Additional task-related practice improves mobility and upper limb function early after stroke: a randomised controlled trial. Circuit-based rehabilitation improves gait endurance but not usual walking activity in chronic stroke: a randomized controlled trial. Circuit class therapy versus individual physiotherapy sessions during inpatient stroke rehabilitation: a controlled trial. Circuit Class Therapy or Seven-Day Week Therapy for Increasing Rehabilitation Intensity of Therapy after Stroke (CIRCIT): A Randomized Controlled Trial People with stroke spend more time in active task practice, but similar time in walking practice, when physiotherapy rehabilitation is provided in circuit classes compared to individual therapy sessions: an observational study. Effectiveness of a structured circuit class therapy model in stroke rehabilitation: a protocol for a randomised controlled trial Effect of the a circuit training program using obstacles on the walking and balance abilities of stroke patients Physiotherapists systematically overestimate the amount of time stroke survivors spend engaged in active therapy rehabilitation: an observational study. Feasibility and Effectiveness of Circuit Training in Acute Stroke Rehabilitation Circuit Class Therapy and 7-Day-Week Therapy Increase Physiotherapy Time, But Not Patient Activity: Early Results From the CIRCIT Trial Circuit Class or Seven-Day Therapy for Increasing Intensity of Rehabilitation after Stroke: Protocol of the CIRCIT Trial Clinical application of circuit training for subacute stroke patients: a preliminary study Effects of circuit training as alternative to usual physiotherapy after stroke: randomised controlled trial Cost-effectiveness of a structured progressive task-oriented circuit class training programme to enhance walking competency after stroke: The protocol of the FIT-Stroke trial Task-related circuit training improves performance of locomotor tasks in chronic stroke: a randomized, controlled pilot trial. Group Balance Skills Class for People with Chronic Stroke: A Case Series Treadmill Exercise Activates Subcortical Neural Networks and Improves Walking After Stroke: A Randomized Controlled Trial Theta-burst stimulation of the left hemisphere accelerates recovery of hemispatial neglect Bihemispheric brain stimulation facilitates motor recovery in chronic stroke patients Task-Oriented Circuit Class Training Program with Motor Imagery for Gait Rehabilitation in Poststroke Patients: A Randomized Controlled Trial Virtual Reality Exercise Improves Mobility After Stroke: An Inpatient Randomized Controlled Trial Group exercise can improve participants' mobility in an outpatient rehabilitation setting: a randomized controlled trial Effects of an aquatic therapy approach (Halliwick-Therapy) on functional mobility in subacute stroke patients: a randomized controlled trial
The purpose of this study was to investigate whether additional practice of either upper limb or mobility tasks improved functional outcome during inpatient stroke rehabilitation . This prospect i ve , r and omised , single blind clinical trial recruited 30 stroke subjects into either an Upper Limb or a Mobility Group . All subjects received their usual rehabilitation and an additional session of task-related practice using a circuit class format . Independent assessors , blinded to group allocation , tested all subjects . Outcome measures used were three items of the Jebsen Taylor H and Function Test ( JTHFT ) , two  arm items  of the Motor Assessment Scale ( MAS ) , and three mobility measures , the Timed Up and Go Test ( TUGT ) , Step Test , and Six Minute Walk Test ( 6MWT ) . Both groups improved significantly between pre- and post-tests on all of the mobility measures , however only the Upper Limb Group made a significant improvement on the JTHFT and MAS upper arm items . Following four weeks training , the Mobility Group had better locomotor ability than the Upper Limb Group ( between-group differences in the 6MWT of 116.4 m , 95 % CI 31.4 to 201.3 m , Step Test 2.6 repetitions , 95 % CI -1.0 to 6.2 repetitions , and TUGT -7.6 sec , 95 % CI -15.5 to 0.2 sec ) . The JTHFT dexterity scores in the Upper Limb Group were 6.5 sec ( 95 % CI -7.4 to 20.4 sec ) faster than the Mobility Group . Our findings support the use of additional task-related practice during inpatient stroke rehabilitation . The circuit class format was a practical and effective means to provide supervised additional practice that led to significant and meaningful functional gains UNLABELLED Mudge S , Barber PA , Stott NS . Circuit-based rehabilitation improves gait endurance but not usual walking activity in chronic stroke : a r and omized controlled trial . OBJECTIVE To determine whether circuit-based rehabilitation would increase the amount and rate that individuals with stroke walk in their usual environments . DESIGN Single-blind r and omized controlled trial . SETTING Rehabilitation clinic . PARTICIPANTS Sixty participants with a residual gait deficit at least 6 months after stroke originally enrolled in the study . Two withdrew in the initial phase , leaving 58 participants ( median age , 71.5y ; range , 39.0 - 89.0y ) who were r and omized to the 2 intervention groups . INTERVENTIONS The exercise group had 12 sessions of clinic-based rehabilitation delivered in a circuit class design ed to improve walking . The control group received a comparable duration of group social and educational classes . MAIN OUTCOME MEASURES Usual walking performance was assessed using the StepWatch Activity Monitor . Clinical tests were gait speed ( timed 10-meter walk ) and endurance ( six-minute walk test [ 6MWT ] ) , confidence ( Activities-Based Confidence Scale ) , self-reported mobility ( Rivermead Mobility Index [ RMI ] ) , and self-reported physical activity ( Physical Activity and Disability Scale ) . RESULTS Intention-to-treat analysis revealed that the exercise group showed a significantly greater distance for the 6MWT than the control group immediately after the intervention ( P=.030 ) but that this effect was not retained 3 months later . There were no changes in the StepWatch measures of usual walking performance for either group . The exercise and control groups had significantly different gait speed ( P=.038 ) and scores on the RMI ( P=.025 ) at the 3-month follow-up . These differences represented a greater decline in the control group compared with the exercise group for both outcome measures . CONCLUSIONS Circuit-based rehabilitation leads to improvements in gait endurance but does not change the amount or rate of walking performance in usual environments . Clinical gains made by the exercise group were lost 3 months later . Future studies should consider whether rehabilitation needs to occur in usual environments to improve walking performance OBJECTIVE To compare the effectiveness of circuit class therapy and individual physiotherapy ( PT ) sessions in improving walking ability and functional balance for people recovering from stroke . DESIGN Nonr and omized , single-blind controlled trial . SETTING Medical rehabilitation ward of a rehabilitation hospital . PARTICIPANTS Sixty-eight persons receiving inpatient rehabilitation after a stroke . INTERVENTIONS Subjects received group circuit class therapy or individual treatment sessions as the sole method of PT service delivery for the duration of their inpatient stay . MAIN OUTCOME MEASURES Five-meter walk test ( 5MWT ) , two-minute walk test ( 2MWT ) , and the Berg Balance Scale ( BBS ) measured 4 weeks after admission . Secondary outcome measures included the Iowa Level of Assistance Scale , Motor Assessment Scale upper-limb items , and patient satisfaction . Measures were taken on admission and 4 weeks later . RESULTS Subjects in both groups showed significant improvements between admission and week 4 in all primary outcome measures . There were no significant between group differences in the primary outcome measures at week 4 ( 5MWT mean difference , .07 m/s ; 2MWT mean difference , 1.8 m ; BBS mean difference , 3.9 points ) . A significantly higher proportion of subjects in the circuit class therapy group were able to walk independently at discharge ( P=.01 ) and were satisfied with the amount of therapy received ( P=.007 ) . CONCLUSIONS Circuit class therapy appeared as effective as individual PT sessions for this sample of subjects receiving inpatient rehabilitation poststroke . Favorable results for circuit classes in terms of increased walking independence and patient satisfaction suggest this model of service delivery warrants further investigation Background Increased therapy has been linked to improvements in functional ability of people with stroke . Aim To determine the effectiveness of two alternative models of increased physiotherapy service delivery ( seven-day week therapy or group circuit class therapy five days a week ) to usual care . Method Three-armed r and omized controlled trial with blinded assessment of outcome . People admitted with a diagnosis of stroke , previously independently ambulant and with a moderate level of disability were recruited .  ‘ Usual care ’ was individual physiotherapy provided five-days a week . Seven-day week therapy was usual care physiotherapy provided seven-days a week . Participants in the circuit class therapy arm of the trial received physiotherapy in group circuit classes in two 90-min sessions , five-days a week . Primary outcome was distance walked on the six-minute walk test at four-weeks post-r and omization . Results Two hundred eighty-three participants were r and omized ; primary outcome data were available for 259 ( 92 % ) . In the seven-day arm participants received an additional three hours of physiotherapy and thosein the circuit class armanadditional 22 h. There were no significant between-group differences at four-weeks in walking distance ( P = 0·72 ) . Length of stay was shorter for seven-day ( mean difference −2·9 days , 95 % confidence interval −17·9 to 12·0 ) and circuit class participants ( mean difference −9·2 days , 95 % confidence interval −24·2 to 5·8 ) compared to usual care , but this was not significant . Conclusions Both seven-day therapy and group circuit class therapy increased physiotherapy time , but walking outcomes were equivalent to usual care QUESTION Do people with stroke spend more time in active task practice during circuit class therapy sessions versus individual physiotherapy sessions ? Do people with stroke practise different tasks during circuit class therapy sessions versus individual physiotherapy sessions ? DESIGN Prospect i ve , observational study . PARTICIPANTS Twenty-nine people with stroke in inpatient rehabilitation setting s. INTERVENTIONS Individual therapy sessions and circuit class therapy sessions provided within a larger r and omised controlled trial . OUTCOME MEASURES Seventy-nine therapy sessions were video-recorded and the footage was analysed for time spent engaged in various categories of activity . In a sub sample of 28 videos , the number of steps taken by people with stroke per therapy session was counted . RESULTS Circuit class therapy sessions were of a longer duration ( mean difference 38.0minutes , 95 % CI 29.9 to 46.1 ) , and participants spent more time engaged in active task practice ( mean difference 23.8minutes , 95 % CI 16.1 