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Introduction We aimed to describe the physical and cognitive health of patients with differing levels of post-stroke disability, as defined by modified Rankin Scale (mRS) scores. We also compared cross-sectional correlations between the mRS and the Quality of Life in Neurological Disorders (Neuro-QoL) T-scores to longitudinal correlations of change estimates from each measure. Methods Mean Neuro-QoL T-scores representing mobility, dexterity, executive function, and cognitive concerns were compared among mRS subgroups. Fixed-effects regression models with robust standard errors estimated correlations among mRS and Neuro-QoL domain scores and correlations among longitudinal change estimates. These change estimates were then compared to distribution-based estimates of minimal clinically important differences. Results Seven hundred forty-five patients with ischemic stroke (79%) or transient ischemic attack (21%) were enrolled in this longitudinal observational study of post-stroke outcomes. Larger differences in cognitive function were observed in the severe mRS groups (ie, 4-5) while larger differences in physical function were observed in the mild-moderate mRS groups (ie, 0-2). Cross-sectional correlations among mRS and Neuro-QoL T-scores were high (r = 0.61-0.83), but correlations among longitudinal change estimates were weak (r = 0.14-0.44). Conclusions Findings from this study undermine the validity and utility of the mRS as an outcome measure in longitudinal studies in ischemic stroke patients. Nevertheless, strong correlations indicate that the mRS score, obtained with a single interview, is efficient at capturing important differences in patient-reported quality of life, and is useful for identifying meaningful cross-sectional differences among clinical subgroups.

PURPOSE: The purpose of this study was to assess the impact of time to initiation of acute rehabilitation therapy on disability following intracerebral hemorrhage (ICH) and to identify predictors of time to initiation of rehabilitation therapy. METHODS: Consecutive adults admitted to a stroke center with ICH were prospectively identified. Disability was assessed with the modified Rankin Scale (mRS), with poor outcome defined as mRS 4-6 (dependence or worse). Time to initiation of acute rehabilitation therapy was defined as time from hospital admission to first acute rehabilitation therapy (physical, occupational, or speech) consult. A multivariable logistic regression model assessed the effect of time to initiation of rehabilitation therapy on poor outcome at 30 and 90 days. A multivariable linear regression model identified the predictors of time to initiation of rehabilitation therapy. RESULTS: Among the 203 participants analyzed (mean age 63.7 years; 51.2% female; 52.7% white), the median number of days from hospital admission to initiation of acute rehabilitation therapy was 3 [2 – 7] days. Multivariable models indicated that each additional day between admission and initiation of acute rehabilitation therapy resulted in increased odds of poor outcome at 30 days (adjusted OR=1.151, 95% CI: 1.044-1.268, p=0.005) and at 90 days (adjusted OR=1.107, 95% CI: 1.003-1.222, p=0.044) for patients with ICH. Current alcohol use, lower Glasgow Coma Scale, pre-morbid mRS < 4, presence of pulmonary embolism and longer length of stay were independent predictors of later initiation of acute rehabilitation therapy. CONCLUSIONS: Longer time to initiation of acute rehabilitation therapy following ICH has persistent effects on post-stroke disability. Delays in acute rehabilitation therapy consults should be minimized and may improve outcomes after ICH.

Higher education is not immune to inequities, although universities often state that those inequities do not align with their mission. Change is often obstructed by blindness to flaws, especially structural barriers that lead to unequal success. In this article, the author utilizes her lived experience to highlight structures at play that go beyond a single story. These experiences are divided in five major themes: 1) representation, 2) belonging, 3) language, 4) class, and 5) sexuality and harassment. The author analyzes each theme combining detailed descriptions of how multiple identities and the socio-political-cultural environment intersect to impact success in all aspects of rehabilitation. In particular, she explores the conflict that occurs when acceptable behaviors, skills, and identities are not embodied by the people who have been underrepresented and marginalized in rehabilitation. Each section concludes with ideas on how to challenge deep-rooted hierarchies that foster division and exclusion. To truly serve diverse communities equitably, we must 1) transform rehabilitation education, clinical practice, and research; 2) embed ourselves into the communities that surround our universities; 3) develop a collective cyclical process of learning to replace behaviors that harm others; and 4) dismantle old practices that prevent everyone from belonging. Until that happens, well-intentioned attempts to diversify the field will remain hollow, ineffective, and harmful.

