Stroke Applied by Physical TherapistsInterrater Reliability of the Extended ICF Core Set for http://ptjournal.apta.org/content/88/7/841 found online at:The online version of this article, along with updated information and services, can be Online-Only Material 1.DC1.html Background and Purpose. The World Health Organization's InternationalClassification of Functioning, Disability and Health (ICF) is gaining recognition in physical therapy. The Extended ICF Core Set for Stroke is a practical tool that represents a selection of categories from the whole classification and can be used along with the ICF qualifier scale to describe patients' functioning and disability following stroke. The application of the ICF qualifier scale poses the question of interrater reliability. The primary objective of this investigation was to study the agreement between physical therapists' ratings of subjects' functioning and disability with the Extended ICF Core Set for Stroke and with the ICF qualifier scale. Further objectives were to explore the relationships between agreement and rater confidence and between agreement and physical therapists' areas of core competence. Subjects and Methods. A monocentric, cross-sectional reliability study wasconducted. A consecutive sample of 30 subjects after stroke participated. Two physical therapists rated the subjects' functioning in 166 ICF categories.Results. The interrater agreement of the 2 physical therapists was moderate across all judgments (observed agreementϭ51%, kappaϭ.41). Interrater reliability was not related to rater confidence or to the physical therapists' areas of core competence. Discussion and Conclusion.The present study suggests potential improvements to enhance the implementation of the ICF and the Extended ICF Core Set for Stroke in practice. The results hint at the importance of the operationalization of the ICF categories and the standardization of the rating process, which might be useful in controlling for rater effects and increasing reliability.

BackgroundFatigue is a frequent and serious symptom in patients with Multiple Sclerosis (MS). However, to date there are only few methods for the objective assessment of fatigue. The aim of this study was to develop a method for the objective assessment of motor fatigue using kinematic gait analysis based on treadmill walking and an infrared-guided system.Patients and methodsFourteen patients with clinically definite MS participated in this study. Fatigue was defined according to the Fatigue Scale for Motor and Cognition (FSMC). Patients underwent a physical exertion test involving walking at their pre-determined patient-specific preferred walking speed until they reached complete exhaustion. Gait was recorded using a video camera, a three line-scanning camera system with 11 infrared sensors. Step length, width and height, maximum circumduction with the right and left leg, maximum knee flexion angle of the right and left leg, and trunk sway were measured and compared using paired t-tests (α = 0.005). In addition, variability in these parameters during one-minute intervals was examined. The fatigue index was defined as the number of significant mean and SD changes from the beginning to the end of the exertion test relative to the total number of gait kinematic parameters.ResultsClearly, for some patients the mean gait parameters were more affected than the variability of their movements while other patients had smaller differences in mean gait parameters with greater increases in variability. Finally, for other patients gait changes with physical exertion manifested both in changes in mean gait parameters and in altered variability. The variability and fatigue indices correlated significantly with the motoric but not with the cognitive dimension of the FSMC score (R = -0.602 and R = -0.592, respectively; P < 0.026).ConclusionsChanges in gait patterns following a physical exertion test in patients with MS suffering from motor fatigue can be measured objectively. These changes in gait patterns can be described using the motor fatigue index and represent an objective measure to assess motor fatigue in MS patients. The results of this study have important implications for the assessments and treatment evaluations of fatigue in MS.

Virtual reality for the treatment of motor impairment is a burgeoning application of digital technology in neurorehabilitation. Virtual reality systems pose an opportunity for health care providers to augment the dose of task-oriented exercises delivered both in the clinic, and via telerehabilitation models in the home. The technology is almost exclusively applied as an adjunct to traditional approaches and is typically characterized by the use of gamified exergames which feature task-oriented physiotherapy exercises. At present, evidence for the efficacy of this technology is sparse, with some reviews suggesting it is the same or no better than conventional approaches. The purpose of this article is to provide real-world insights on the adoption of a virtual reality by 3 European clinics in 3 different service delivery models. These include an inpatient setting for Parkinson disease, a kiosk model for pediatric neurorehabilitation, and a home-based telerehabilitation model for neurologic patients. Motivations, settings, requirements for the pathology, outcomes, and challenges encountered during this process are reported with the objective of priming clinicians on what to expect when implementing virtual reality in neurorehabilitation.

Background: The most used assessments in neuro-rehabilitation were often criticized because of their insufficient sensitivity. For this purpose, the Kliniken Schmieder in Germany have developed the Assessment of the Kliniken Schmieder/C (AKS/C) in order to collect motor function, cognition, communication and self-care competence of post-primary rehabilitation patients. Objective: To determine validity, reliability and responsiveness of the AKS/C motor domain. Method: Patients with various neurologic diagnoses in post-primary rehabilitation (n = 31 at admission, n = 24 at discharge) were tested. For concurrent validity determination AKS/C data were compared with those of FIM mobility and locomotor items. For assessing reliability intraclass correlation coefficients (ICC) and Cronbach's Alpha and for assessing responsiveness standardised response mean (SRM) were calculated. Results:Validity (ICC = 0.93) and reliability (ICC = 0.86 -0.99; Cronbach's Alpha = 0.95) of AKS/ C were good. Responsiveness of the AKS/C was slightly higher (SRM = 1.3) than of FIM motor items (SRM = 1.2). Combination of AKS/C and FIM items did not increase responsiveness. Conclusion: The motor domain of the AKS/C proved to be a valid, reliable and responsive motor function assessment tool for patients in postprimary neuro-rehabilitation. Starrost K et al. Motorische Funktionen in… physioscience 2011; 7: 99 -111 Originalarbeit 99Heruntergeladen von: University of Pennsylvania Libraries. Urheberrechtlich geschützt.

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