This article describes a study conducted to determine the effectiveness of NDT in patients after an ischemic stroke. Patients after having a stroke often have many limitations in completing ADLs and IADLs will need adequate rehab to do so. NDT (Neurodevelopmental Treatment) is method and concept of assessment and analysis of functional deficits to promote normal movement and integration of affected and unaffected sides of the body. This is done through direct patient handling while inhibiting abnormal movement patterns. Past research has suggested that NDT though widely used in some manner by therapists, is not superior to any other method of treatment of adults. However these studies offered very little discussion in terms of the use of NDT for specific diagnosis. The question still remains whether NDT in itself is an effective treatment still worth using to improve ADL performance particularly for CVA patients. Another big question is how much of past research was conducted by therapists with extended or deep knowledge of the NDT method and how does this affect results?
This study included 60 post CVA patients (ischemic CVA) equal numbers men and women and equal numbers LCVA and RCVA. All patients were over 18 with mean age of 67. These patients received 30 minute sessions of NDT for 2 weeks (10 sessions). Therapy was carried out by certified and experienced NDT therapist. Results were measured using the following selected part of the Barthel Index: Transfers ( bed to chair), mobility (on level surface), and walking up stairs. Result showed that overall NDT is an effective method for the increase of ADL function. The favorable results were for patient 2-3 years poststroke, women, patients with Left sided paralysis/paresis and those aged 78-87. Further studies are needed to look at effectiveness at various ranges poststroke and for more functional ADLs such as self-feeding, bathing, or dressing. Such studies should also have a control group for comparison which this one did not.
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Changes in Barthel Index outcomes as result of poststroke rehabilitation using NDT-Bobath methodAuthor: Mikolajewska, EmiliaAbstract:Background: Poststroke patients need effective rehabilitation because of limitations in activities of daily living (ADLs). The aim of the study was to assess the results of ADL rehabilitation of patients after ischemic stroke who underwent NDT-Bobath therapy for adults method using selected items of the Barthel Index.Methods: The investigated group consisted of 60 patients after ischemic stroke who participated in the program of rehabilitation: 10 sessions of the NDT-Bobath therapy for 2 weeks (10 days of the therapy). The measurement of the ADLs using selected items of the Barthel Index were performed in every patient on admission (before the therapy) and after the last session of the therapy to assess rehabilitation effects.Results: Results among patients involved in the research were as follows: recovery, 30 cases (50%); no measurable changes, two cases (3.33%); relapse, not stated.Conclusions: Observed statistically significant and favorable changes in the health status of patients, described by Barthel Index outcomes, confirm the effectiveness of the NDT-Bobath method.Full text:Introduction
Stroke constitutes a huge medical, social, and financial problem. Fifteen million people experience stroke worldwide each year, with 5 million resulting to death. Of all stroke cases, 80%-85% constitutes ischemic stroke. The effect of the stroke depends mainly on area of the brain where it occurs and the extent of brain injury. About 50% of poststroke patients have limited independence, need the help of another person in accomplishing activities of daily living (ADLs), and/or are unable to participate fully in regular community life, learn, work, etc. [1, 2]. In poststroke patients, performance of ADLs is compromised, and one of the aims of poststroke rehabilitation is to restore the patients' best possible functioning in ADLs. Particular attention is directed to looking for more effective ways of doing the ADLs. The aim of this study was to assess the results of poststroke rehabilitation based on the neurodevelopmental treatment - Bobath (NDT-Bobath) method for adults in ADL restoration using selected items of the Barthel Index. The NDT-Bobath method for adults is one of the leading methods used in poststroke rehabilitation [3-11]. This method is not only a set of exercises but a whole concept that includes disability analysis and assessment of functional deficits and their causes. Particular attention is paid to "direct" stimulated use of the affected side. The uniqueness of the NDT-Bobath method lies in its attempts to integrate both the affected and unaffected sides of the body. Neuroplasticity plays the most important role. Patient-oriented therapy, problem-solving approach, and cause-to-goals analysis are used to plan the proper intervention. The main theoretical assumptions and therapy rules are not quite simple: the newest Polish book in the area of the NDT-Bobath method in the neurorehabilitation of adults has 232 pages and yet is considered basic [11].
Despite its wide use, there is lack of studies in the area of outcomes of poststroke rehabilitation using the NDT-Bobath method [10] including ADL rehabilitation (1, 2, 12-17). Almost every research in this area is considered valuable, as each increases knowledge and improves clinical practice in neurorehabilitation.
Patients and methods
Patients
The study was carried out in 60 patients after ischemic stroke. The study group was established based on the following inclusion criteria (confirmed by medical records): age, older than 18 years; time after cerebrovascular accident (CVA), from 6 weeks to 3 years; diagnosis, ischemic stroke. The size and anatomical involvement of infarct varied among patients, and the general extent of involvement of motor areas and tracts was not described. The patients' profiles are presented in Table 1 .