Introduction During recovery from stroke, augmented performance feedback can be applied with simple displays of metrics, as well as enhanced with virtual reality (VR) and exergames. VR, as augmented feedback, can provided to enhance walking speed after six months of stroke onset. There are several mechanisms to induce improved motor performance and motivation. Our objective is to design a study to demonstrate the different effects of augmented feedback, simple VR and exergaming applications on motivation and walking speed performance in post stroke. Methods Eighteen individuals with chronic stroke will be recruited and asked to walk as fast and safely as they can while on a robotic, user speed-driven treadmill (KineAssist-MX®) in three conditions: (1) with simple visual augmented feedback, but without a VR interface, (2) with a basic VR interface and (3) with a VR exergame. The main outcome measures are 30 s of fast walking speed and intrinsic motivation measured using the Intrinsic Motivation Inventory-Interest and Enjoyment Subscale. A within-subjects repeated measure ANOVA test and post hoc analysis will be used to determine the differences in changes of maximum walking speeds among the three performance conditions. Discussion The additive impact of augmented feedback with or without VR and VR-exergames on motivation and walking speed during stroke rehabilitation is unknown, a gap we aim to address. Our findings will contribute key details regarding the effects of different types of augmented feedback on walking speed and intrinsic motivation and to the refinement of theoretical frameworks that guide the design and implementation of augmented feedback during recovery after stroke.

Using a Survey to Characterize Rehabilitation Professionals' Perceptions and Use of Complementary, Integrative, and Alternative Medicine

Aim Characterize the relationship between patient ambulatory status and in-hospital call bell use. Background Although call bells are frequently used by patients to request help, the relationship between physical functioning and call bell use has not been evaluated. Methods Retrospective cohort study of 944 neuroscience patients hospitalized in a large academic urban medical centre between April 1, 2014 and August 1, 2014. We conducted multiple linear regression analyses with number of daily call bells from each patient as the primary outcome and patients' average ambulation status as the primary exposure variable. Results The mean number of daily call bell requests for all patients was 6.9 (6.1), for ambulatory patients 5.6 (4.8), and for non-ambulatory patients, it was 7.7 (6.6). Compared with non-ambulatory patients, ambulatory patients had a mean reduction in call bell use by 1.7 (95% CI 2.5 to -0.93, p 250 feet had 5 fewer daily call bells than patients who were able to perform in-bed mobility. Conclusion Ambulatory patients use their call bells less frequently than non-ambulatory patients. Implications for nursing management Frequent use of call bells by non-ambulatory patients can place additional demands on nursing staff; patient mobility status should be considered in nurse workload/patient assignment.

Persons with mild stroke experience motor and cognitive impairments that negatively affect their health and quality of life. To address these deficits, it is essential for clinicians and researchers to precisely identify mild stroke survivors. Despite the fact that half of all strokes are categorized as mild, no standards exist on what constitutes a "mild" stroke. The purpose of this study is to summarize the current classification of mild stroke using a mapping review approach. Strategies to categorize "mild stroke" severity were explored in 188 papers indexed in the PubMed database. The results indicate that there was substantial variability in the procedures and scoring criteria used to determine mild stroke. To identify persons with mild stroke, researchers have largely applied assessment instruments developed to inform acute stroke care (eg, National Institutes of Health Stroke Scale, Modified Rankin Scale, Barthel Index). Unfortunately, these approaches demonstrate floor effects and fail to detect the long-term disabling impairments that often limit the outcomes of mild stroke survivors. Additional research is warranted to suggest an evidence-based mild stroke categorization strategy that enhances diagnosis, treatment, and referral decisions to the benefit of mild stroke survivors.

