Urinary incontinence (UI) is a common problem after stroke. Risk factors for UI seem to be multifactorial. There is still controversy in which risk factors contribute to UI. The aim of this study was ...to investigate risk factors for UI in stroke patients during rehabilitation. Study investigated 150 participants after the first stroke consecutively admitted to a post-acute inpatient rehabilitation program. They were divided into continence and incontinence group according to continence status on rehabilitation admission. Data about sociodemographic factors, functional status, comorbidities, current medications, type and localisation of stroke were collected. Compared with the continence group, incontinent participants had significantly worse cognitive status and upper limb function (P ≤ 0.005), more common global aphasia, neglect, visual field defect, agitation/confusion and deficits in somatic sensation (P ≤ 0.014). There were no differences between the groups regarding comorbidities, but incontinent participants received a larger number of current medications (P = 0.020). Incontinent participants had stroke located more common in the right hemisphere, corticosubcortical region and in the total anterior circulation region (P ≤ 0.051). In the multivariate analysis, Brunnstrom recovery stages of the affected upper limb odds ratio (95% confidence interval1.61 (1.27–2.03), agitation/confusion 5.36 (1.74–16.54), global aphasia 5.06 (1.40–18.26) and faecal impaction 3.41 (1.15–10.09) were independent risk factors for UI. Findings suggest that communicative and cognitive problems, affected upper limb function and faecal impaction are the most important clinical risk factors for UI after stroke. Knowledge of these risk factors may help in the management of UI during rehabilitation of stroke patients.
Purpose of Review
This comprehensive up-to-date review will synthesise relevant available literature on the topic of post-stroke lower urinary tract dysfunction (LUTD). Topics include epidemiology of ...LUTD, LUTD as a prognostic indicator for stroke recovery, urinary incontinence and retention, correlations between brain lesion localisation and LUTD, causes of LUTD, medical complications due to LUTD, diagnostics and contemporary management of LUTD in stroke patients.
Recent Findings
LUTD frequently occurs after a stroke and is associated with poor overall functional outcome, increased institutionalisation and mortality rates. The predominant symptoms are urinary frequency, urgency and urge incontinence. In the urodynamic findings, detrusor overactivity is predominant and detrusor underactivity is somewhat less prevalent. LUTD is correlated with the size and site of the brain lesion, and the presence of cognitive, motor, sensory, vision impairment and aphasia. There are multiple aetiologies for LUTD and the treatment usually includes continence aids, behavioural, pharmacological and surgical measures. A variety of behavioural therapeutic interventions is described in the literature, including bladder training and pelvic floor muscle training, but the evidence of the effectiveness is still sparse.
Summary
LUTD after a stroke remains under-recognised, poorly addressed and there is still a lack of clinical practice guidelines available in the literature. At the moment, a structured clinical assessment and the use of a multimodal treatment approach that includes a systematic voiding programme with the participation of all team members is recommended. In the future, additional evidence-based research should be performed to evaluate the effectiveness of various therapeutic approaches.
Generating appropriate balancing reactions in response to unexpected loss of balance during walking is important to prevent falls. The purpose of this study was to assess dynamic balancing responses ...following pushes to the pelvis in groups of post-stroke and healthy subjects.
Forty-one post-stroke subjects and forty-three healthy subjects participated in the study. Dynamic balancing responses to perturbations triggered at heel strike of the left or right leg, directed in the forward, backward, inward and outward directions during slow treadmill walking were assessed. Responses of the healthy group provided reference values used to classify responses of the post-stroke group into two subgroups; one within the reference responses ("inside" subgroup) and the other that falls out ("outside" subgroup). A battery of selected clinical outcome measures (6-Minute Walk Test, 10-Meter Walk Test, Timed-Up-and-Go test, Four Square Step Test, Functional Gait Assessment, Functional Independence Measure and One-legged stance test) was additionally assessed in the post-stroke group.
The "inside" subgroup of post-stroke subjects was able to appropriately modulate centre-of-pressure and ground-reaction-force both under the impaired and non-impaired leg in response to perturbations. The "outside" subgroup of post-stroke subjects showed limited modulation of centre-of-pressure and ground-reaction-force under the impaired leg; instead stepping strategy was used in which the non-impaired leg was placed such as to make a longer step (forward perturbation), to make a shorter step (backward perturbation) or to make a cross-step (outward perturbation). Consequently, peak centre-of-mass displacements following perturbations were significantly higher in the "outside" subgroup compared to the "inside" subgroup. Responses in both subgroups following inward perturbations did not differ. Majority of clinical outcome measures moderately correlated with the peak centre-of-mass displacements for forward perturbations and exhibited weak correlations for other perturbation directions.
