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Action for rehabilitation from neurological injury (ARNI): functional training after stroke
Balchin TBD
ARNI Trust, Surrey, UK
Introduction: At present only a fifth of patients' rehabilitative needs are met 12 months after stroke. The UK Stroke Strategy (2007) highlights the importance of community programmes guided by the voluntary sector. ARNI is a national charity which trains and matches specialist exercise instructors with stroke survivors who require further training and monitoring after formal therapy interventions stop.
Method: ARNI has refined an approach to stroke recovery over 10 years, incorporating evidence from stroke reviews that suggest intensive task-related practice and resistance training allied to the personalising of physical coping techniques can lead to functional improvements. From 2008, many UK stroke networks, councils and gyms have sponsored specialist exercise instructors through a 300-hour practical and theory accreditation incorporating this approach. In return, instructors give commitment to teach individuals intensively one-to-one in patients' homes, and run group classes.
Results: A total of 68 instructors have been accredited and are working with stroke survivors of all ages who have mild to moderate levels of disability. Successes are being reported; e.g. in February 2010, a North East council funded a twice-weekly pilot course for a stroke group for 10 weeks. Participants (n = 8) with (n = 5) completing all sessions, reported improved mobility, range of movement, action control, confidence and reduced fear of the consequences of exercise.
Conclusion: There exists a subset of stroke survivors who require training in functional recovery strategies by specialist exercise instructors after formal therapy finishes. A feasibility study of the ARNI approach is currently underway and a full clinical effectiveness trial is planned.
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Feasibility, acceptability and accuracy of pedometers to promote walking in patients after stroke
Carroll S1, Greig CA1, Johnstone D2, Johnstone M2, Lewis S1, Mead GE1, McMurdo MET3, Scopes J4, Sniehotta F2
1School of Clinical Sciences and Community Health, The University of Edinburgh, UK, 2Department of Psychology, University of Aberdeen, UK, 3Department of Ageing and Health, University of Dundee, UK, 4Physiotherapy, Astley Ainslie Hospital, UK
Introduction: Physical activity after stroke is low. In sedentary older people, pedometers plus systematic advice increase physical activity. Our aim was to determine the feasibility, acceptability and accuracy of pedometers in people after stroke.
Method: We recruited mobile stroke patients nearing discharge from six stroke units. One pedometer was applied around the neck and one above each hip. Patients performed a short bout of activity including sitting for 10 s, standing 10 s and walking 20 s and a 6 min walk (6MWT). ‘Gold standard’ step count was determined by video recording. Feasibility was measured by the patient's ability to apply, remove and read the pedometers. We asked patients about the acceptability of pedometers.
Results: A total of 50 patients were recruited. Sixteen patients completed the 6MWT, with a mean walking speed of 0.90 m/s and 94% of steps detected. The remaining 34 patients were unable to complete the 6MWT. Nineteen of these patients had gait speeds > 0.5 m/s; the pedometers detected 76% of steps. Of the remaining fifteen patients who walked <0.5 m/s; the pedometers detected 6% of steps. Similar results were found in the short bouts of activity. Forty of fifty patients stated they would use a pedometer as part of further trials. A total of 47 (94%) patients reported no difficulties in applying/removing pedometers from the three locations but five (10%) patients were unable to read the pedometers.
Conclusion: Pedometers appear feasible and acceptable in patients after stroke. Accuracy depended on gait speed, declining substantially when gait speed was below 0.5 m/s.