to 31.4 ) compared with individual sessions . A greater percentage of time in circuit class therapy sessions was spent practising tasks in sitting ( mean difference 5.3 % , 95 % CI 2.4 to 8.2 ) and in sit-to-st and practice ( mean difference 2.7 % , 95 % CI 1.4 to 4.1 ) , and a lower percentage of time in walking practice ( mean difference 19.1 % , 95 % CI 10.0 to 28.1 ) compared with individual sessions . PARTICIPANTS took an average of 371 steps ( SD 418 ) during therapy sessions and this did not differ significantly between group and individual sessions . CONCLUSION People with stroke spent more time in active task practice , but a similar amount of time in walking practice when physiotherapy was offered in circuit class therapy sessions versus individual therapy sessions . There is a need for effective strategies to increase the amount of walking practice during physiotherapy sessions for people after stroke Background Currently , the key advocacy in neuroscientific studies for stroke rehabilitation is that therapy should be directed towards task specificity performed with multiple repetitions . Circuit Class Therapy ( CCT ) is well suited to accomplish multiple task-specific activities . However , while repetitive task practice is achievable with circuit class therapy , in stroke survivors repetitive activities may be affected by poor neurologic inputs to motor units , result ing in decreases in discharging rates which consequently may reduce the efficiency of muscular contraction . To accomplish multiple repetitions , stroke survivors may require augmented duration of practice . To date , no study has examined the effect of augmented duration of CCT in stroke rehabilitation , and specifically what duration of CCT is more effective in influencing functional capacity among stroke survivors . Methods / design Using a r and omised controlled trial with blinded outcome assessment , this study is aim ed at determining the effectiveness of structured augmented CCT in stroke rehabilitation . Sixty-eight stroke survivors ( to be recruited from a tertiary health institution in Kano , Northwest , Nigeria ) will be r and omised into one of four groups : three intervention groups of differing CCT duration s namely : 60 min , 90 min , and 120minuntes respectively , and a control group . Participants will take part in an 8-week structured intensive CCT intervention . Participants will be assessed at baseline , post-intervention , and six-month follow-up for the effectiveness of the varied duration s of therapy , using st and ardised tools . Based on the WHO-ICF model , the outcomes are body structure/function , activity limitation , and participation restriction measures . Discussion It is expected that the outcome of this study will clarify whether increasing CCT duration leads to better recovery of motor function in stroke survivors . Trial registration Pan African Clinical Trial Registry ( PACTR ) : [ Purpose ] The aim of this study was to investigate the impact of a circuit training program on the walking and balance abilities of stroke patients using an up-to- date walking analysis device . [ Subjects and Methods ] The subjects of this study were 12 adults who were diagnosed with stroke . Evaluation was conducted using the Smart Step test for walking ability ; ( BBS ) for balance ability ; and the Timed Up and Go test ( TUG ) for functional mobility and movement ability . The 12 stroke patients were r and omly recruited and divided into two groups ; an experimental group which performed circuit training with obstacles , and a control group which performed flat gait training ) . [ Results ] Between-group comparison of the change in the 10-m walking speed found a statistically significant difference between the two groups . Between-group comparison of the changes in BBS and TUG found statistically significant differences between the two groups . [ Conclusion ] The circuit training program using obstacles had a positive effect on the gait and balance abilities of the stroke patients QUESTIONS How accurately do physiotherapists estimate how long stroke survivors spend in  physiotherapy sessions and the amount of time stroke survivors are engaged in physical activity during physiotherapy sessions ? Does the mode of therapy ( individual sessions or group circuit classes ) affect the accuracy of therapists ' estimates ? DESIGN Observational study embedded within a r and omised trial . PARTICIPANTS People who participated in the CIRCIT trial after having a stroke . INTERVENTION  47 therapy sessions scheduled and supervised by physiotherapists  ( n = 8) and physiotherapy assistants ( n = 4 ) for trial participants were video-recorded . OUTCOME MEASURES Therapists ' estimations of therapy time were compared to the video-recorded times . RESULTS The agreement between therapist-estimated and video-recorded data for total therapy time and active time was excellent , with intraclass correlation coefficients ( ICC ) of 0.90 ( 95 % CI 0.83 to 0.95 ) and 0.83 ( 95 % CI 0.73 to 0.93 ) respectively . Agreement between therapist-estimated and video-recorded data for inactive time was good ( ICC score 0.62 , 95 % CI 0.40 to 0.77 ) . The mean ( SD ) difference between therapist-estimated and video-recorded total therapy time , active time , and inactive time for all sessions was 7.7 ( 10.5 ) , 14.1 ( 10.3 ) and -6.9 ( 9.5 ) minutes respectively . Bl and -Altman analyses revealed a systematic bias of overestimation of total therapy time and total active time , and underestimation of inactive time by therapists . Compared to individual therapy sessions , therapists estimated total circuit class therapy duration more accurately , but estimated active time within circuit classes less accurately . CONCLUSION Therapists are inaccurate in their estimation of the amount of time stroke survivors are active during therapy sessions . When accurate therapy data are required , use of objective measures is recommended Background : Task-specificity , repetition and progression are key variables in the acquisition of motor skill however they have not been consistently implemented in post-stroke rehabilitation . Objective : To evaluate the effectiveness of a stroke rehabilitation plan of care that incorporated task-specific practice , repetition and progression to facilitate functional gain compared to st and ard physical therapy for individuals admitted to an inpatient stroke unit . Methods : Individuals participated in either a circuit training ( CTPT ) model ( n = 72 ) or a st and ard ( SPT ) model ( n = 108 ) of physical therapy , 5 days/week . Each 60 minute circuit training session , delivered according to severity level , consisted of four functional mobility tasks . Daily exercise logs documented both task repetition and progression . Results : The CTPT model was successfully implemented in an acute rehabilitation setting . The CTPT group showed a significantly greater improved change in gait speed from hospital admission to discharge than the SPT group ( 0.21± 0.25 m/sec vs. 0.13± 0.22 m/sec ; p = 0.03 ) . The difference between groups occurred primarily among those who were ambulatory upon admission . There were no significant differences between the two cohorts at 90 days post-stroke as measured by the FONE-FIM , SF-36 and living location . Conclusions : Therapy focused on systematic ally progressed functional tasks can be successfully implemented in an inpatient rehabilitation stroke program . This circuit-training model result ed in greater gains in gait velocity over the course of inpatient rehabilitation compared to the st and ard model of care . Community-based services following hospital discharge to maintain these gains should be included in the continuum of post-stroke care Background and Purpose — The optimum model of physiotherapy service delivery for maximizing active task practice during rehabilitation after stroke is unknown . The purpose of the study was to examine the relative effectiveness of 2 alternative models of physiotherapy service delivery against a usual care control with regard to increasing patient activity . Methods — Sub study within a large 3-armed r and omized controlled trial , which compared 3 different models of physiotherapy service delivery , was provided for 4 weeks during subacute , inpatient rehabilitation ( n=283 ) . The duration of all physiotherapy sessions was recorded . In addition , 32 participants were observed at 10-minute intervals for 1 weekday and 1 weekend day between 8:00 AM and 4:30 PM . At each observation , we recorded physical activity , location , and people present . Results — Participants receiving 7-day-week and circuit class therapy received an additional 3 hours and 22 hours of physiotherapy time , respectively , when compared with usual care . Participants were  st and ing or walking  for a median of 8.2 % of observations . On weekdays , circuit class therapy participants spent more time in therapy-related activity ( 10.2 % of observations ) when compared with usual care participants ( 6.1 % of observations ) . On weekends , 7-day therapy participants spent more time in therapy-related activity ( 4.2 % of observations ) when compared with both usual care and circuit class therapy participants ( 0 % of observations for both groups ) . Activity levels outside of therapy sessions did not differ between groups . Conclusions — A greater dosage of physiotherapy time did not translate into meaningful increases in physical activity across the day . Clinical Trial Registration — URL : http://www.anzctr.org.au/. Unique identifier : ACTRN12610000096055 Rationale There is strong evidence for a dose – response relationship between physical therapy early after stroke and recovery of function . The optimal method of maximizing physical therapy within finite health care re sources is unknown . Aims To determine the effectiveness and cost-effectiveness of two alternative models of physical therapy service delivery ( seven-days per week therapy services or group circuit class therapy over five-days a week ) to usual care for people receiving inpatient rehabilitation after stroke . Design Multicenter , three-armed r and omized controlled trial with blinded assessment of outcomes . Study A total of 282 people admitted to inpatient rehabilitation facilities after stroke with an admission functional independence measure ( FIM ) score within the moderate range ( total 40–80 points or motor 38–62 points ) will be r and omized to receive one of three interventions : • usual care therapy over five-days a week • st and ard care therapy over seven-days a week , or • group circuit class therapy over five-days a week . Participants will receive the allocated intervention for the length of their hospital stay . Analysis will be by intention-to-treat . Outcomes The primary outcome measure is walking ability ( six-minute walk test ) at four-week postintervention with three- and six-month follow-up . Economic analysis will include a costing analysis based on length of hospital stay and staffing/re source costs and a cost-utility analysis ( incremental quality of life per incremental cost , relative to usual care ) . Secondary outcomes include walking speed and independence , ability to perform activities of daily living , arm function , quality of life and participant satisfaction [ Purpose ] To