The current qualitative study sought to obtain an in-depth understanding of how Arab-Americans conceptualize perceived injustice concerning their chronic low back pain (CLBP) by reflecting on the Injustice Experience Questionnaire (IEQ). Twelve Arab-American adults with CLBP were recruited from a metropolitan area in Alabama using a purposive sampling technique. Participants took part in individual, face-to-face, semi-structured interviews reflecting on each statement from the IEQ. Descriptive data analysis was generated for demographic and pain variables. Directed content analysis was conducted to identify themes and sub-themes. ‘Blame and unfairness’ and ‘severity and irreparability of loss,’ the two established theoretical factors comprising pain-related injustice appraisal were used as predominant themes. Acceptance emerged as an inductive theme with the following sub-themes: positive appraisal and resilience, attempts to reduce pain, religious values and fate, and belief that everything happening for a reason. The influence of religion was noted across all themes. The current pilot findings suggest that Arabic culture, heavily infused with Islamic beliefs, influences how Arab-Americans conceptualize pain-related injustice appraisals. Additional exploration of the cultural appropriateness of the IEQ among individuals of Arab background is needed to further elaborate on the subject of faith and religious belief suggested by the current study. Perspective: Although the study findings largely reflected established injustice literature constructs, several emergent themes regarding pain-related injustice appraisal were influenced by the participants’ culture and religious beliefs. These findings may indicate that specific psychotherapeutic approaches that have been proven effective among some groups may not function similarly in other populations.

This study aims to compare delivery of acute rehabilitation therapy using metrics reflecting distinct aspects of rehabilitation therapy services. Seven general medical-surgical hospitals in Illinois and Indiana prospectively collected rehabilitation therapy data. De-identified data on all patients who received any type of acute rehabilitation therapy (n = 35,449) were extracted and reported as aggregate of minutes of therapy services per discipline. Metrics included therapy types, total minutes, and minutes per day (intensity), as charted by therapists. Extended hospital stay was defined as a length of stay (LOS) longer than Medicare's geometric mean LOS. Discharge destination was coded as postacute care or home discharge. Substantial variability was observed in types, number of minutes, and intensity of therapy services by condition and hospital. The odds of an extended hospital stay increased with increased number of minutes, increased number of therapy types, and decreased with increased rehabilitation intensity. This comparative approach to assessing provision of acute therapy services reflect differential effects of service provision on LOS and discharge destination. Investigators, policymakers, and hospital administrators should examine multiple metrics of rehabilitation therapy provision when evaluating the impact of health care processes on patient outcomes.

Objectives To describe the development and field testing of the patient-reported outcome measures of Mobility and Upper Extremity function from the Traumatic Brain Injury Quality of Life (TBI-QOL) measurement system, and to evaluate the use of computer adaptive testing. Setting Five rehabilitation facilities funded as part of the TBI Model Systems network. Participants Individuals with complicated mild, moderate, or severe traumatic brain injury (n = 590). Interventions Not available. Outcome measures TBI-QOL Mobility and Upper Extremity item banks. Results Item response theory and factor analyses supported the unidimensionality of the Mobility and Upper Extremity banks. Descriptive statistics showed a ceiling effect for both measures. Simulated computer adaptive tests (CATs) showed that measurement precision was maintained across administration formats for both measures. The Upper Extremity CAT showed a loss of precision for individuals without impairment and that a higher number of items were required to achieve sufficiently precise measurement, compared to the Mobility CAT. Conclusions The TBI-QOL Upper Extremity and Mobility item banks achieved good breadth of coverage, particularly among those individuals who have experienced some degree of functional limitation. The use of CAT administration minimizes respondent burden, while allowing for the comprehensive assessment of adults with TBI. The combined use of the TBI-QOL with performance-based measures could guide the development of targeted rehabilitation treatments.

