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Jin Y, Lee Y, Park S, Lee S, Lim C. Effects of Curved-Path Gait Training on Gait Ability in Middle-Aged Patients with Stroke: Protocol for a Randomized Controlled Trial. Healthcare (Basel) 2023; 11:1777. [PMID: 37372895 DOI: 10.3390/healthcare11121777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/22/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
(1) Introduction: This study aimed to investigate the effects of curved-path stride gait training on the gait ability of patients with stroke. (2) Materials and Methods: Thirty patients with stroke were randomly assigned to curved-path stride gait training (n = 15) and general gait training groups (n = 15). Both groups underwent training for 30 min five times a week for 8 weeks. The gait ability of each was assessed using the Dynamic Gait Index (DGI), Timed-Up-and-Go (TUG) test, 10-meter walk test, and Figure-of-8 walk test (F8WT). (3) Results: The curved-path gait training group showed significant differences in the DGI, TUG test, 10-m walk test, and F8WT pre- versus post- intervention (p < 0.05). The general gait training group showed no significant difference in F8WT pre- versus post-intervention (p > 0.05). Additionally, there was a statistically significant intergroup difference in gait ability (p < 0.05). (4) Conclusions: Curved-path gait training resulted in greater improvement in gait ability than general gait training. Therefore, curved-path gait training can be a meaningful intervention for improving the gait ability of patients with stroke.
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Affiliation(s)
- Youngmi Jin
- Department of Special Education of Graduate School, Dankook University, Yongin 16890, Republic of Korea
| | - Yubin Lee
- Department of Health Science, Gachon University Graduate School, Incheon 21936, Republic of Korea
| | - Seiyoun Park
- Department of Physical Therapy, Wonkwang Health Science University, Iksan 54538, Republic of Korea
| | - Sangbin Lee
- Department of Physical Therapy, Namseoul University, Cheonan 31020, Republic of Korea
| | - Chaegil Lim
- Department of Physical Therapy, Gachon University, Incheon 21936, Republic of Korea
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2
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Maulet T, Cattagni T, Dubois F, Roche N, Laforet P, Bonnyaud C. Determinants and Characterization of Locomotion in Adults with Late-Onset Pompe Disease: New Clinical Biomarkers. J Neuromuscul Dis 2023; 10:963-976. [PMID: 37545258 PMCID: PMC10578228 DOI: 10.3233/jnd-230060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND The late-onset form of Pompe disease (LOPD) is characterized by muscle weakness, locomotor limitations and a risk of falls. The mechanisms responsible for altered locomotion in adults with LOPD are unknown. The identification of clinical biomarkers is essential for clinical follow-up and research. OBJECTIVES To identify muscle determinants of impaired locomotor performance, gait stability and gait pattern, and biomechanical determinants of falls in adults with LOPD. METHODS In this cross-sectional, case-control study, LOPD and control participants underwent 3D gait analysis, locomotor performance tests and muscle strength measurements (isokinetic dynamometer). We explored the muscular determinants of locomotor performance (gait speed, 6-minute walk test distance and timed up and go test), gait stability (spatiotemporal gait variables) and the gait pattern. We also explored biomechanical gait determinants of falls. After intergroup comparisons, determinants were sought to use forward stepwise multiple regression. RESULTS Eighteen participants with LOPD and 20 control participants were included. Locomotor performance, gait stability, and the gait pattern were significantly altered in LOPD compared to control participants. Hip abductor strength was the main common determinant of locomotor performance, gait stability and pelvic instability. Hip flexor strength was the main determinant of abnormal gait kinematics at the hip and knee. Percentage duration of single support phase during the gait cycle was the main determinant of falls. CONCLUSIONS Hip abductor strength and percentage duration of single support during gait were the major determinants of locomotor performance, gait stability, falls and the gait pattern in LOPD. These new clinical biomarkers should therefore be systematically assessed using instrumented tools to improve the follow-up of adults with LOPD. They should also be considered in future studies to accurately assess the effects of new therapies. Hip abductor strength and single support phase should also be priority targets for rehabilitation.