investigate how task-oriented circuit training for the recovery motor control of the lower-extremity , balance and walking endurance could be clinical ly applied to subacute stroke inpatient group therapy . [ Subjects and Methods ] Twenty subacute stroke patients were r and omly assigned to the intervention group ( n=10 ) or the control group ( n=10 ) . The intervention consisted of a structured , progressive , inpatient circuit training program focused on mobility and gait training as well as physical fitness training that was performed for 90 minutes , 5 days a week for 4 weeks . The control group received individual physiotherapy of neurodevelopmental treatment for 60 minutes , 5 days a week for 4 weeks . Outcome measures were lower-extremity motor control , balance , gait endurance and activities of daily living before and after 4 weeks . [ Results ] There were no significant differences at baseline between the two groups . After 4 weeks , both groups showed significant improvements in all outcome measures , but there were no significant differences between the two groups during the invention period . [ Conclusion ] In spite of the small sample size , these findings suggest that task-oriented circuit training might be used as a cost-effective and alternative method of individual physiotherapy for the motor recovery of lower-extremity , balance and walking endurance of subacute stroke patients Objective To analyse the effect of task oriented circuit training compared with usual physiotherapy in terms of self reported walking competency for patients with stroke discharged from a rehabilitation centre to their own home . Design R and omised controlled trial with follow-up to 24 weeks . Setting Multicentre trial in nine outpatient rehabilitation centres in the Netherl and s Participants Patients with stroke who were able to walk a minimum of 10 m without physical assistance and were discharged from inpatient rehabilitation to an outpatient rehabilitation clinic . Patients were r and omly allocated to circuit training or usual physiotherapy , after stratification by rehabilitation centre , with an online r and omisation procedure . Intervention Patients in the intervention group received circuit training in 90 minute sessions twice a week for 12 weeks . The training included eight different workstations in a gym and was intended to improve performance in tasks relating to walking competency . The control group received usual outpatient physiotherapy . Main outcome measures The primary outcome was the mobility domain of the stroke impact scale ( SIS , version 3.0 ) . Secondary outcomes were st and ing balance , self reported abilities , gait speed , walking distance , stair climbing , instrumental activities of daily living , fatigue , anxiety , and depression . Differences between groups were analysed according to the intention to treat principle . All outcomes were assessed by blinded observers in a repeated measurement design lasting 24 weeks . Results 126 patients were included in the circuit training group and 124 in the usual care group ( control ) , with data from 125 and 117 , respectively , available for analysis . One patient from the circuit training  group and seven from the control group dropped out . Circuit training was a safe intervention , and no serious adverse events were reported . There were no significant differences between groups for the stroke impact scale mobility domain ( β=0.05 ( SE 0.68 ) , P=0.943 ) at 12 weeks . Circuit training was associated with significantly higher scores in terms of gait speed ( 0.09 m/s ( SE 0.02 ) , P<0.001 ) , walking distance ( 20.0 m ( SE 7.4 ) , P=0.007 ) , and modified stairs test ( −1.6 s ( SE 0.7 ) , P=0.015 ) . There were no significant differences between groups for the other secondary outcomes , except for the leisure domain of the Nottingham extended activities of daily living and the memory and thinking domain of the stroke impact scale . With the exception of gait speed ( −0.04 m/s ( SE 0.02 ) , P=0.040 ) , there were no significant differences between groups at follow-up . Conclusion Task oriented circuit training can safely replace usual physiotherapy for patients with stroke who are discharged from inpatient rehabilitation to the community and need further training in gait and gait related activities as an outpatient . Trial registration Dutch Trial Register ( NTR1534 ) Background Most patients who suffer a stroke experience reduced walking competency and health-related quality of life ( HRQoL ) . A key factor in effective stroke rehabilitation is intensive , task-specific training . Recent studies suggest that intensive , patient-tailored training can be organized as a circuit with a series of task-oriented workstations . Primary aim of the FIT-Stroke trial is to evaluate the effects and cost-effectiveness of a structured , progressive task-oriented circuit class training ( CCT ) programme , compared to usual physiotherapeutic care during outpatient rehabilitation in a rehabilitation centre . The task-oriented CCT will be applied in groups of 4 to 6 patients . Outcome will be defined in terms of gait and gait-related ADLs after stroke . The trial will also investigate the generalizability of treatment effects of task-oriented CCT in terms of perceived fatigue , anxiety , depression and perceived HRQoL. Methods / design The multicentre single-blinded r and omized trial will include 220 stroke patients discharged to the community from inpatient rehabilitation , who are able to communicate and walk at least 10 m without physical , h and s-on assistance . After discharge from inpatient rehabilitation , patients in the experimental group