To assess the effect of time to acute therapy on health-related quality of life (HRQoL) and disability after ischemic stroke.Prospective cohort study.Comprehensive stroke care center in a large metropolitan city.Patients (N=553; mean age, 67 y; 51.9% male; 64.4% white; 88.8% ischemic stroke) with ischemic stroke or transient ischemic attack (TIA) enrolled in a longitudinal observational study between August 2012 to January 2014 who received rehabilitation services.Not applicable.Disability status was assessed with the modified Rankin Scale (mRS) and Barthel Index (BI). HRQoL was assessed using the Quality of Life in Neurological Disorders measures of executive function, general cognitive concerns, upper extremity dexterity, and lower extremity mobility. Time to therapy consult and treatment were defined as the number of days from hospital admission to initial consult by a therapist and number of days from hospital admission to initial treatment, respectively.Among the participants, the median number of days from hospital admission to acute therapy consult was 2 days (interquartile range, 1-3d). Multivariable linear and logistic regression models indicated that for those with the National Institutes of Health Stroke Scale (NIHSS) score5, longer time to therapy consult was associated with worse BI scores (BI=100; odds ratio [OR], 0.818; P=.008), executive function T scores (b=-0.865; P=.001), and general cognitive concerns T scores (b=-0.609; P=.009) at 1-month in adjusted analyses. In those with NIHSS score≥5, longer time to therapy treatment led to increased disability (ie, mRS≥ 2; OR, 1.15; P=.039) and lower extremity mobility T scores (b=-0.591; P=.046) at 1 month in adjusted analyses.Longer time to initiation of acute therapy has differential effects on poststroke disability and HRQoL up to 1-month after ischemic stroke and TIA. The effect of acute therapy consult is more notable for those with mild deficits, while the effect of acute therapy treatment is more notable for those with moderate to severe deficits. Minimizing time to therapy consults and treatments in the acute hospital period might improve outcomes after ischemic stroke and TIA.

Background A substantial number of patients with stroke never receive acute care therapy services, despite the fact that therapy after stroke reduces the odds of death and disability and improves patients’ functioning. Objective The aim of this study was to estimate the proportion of and factors associated with receipt of therapist consultations and interventions during acute care hospitalization following ischemic and hemorrhagic stroke. Design This was a single-center longitudinal observational study. Methods Adults with a diagnosis of ischemic or hemorrhagic stroke (N = 1366) were enrolled during their hospitalization in an acute stroke center in a large metropolitan area. The main outcomes were receipt of therapist consultations, interventions, or both. Results Participants with acute hemorrhagic stroke (intracerebral: odds ratio [OR] = 0.34 [95% CI = 0.19–0.60]; subarachnoid: OR = 0.52 [95% CI = 0.28–0.99]) and with greater stroke severity by National Institutes of Health Stroke Scale (NIHSS) score (NIHSS score of > 15: OR = 0.34 [95% CI = 0.23–0.51]) were less likely to receive therapist consultations. Participants with moderate stroke severity (NIHSS score of 6–15: OR = 1.43 [95% CI = 1.01–2.33]) were more likely to receive therapy interventions. Those who were able to ambulate before admission were more than 5 times as likely to receive therapy interventions (OR = 5.08 [95% CI = 1.91–13.52]). Also, participants with longer lengths of stay (ie, more intensive care unit and non–intensive care unit days) were more likely to receive therapist consultations and interventions. Tests or procedures were the most common reasons for unsuccessful attempts to complete therapist consultations. Limitations Lack of operational and qualitative data prohibited detailed explorations of barriers to delivery of therapist consultations and interventions. Conclusions Approximately 1 in 4 participants with acute stroke received neither a consultation nor an intervention. Efforts to improve the delivery of acute care therapy services are needed to optimize care for these people.

