Clinical measurement of muscle tone using a velocity-corrected modified ashworth scale

Objective: To develop a new form of the modified Ashworth scale (MAS) for muscle-tone assessment that combines the MAS score with the passive muscle-stretching velocity during the assessment of muscle tone, resulting in a measure that has higher intertester reliability than the MAS.

Design: Twanty-two volunteer subjects with spinal cord injuries at a tertiary care outpatient and inpatient spinal cord injury rehabilitation center affiliated with a university were recruited for this study.

Results: A decision tree in which V-MAS scores were obtained was developed. The data obtained from three independent raters, when adjusted by means of the V-MAS, showed an excellent interrater reliability.

Conclusions: Results indicated that the V-MAS is a more reliable measure. In addition, the resulting units of the V-MAS, ranging from 0 to 1, are of the same form as pendulum test data. The V-MAS method is quite simple to use because the rater need only measure the angular range and duration of the passive movement to calculate average velocity during the MAS assessment in addition to the normal MAS rating of muscle tone.

Prediction of functional oucomes in stroke inpatients receiving rehabilitation

Background and Purpose: Early identification of predictive factors relevant to functional outcomes for stroke patients is important to the establishment of an effective continuing care program. The objective of this studywas to identify the predictive factors related to functional outcome at discharge after stroke rehabilitation therapy. Methods: 105 first-time stroke patients admitted to the inpatient rehabilitation department of a university-based medical center were recruited for this prospective study. The functional outcomes of the patients were assessed at admission and at discharge using the Functional Independence Measure (FIM). Severity of stroke was determined using the Canadian Neurological Scale (CNS). Age, gender, side of hemiplegia (SIDE), type of stroke (TYPE), onset to admission interval (OAI), and length of rehabilitation stay (LORS) were also included as predictor variables. Results: The mean (′SD) FIM score at discharge (76.6 ′ 26.4) correlated strongly (r = 0.78, p < 0.001) with the admission FIM score (56.3 ′ 24.1), moderately (r = 0.46, p < 0.001) with the admission CNS score (6.1 ′ 2.2), negatively (r = -0.38, p < 0.001) with age (63.2 ′ 12.3 years), negatively (r = -0.26, p = 0.009) with OAI (24.2 ′ 16.0 days), and negatively (r = -0.29, p = 0.002) with LORS (34.7 ′ 16.8 ays). Stepwise regression analyses indicated that admission FIM score, age, and admission CNS score were the stronge predictors of functional outcome and accounted for 66% of the total variation in discharge FIM total score. The admission FIM score was the best predictor and accounted for 61% of the variation. Conclusions: The findings of this study imply that the admission FIM scores for inpatients receiving stroke rehabilitation can be used to predict functional outcomes at discharge from hospital.

Remotely delivered exercise-based cardiac rehabilitation: design and content development of a novel mHealth platform

BACKGROUND: Participation in traditional center-based cardiac rehabilitation exercise programs (exCR) is limited by accessibility barriers. Mobile health (mHealth) technologies can overcome these barriers while preserving critical attributes of center-based exCR monitoring and coaching, but these opportunities have not yet been capitalized on.

OBJECTIVE: We aimed to design and develop an evidence- and theory-based mHealth platform for remote delivery of exCR to any geographical location.

METHODS: An iterative process was used to design and develop an evidence- and theory-based mHealth platform (REMOTE-CR) that provides real-time remote exercise monitoring and coaching, behavior change education, and social support.

RESULTS: The REMOTE-CR platform comprises a commercially available smartphone and wearable sensor, custom smartphone and Web-based applications (apps), and a custom middleware. The platform allows exCR specialists to monitor patients' exercise and provide individualized coaching in real-time, from almost any location, and provide behavior change education and social support. Intervention content incorporates Social Cognitive Theory, Self-determination Theory, and a taxonomy of behavior change techniques. Exercise components are based on guidelines for clinical exercise prescription.

CONCLUSIONS: The REMOTE-CR platform extends the capabilities of previous telehealth exCR platforms and narrows the gap between existing center- and home-based exCR services. REMOTE-CR can complement center-based exCR by providing an alternative option for patients whose needs are not being met. Remotely monitored exCR may be more cost-effective than establishing additional center-based programs. The effectiveness and acceptability of REMOTE-CR are now being evaluated in a noninferiority randomized controlled trial.