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Affiliation(s)
- Théo Maulet
- Laboratory End: icap, Inserm Unit 1179, UVSQ, Université Paris-Saclay, France
- Research Unit ERPHAN, Université Paris-Saclay, France
- Movement Analysis Laboratory, Functional Exploration Unit, Raymond Poincaré Garches, G. H. U.Paris Saclay, APHP, France
| | - Thomas Cattagni
- Mouvement– Interactions – Performance, MIP, UR 4334, F-44000, Nantes University, Nantes, France
| | - Fabien Dubois
- Movement Analysis Laboratory, Functional Exploration Unit, Raymond Poincaré Garches, G. H. U.Paris Saclay, APHP, France
| | - Nicolas Roche
- Laboratory End: icap, Inserm Unit 1179, UVSQ, Université Paris-Saclay, France
- Movement Analysis Laboratory, Functional Exploration Unit, Raymond Poincaré Garches, G. H. U.Paris Saclay, APHP, France
| | - Pascal Laforet
- Laboratory End: icap, Inserm Unit 1179, UVSQ, Université Paris-Saclay, France
- Neurology Unit, Raymond Poincaré Garches, G.H. U. Paris Saclay, APHP, France
| | - Céline Bonnyaud
- Research Unit ERPHAN, Université Paris-Saclay, France
- Movement Analysis Laboratory, Functional Exploration Unit, Raymond Poincaré Garches, G. H. U.Paris Saclay, APHP, France
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3
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Ishiwatari M, Tani M, Isayama R, Honaga K, Hayakawa M, Takakura T, Tanuma A, Kurosu A, Hatori K, Wada F, Fujiwara T. Prediction of gait independence using the Trunk Impairment Scale in patients with acute stroke. Ther Adv Neurol Disord 2022; 15:17562864221140180. [PMID: 36506941 PMCID: PMC9730005 DOI: 10.1177/17562864221140180] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 11/03/2022] [Indexed: 12/12/2022] Open
Abstract
Background Gait recovery is one of the primary goals of stroke rehabilitation. Gait independence is a key functional component of independent activities in daily living and social participation. Therefore, early prediction of gait independence is essential for stroke rehabilitation. Trunk function is important for recovery of gait, balance, and lower extremity function. The Trunk Impairment Scale (TIS) was developed to assess trunk impairment in patients with stroke. Objective To evaluate the predictive validity of the TIS for gait independence in patients with acute stroke. Methods A total of 102 patients with acute stroke participated in this study. Every participant was assessed using the TIS, Stroke Impairment Assessment Set (SIAS), and Functional Independence Measure (FIM) within 48 h of stroke onset and at discharge. Gait independence was defined as FIM gait scores of 6 and 7. Multiple regression analysis was used to predict the FIM gait score, and multiple logistic regression analysis was used to predict gait independence. Cut-off values were determined using receiver operating characteristic (ROC) curves for variables considered significant in the multiple logistic regression analysis. In addition, the area under the curve (AUC), sensitivity, and specificity were calculated. Results For the prediction of the FIM gait score at discharge, the TIS at admission showed a good-fitting adjusted coefficient of determination (R 2 = 0.672, p < 0.001). The TIS and age were selected as predictors of gait independence. The ROC curve had a TIS cut-off value of 12 points (sensitivity: 81.4%, specificity: 79.7%) and an AUC of 0.911. The cut-off value for age was 75 years (sensitivity: 74.6%, specificity: 65.1%), and the AUC was 0.709. Conclusion The TIS is a useful early predictor of gait ability in patients with acute stroke.