Substantial number of post-stroke subjects, that were considered to be independent walkers, have reduced capabilities to execute appropriate balancing responses following perturbations commencing on the hemiparetic leg and may thus benefit from perturbation-based training. Timed-Up-and-Go and Functional Independence Measure tests may provide an indication on the abilities of each subject to counteract unexpected loss of balance. However, a reliable assessment should be done through perturbation-based measures.
Highlights • ALS patients have decreased alpha activity possibly due to pyramidal and thalamic degeneration. • Decreased beta desynchronization could indicate altered motor network connections ...whereas unilateral post-movement synchronisation supports ALS-related corpus callosum degeneration. • ALS affects movement-related cortical potentials and ERD/ERS measures via different mechanisms.
The aim of the study was to design an algorithm of selecting the balance assessment tool in patients after stroke, which could be used in a subacute rehabilitation setting. A retrospective study was ...carried out to analyse results of standardized balance measurements in three groups of stroke patients classified by Functional Ambulation Category (FAC) (FAC 1 or 2, non-functional ambulation; FAC 3 or 4, ambulatory dependent; FAC 5 or 6, ambulatory independent). Balance functions were evaluated in 62 out of 70 patients (88.6%) at admission and discharge with at least with one standardized assessment tool. In 21 patients (30%), two or more assessment tools were used. From admission to discharge significant changes in balance functions in the non-functional ambulatory group were detected by Postural Assessment Scale for Stroke (PASS) (P = 0.003), in the ambulatory dependent group with PASS (P = 0.025) and Berg Balance Scale (BBS) (P = 0.009) and in the ambulatory independent group with the Timed Up and Go Test (P = 0.002) and Functional Gait Assessment (P = 0.029). In a post-stroke rehabilitation most commonly used BBS and PASS are sensitive enough in non-functional ambulatory and ambulatory dependent patients, though they do not reflect the overall balance function. In ambulatory independent patients, significant changes in balance functions can be detected only with the assessment tools that include the measurements of dynamic balance. Based on the findings, the algorithm for the selection of balance assessment tools in post-stroke rehabilitation setting was formulated according to FAC.
Perturbation-based balance training (PBT) has been shown to improve reactive balancing abilities in chronic stroke. To inform future investigations in the subacute phase of stroke, the objective of ...this series of N-of-1 studies was to investigate the range of balancing responses to unexpected mechanical perturbations applied to the pelvis during walking on an instrumented treadmill before and after PBT training. Three subacute stroke subjects were assessed on each occasion with clinical tests and biomechanical measurements following perturbations applied in forward, backward, inward and outward directions. After 15 daily sessions of PBT, most clinical mobility outcomes showed improvements in all three subjects. Assessment of reactive balancing also showed improvements in all subjects when responding to perturbations in backward and inward directions whereas the changes following perturbations in forward and outward directions were subject-specific. The results suggest that PBT should be individually tailored to target balance deficiencies identified through a serial biomechanical assessment.
Introduction: Work-related musculoskeletal disorders (WMSDs) represent a major problem for society, employers, and employees. These kinds of problems can cause discomfort, pain, and poor work ...performance. Among physiotherapists, the 1-year prevalence of WMSD ranges from 28 to 96%. Most problems occur in the lower back, with a 1-year prevalence of up to 83%. This study aimed to determine the prevalence of WMSD on a sample of physiotherapists from Slovenia and to identify associations between demographic/anthropometric variables, job satisfaction, and physical activity with WRMD aiming to contribute to the development of effective prevention and control strategies.
Methods: The extended Nordic musculoskeletal questionnaire was used to obtain data from a sample of 102 physiotherapists. Data were presented with descriptive statistics and processing was performed with the Spearman’s rank correlation coefficient for non-parametric variables. The level of statistical significance was set as p ≤ 0.05.
Results: The 1-year prevalence of WMSD was 92.2%. One-year prevalence of WMSD was highest for the neck (64%) and lower back (63%). Higher age and more years of practice were correlated with WMSD for shoulders and ankles/feet areas. Several patients treated by a physiotherapist were a risk factor for difficulties in the neck and multiple body areas. The level of physical activity was not correlated with WMSD in different body areas.
Conclusion: The prevalence of WMSD found in our study sample was among the highest compared to other countries, despite probably having similar working conditions as elsewhere in Europe. The first WMSD of Slovenian physiotherapists mostly did not occur in the first 5 years of practice as other studies reported, which could be explained as a result of a good educational training of young physiotherapists. Possible reasons for the high prevalence of WMSD could be that our study sample represented only secondary and tertiary levels of health care; another reason could also be non-ergonomic and hard working conditions during their careers. Physiotherapists are mostly adequately physically active, however, that did not turn out to be effective WMSD prevention in our sample. The relatively high prevalence is indicating the need for better interventions and prevention of WMSD in Slovenian physiotherapists.