will receive task-oriented CCT two times a week for 12 weeks at the physiotherapy department of the rehabilitation centre . Control group patients will receive usual individual , face-to-face , physiotherapy . Costs will be evaluated by having each patient keep a cost diary for the first 24 weeks after r and omisation . Primary outcomes are the mobility part of the Stroke Impact Scale ( SIS-3.0 ) and the EuroQol . Secondary outcomes are the other domains of SIS-3.0 , lower limb muscle strength , walking endurance , gait speed , balance , confidence not to fall , instrumental ADL , fatigue , anxiety , depression and HRQoL. Discussion Based on assumptions about the effect of intensity of practice and specificity of treatment effects , FIT-Stroke will address two key aims . The first aim is to investigate the effects of task-oriented CCT on walking competency and HRQoL compared to usual face-to-face physiotherapy . The second aim is to reveal the cost-effectiveness of task-oriented CCT in the first 6 months post stroke . Both aims were recently recommended as priorities by the American Hearth Association and Stroke Council . Trial registration This study is registered in the Dutch Trial Register as NTR1534 OBJECTIVE To evaluate the immediate and retention effects of a 4-week training program on the performance of locomotor-related tasks in chronic stroke . DESIGN R and omized , controlled pilot study with 2-month follow-up . SETTING Rehabilitation center . SUBJECTS A convenience sample consisting of 12 chronic stroke subjects was used . Subjects were r and omly assigned to the experimental or the control group . Three subjects withdrew from the study . INTERVENTION Both experimental and control groups participated in exercise classes three times a week for 4 weeks . The exercise class for the experimental group focused on strengthening the affected lower limb and practicing functional tasks involving the lower limbs , while the control group practice d upper-limb tasks . MAIN OUTCOME MEASURES Lower-limb function was evaluated by measuring walking speed and endurance , peak vertical ground reaction force through the affected foot during sit-to-st and , and the step test . RESULTS The experimental group demonstrated significant immediate and retained ( 2-month follow-up ) improvement ( p < or = .05 ) compared with the control group in walking speed and endurance , force production through the affected leg during sit-to-st and , and the number of repetitions of the step test . CONCLUSION The pilot study provides evidence for the efficacy of a task-related circuit class at improving locomotor function in chronic stroke Background and Purpose A history of stroke increases risk of falls even years after stroke , and subsequent fear of falling causes individuals to reduce their activities . The purpose of this case series is to describe a group balance skills class for individuals poststroke living in the community , and to assess the feasibility and outcomes of this class . Examination and Intervention Twice a week for 8 weeks , 4 individuals > 6 months poststroke attended a group class design ed to challenge their balance . The group was carried out under the supervision of one physical therapist assisted by physical therapy students . Changes in balance were measured using Berg Balance Scale ( BBS ) , Performance Oriented Mobility Assessment ( POMA ) , and a post-test question naire addressing changes in daily activities . Outcomes Participants ' responses to the question naire and pretest/post-test differences in scores on BBS and POMA suggest trends towards improvement in balance . Relevance A group balance skills class for individuals who had a stroke > 6 months ago appears feasible . Further research is needed to determine the effectiveness of this class for improving functional balance and decreasing incidence of falls Background and Purpose — Stroke often impairs gait thereby reducing mobility and fitness and promoting chronic disability . Gait is a complex sensorimotor function controlled by integrated cortical , subcortical , and spinal networks . The mechanisms of gait recovery after stroke are not well understood . This study examines the hypothesis that progressive task-repetitive treadmill exercise ( T-EX ) improves fitness and gait function in subjects with chronic hemiparetic stroke by inducing adaptations in the brain ( plasticity ) . Methods — A r and omized controlled trial determined the effects of 6-month T-EX  ( n=37 ) versus comparable duration stretching ( CON , n=34 ) on walking , aerobic fitness and in a subset ( n=15/17 ) on brain activation measured by functional MRI . Results — T-EX significantly improved treadmill-walking velocity by 51 % and cardiovascular fitness by 18 % ( 11 % and −3 % for CON , respectively ; P<0.05 ) . T-EX but not CON affected brain activation during paretic , but not during nonparetic limb movement , showing 72 % increased activation in posterior cerebellar lobe and 18 % in midbrain ( P<0.005 ) . Exercise-mediated improvements in walking velocity correlated with increased activation in cerebellum and midbrain . Conclusions — T-EX  improves walking , fitness and recruits cerebellum-midbrain circuits , likely reflecting neural network plasticity . This neural recruitment is associated with better walking . These findings demonstrate the effectiveness of T-EX rehabilitation in promoting gait recovery of stroke survivors with long-term mobility impairment and provide evidence of neuroplastic mechanisms that could lead to further refinements in these paradigms to improve functional outcomes Objective : Cortico-cortical circuits originating from the posterior parietal cortex ( PPC ) of the intact left hemisphere ( LH ) may become hyperexcitable in patients with hemispatial neglect due to a right hemispheric ( RH ) stroke . Methods : In the current r and omized , double-blind , sham-controlled study , we investigated safety and efficacy of continuous theta-burst stimulation ( cTBS ) in 10 sessions over 2 weeks applied over the intact PPC of the LH in subacute ischemic stroke patients .  