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Affiliation(s)
| | - Mami Tani
- Department of Rehabilitation Medicine, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Reina Isayama
- Department of Rehabilitation Medicine, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Kaoru Honaga
- Department of Rehabilitation Medicine, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | | | - Tomokazu Takakura
- Department of Rehabilitation Medicine, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Akira Tanuma
- Department of Rehabilitation Medicine, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Akihiro Kurosu
- Department of Rehabilitation Medicine, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Kozo Hatori
- Department of Rehabilitation Medicine, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Futoshi Wada
- Department of Rehabilitation Medicine, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Toshiyuki Fujiwara
- Department of Rehabilitation Medicine, Graduate School of Medicine, Juntendo University, Tokyo, Japan,Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan
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4
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Johnson RT, Bianco NA, Finley JM. Patterns of asymmetry and energy cost generated from predictive simulations of hemiparetic gait. PLoS Comput Biol 2022; 18:e1010466. [PMID: 36084139 PMCID: PMC9491609 DOI: 10.1371/journal.pcbi.1010466] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 09/21/2022] [Accepted: 08/03/2022] [Indexed: 11/18/2022] Open
Abstract
Hemiparesis, defined as unilateral muscle weakness, often occurs in people post-stroke or people with cerebral palsy, however it is difficult to understand how this hemiparesis affects movement patterns as it often presents alongside a variety of other neuromuscular impairments. Predictive musculoskeletal modeling presents an opportunity to investigate how impairments affect gait performance assuming a particular cost function. Here, we use predictive simulation to quantify the spatiotemporal asymmetries and changes to metabolic cost that emerge when muscle strength is unilaterally reduced and how reducing spatiotemporal symmetry affects metabolic cost. We modified a 2-D musculoskeletal model by uniformly reducing the peak isometric muscle force unilaterally. We then solved optimal control simulations of walking across a range of speeds by minimizing the sum of the cubed muscle excitations. Lastly, we ran additional optimizations to test if reducing spatiotemporal asymmetry would result in an increase in metabolic cost. Our results showed that the magnitude and direction of effort-optimal spatiotemporal asymmetries depends on both the gait speed and level of weakness. Also, the optimal speed was 1.25 m/s for the symmetrical and 20% weakness models but slower (1.00 m/s) for the 40% and 60% weakness models, suggesting that hemiparesis can account for a portion of the slower gait speed seen in people with hemiparesis. Modifying the cost function to minimize spatiotemporal asymmetry resulted in small increases (~4%) in metabolic cost. Overall, our results indicate that spatiotemporal asymmetry may be optimal for people with hemiparesis. Additionally, the effect of speed and the level of weakness on spatiotemporal asymmetry may help explain the well-known heterogenous distribution of spatiotemporal asymmetries observed in the clinic. Future work could extend our results by testing the effects of other neuromuscular impairments on optimal gait strategies, and therefore build a more comprehensive understanding of the gait patterns observed in clinical populations.
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Affiliation(s)
- Russell T. Johnson
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California, United States of America
- * E-mail:
| | - Nicholas A. Bianco
- Department of Mechanical Engineering, Stanford University, Palo Alto, California, United States of America
| | - James M. Finley
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California, United States of America
- Department of Biomedical Engineering, University of Southern California, Los Angeles, California, United States of America
- Neuroscience Graduate Program, University of Southern California, Los Angeles, California, United States of America
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Kim JH, Han EY, Kang SY, Im SH. Paretic knee extensor strength, gait velocity, and fat mass are major determinants of peak aerobic capacity in subacute stroke: observational cohort study. Sci Rep 2020; 10:13917. [PMID: 32811893 PMCID: PMC7434872 DOI: 10.1038/s41598-020-70936-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 08/06/2020] [Indexed: 12/01/2022] Open
Abstract
The purpose of this study is to investigate major determinants of peak aerobic capacity in subacute stroke patients among body composition, balance function, walking capacity, and lower limb muscular strength. This was a retrospective observational cohort study. Eighty-three subacute stroke patients were enrolled and their medical records were retrospectively reviewed in the study (47 males; mean age: 62.95 ± 13.9 years). Gait capacity was assessed by gait velocity (10 m walk velocity:10MWV) and gait endurance (6 min walk distance:6MWD). Balance function was evaluated with Berg Balance Scale (BBS). The isometric muscular strengths of bilateral knee extensors were measured with an isokinetic dynamometer. Cardiovascular fitness was evaluated with an expired gas analyzer. In backward linear regression analyses, paretic isometric extensor strength (p < 0.001), fat mass (p = 0.005) and 10MWV (p < 0.001) are significantly correlated with peak aerobic capacity (adjusted R2 = 0.499) in all patients. Our results confirmed that paretic knee extensor strength, gait velocity, and fat mass were major determinants of peak aerobic capacity in subacute stroke. Therefore, therapeutic approaches should focus on improving gait velocity and paretic knee extensor strength in the early stages of recovery from stroke.
