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We investigated the experience of ten patients who received video-based physiotherapy at home for two months after a shoulder joint replacement. Videoconferencing took place via the patient's home broadband connection at a bandwidth of 256-768 kbit/s. Qualitative interviews were carried out, transcribed and analysed. Through qualitative content analysis six categories were identified: (1) a different reinforced communication; (2) pain-free exercising as an effective routine; (3) from a dependent patient to a strengthened person at home; (4) closeness at a distance; (5) facilitated daily living; and (6) continuous physiotherapy chain. The access to bodily knowledge, continuity, collaboration and being at home were all aspects that contributed to the patients' recovery. The patients described experiences of safety, and strengthening during their daily exercise routine at home. The frequent interplay with the patient during telerehabilitation made it possible for the physiotherapist to make an individual judgement about each patient; this could be one reason for the positive findings. Home video-based physiotherapy may be useful in other kinds of physiotherapy.

We explored the benefit of video communication in home rehabilitation after shoulder joint replacement and compared it to referral for physiotherapy in the conventional way. A total of 22 patients were included in the study. The intervention group (n = 10) had training at home under the supervision of a physiotherapist at the hospital using videoconferencing. The control group (n = 12) had physiotherapy training in a conventional way in their home town. All patients had the same postoperative, three-phase-programme for two months. The outcome measures were a Visual Analogue Scale (VAS) for pain, range of motion (ROM), shoulder function ability (Constant score and SRQ-S) and health-related quality of life (SF-36). Questions about areas of priority for improvement and general satisfaction with the shoulder were also included. The telemedicine group received a greater number of treatments compared to the control group. After the intervention, there were significant improvements in VAS-pain, Constant score and SRQ-S for both groups. The telemedicine group improved significantly more in all three measurements than the control group (P < 0.001 for all). When changes from baseline to follow-up were compared, the telemedicine group improved significantly more in terms of decrease in pain (P = 0.004) and vitality (P = 0.001) than the control group. Despite some limitations, there seem to be clear benefits from physiotherapy at a distance with a telemedicine technique that allows patients to obtain access to physiotherapy at home.

Objectives: Weaknesses of the nine-hole peg test include high floor effects and a result that might be difficult to interpret. In the twenty-five-hole peg test (TFHPT), the larger number of available pegs allows for the straightforward counting of the number of pegs inserted as the result. The TFHPT provides a comprehensible result and low floor effects. The objective was to assess the test-retest reliability of the TFHPT when testing persons with stroke. A particular focus was placed on the absolute reliability, as quantified by the smallest real difference (SRD). Complementary aims were to investigate possible implications for how the TFHPT should be used and for how the SRD of the TFHPT performance should be expressed.

Design: This study employed a test-retest design including three trials. The pause between trials was approximately 10-120 s.

Participants, setting and outcome measure: Thirty-one participants who had suffered a stroke were recruited from a group designated for constraint-induced movement therapy at outpatient clinics. The TFHPT result was expressed as the number of pegs inserted.

Methods: Absolute reliability was quantified by the SRD, including random and systematic error for a single trial, SRD2.1, and for an average of three trials, SRD2.3. For the SRD measures, the corresponding SRD percentage (SRD%) measure was also reported.

Results: The differences in the number of pegs necessary to detect a change in the TFHPT for SRD2.1 and SRD2.3 were 4.0 and 2.3, respectively. The corresponding SRD% values for SRD2.1 and SRD2.3 were 36.5% and 21.3%, respectively.

Conclusions: The smallest change that can be detected in the TFHPT should be just above two pegs for a test procedure including an average of three trials. The use of an average of three trials compared with a single trial substantially reduces the measurement error.

Ventrolateral prefrontal cortex (VLPFC) is part of a network that exerts inhibitory control over the motor cortex (MC). Recently, we demonstrated that VLPFC was more activated during imagined maximum eccentric than during imagined concentric contractions in healthy participants. This was accompanied with lower activation levels within motor regions during imagined eccentric contractions. The aim was to test a novel hypothesis of an involvement of VLPFC in contraction mode-specific modulation of force. Functional magnetic resonance imaging was used to examine differences in VLPFC and motor regions during the concentric and the eccentric phases of imagined maximum contractions in a selected sample of subjects with stroke (n = 4). The subjects were included as they exhibited disturbed modulation of force. The previously demonstrated pattern within VLPFC was evident only on the contralesional hemisphere. On the ipsilesional hemisphere, the recruitment in VLPFC was similar for both modes of contractions. The findings support a hypothesis of the involvement of VLPFC in contraction mode-specific modulation of maximum force production. A disturbance of this system might underlie the lack of contraction mode-specific modulation commonly found among stroke subjects, often expressed as an increased ratio between eccentric and concentric strength.