Objective To expand an existing validated measure of basic mobility (Activity Measure for Post-Acute Care [AM-PAC]) for patients at the lowest levels of function. Design Item replenishment for existing item response theory (IRT) derived measure via (1) idea generation and creation of potential new items, (2) item calibration and field testing, and (3) longitudinal pilot test. Setting Two tertiary acute care hospitals. Participants Consecutive inpatients (N=502) ≥18 years old, with an AM-PAC Inpatient Mobility Short Form (IMSF) raw score ≤15. For the longitudinal pilot test, 8 inpatients were evaluated. Results Fifteen new AM-PAC items were developed, 2 of which improved mobility measurement at the lower levels of functioning. Specifically, with the 2 new items, the floor effect of the AM-PAC IMSF was reduced by 19%, statistical power and measurement breadth were greater, and there was greater measurement sensitivity in longitudinal pilot testing. Conclusion Adding 2 new items to the AM-PAC IMSF lowered the floor and increased statistical power, measurement breadth, and sensitivity.

Adults with intellectual disability and their families are required to manage their disabilities in addition to a variety of secondary conditions, such as diabetes, heart disease, dental problems, and movement and cognitive decline. Secondary health conditions can limit the ability of adults with intellectual disability to live a healthy and productive life. In this chapter, discussed are secondary oral, mental, physical and sensory health conditions. Discussed also is health-self-management and the difficulties adults with intellectual disability experience in completing tasks such as brushing teeth, cooking healthful meals, and communicating needs. We conclude with information that can be helpful for health care professionals to evaluate and develop interventions to improve health-related self-management.

Objective: Based on patient, caregiver, and layperson input, we aimed to identify themes, preferences, content, framing, and sequencing of the informed consent process for tPA in acute ischemic stroke (AIS) patients. Background: Informed consent potentially delays or results in refusal of tPA in up to 10% of eligible AIS patients. There remain critical gaps in the appropriate content, delivery mode, and optimal timing of the informed consent process for tPA. Methods: Using a mixed-methods qualitative approach through separate focus groups of stroke patients and caregivers, and laypeople with limited experience with stroke and from diverse race and ethnic backgrounds, we identified preferences in describing risks and benefits of tPA during AIS patient evaluation. All focus groups followed a structured guide designed to elicit participant feedback regarding (1) decision-making preferences, (2) existing and hypothetical decision aid content, and (3) timing of information delivery for an informed consent process for tPA. Results: Stroke patients (n=15) and their caregivers (n=7) preferred a shared decision-making model that included minimal information and emphasized rapid decision making. Laypeople (n=31) also preferred a shared decision-making model for providing informed consent, but had higher information needs than stroke patients and caregivers. The majority of all focus group participants expressed a preference for a verbal description of risk and benefits. A minority of laypeople desired detailed visual aids to facilitate information exchanged during the informed consent process. The majority of focus group participants preferred stacked bar graphs or pie charts over pictograms to convey information regarding outcomes following tPA. Conclusions: Qualitative analyses of informed consent for tPA suggest that laypeople have higher information needs than stroke patients and caregiver. Given that the majority of patients who receive tPA do not have a history of prior stroke, shared decision-making aids should consider laypeople preferences while remaining brief given the time-sensitivity of tPA therapy. Optimizing the shared decision-making process for tPA could reduce consent-related delays and refusals of tPA.