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Affiliation(s)
- Ji Hyun Kim
- Department of Medicine, Graduate School, Jeju National University, Jejusi, Jejudo, 63241, Republic of Korea
| | - Eun Young Han
- Department of Medicine, Graduate School, Jeju National University, Jejusi, Jejudo, 63241, Republic of Korea. .,Department of Rehabilitation Medicine, Jeju National University, College of Medicine, 15 Aran 13 gil, Jejusi, Jejudo, 63241, Republic of Korea.
| | - Sa-Yoon Kang
- Department of Neurology, Jeju National University, College of Medicine, Jejusi, Jejudo, 63241, Republic of Korea
| | - Sang Hee Im
- Department of Rehabilitation Medicine and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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6
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Bohannon RW. Isokinetic testing of muscle strength of older individuals post-stroke: An integrative review. ISOKINET EXERC SCI 2020. [DOI: 10.3233/ies-201146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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7
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Tsuji Y, Akezaki Y, Katsumura H, Hara T, Sawashita Y, Kakizaki H, Mori K, Yuri Y, Nomura T, Hirao F. Factors Affecting Walking Speed in Schizophrenia Patients. Prog Rehabil Med 2019; 4:20190003. [PMID: 32789250 DOI: 10.2490/prm.20190003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 01/17/2019] [Indexed: 11/09/2022] Open
Abstract
Objective This study investigated the factors affecting walking speed in schizophrenia patients who were inpatients at a psychiatric hospital. Methods The study subjects were 37 patients with schizophrenia who were hospitalized in a psychiatric hospital. The measured assessment items included age, duration of hospitalization, duration of disease, muscle strength (30-s chair stand test), balance ability (one-leg standing time with eyes open/closed, Functional Reach Test, and Timed Up & Go Test), flexibility (long sitting position toe-touching distance), walking speed (10-m maximum walking speed), and the antipsychotic drug intake. Results The walking speed was found to be correlated with the results of the 30-s chair stand test, the one-leg standing time with eyes open, the one-leg standing time with eyes closed, and the Timed Up & Go Test. Stepwise multiple regression analysis revealed that only the Timed Up & Go Test results affected walking speed. Conclusion In schizophrenia patients, walking speed is influenced by balance and lower-limb muscle force, just as it is for patients without mental diseases. In schizophrenia patients, the dynamic balance ability has a strong influence on the walking speed.