Patients' overall profile. (Table omitted, see PDF)
The study was accepted by the appropriate Bioethical Committee. The subjects gave written informed consent before entering the study in accordance with the recommendations of the Bioethical Committee, acting on the rules of good clinical practice and the Helsinki Declaration.
Methods
The patients underwent 10 sessions of NDT-Bobath therapy for 2 weeks (i.e., 5 days per week, for a total of 10 days). It will be easy to compare results of further studies and experiences of clinical practice. Each session lasted 30 min.
Patients were treated according to the NDT-Bobath method by an internationally certified and experienced therapist. The international certification in the NDT-Bobath method for adults was required to provide an easier comparison of professional qualifications in the NDT-Bobath method, as recommended by Paci [10], and includes the following: *International Bobath Instructors Training Association (IBITA)-recognized basic course, "Assessment and Treatment of Adults with Hemiplegia - The Bobath Concept" *IBITA-recognized advanced course, "Assessment and Treatment of Adults with Neurological Conditions - The Bobath Concept" *EBTA-recognized NDT-Bobath basic course, "Assessment and Treatment of Children"
The measurement of the ADLs, where available, was performed twice in every patient using selected items of the Barthel Index in the areas of transfers, mobility, and stairs ( Table 2 ), on admission (before the therapy) and after the last session of the therapy, to assess the effects of rehabilitation.
Barthel Index - part of the test [18]. (Table omitted, see PDF)
Guidelines: The assessment can be used to determine a baseline level of functioning and can be used to monitor improvement in ADLs over time. The items are weighted according to a scheme developed by the authors. The person receives a score based on whether they have received help while doing the task. The scores for each of the items are summed to create a total score. The higher the score the more "independent" the person. Independence means that the person needs no assistance at any part of the task. If a person does about 50% independently then the "middle" score would apply.
A selected part of the Barthel Index consists of three items measuring patients' daily functioning in the area of ADLs and mobility: moving from wheelchair to bed and back, walking on level surface, and going upstairs and downstairs. The reliability of the test is "valid" according to studies [19-21].
The possible results were generally defined as follows: *Recovery: After therapy, there was a measured significant difference (favorable change) compared with the result at the beginning of the therapy. *Relapse: There was a measured unfavorable change compared with the result at the beginning of the therapy. *Recovery: There was no measured significant difference compared with the result at the beginning of the therapy.
Statistical analysis
The results are expressed as mean, median, maximal value, minimal value, and standard deviation (SD). The results were statistically analyzed using the Wilcoxon's test. A probability p
Results
The results are presented in Tables 3 - 8 . This study has focused on the determination of changes in three areas of ADL (moving from wheelchair to bed and back, walking on level surface, going upstairs and downstairs) that were observed as a result of the therapy conducted according to the NDT-Bobath method in a group of patients after ischemic stroke. These elements are often impaired as a result of the stroke. There were observed statistically relevant changes reflecting recovery as the result of the therapy using the NDT-Bobath method. The observed changes reflect the recovery in the areas of ADL. The results found in the patients (n=60) involved in the study were as follows: recovery, 30 cases (50%); no measurable changes, 2 cases (3.33%); relapse, not stated.
Results for whole group of patients. (Table omitted, see PDF)
Statistical analysis of the results for whole group of patients. (Table omitted, see PDF)
In the whole group, the recovery was statistically significant (p
Results depend on the side of the paresis. (Table omitted, see PDF)
In the group of patients with right-sided paresis, recovery was statistically significant (p=0.001), with the mean recovery increasing from 32.0 (median, 35.0) in the first examination to 35.8 (median, 40.0) in the second examination. In the group of patients with left-sided paresis, recovery was statistically significant (p
Results depend on sex. (Table omitted, see PDF)
In the group of women, recovery was statistically significant (p
Results depend on age. (Table omitted, see PDF)
In the group of patients younger than 68 years, recovery was statistically significant (p=0.001), with the mean recovery increasing from 33.6 (median, 35.0) in the first examination to 37.5 (median, 40.0) in the second examination. In the group of patients older than 68 years, recovery was statistically significant (p=0.001), with the mean recovery increasing from 29.5 (median, 30.0) in the first examination to 34.1 (median, 40.0) in the second examination.