Objective: Early rehabilitation has been suggested to improve outcomes after stroke, though evidence is controversial. The purpose of this study is to assess the impact of time to in-hospital (acute) rehabilitation on health-related quality of life (HRQoL) and disability. Methods: Patients with ischemic stroke or TIA were enrolled in a prospective observational cohort study. At 1-month, HRQoL was assessed using Neuro-QOL measures of executive function (EF), general cognitive concerns (GCC), upper extremity dexterity (UED), and lower extremity mobility (LEM). Disability was assessed with the modified Rankin Scale (mRS) and the Barthel Index (BI). Time to acute rehabilitation evaluation and treatment were defined as time (in days) from hospital admission to first rehabilitation evaluation and treatment, respectively. The sample was stratified by baseline NIHSS score to investigate potential differential effects. Linear and logistic regression models with robust standard errors estimated the effect of time to rehabilitation services on patient outcomes while controlling for age, baseline NIHSS score, TOAST and stroke subtype. Results: Among the 553 participants analyzed (mean age 67 years; 51.9% male; 64.4% white; 88.8% ischemic stroke), the median time from hospital admission to acute rehabilitation evaluation was 2 [IQR: 1-3] days. For those with NIHSS score =2: OR=1.15, p=0.039) and worse LEM T-scores (b=-0.591, p=0.046) at 1 month. Conclusions: Longer time to initiation of acute rehabilitation has differential effects on post-stroke disability and HRQoL at 1-month after ischemic stroke and TIA. The effect of time to acute rehabilitation evaluation is more impactful for those with mild deficits, while the effect of time to treatment is more impactful for those with moderate to severe deficits. Minimizing time to in-hospital rehabilitation evaluations and treatments might improve outcomes after ischemic stroke and TIA.

The field of physical medicinerehabilitation (PMR), along with all the disciplines it encompasses, has evolved rapidly in the past 50 years. The number of controlled trials, systematic reviews, and meta-analyses in PMR increased 5-fold from 1998 to 2013. In recent years, professional, private, and governmental institutions have identified the need to track function and functional status across providers and settings of care and on a larger scale. Because function and functional status are key aspects of PMR, access to and sharing of reliable data will have an important impact on clinical practice. We reviewed the current landscape of PMR databases and data repositories, the clinical applicability and practice implications of data sharing, and challenges and future directions. We included articles that (1) addressed any aspect of function, disability, or participation; (2) focused on recovery or maintenance of any function; and (3) used data repositories or research databases. We identified 398 articles that cited 244 data sources. The data sources included 66 data repositories and 179 research databases. We categorized the data sources based on their purposes and uses, geographic distribution, and other characteristics. This study collates the range of databases, data repositories, and data-sharing mechanisms that have been used in PMR internationally. In recent years, these data sources have provided significant information for the field, especially at the population-health level. Implications and future directions for data sources also are discussed.

Introduction: Unrecognized, high-risk conditions like transient ischemic attack (TIA) are missed opportunities to initiate timely preventive treatment to reduce the risk of subsequent stroke, disability, and death. Up to 50% of patients with a TIA may have a subsequent disabling stroke, many within 30 days. Hypothesis: Among patients with an Emergency Department (ED) visit at which no diagnosis of TIA or stroke was recorded, analysis of electronic health record (EHR) data can help predict risk of subsequent stroke. Methods: We performed a retrospective cohort study of EHR data (2011-2015) from a high-volume comprehensive stroke center with an annual ED volume of >85,000. Patients age 60-89 years who were discharged to home from the ED in 1 qualifying index visit during the study period, we used the first. For each patient we determined presence or absence during the ED visit of a head CT and/or any of these strings in the ED chief complaint (“Symptoms”): slur, speech, aphasia, confuse, word, difficult, comprehen, weak, clumsy, clumsiness, droop, paralysis, move, moving, face, or facial (but not “facial injury”). In four mutually-exclusive categories, CT (Yes/No) by Symptoms (Yes/No), we calculated rate of stroke in the 30, 90, and 365-day periods after discharge from the ED. Ischemic stroke ascertainment was based on diagnostic codes at subsequent ED or hospital visits. Results: Among 40,450 patients, mean age was 69 years, and 59% were women. Race was 57% white, 15% African-American, 23% other, and 4% unknown. Numbers of patients and rates of stroke by category are shown in the table. Conclusion: This simple approach established a clinically meaningful risk gradient across four groups. Present and future work to refine this model may contribute to comparative effectiveness research that evaluates management and triage strategies for patients across the stroke risk spectrum.