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Affiliation(s)
- Yoko Tsuji
- Division of Occupational Therapy, Department of Rehabilitation Sciences, Faculty of Allied Health Sciences, Kansai University of Welfare Sciences, Osaka, Japan
| | - Yoshiteru Akezaki
- Department of Rehabilitation, National Hospital Organization Shikoku Cancer Center, Ehime, Japan
| | - Hitomi Katsumura
- Ueno Hospital, General Incorporated Foundation Shigisan Hospital, Mie, Japan
| | - Tomihiro Hara
- Ueno Hospital, General Incorporated Foundation Shigisan Hospital, Mie, Japan
| | - Yuki Sawashita
- Ueno Hospital, General Incorporated Foundation Shigisan Hospital, Mie, Japan
| | - Hitoshi Kakizaki
- Ueno Hospital, General Incorporated Foundation Shigisan Hospital, Mie, Japan
| | - Kohei Mori
- Division of Occupational Therapy, Department of Rehabilitation Sciences, Faculty of Allied Health Sciences, Kansai University of Welfare Sciences, Osaka, Japan
| | - Yoshimi Yuri
- Division of Occupational Therapy, Department of Rehabilitation Sciences, Faculty of Allied Health Sciences, Kansai University of Welfare Sciences, Osaka, Japan
| | - Takuo Nomura
- Division of Occupational Therapy, Department of Rehabilitation Sciences, Faculty of Allied Health Sciences, Kansai University of Welfare Sciences, Osaka, Japan
| | - Fumio Hirao
- Ueno Hospital, General Incorporated Foundation Shigisan Hospital, Mie, Japan
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8
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Avelino PR, Menezes KKP, Nascimento LR, Faria-Fortini I, Faria CDCDM, Teixeira-Salmela LF. Walking speed best explains perceived locomotion ability in ambulatory people with chronic stroke, assessed by the ABILOCO questionnaire. Braz J Phys Ther 2018; 23:412-418. [PMID: 30598364 DOI: 10.1016/j.bjpt.2018.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 11/26/2018] [Accepted: 12/10/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The identification of the predictors of locomotion ability could help professionals select variables to be considered during clinical evaluations and interventions. OBJECTIVE To investigate which impairment measures would best predict locomotion ability in people with chronic stroke. METHODS Individuals (n=115) with a chronic stroke were assessed. Predictors were characteristics of the participants (i.e. age, sex, and time since stroke), motor impairments (i.e. muscle tonus, strength, and motor coordination), and activity limitation (i.e. walking speed). The outcome of interest was the ABILOCO scores, a self-reported questionnaire for the assessment of locomotion ability, designed specifically for individuals who have suffered a stroke. RESULTS Age, sex, and time since stroke did not significantly correlate with the ABILOCO scores (-0.07<ρ<0.05; 0.48<p<0.99). Measures of motor impairments and walking speed were significantly correlated with the ABILOCO scores (-0.25<r<0.57; p<0.001), but only walking speed and strength were kept in the regression model. Walking speed alone explained 35% (F=55.5; p<0.001) of the variance in self-reported locomotion ability. When strength was included in the model, the explained variance increased to 37% (F=31.4; p<0.001). CONCLUSIONS Walking speed and lower limb strength best predicted locomotion ability as perceived by individuals who have suffered a stroke.
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Affiliation(s)
- Patrick R Avelino
- NeuroGroup, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Kênia K P Menezes
- NeuroGroup, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Lucas Rodrigues Nascimento
- NeuroGroup, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil; Center of Health Sciences, Universidade Federal do Espírito Santo (UFES), Vitória, ES, Brazil
| | - Iza Faria-Fortini
- Discipline of Ocupational Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
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The Effects of a Motorized Aquatic Treadmill Exercise Program on Muscle Strength, Cardiorespiratory Fitness, and Clinical Function in Subacute Stroke Patients. Am J Phys Med Rehabil 2018. [DOI: 10.1097/phm.0000000000000920] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Menezes KKP, Nascimento LR, Faria CDCM, Avelino PR, Scianni AA, Polese JC, Faria-Fortini I, Teixeira-Salmela LF. Deficits in motor coordination of the paretic lower limb best explained activity limitations after stroke. Physiother Theory Pract 2018; 36:417-423. [DOI: 10.1080/09593985.2018.1488193] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Kênia KP Menezes
- NeuroGroup, Discipline of Physiotherapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Lucas R Nascimento
- NeuroGroup, Discipline of Physiotherapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Center of Health Sciences, Discipline of Physiotherapy, Universidade Federal do Espírito Santo, Vitória, Brazil
| | - Christina DCM Faria
- NeuroGroup, Discipline of Physiotherapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Patrick R Avelino
