Sheltering Arms Physical Rehabilitation Centers

Introduction: Although there are a number of research studies investigating walking recovery after stroke, most focus on one intervention or piece of equipment in order to achieve a controlled experimental environment. Such studies have yet to produce a comprehensive clinical practice guideline (CPG) for gait training. To fill this void, we implemented a clinical program for walking recovery, iWalk™, using a variety of advanced technologies, and an evidence-based CPG to assist in making assessment and intervention decisions. This study compares outcomes of patients treated using a traditional therapy program to those treated with the iWalk program. Hypothesis: The systematic application of a novel, evidence-based CPG for walking recovery will result in superior motor performance when compared to traditional therapy in patients post stroke. Methods: This study included all stroke survivors admitted to a rehab facility during a 24 month period, with the cohort split into two groups. The control group received traditional rehabilitation (n=152) and the experimental group received the iWalk protocol (n=165). Since full implementation of the protocol could not be assigned a specific date, a buffer group (n=50) between the two groups was excluded from this analysis. Results: Functional Independence Measure: An interaction between age and treatment program was detected (p<0.001). Motor FIM scores showed greater improvement for younger patients in iWalk than in the traditional therapy program. Length of Stay: When examining LOS as an outcome, an interaction between treatment group and total FIM score was detected (p=0.073). Patients who were lower functioning on admission were more likely to be discharged home if they were in the iWalk program. Examining LOS as a predictor, the difference in timed-up-and-go scores between the treatment groups reveals that iWalk seems to be better for a LOS around 3 weeks, but is not significant (p>0.05). Conclusions: This study demonstrates outcome differences that favor iWalk. Additionally, there may be a LOS range which optimizes motor recovery. It is unclear whether a patient’s LOS is a reflection of the improvement of clinical variables or practical reasons. Further work is necessary on this topic.

There are an estimated two million traumatic brain injuries (TBI) each year in the US. Behavioural and psychosocial sequelae are the most disabling consequences of TBI, but relatively little empirical data exist that identify factors underlying the variability in patient outcomes. There is an increasing appreciation that pre-injury coping liabilities are likely to contribute to persistent disability and that outcome reflects the combined effects of pre-morbid, injury-related, and post-injury factors. Despite this, most outcome studies focus on the effects of injury-related and post-injury variables. The present study evaluated outcome in 45 adults who suffered a moderate or severe TBI at least 2 years earlier. It was hypothesized that severity of pre-morbid psychiatric and substance abuse problems and less social support following brain injury would be associated with poorer post-injury adaptation as measured by employment status, independent living status, and neurobehavioural symptomatology. The authors found that pre-injury psychiatric and substance abuse histories predicted employment status and that pre-injury substance abuse predicted independent living status. Social support following TBI predicted significant other's assessment of the patients' neurobehavioural status. None of the independent variables were found to predict patient assessment of his or her own neurobehavioural functioning. These findings support the premise that pre-morbid coping liabilities are related to the degree of post-injury disability.

Comoss, Pat RN; Hillegass, Ellen A. MMSc, PT, CCS; Sadowsky, H. Steven MS, RRT, PT, CCS, eds.; Jewell, Dianne Valle MS, PT Author Information