Introduction: After discharge from a structured rehabilitation setting, mild-moderate stroke patients report feeling unprepared to manage their home recovery plan. Through Design for America, we worked with undergraduate students to develop prototypes to empower patients in their post-stroke home-based recovery. Methods: “User centered design”, a six step process, was applied over a 6-week summer program, with design and process experts’ mentorship. We obtained qualitative data from patients, caregivers and healthcare professionals through focus groups, interviews and web-based surveys (N=60). The insights gained from users were utilized to design solutions. Results: Insights gained include: 1) 96% of patients reported they were unable to follow home rehabilitation schedules; 2) 66.7% reported being “comfortable” with technology and 10% having previously used Apps for exercise; 3) often insurance does not cover rehabilitation in mild strokes cases; and 4) patients like to hear from others and often develop their own exercises. Solutions designed included:1) a wearable device (Figure 1A) for stroke survivors to alert them of exercise schedule, track activity, appointments, and medication reminders, 2) a website (Figure 1B) that provides patients an online community to find user-submitted therapeutic exercises, share stories, and motivate others. Conclusion: In partnership with Design for America, we created unique solutions that fill a gap in the continuity of stroke recovery: community-based, patient-centered, and self-empowering tools. In the coming months, we plan to build and pilot test these products in a clinical setting.

Objective To compare landing mechanics and neuromuscular recruitment strategies between women with semitendinosus-gracilis anterior cruciate ligament reconstruction (SG-ACLr) and noninjured women during double- and single-legged drop jumps. Design Cross-sectional biomechanical study. Setting Single university-based biomechanics laboratory. Participants Fourteen women 1-5 years post–SG-ACLr and 16 noninjured women participated in this study. Methods After anthropometric measurements, warm-up, and familiarization procedures, participants performed 5 trials of a double- and single-legged drop jumps. Main Outcome Measurements Dynamic knee valgus was measured as the distance between knee joints during the landing phase of the double-leg drop jumps. Medial knee displacement was the outcome considered during the landing phase of the single-leg drop jumps. For both drop jump tasks, neuromuscular recruitment was evaluated through rectified normalized electromyographic activity of the quadriceps and hamstrings (amplitude and latency), and quadriceps/hamstrings electromyographic co-contraction ratio. Results Although the SG-ACLr group demonstrated a tendency toward a greater dynamic knee valgus during both drop jumps, these differences did not reach statistical significance. EMG data revealed different neuromuscular strategies for each group, depending on the specific jump. Conclusions These findings suggest that women with SG-ACLr have a tendency toward greater dynamic knee valgus that could predispose to additional knee injuries. Rehabilitation specialists need to be aware of existing kinematic and neuromuscular deficiencies years after SG-ACLr. Taking this into consideration will aid in prescribing appropriate interventions designed to prevent re-injury.

BACKGROUND: Walking, while experiencing horizontal resistive forces, can allow researchers to assess characteristics of force generation in a task specific manner for individuals post-stroke. METHODS: Ten neurologically nonimpaired individuals (mean age 52years) and fourteen chronic stroke survivors (mean age 54years) with hemiparesis walked in the treadmill-based KineAssist Walking and Balance System, while experiencing twelve progressive horizontal resistive forces at their comfortable walking speed. Slope coefficients of the observed force-velocity relationship were quantified and submitted to an iterative k-means cluster analysis to test for subgroups within the post-stroke sample. Extrapolated force values for individuals were quantified by extrapolating the line of best fit of the force-velocity relationship to the x-intercept. FINDINGS: Within the post-stroke group, six individuals were clustered into a high sensitivity group, i.e., large reduction in speed with resistance, and eight were clustered into a low sensitive group, i.e., small reduction in speed with resistance. The low sensitivity group was similar to non-impaired individual. The extrapolated force was significantly higher for non-impaired individuals compared to individuals post-stroke in either the high or low sensitivity group. The differences between low and high sensitivity group suggest that high sensitivity of walking speed to applied resistive force is indicative of overall weakness. INTERPRETATION: Individuals with high sensitivity to horizontal resistive force may be walking at or near their maximum force generating capacity when at comfortable walking speed, while low sensitivity individuals may have greater reserve force generating capacity when walking at a particular comfortable walking speed. Language: en