- NeuroGroup, Discipline of Physiotherapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Aline A Scianni
- NeuroGroup, Discipline of Physiotherapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Janaine C Polese
- NeuroGroup, Discipline of Physiotherapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Iza Faria-Fortini
- NeuroGroup, Discipline of Physiotherapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Luci F Teixeira-Salmela
- NeuroGroup, Discipline of Physiotherapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Akazawa N, Harada K, Okawa N, Tamura K, Hayase A, Moriyama H. Relationships between muscle mass, intramuscular adipose and fibrous tissues of the quadriceps, and gait independence in chronic stroke survivors: a cross-sectional study. Physiotherapy 2017; 104:438-445. [PMID: 29290379 DOI: 10.1016/j.physio.2017.08.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 08/12/2017] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To examine the relationships between muscle mass, intramuscular adipose and fibrous tissues of the quadriceps, and gait independence in chronic stroke survivors. DESIGN Cross-sectional study. SETTING Hospital-based research. PARTICIPANTS Seventeen chronic stroke survivors who were unable to walk independently (non-independent walker group) and 11 chronic stroke survivors who were able to walk independently (independent walker group) participated in this study. In addition, 25 healthy older adults (healthy group) were enrolled. INTERVENTIONS None. MAIN OUTCOME MEASURES The muscle mass and intramuscular adipose and fibrous tissues of the rectus femoris and vastus intermedius were assessed based on muscle thickness and echo intensity of ultrasound images, respectively. RESULTS The thicknesses of the rectus femoris and vastus intermedius on the paretic and non-paretic sides in the non-independent walker group were significantly lower than those in the healthy group (mean difference -0.5 to -0.2cm; P<0.001-0.037). The paretic side in the non-independent walker group had significantly higher rectus femoris and vastus intermedius echo intensity compared with the healthy group (mean difference 15.8-17.4; P=0.007-0.025). The thickness of the rectus femoris on the non-paretic side was significantly lower in the independent walker group than in the healthy group (mean difference -0.3cm; P=0.001). CONCLUSIONS These results suggest that chronic stroke survivors who are unable to walk independently are likely to experience secondary changes in skeletal muscle on both the paretic and non-paretic sides.
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Affiliation(s)
- Naoki Akazawa
- Department of Physical Therapy, Faculty of Health and Welfare, Tokushima Bunri University, Boji 180, Nishihama, Yamashiro-cho, Tokushima, Tokushima 770-8514, Japan.
| | - Kazuhiro Harada
- Department of Physical Therapy, Faculty of Health, Medical Care and Welfare, Kibi International University, Takahashi, Okayama, Japan
| | - Naomi Okawa
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Kimiyuki Tamura
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Atsushi Hayase
- Department of Rehabilitation, Tsuyama Chuo Hospital, Tsuyama, Okayama, Japan
| | - Hideki Moriyama
- Life and Medical Sciences Area, Health Sciences Discipline, Kobe University, Kobe, Hyogo, Japan
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12
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Yoshikawa K, Mizukami M, Kawamoto H, Sano A, Koseki K, Sano K, Asakawa Y, Kohno Y, Nakai K, Gosho M, Tsurushima H. Gait training with Hybrid Assistive Limb enhances the gait functions in subacute stroke patients: A pilot study. NeuroRehabilitation 2017; 40:87-97. [PMID: 27814305 DOI: 10.3233/nre-161393] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The robotic Hybrid Assistive Limb (HAL) provides motion according to the wearer's voluntary activity. HAL training effects on walking speed and capacity have not been clarified in subacute stroke. OBJECTIVES To determine improvement in walking ability by HAL and the most effective improvement measure for use in future large-scale trials. METHODS Sixteen first-ever hemiplegic stroke patients completed at least 20 sessions over 5 weeks. Per session, the experimental group received no more than 20 min of gait training with HAL (HT) and 40 min of conventional physiotherapy, whereas the control group received at least 60 min of conventional physiotherapy. Primary outcome was maximum walking speed (MWS). RESULTS The change in MWS from baseline at week 5 was 11.6±10.6 m/min (HAL group) and 2.2±4.1 m/min (control group) (adjusted mean difference = 9.24 m/min, 95% confidence interval 0.48-18.01, P = 0.040). In HAL subjects there were significant increases in Self-selected walking speed (SWS; a secondary outcome) and in step length (a secondary outcome) at MWS and SWS compared with controls. CONCLUSIONS HT improved walking speed in hemiplegic sub-acute stroke patients. In future, randomized controlled trials are needed to confirm the utility of HT.