Gait and balance impairments contribute significantly to long-term disability after stroke. Modern concepts of stroke rehabilitation recommend a task-specific repetitive approach, such as using ...treadmill training. The purpose of this study was to investigate the effectiveness of using virtual reality-based treadmill training to improve balance and gait in subacute stroke patients. Twenty-two stroke patients were randomly stratified into two groups: the experimental (n = 11) and the control group (n = 11). Parameters associated with balance and gait were measured using the 6-minute walk test, the 10-meter walk test, the timed “up and go” test, the functional gait assessment, and the four square step test. Gait analysis using the zebris Rehawalk® treadmill system was also performed. Patients in the experimental group received virtual reality-based treadmill training five times a week for a period of four weeks, while those in the control group received treadmill training at the same frequency, duration, intensity, and structure, along with a progressively more difficult task demands. Significant improvements were observed in selected outcome measures in both groups after training. Patients in the experimental group experienced improvements in all of the spatiotemporal gait parameters, but there was a significant difference before and after training in duration of double support and lateral asymmetry. The findings of this pilot randomized controlled trial support the benefits of using a virtual reality-based treadmill training program to improve gait and balance in subacute stroke patients.
Izhodišče: Postavljanje ciljev je ključni element rehabilitacijske obravnave bolnikov po možganski kapi. V bolnika usmerjeni pristop ni pomemben le za zdravstvene in rehabilitacijske storitve, ampak ...ima velik pomen tudi v procesu postavljanja ciljev. Trenutne raziskave na področju rehabilitacijske obravnave bolnikov po možganski kapi še niso dale jasnega odgovora glede najboljše klinične prakse pri postavljanju rehabilitacijskih ciljev. Namen raziskave je bil ugotoviti, na kakšen način člani rehabilitacijskega tima pri bolnikih po možganski kapi postavljajo rehabilitacijske cilje, katera ocenjevalna orodja pri tem uporabljajo in katere ovire so prisotne pri postavljanju ciljev.Metode: Anketni vprašalnik je izpolnilo 35 članov rehabilitacijskega tima na Oddelku za rehabilitacijo bolnikov po možganski kapi Univerzitetnega rehabilitacijskega inštituta Republike Slovenije – Soča. Vprašalnik je vseboval vprašanja glede splošnih kliničnih izkušenj pri postavljanju ciljev v procesu rehabilitacije, uporabi ocenjevalnih orodij in težavah, ki se pojavijo pri postavljanju ciljev.Rezultati: Večina članov rehabilitacijskega tima je že uporabljala postavljanje ciljev kot merilo učinkovitosti rehabilitacijske obravnave in so dojemali postavljanje ciljev kot zahteven proces. Najpogostejše ovire pri postavljanju ciljev so bile pomanjkanje časa in značilnosti bolnika (soobolevnost, osebnostne lastnosti in pričakovanja).Zaključek: Naša raziskava je prikazala številne vidike s strani članov rehabilitacijskega tima, ki so pomembni za postavljanje ciljev v rehabilitaciji bolnikov po možganski kapi. Rehabilitacijski proces se bi moral usmeriti v bolnika in voditi do zastavljenih ciljev. V prihodnje bi bilo smiselno razviti jasne smernice glede postavljanja ciljev v rehabilitaciji bolnikov po možganski kapi kot tudi dodatno izobraževanje zdravstvenega osebja tega področja.
Regaining of the patient’s ability to walk after stroke is an important goal of rehabilitation programmes. The ultimate goal of gait rehabilitation is to empower patients for overground walking. We ...have previously developed a prototype of a therapist-controlled mobile platform with compliant pelvis support mechanism that enables balance training during overground walking (device E-go). The aim of this pilot randomized controlled study was to explore the usefulness of the E-go in reducing the number of therapists needed during walking training, and to explore the effectiveness of the E-go on walking abilities in severely affected stroke patients. The study included 19 subacute poststroke patients divided into two groups. The experimental group (nine patients) trained to walk with the E-go and the control group trained within conventional physiotherapy programs for 3 weeks. Outcome measures were walking distance and speed, Fugl–Meyer Assessment, Berg Balance Scale, Functional Ambulation Category and the number of therapists needed during training. At the end of the training both groups significantly improved in walking speed, walking distance, Berg Balance Scale and Fugl–Meyer Assessment (P≤0.001), but there were no between-group differences. The experimental group on average needed a lower number of therapists (P=0.040). These findings highlight the potential of the E-go for overground walking training in severely disabled subacute stroke patients.
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