Severity of neglect was assessed through the st and ardized Behavioral Inattention Test ( BIT ) . We also measured , by means of bifocal transcranial magnetic stimulation ( TMS ) , how cTBS modified the excitability of the parieto-frontal functional connections in the intact LH . Results : We found that 2 weeks of cTBS , but not sham cTBS , were effective in improving neglect symptoms as measured by BIT score . BIT scores improved by 16.3 % after 2 weeks of cTBS and 22.6 % at 1 month follow-up . We also found that hyperexcitability of LH parieto-frontal circuits was reduced following treatment with real but not sham cTBS . Conclusion : These findings suggest that a 2-week course of cTBS over the LH PPC may be a potential effective strategy in accelerating recovery from visuospatial neglect in subacute stroke patients , possibly counteracting the hyperexcitability of LH parieto-frontal circuits . Classification of evidence : This study provides Class III evidence that left posterior parietal cortex theta-burst stimulation improves hemispatial neglect for up to 2 weeks after treatment Objective : Motor recovery after stroke depends on the integrity of ipsilesional motor circuits and interactions between the ipsilesional and contralesional hemispheres . In this sham-controlled r and omized trial , we investigated whether noninvasive modulation of regional excitability of bilateral motor cortices in combination with physical and occupational therapy improves motor outcome after stroke . Methods : Twenty chronic stroke patients were r and omly assigned to receive 5 consecutive sessions of either 1 ) bihemispheric transcranial direct current stimulation ( tDCS ) ( anodal tDCS to upregulate excitability of ipsilesional motor cortex and cathodal tDCS to downregulate excitability of contralesional motor cortex ) with simultaneous physical/occupational therapy or 2 ) sham stimulation with simultaneous physical/occupational therapy .  Changes in motor impairment ( Upper Extremity Fugl-Meyer ) and motor activity ( Wolf Motor Function Test ) assessment s were outcome measures while functional imaging parameters were used to identify neural correlates of motor improvement . Results : The improvement of motor function was significantly greater in the real stimulation group ( 20.7 % in Fugl-Meyer and 19.1 % in Wolf Motor Function Test scores ) when compared to the sham group ( 3.2 % in Fugl-Meyer and 6.0 % in Wolf Motor Function Test scores ) . The effects outlasted the stimulation by at least 1 week . In the real-stimulation group , stronger activation of intact ipsilesional motor regions during paced movements of the affected limb were found postintervention whereas no significant activation changes were seen in the control group . Conclusions : The combination of bihemispheric tDCS and peripheral sensorimotor activities improved motor functions in chronic stroke patients that outlasted the intervention period . This novel approach may potentiate cerebral adaptive processes that facilitate motor recovery after stroke . Classification of evidence : This study provides Class I evidence that for adult patients with ischemic stroke treated at least 5 months after their first and only stroke , bihemispheric tDCS and simultaneous physical/occupational therapy given over 5 consecutive sessions significantly improves motor function as measured by the Upper Extremity Fugl-Meyer assessment ( raw change treated 6.1 ± 3.4 , sham 1.2 ± 1.0 ) Abstract Background and Objective : The ability to walk is impaired in more than 80 % of poststroke patients . The objective of the present study was to evaluate the effectiveness of the task-oriented circuit class training ( TOCCT ) with motor imagery ( MI ) on the gait during the subacute phase after a stroke . Method : This was a r and omized , controlled , assessor-blinded trial in a neurology department of a university hospital . A convenience sample of 30 people , 4 to 12 weeks ( mean , 6.3 weeks ) after the stroke was r and omized into 2 groups ( the TOCCT with MI and st and ard training group ) of 15 people each . Twenty-nine participants completed the 6-week follow-up . Participants were assigned to receive either the TOCCT with MI or dose-matched st and ard training program based on the Bobath ’s neurodevelopmental technique , 7 days a week for 2 weeks , as out patients or in patients . Outcome measures were the Functional Ambulation Classification ( FAC ) , the Rivermead Visual Gait Assessment ( RVGA ) , step length asymmetry , walking speed , and 6-minute walk test ( 6MWT ) . Results : The TOCCT with MI group showed a positive improvement in the mean/median scores on most of the outcome measures at post and follow-up assessment s in comparison to the control group . However , statistically significant differences were observed in changes between the groups at post and follow-up assessment for FAC , RVGA , walking speed , and 6MWT ( ANOVA , P = .001 to .049 ; Mann-Whitney U test , P = .001 ) . Conclusion : Among the patients who had a stroke within the previous 4 to 12 weeks , the TOCCT with MI produced statistically significant and clinical ly relevant improvements in the gait and the gait-related activities Background and Purpose — Exercise using