The Palliative Performance Scale has been shown to predict survival among hospice and palliative medicine patients in the outpatient and inpatient clinical settings, where lower PPS scores are directly related to shorter survival. We seek to evaluate if this relationship persists among a racially diverse, older adult population when assessed at the time of admission from the emergency department.
This study, for stroke survivors with partial paralysis of one arm, will test whether or not an arm exoskeleton (the MyoPro Motion-G) immediately impacts arm movement more than a regular brace or more than wearing no brace. A stroke survivor who is 1 year or more post-stroke will qualify for this study if he/she has at least a little movement in the more affected arm. Subjects who qualify will come to MUSC 4 times over 3 weeks for about 2-3 hours per visit. During that time subjects will be fit for, and learn how to operate the exoskeleton and the comparison brace. Subjects' arm movement will be tested with a series of standard clinical measures of dexterity, functional task performance, range of motion, and strength.
The purpose of this clinical study is to see whether injections of AbobotulinumtoxinA in the upper limb (arm) and lower limb (leg) in combination with a personal exercise plan can improve voluntary movements in subjects with hemiparesis.
Post-stroke hand impairment is highly prevalent and severely restricts functional ability and independence. Yet, there is no assistive device to help hand function at home, every day, during activities of daily living. This study addresses this gap by providing an innovative technology. The ?TheraBracelet? is a wristband applying imperceptible white-noise vibration to skin. TheraBracelet is efficacious, as it has been shown to immediately improve chronic stroke survivors? touch sensation and hand dexterity in preliminary studies. TheraBracelet is affordable by using only a low-cost vibrator. TheraBracelet is also translational, because a vibrator strategically placed at the wrist does not interfere with dexterous finger motions, and it is low-risk by involving only imperceptible vibration on skin. These practicalities assure easy adoption in home environment for large impact on sensorimotor impairment. This study is to determine the feasibility and safety of using this assistive device all day every day for a month during daily activity, and to determine if TheraBracelet?s instant effects are sustained during prolonged use. This objective will be accomplished in a double-blinded, randomized, controlled, crossover design study. Feasibility (compliance of using the device everyday) and safety will be assessed for the treatment condition compared to the control condition (wearing the device without vibration) through weekly evaluations. In addition, TheraBracelet?s instant benefits in improving hand function will be assessed weekly. Persistence of TheraBracelet?s instant benefits across all weekly evaluations will support durability (i.e. desensitization to vibration does not occur during extended daily use over a one-month period). This project is expected to lead to an assistive wristband that increases hand function during activities of daily living, thus increasing independence and quality of life and reducing caregiver burden for a large number of stroke survivors with hand impairment.
Many individuals post-stroke have a hard time walking independently and freely in their homes and communities. Therefore, it is not surprising that the number one goal stated post-stroke is to regain walking function and is a central focus in rehabilitation. Current recommendations for improving post-stroke walking speed involves walking at a constant or continuous speed, however an new approach is the use of interval training that includes alternating between higher intensity and low intensity periods. Interval training is shown to result in larger gains in speed in neurologically healthy subjects. Preliminary data show higher intensity interval training to be possible in individuals following stroke, however direct comparisons of interval training to continuous training on walking function are not known. For this study there are two required sessions with the possibility of being asked to participate in additional sessions. A minimum of 48 hours in required between sessions. Each session lasts approximately two and half hours.
Our long term goal is to enhance the locomotion of impaired individuals after a neurological injury.
We are trying to recruit as healthy control participants, and neurologically impaired individuals (incomplete SCI and after-stroke patients) to participate in this study.
For neurologically impaired individuals a physical therapist will complete IRB approved questionnaires to measure your mobility, muscle strength, balance, walking speed, and distance.
All participants will meet with study staff who would then test your reflexes by placing some superficial skin based electrodes behind the knee and apply mild stimulation while standing/sitting.
If enrolled, you may be required to participate for 30 sessions (3 sessions/week), each lasting about one hour over a period of 3 months. Compensation is available for your participation.
We have designed a comprehensive, evidence-based approach to physical therapy rehabilitation after stroke that focuses on the intensity of cardiovascular, strength, and gait training, standardizing the dosage and progression of each type of training. Implementation of this standardization of intensity protocol will be guided via an internet-based (REDCap) interactive program available to each treating therapist. This program will cue the therapist to complete two sessions of cardiovascular, strength, and gait training each week at the appropriate intensity while not being prescriptive about specific activities to meet the stated goals. Eighty individuals with stroke (20 each from Charleston, SC; Anderson, SC; Rock Hill, SC; and York, PA ) who meet inclusion and exclusion criteria and will undergo a standardized evaluation at admission and discharge assessing gait speed, endurance, strength, balance, and overall functional independence and will be compared to 80 individuals with stroke receiving usual care. In addition, each enrollee will participate in a telephone screen at 90 days post-stroke to assess participation, quality of life, falls efficacy, falls history, and stroke-related secondary health conditions/readmissions.
Speech and language therapy for the management of aphasia (a language impairment that often occurs as a result of a stroke) is generally shown to be effective. However, the reasons that certain treatments may work for some individuals, and not others, and why some individuals do not respond to treatment is largely unknown. In this study, we plan to identify and model the relationship between many different factors (such as personal/biographical factors and an individual's baseline cognitive and language abilities) to help predict aphasia treatment outcome. Participants will be recruited for speech and language testing, brain imaging (MRI), and aphasia treatment (as warranted).
This study has 2 parts: In one part of this study, people with stroke will either play a custom designed computer game for stroke rehabilitation called Duck Duck Punch or an off the shelf computer game with their weaker arm 3 times per week for 6 weeks. Evaluations will determine whether or not one computer game improved arm movement more than the other. In the second part of the study, people with stroke, caregivers of people with stroke and stroke rehabilitation therapists will meet in several focus groups to design a useful and informative Duck Duck Punch performance report.
Patients with spontaneous non-traumatic intracerebral bleeding and acute respiratory insufficiency will be considered for a minitracheostomy to help facilitate suctioning and airway clearance. Selected patients will be adults who are intubated for at least 24 hours, who are not candidates for surgical evacuation of the hematoma, and who are considered to be higher risk for extubation failure based on depressed mental status and airway secretions. After obtaining informed consent for the procedure, a spontaneous breathing trial will be performed to make sure that the patient is capable of breathing without the assistance of the mechanical ventilator. A small, 1 cm incision will be made over the cricothyroid membrane using standard aseptic precautions and local anesthesia. The endotracheal tube will be withdrawn, and the minitracheostomy catheter will be passed through the incision into the airway. The minitracheostomy catheter will remain in place until the patient's attending physician feels that it is no longer needed for airway clearance.