The aim of this study was to compare the effect of isokinetic contraction mode and velocity on the torque-angle relationship during maximum voluntary elbow flexion in patients with stroke, age-matched healthy subjects and young subjects. To eliminate the effect of torque amplitude differences between subjects and groups, the torque values throughout the ROM were individually normalized to the peak value for each contraction velocity. The results show that in stroke patients the normalized torque angle relationship during the eccentric contractions was better preserved than during concentric contractions. Specifically, during eccentric contractions, stroke patients exhibited a torque-angle relationship that was closer to normal as the test velocity increased. The opposite trend could be seen in concentric contractions where the torque-angle relationship became more divergent from normal with a rise in the velocity. The torque-angle relationships were essentially the same for the control groups, irrespective of contraction mode or velocity. These findings may have significance for loading patterns of resistance training exercises used with stroke patients as such exercises normally are biomechanically designed for normal torque angle relationships. In clinical practice, these findings may partly explain why the strength increases due to resistance training are limited for patients with stroke.   

The aim of the study was to evaluate a high intensive exercise program in stroke subjects with risk of falls regarding balance, activities of daily life, falls efficacy, number of falls and lifestyle activities. The intervention program contained high intensity functional exercises (HIFE) implemented to real-life situations together with education on falls and security aspects. This was a single-center, single-blinded, randomized controlled trial. Consecutive >55-year-old patients with risk of falls were enrolled and randomized 3–6 months after first or recurrent stroke to the intervention group (IG, n=15) or to the control group (CG, n=19) who received group discussions about hidden dysfunctions after stroke. Outcomes were Berg Balance Scale (BBS) primarily, Barthel Index (BI), Falls Efficacy Scale – International (FES-I) and number of falls secondarily and Frenchay Activities Index last 3 months (FAI-3) tertially. Assessments were done at baseline, post-intervention, 3- and 6-month follow-up by two physiotherapists and one nurse blinded to group allocation. Generalized Estimating Equations with Repeated-measure statistics were used to analyze the data. There were no significant differences between the IG and the CG regarding balance (BBS). BI at 6 months and FES-I post-intervention and 3 months follow-up showed significant improvement in the IG compared with the CG (p<0.05). Number of falls and FAI-3 were without significant change. This study suggests that our program consisting of HIFE implemented in real-life situations together with educational discussions may improve performance of everyday life activities and improve falls efficacy in stroke subjects with risk of falls.

The aim of the study was to evaluate the impact of a high-intensive exercise program containing high-intensive functional exercises implemented to real-life situations together with group discussions on falls and security aspects in stroke subjects with risk of falls. This was a pre-specified secondary outcome for this study. For evaluation, Short Form-36 (SF-36) health-related quality of life (HRQoL) and the Geriatric Depression Scale-15 (GDS-15) were used. This was a single-center, single-blinded, randomized, controlled trial. Consecutive ≥55 years old stroke patients with risk of falls at 3–6 months after first or recurrent stroke were randomized to the intervention group (IG, n=15) or to the control group (CG, n=19) who received group discussion with focus on hidden dysfunctions but no physical fitness training. The 5-week high-intensive exercise program was related to an improvement in the CG in the SF-36 Mental Component Scale and the Mental Health subscale at 3 months follow-up compared with baseline values while no improvement was seen in the IG at this time. For the SF-36 Physical Component Scale, there was an improvement in the whole study group at 3 and 6 months follow-up compared with baseline values without any significant changes between the IG and CG. The GDS-15 was unchanged throughout the follow-up period for both groups. Based on these data, it is concluded that high-intensive functional exercises implemented in real-life situations should also include education on hidden dysfunctions after stroke instead of solely focus on falls and safety aspects to have a favorable impact on HRQoL.