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nkarman
Instructor
| Joined: | Sat Jul 15th, 2006 |
| Location: | New York USA |
| Posts: | 48 |
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Posted: Mon Mar 23rd, 2009 10:42 pm |
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I find it interesting that the question posted below(in Leslie Smith's post: "The question I am asked is, "Is there evidence to show that just three weeks of BWSTT is superior to "traditional" rehab in the acute-care setting?" The anecdotal evidence is there but I need studies to persuade the nay sayers!") is "do you have any evidence that BSWTT is superior to 'traditional' therapy in this setting?" I tend to reverse that question: "do you have any evidence that 'traditional' therapy is superior to BWSTT?" Why assume that your current standard is any good to begin with? Knowing that in other settings BWSTT has been demonstrated superior, why not go with that until the evidence proves that traditional intervention is superior. I would say that from an employee-protection (workplace injury) standpoint, if BWSTT is not proven inferior to 'traditional' intervention in terms of outcome, then it should be the treatment of choice for equivalent outcomes with less risk to caregiver. That is the way many facilities are going with regard to transfers (i.e. using lift devices in place of manual assistance for transfers, in order to prevent falls and reduce workplace injuries.) Changing the paradigm starts with asking the right question. 
NK
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tpazier
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| Joined: | Wed Sep 19th, 2007 |
| Location: | Tacoma, WA |
| Posts: | 8 |
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Posted: Sun Jan 27th, 2008 07:46 am |
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Lesley's comment about the limited time patients spend on rehab and the numerous things one needs to address rings true for me, too.
When I think about the amount of time and resouces needed to achieve productive time on the LG for someone early in the recovery stage, I wonder if it's time well spent. Then I consider from a motor learning standpoint the abnormal patterns that are being laid down in the recovering nervous system when we have people walk overground using even our best techniques. Teaching compensation is often the necessary path one takes to achieve some semblence of walking ability, thinking that the outpatient folks can work on symmetry. Well, I'm convinced that we need to work on the behavior from the very beginning. What if introducing the concept of limb symmetry and awareness of the impaired side can also carry over into transfers or bed mobility for those who would neglect the arm and/or leg? It seems plausable that facilitating as normal of a movement that has a task-oriented bias would carry over into areas that are also goal directed. We may need less time devoted to the less "sexy" aspects of rehab.
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Lesley Smith
Instructor
| Joined: | Wed Aug 29th, 2007 |
| Location: | Humarock, MA |
| Posts: | 46 |
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Posted: Thu Jan 3rd, 2008 02:19 am |
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Thank you, gentleman, for your responses. With the Hesse study, my hesitation was the fact that the seven patients were a minimum of three months post-stroke. In the acute rehab setting that I work, we see patients 1-2 weeks post event. With the Visintin study, the intervention was for six weeks, which was a realistic time-frame when the study was published in 1998 but, sadly, not today.
At the acute-rehab phase, BWSTT can be very labor-intensive. Since we have on average three weeks, the focus of rehab tends to be limited to getting the patient, and their caregivers, to a level where they can be safely transferred at home. The question I am asked is, "Is there evidence to show that just three weeks of BWSTT is superior to "traditional" rehab in the acute-care setting?" The anecdotal evidence is there but I need studies to persuade the nay sayers!
The patient in the McCain and Smith study, however, was OUR patient; dense MCA CVA, transferred to acute rehab 7 days post event, non-ambulatory upon admission and D/C after 25 days. I treat this patient all the time and I should have written that paper!!
The study's limitation was that it was only a single-subject design - but it is a good start.
I came across another study that concluded that a subgroup (those with a "major" hemispheric stroke) of patients in an inpatient rehab program who received > 12 treatment sessions showed significantly better overground endurance and speed scores with BWSTT compared to Aggressive Bracing Assisted Walking (therapist assisted ambulation using knee-ankle combination bracing and hemibar. if needed). The conclusion being that, with patients with a major hemispheric CVA, mobilization of any sort is difficult and limited, whereas something such as LiteGait at least gets them up and moving. Comparison of BWSTT vs ABAW Post-stroke. Kosak MC, Reding MJ. Neurorehabilitative Neural Repair. 2000; 14(1):13-9.
Good discussion - any other thoughts?
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tpazier
Member
| Joined: | Wed Sep 19th, 2007 |
| Location: | Tacoma, WA |
| Posts: | 8 |
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Posted: Wed Dec 12th, 2007 03:00 pm |
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McCain & Smith used BWS-TT for a patient in inpatient rehab who experienced a stroke. Interestingly, they did not begin overground training until the 12th rehab day, instead focusing treatment on the treadmill. The patient spent 25 days on rehab and made significant gains in mobility. See the full article in Topics in Stroke Rehab Sept-Oct 2007. I reviewed the article at the APTA site, "Hooked on Evidence"
Tim Pazier, MPT
St. Joseph Medical Center
Tacoma, WA
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Andrew M. Ball, PT, DPT, PhD
Instructor
| Joined: | Tue Dec 26th, 2006 |
| Location: | Charlotte, NC |
| Posts: | 7 |
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Posted: Sun Dec 2nd, 2007 08:01 pm |
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The Hesse study took nonambulatory patients with hemiparesis and placed them on the BWSTT system over a 9 week course of intervention. Keep in mind, however, that the study was designed as 3 weeks of treatment (in which improvements were noted by the end of 3 weeks), a 3 week "wash-out" of traditional NDT therapy (where improvements were NOT noted), and 3 final weeks of intervention (in which improvements were once again noted.
The Visintin study was also of short duration, showing that patients placed on a Litegait, as opposed to in parallel bars, immediatly post-stroke (e.g. acute phase), were SIGNIFICANTLY less likely to develop the "dorsal foot drag" pathomechanic gait abnormality. This should make at least intuitive sense to us . . . parallel bars teach the body STABILITY (with unnatural/UE support at that), whereas the LiteGait allows for early mobility. This shouldn't surprise any of us, teach stability if you want stability. Teach mobility if you want mobility. Don't expect that there's going to be much cross-over. Expect unintended consequences if you do.
Or as my Grandfather used to say . . . "Don't pine for one [girl] and kiss another."
The moral of the story is that over 3 weeks, SIGNIFICANT gait benefits can be realized.
Dr. Andrew M. Ball, PT, DPT, PhD
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Lesley Smith
Instructor
| Joined: | Wed Aug 29th, 2007 |
| Location: | Humarock, MA |
| Posts: | 46 |
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Posted: Fri Oct 26th, 2007 03:02 am |
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I work in an acute rehab facility where length of stay is, unfortunately, often less than three weeks. Does anyone know of any studies involving BWSTT either in the acute care setting and/or involving such a short duration?
Thanks,
Lesley
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