Results depend on time after CVA. (Table omitted, see PDF)
In the group of patients treated within 6 weeks to 6 months after CVA, recovery was statistically significant (p=0.005), the mean recovery increasing from 30.0 (median, 30.0) in the first examination to 35.0 (median, 40.0) in the second examination. In the group of patients treated within 6 months to 1 year after CVA, recovery was statistically significant (p=0.043), with the mean recovery increasing from 34.6 (median, 40.0) in the first examination to 37.9 (median, 40.0) in the second examination. In the group of patients treated within 1 year to 2 years after CVA, recovery was statistically significant (p=0.043), with the mean recovery increasing from 35.0 (median, 40.0) in the first examination to 37.4 (median, 40.0) in the second examination. In the group of patients treated within 2 to 3 years after CVA, recovery was statistically significant (p=0.008), with the mean recovery increasing from 27.1 (median, 30.0) in the first examination to 33.6 (median, 40.0) in the second examination.
For the purposes of statistical analysis, the whole group was divided into two groups using median age (68 years).
Discussion
The results of the therapy using the NDT-Bobath method showed statistically significant changes in the health status of patients in the selected items of the Barthel Index. These changes in three areas of ADL (moving from wheelchair to bed and back, walking on level surface, going upstairs and downstairs) were favorable. The results are very good, considering the short period of rehabilitation (2 weeks, with 10 sessions) and the mean age of patients (65.7 years).
The most favorable results of the therapy were achieved by patients with the following prognostic signs: *Therapy was started between 2 and 3 years after CVA, which suggests the effectivity of the method during the late period after CVA, especially in transfer activities. *Age between 78 and 87 years, which suggest the effectivity of the method in older patients, especially in transfer activities. *Women showed the biggest change in this group, as observed in mobility on level surface areas. *Left-side paresis.
The next stages of therapy should provide better results, but there is a need for longer rehabilitation. Unfortunately, there is lack of research on the use the NDT-Bobath method for adults to compare the outcomes of the study. A systematic literature review of 15 clinical trials performed by Paci [10] demonstrated that the results show no evidence of the effectiveness of the NDT-Bobath method, but this conclusion is widely discussed and needs additional studies. Paci [10] stated that it is necessary to perform further investigations to develop outcome measures concerning the goals of the Bobath approach (motor performance and others). One of criteria of the study is the therapist's deep knowledge of the NDT-Bobath method for adults, as confirmed by international certificates and several years of experience [10, 11]; this was required because only the outcomes of the NDT-Bobath method performed by certified and experience therapists can be objectively compared. The author has reviewed publications in the PubMed (US National Library of Medicine) database, but very little research is conducted in the aforementioned area. There was no review on the subject, and there were only six articles with the specified keywords "Bobath+adults+ADL" and one research in Chinese investigating the effects of early rehabilitation on ADLs within 1 month after the first stroke [22]. This was impossible to compare their results with the present study because of a different range of time after CVA.
The main limitation of this research is the lack of a control group. In most cases, a research without a control is insufficient. However, despite this study's lack of a control group, the results presented here is an important step toward a better understanding of ADL rehabilitation of adult stroke survivors using the NDT-Bobath method. Further studies should add a control group using another rehabilitation method or solely using the NDT-Bobath method to compare the results and examine the effectiveness of method.
No doubt, there is a need to provide further studies in the area, as independent sources of knowledge are necessary to estimate the effectiveness of the NDT-Bobath method for adults in the ADL recovery of poststroke patients. Based on this study, there is a need for further research using a control group and to provide better evidence.
In conclusion, the results showed that the NDT-Bobath method for adults is an effective in the ADL rehabilitation of adult patients after ischemic stroke. There were statistically significant and favorable changes in the health status of patients in terms of ADL outcomes measured using parts of the Barthel Index.
Conflict of interest statement
Authors' conflict of interest disclosure: The authors stated that there are no conflicts of interest regarding the publication of this article.
Research funding: None declared.
Employment or leadership: None declared.
Honorarium: None declared.
Subject: Stroke; Methods; Therapy; Adults; Studies; Bioethics; Clinical medicine; Rehabilitation; Activities of daily livingIdentifier / keyword: activities of daily living (ADLs), Barthel Index, ischemic stroke, NDT-Bobath, physical therapy, rehabilitationPublication title: International Journal on Disability and Human DevelopmentVolume: 12Issue: 3Pages: 363-367Number of pages: 5Publication year: 2013Publication date: 2013Year: 2013Publisher: Walter de Gruyter GmbHPlace of publication: BerlinCountry of publication: GermanyPublication subject: Biology--Genetics, Medical Sciences--EndocrinologyISSN: 21911231Source type: Scholarly JournalsLanguage of publication: EnglishDocument type: Journal ArticleProQuest document ID: 1704337687Document URL: http://ccbcmd.idm.oclc.org/login?url=http://search.proquest.com/docview/1704337687?accountid=3784Copyright: Copyright Walter de Gruyter GmbH 2013Last updated: 2015-08-21Database: ProQuest Central
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