virtual reality ( VR ) has improved balance in adults with traumatic brain injury and community-dwelling older adults . Rigorous r and omized studies regarding its efficacy , safety , and applicability with individuals after stroke are lacking . The purpose of this study was to determine whether an adjunct VR therapy improves balance , mobility , and gait in stroke rehabilitation in patients . Methods — A blinded r and omized controlled trial study ing 59 stroke survivors on an inpatient stroke rehabilitation unit was performed . The treatment group ( n=30 ) received st and ard stroke rehabilitation therapy plus a program of VR exercises that challenged balance ( eg , soccer goal tending , snowboarding ) performed while st and ing . The control group ( n=29 ) received st and ard stroke rehabilitation therapy plus exposure to identical VR environments but whose games did not challenge balance ( performed in sitting ) . VR training consisted of 10 to 12 thirty-minute daily sessions for a 3-week period . Objective outcome measures of balance and mobility were assessed before , immediately after , and 1 month after training . Results — Confidence intervals and effect sizes favored the treatment group on the Timed Up and Go and the Two-Minute Walk Test , with both groups meeting minimal clinical important differences after training . More individuals in the treatment group than in the control group showed reduced impairment in the lower extremity as measured by the Chedoke McMaster Leg domain ( P=0.04 ) immediately after training . Conclusions — This VR exercise intervention for inpatient stroke rehabilitation improved mobility-related outcomes . Future studies could include nonambulatory participants as well as the implementation strategies for the clinical use of VR . Clinical Trial Registration — URL : http://www.ANZCTR.org.au/. Unique identifier : ACTRN12613000710729 Objective : To establish the effects of group exercise on mobility and strength . Design : R and omized controlled trial . Setting : Two public hospital outpatient rehabilitation services . Participants : One hundred and seventy-three people ( mean age 74.9 years , SD 10.8 ) with impaired mobility were r and omized and 159 people ( 92 % ) completed the trial . Interventions : Five-week , twice-weekly ` circuit-style ' group exercise programme run by a physiotherapist ( n = 85 ) and a no-intervention waiting list control group ( n = 88 ) . Main outcome measures : Three aspects of mobility : balance while st and ing and stepping ( Step Test , semi-t and em and t and em stance times ) ; sit-to-st and ability ( rate and minimum height ) and gait ( 6-metre and 6-minute walk tests ) . Lower limb muscle strength ( knee flexion and extension ) . Results : At retest , exercise participants had improved significantly more than their control counterparts on measures of balance while stepping , sit to st and and gait . Exercise participants averaged 1.6 more steps on the 15-second Step Test ( 95 % confidence interval ( CI ) 0.5 to 2.8 , P=0.005 ) , walked an average of 0.12 m/s faster ( 95 % CI 0.05 to 0.2 , P=0.002 ) and took 2.5 fewer steps in 6 metres ( 95 % CI —4.2 to —0.8 , P=0.004 ) . Exercise participants also averaged 0.04 more sit-to-st and s/second , ( 95 % CI 0.003 to 0.08 , P=0.037 ) and walked an average of 30.9 metres further in 6 minutes ( 95 % CI 9.4 to 52.4 , P=0.005 ) . There were no clinical ly important or statistically significant between-group differences at retest for the measures of strength ( knee extension and flexion ) , balance while st and ing or minimal sit-to-st and height . Conclusion : This short- duration circuit class programme improved mobility , but not strength Objective : To evaluate the effects of an aquatic physiotherapy method ( Halliwick-Therapy ) upon mobility in the post-acute phase of stroke rehabilitation . Design : R and omized controlled trial . Setting : Hospital for neurological rehabilitation . Participants : Adult patients after first-ever stroke in post-acute inpatient rehabilitation at least two weeks after the onset of stroke ( n = 30 ) . Interventions : In the Halliwick-Therapy group ( n = 14 ) the treatment over a period of two weeks included 45 minutes of aquatic therapy three times per week and a conventional physiotherapeutic treatment twice a week . Subjects in the control group ( n = 16 ) received conventional physiotherapeutic treatment over a period of two weeks five times per week . Outcome measures : The primary outcome variable was postural stability ( Berg Balance Scale ) . Secondary outcome variables were functional reach , functional gait ability and basic functional mobility . Results : Compared to the control group , significantly more subjects in the Halliwick-Therapy group ( 83.3 % versus 46.7 % ) attained significant improvement of the Berg Balance Scale ( P < 0.05 ) . Improvement of the functional gait ability was significantly higher in the Halliwick-Therapy group ( mean ( SD ) 1.25(0.86 ) ) than in the control group ( mean ( SD ) 0.73 ( 0.70 ) ) ( P < 0.1 ) . The mean differences of improvements in functional reach and basic functional mobility were not statistically significant between groups . Conclusions : This study indicates that Halliwick-Therapy is safe and well tolerated in stroke patients in post-acute rehabilitation and has positive effects upon some aspects of mobility
Circuit class therapy is safe and effective in improving mobility in people after stroke and , when provided as part of hospital-based rehabilitation , may reduce length of stay
OBJECTIVE To examine the effectiveness of group circuit class therapy for improving the mobility of adults after stroke .