Please select the eligibility criteria that correspond to the clinical trial below.
Title: A Tai Chi Based Exercise Program Provided Via Telerehabilitation Compared to During Home Visits in Persons Post-Stroke Who Have Returned Home Without Intensive Rehabilitation: A Randomized, Non-inferiority Clinical Trial
Brief Summary: Telerehabilitation is a promising alternative approach that can help improve access to rehabilitation services once patients are discharged home after stroke. The investigators therefore postulate a non-inferiority hypothesis of the telerehabilitation approach compared to home visits to improve balance problem related to stroke. The platform used will be based on a technological infrastructure that was developed and tested in previous telerehabilitation studies. The study is a randomized control trial (RCT).The study population of interest will target individuals who have had a stroke who stayed in a hospital or chronic stroke population. Participants will be recruited during the hospitalization period at each of the three sites or in the community. The investigators expect to recruit 240 participants, 120 per group. The first evaluation will be conducted at recruitment to establish the baseline measures. The two other evaluations will be conducted 2 months (T2) and four months (T3) following recruitment.


Options:
A: Inclusion Criteria:

* veteran
* in the Indianapolis, IN area
* survived a stroke
* on blood pressure medication
* completed all rehabilitation
* ability to stand with or without a device
* able to speak and understand English
* a score \>4 out of 6 on the short mini mental status exam (MMSE)

Exclusion Criteria:

* would not commit to the yoga intervention
* self report of: serious cardiac conditions; history of serious chronic obstructive pulmonary disease or oxygen dependence; severe weight bearing pain; a history of significant psychiatric illness; uncontrollable diabetes with recent weight loss; and current enrollment in another research trial
B: Inclusion Criteria for patients:

* diagnosis of stroke within 5-45 days after stroke
* age \>= 18 years
* able to sit for at least 30 seconds
* Barthel index \< =65 at inclusion
* considered able to perform aerobic exercise as determined by responsible physician
* Written informed consent of the patient

Exclusion Criteria:

* Patient considered unable to comply with study requirements
* stroke due to intracranial hemorrhage primarily due to bleeding from ruptured aneurysm or arteriovenous malformation
* patients with progressive stroke
* unable to perfom the required exercises due to

  1. medical problems
  2. musculo-skeletal problems
  3. neurological problems
* required help to at least 1 persons to walk before stroke due to neurological or non-neurological co-morbidities
* life expectancy of less than 1 year as determined by responsible physician
* alcohol or drug addiction within the last 6 months
* significant current psychiatric illness as defined as medication-refractory of bipolar affective disorder, psychosis, schizophrenia or suicidality
* current participation in another intervention study
C: Inclusion Criteria:

* have had a stroke with a Rankin score of 2 or 3;
* was not referred to an Intensive Functional Rehabilitation Unit (IFRU) and returned home following discharge from hospital;
* understands instructions to allow participation in evaluations and interventions;
* has a balance problem as evidenced by a score between 46 and 54 on the Berg Balance Scale96;
* has a caregiver that would be available during the telerehabilitation sessions to ensure safety during exercises;
* live in an area serviced by high speed Internet.

Exclusion Criteria:

* severe body hemineglect;
* significant hemianopsia visual problems accompanied by hemineglect;
* uncontrolled medical problems;
* moderate to severe aphasia
D: Inclusion Criteria:

* age 18 years or older
* 4 months to 5 years after first-time onset of a ischemic or hemorrhagic cerebrovascular accident (CVA) confirmed by CT, MRI, or clinical criteria
* able to ambulate at least 14 meters with assistive and/or orthotic device and one person assist (minimum Functional Ambulation Classification Level II
* self-selected walking velocity of ≤1.0 meters/second
* approval of primary care physician to participate.

Exclusion Criteria:

* resting systolic blood pressure greater than 180mmHg and/or diastolic blood pressure greater than 110mmHg and/or resting heart rate greater than 100 beats/minute;
* lower limb orthopedic conditions such as prior joint replacement or range of motion limitations;
* spasticity management that included Botox injection (\< 4 months earlier) or phenol block injection (\< 12 months earlier) to affected lower extremity and intrathecal Baclofen or oral Baclofen (within past 30 days);
* Mini-Mental State Exam score \< 24;
* currently receiving lower extremity strengthening exercises or gait training,
* past participation in any study examining the effects of long term (\>4 weeks training) body weight support treadmill training; limb loaded pedaling, or lower extremity strengthening;
* plans to move out of the area in the next year,
* no transportation to the study site for all evaluations and intervention sessions.

Answer: C