimum angles of swing phase increased significantly (all P < 0.05); There was no significant difference in other kinematics, in parameters between time and space, in walking speed among subjective gait parameters (P > 0.05). Walking distance, confidence, sense of security, and the feeling of walking hyperextension were all improved. In addition, the number of asymmetric kinematic parameters and spatiotemporal parameters decreased. CONCLUSION: The buffered knee orthosis can effectively prevent knee hyperextension after stroke, improve the knee and ankle sagittal motion, gait asymmetry, gait subjective feeling, and does not affect gait space-time parameters. [ABSTRACT FROM AUTHOR]

Introduction: The Ankle Lunge Test (ALT) is a reliable method of measuring weight bearing ankle dorsiflexion range, a key component of gait, in healthy ankles and a range of musculoskeletal conditions. The aim of this study is to evaluate the reliability and concurrent validity of the ALT in people with stroke and investigate whether change in ALT is observed following treatment of spasticity with Botulinum Toxin. Methodology: Repeated Measure Design: Forty stroke survivors were recruited for reliability testing. Twenty three stroke survivors were evaluated with the ALT before and after treatment of the lower limb with Botulinum Toxin. Measurement with the ALT was performed for all participants. For the reliability group, two physiotherapists evaluated the ALT on Day 1 and one therapist re‐evaluated the ALT one to 5 days later. For the change evaluation group, the ALT was tested prior to and six to eight weeks after intervention. Other measures evaluated were velocity, the Functional Ambulation Category, Timed Up and Go and the Modified Tardieu Scale. Results: Intra‐rater, inter‐rater and test‐retest reliability yielded intra‐class correlation coefficients at or above 0.92. Moderate correlations were found between the ALT and velocity r = 0.605 (p < 0.01), the Timed Up and Go r = −0.598 (p < 0.01) and the Functional Ambulation Category r = 0.380 (p < 0.05). Following intervention with Botulinum Toxin, there was significant (p < 0.02) improvement in the ALT; pre‐median 20 mm (IQR −25 to 35) to post‐median 21 mm (IQR 0 to 40) and the Timed Up and Go; pre‐median 21.40 s (IQR 13.43 to 28.82) to post‐median 20.08 s (IQR 14.06 to 28.47). Conclusion/Significance: The ALT is a reliable and valid measure which may be applied in clinical practice to evaluate change in weight bearing ankle dorsiflexion in people with stroke. [ABSTRACT FROM AUTHOR]