Background. Few studies have addressed early out-of-bed mobilization specifically in acute intracerebral hemorrhage (ICH) patients. Patient benefit in such cases is unclear, with early intervention timing and duration identical to those in standard care. Objective. We investigated the efficacy of an early mobilization (EM) protocol, administered within 24 to 72 hours of stroke onset, for early functional independence in mild-moderate ICH patients. Methods. Sixty patients admitted to a stroke center within 24 hours of ICH were randomly assigned to early mobilization (EM) or standard early rehabilitation (SER). The EM group underwent an early out-of-bed mobilization protocol, while the SER group underwent a standard protocol focusing on in-bed training in the stroke center. Intervention in both groups lasted 30 minutes per session, once a day, 5 days a week. Motor subscales of the Functional Independence Measure (FIM-motor; primary outcome), Postural Assessment Scale for Stroke Patients, and Functional Ambulation Category (FAC) were evaluated (assessor-blinded) at baseline, and at 2 weeks, 4 weeks, and 3 months after stroke. Length of stay in the stroke center was also recorded. Results. The EM group showed significant improvement in FIM-motor score at all evaluated time points ( P = .004) and in FAC outcomes at 2 weeks ( P = .033) and 4 weeks ( P = .011) after stroke. Length of stay in the stroke center was significantly shorter for the EM group ( P = .004). Conclusion. Early out-of-bed mobilization via rehabilitation in a stroke center, within 24 to 72 hours of ICH, may improve early functional independence compared with standard early rehabilitation. Clinical Trial Registration: NCT03292211.
[Purpose] No literature has described a suitable method for measuring muscle strength in
a supine position during acute phase after stroke. This study investigated the feasibility
and reliability of using a commercial handheld dynamometer to measure the muscle strengths
of the hip flexor, knee extensor, and dorsiflexor in the supine position with a modified
method for patients at a stroke intensive care center within 7 days of stroke onset.
[Subjects and Methods] Fifteen persons with acute stroke participated in this
cross-sectional study. For each patient, the muscle strengths of the hip flexors, knee
extensors, and dorsiflexors were measured twice by two testers on the same day. Each
patient was re-tested at the same time of day one day later. Inter-rater and test-retest
reliability were then determined by the intraclass correlation coefficients (ICCs).
[Results] For the three muscle groups, the inter-rater reliability ICCs were all 0.99 and
the test-retest reliability ICCs were greater than 0.85. The investigated method thus has
good inter-rater reliability and high agreement between the test-retest measurements, with
acceptable measurement errors. [Conclusion] The modified method using a handheld
dynamometer to test the muscle strength of acute stroke patients is a feasible and
reliable method for clinical use.
Joint accessory motion testing (JAMT) is a standard procedure used by manual therapists to assess and treat musculoskeletal disorders. Joint accessory motion (JAM) is movement that occurs between joint surfaces, and can be induced by applying force. The motion amount, end feel, symptoms, and resistance perceived by therapists during test procedures are recorded as evidence for the diagnosis, prognosis, treatment decision making, and intervention outcome. However, previous studies have shown that accessory motion tests have insufficient reliability. Recently, many instruments have been developed to increase test reliability, but these instruments quantify the test results with a single probe and utilize the external environment as a reference. Therefore, the measured displacement amount may be affected by other spinal segments. This study proposes an objective portable measurement device with two indenter probes for spinal JAMT, wherein the JAM was quantified by displacement and force measurements between two bones. The instrument was verified with a homemade spinal simulator and computer simulation. The results showed that the force-displacement curves measured by the JAMT device (JAMTD) and those simulated by the computer model exhibited similar characteristics. Moreover, a two-probe measurement could distinguish the differences in stiffness better than a one-probe measurement.
Adding the TL-FRAT to the fall protocol on the units effectively reduced the incidence of falls related to impaired mobility. The TL-FRAT can improve nurses' sensitivity to falls related to impaired mobility and, subsequently, guide corresponding fall prevention strategies.
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