Background Previous studies demonstrated that stroke survivors have a limited capacity to increase their walking speeds beyond their self-selected maximum walking speed (SMWS). The purpose of this study was to determine the capacity of stroke survivors to reach faster speeds than their SMWS while walking on a treadmill belt or while being pushed by a robotic system (i.e. “push mode”). Methods Eighteen chronic stroke survivors with hemiplegia were involved in the study. We calculated their self-selected comfortable walking speed (SCWS) and SMWS overground using a 5-meter walk test (5-MWT). Then, they were exposed to walking at increased speeds, on a treadmill and while in “push mode” in an overground robotic device, the KineAssist, until they were tested at a speed that they could not sustain without losing balance. We recorded the time and number of steps during each trial and calculated gait speed, average cadence and average step length. Results Maximum walking speed in the “push mode” was 13% higher than the maximum walking speed on the treadmill and both were higher (“push mode”: 61%; treadmill: 40%) than the maximum walking speed overground. Subjects achieved these faster speeds by initially increasing both step length and cadence and, once individuals stopped increasing their step length, by only increasing cadence. Conclusions With post-stroke hemiplegia, individuals are able to walk at faster speeds than their SMWS overground, when provided with a safe environment that provides external forces that requires them to attempt dynamic stability maintenance at higher gait speeds. Therefore, this study suggests the possibility that, given the appropriate conditions, people post-stroke can be trained at higher speeds than previously attempted.

Objective(s): To assess the impact of delays in evaluation for rehabilitation services on disability and health-related quality of life (HRQoL) after ischemic stroke and transient ischemic attack (TIA). Design: Rehabilitation evaluations (i.e., PT: physical therapy; OT: occupational therapy) were obtained from a retrospective chart review and HRQoL measures from a longitudinal observational study of poststroke outcomes. Setting: Stroke Center provided rehabilitation-related data. Participants in the community provided HRQoL data. Participants: Individuals post-stroke (nZ420) who underwent physical or occupational therapy evaluations. The sample was on average 66.2 years old (SDZ15.7), was largely white (64.1%); 47.4% were female, and 13.3% had a TIA diagnosis. Interventions: Usual rehabilitation services. Main Outcome Measure(s): Modified Rankin Scale (mRS) at 1 and 3months post-stroke and Neurological Quality of Life (NeuroQoL) measures of upperand lower-extremity physical function, general cognitive concerns, and executive function. Results: The mean number of days between hospital admission to evaluation (i.e., delay) was 3.2 (SDZ2.9) for PT and 4.4 (SDZ4.5) for OT. After controlling for age, stroke severity and stroke subtype, each additional day of delay resulted in higher levels of disability (mRS: PT, bZ0.06, p

Background Individuals post-stroke select slow comfortable walking speeds (CWS) and the major factors used to select their CWS is unknown. Objective To determine the extent to which slow CWS post-stroke is achieved through matching a relative force output or targeting a particular walking speed. Methods Ten neurologically nonimpaired individuals and fourteen chronic stroke survivors with hemiplegia were recruited. Participants were instructed to “walk at the speed that feels most comfortable” on a treadmill against 12 progressively increasing horizontal resistive force levels applied at the pelvis using a robotic system that allowed participant to self-select their walking speed. We compared slope coefficients of the simple linear regressions between the observed normalized force vs. normalized speed relationship in each group to a slope of -1.0 (i.e. ideal slope for a constant relative force output) and 0.0 (i.e. ideal slope for a constant relative speed). We also compared slope coefficients between groups. Results The slope coefficients were significantly greater than -1.0 (p