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Open AccessArticle

Innovative Long-Dose Neurorehabilitation for Balance and Mobility in Chronic Stroke: A Preliminary Case Series

1
Department of Neurology, College of Medicine, University of Florida, Gainesville, FL 32608, USA
2
Department of Biostatistics, College of Public Health and Health Professions, University of Florida, Gainesville, FL 32608, USA
3
Department of Physical Therapy College of Public Health and Health Professions, University of Florida, Gainesville, FL 32608, USA
4
Brain Rehabilitation Research Center, North Florida/South Georgia VA Medical Center, Gainesville, FL 32608, USA
5
Neurovascular Division and Stroke Program, Department of Neurology, Barrow Neurological Institute at Dignity Health St. Joseph’s Hospital and Medical Center, Phoenix, AZ 85013, USA
*
Author to whom correspondence should be addressed.
Brain Sci. 2020, 10(8), 555; https://doi.org/10.3390/brainsci10080555
Received: 14 July 2020 / Revised: 8 August 2020 / Accepted: 13 August 2020 / Published: 14 August 2020
(This article belongs to the Special Issue Stroke Treatments and Therapies)
(1) Objective: The objective was two-fold: (a) test a protocol of combined interventions; (b) administer this combined protocol within the framework of a six-month, intensive, long-duration program. The array of interventions was designed to target the treatment-resistant impairments underlying persistent mobility dysfunction: weakness, balance deficit, limb movement dyscoordination, and gait dyscoordination. (2) Methods: A convenience sample of eight chronic stroke survivors (>4 months post stroke) was enrolled. Treatment was 5 days/week, 1–2.5 h/day for 6 months, as follows: strengthening exercise, balance training, limb/gait coordination training, and aerobic exercise. Outcome measures: Berg Balance Scale (BBS), Fugl-Meyer Lower Limb Coordination (FM), gait speed, 6 Minute Walk Test (6MWT), Timed up and Go (TUG), Functional Independence Measure (FIM), Craig Handicap Assessment Rating Tool (CHART), and personal milestones. Pre-/post-treatment comparisons were conducted using the Permutation Test, suitable for ordinal measures and small sample size. (3) Results: For the group, there was a statistically (p0.04) significant improvement in balance, limb movement coordination (FM), gait speed, functional mobility (TUG), and functional activities (FIM). There were measurable differences (minimum detectible change: MDC) in BBS, FM, gait speed, 6MWT, and TUG. There were clinically significant milestones achieved for selected subjects according to clinical benchmarks for the BBS, 6MWT, gait speed, and TUG, as well as achievement of personal milestones of life role participation. Effect sizes (Cohen’s D) ranged from 0.5 to 1.0 (with the exception of the (6MWT)). After six months of treatment, the above array of gains were beyond that reported by other published studies of chronic stroke survivor interventions. Personal milestones included: walking to mailbox, gardening/yardwork, walking a distance to neighbors, return to driving, membership at a fitness center, vacation trip to the beach, swimming at local pool, returning to work, housework, cooking meals. (4) Conclusions: Stroke survivors with mobility dysfunction were able to participate in the long-duration, intensive program, with the intervention array targeted to address impairments underlying mobility dysfunction. There were either clinically or statistically significant improvements in an array of measures of impairment, functional mobility, and personal milestone achievements. View Full-Text
Keywords: balance; coordination; function; gait; mobility; quality of life; stroke balance; coordination; function; gait; mobility; quality of life; stroke
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MDPI and ACS Style

Boissoneault, C.; Grimes, T.; Rose, D.K.; Waters, M.F.; Khanna, A.; Datta, S.; Daly, J.J. Innovative Long-Dose Neurorehabilitation for Balance and Mobility in Chronic Stroke: A Preliminary Case Series. Brain Sci. 2020, 10, 555.

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