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Affiliation(s)
- Kenichi Yoshikawa
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ami Ibaraki, Japan
| | - Masafumi Mizukami
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Ami Ibaraki, Japan
| | - Hiroaki Kawamoto
- Faculty of Systems and Information Engineering, University of Tsukuba, Tsukuba Ibaraki, Japan
| | - Ayumu Sano
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ami Ibaraki, Japan
| | - Kazunori Koseki
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ami Ibaraki, Japan
| | - Kumiko Sano
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ami Ibaraki, Japan
| | - Yasutsugu Asakawa
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Ami Ibaraki, Japan
| | - Yutaka Kohno
- Department of Neurology, Ibaraki Prefectural University of Health Sciences Hospital, Ami Ibaraki, Japan
| | - Kei Nakai
- Department of Neurology, Ibaraki Prefectural University of Health Sciences Hospital, Ami Ibaraki, Japan.,Faculty of Medicine, University of Tsukuba, Tsukuba Ibaraki, Japan
| | - Masahiko Gosho
- Department of Clinical Trial and Clinical Epidemiology, Faculty of Medicine, University of Tsukuba, Tsukuba Ibaraki, Japan
| | - Hideo Tsurushima
- Faculty of Medicine, University of Tsukuba, Tsukuba Ibaraki, Japan
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Tsuji Y, Akezaki Y, Mori K, Yuri Y, Katsumura H, Hara T, Usui Y, Fujino Y, Nomura T, Hirao F. Factors inducing falling in schizophrenia patients. J Phys Ther Sci 2017; 29:448-451. [PMID: 28356628 PMCID: PMC5361007 DOI: 10.1589/jpts.29.448] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 11/24/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study is to investigate the factors causing falling among
patients with schizophrenia hospitalized in psychiatric hospitals. [Subjects and Methods]
The study subjects were divided into either those having experienced a fall within the
past one year (Fall group, 12 patients) and those not having experienced a fall (Non-fall
group, 7 patients), and we examined differences between the two groups. Assessment items
measured included muscle strength, balance ability, flexibility, body composition
assessment, Global Assessment of Functioning scale (GAF), the antipsychotic drug intake,
and Drug Induced Extra-Pyramidal Symptoms Scale (DIEPSS). [Results] As a result,
significant differences were observed in regard to One leg standing time with eyes open,
Time Up and Go Test (TUGT), and DIEPSS Sialorrhea between the Fall group and the Non-fall
group. [Conclusion] These results suggest that a decrease in balance ability was
significantly correlated with falling in schizophrenia patients.
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Affiliation(s)
- Yoko Tsuji
- Division of Occupational Therapy, Department of Rehabilitation Sciences, Faculty of Allied Health Sciences, Kansai University of Welfare Sciences, Japan
| | - Yoshiteru Akezaki
- Department of Rehabilitation, National Hospital Organization Shikoku Cancer Center, Japan
| | - Kohei Mori
- Division of Occupational Therapy, Department of Rehabilitation Sciences, Faculty of Allied Health Sciences, Kansai University of Welfare Sciences, Japan
| | - Yoshimi Yuri
- Division of Occupational Therapy, Department of Rehabilitation Sciences, Faculty of Allied Health Sciences, Kansai University of Welfare Sciences, Japan
| | - Hitomi Katsumura
- Ueno Hospital, General Incorporated Foundation Shigisan Hospital, Japan
| | - Tomihiro Hara
- Ueno Hospital, General Incorporated Foundation Shigisan Hospital, Japan
| | - Yuki Usui
- Ueno Hospital, General Incorporated Foundation Shigisan Hospital, Japan
| | - Yoritaka Fujino
- Ueno Hospital, General Incorporated Foundation Shigisan Hospital, Japan
| | - Takuo Nomura
- Division of Occupational Therapy, Department of Rehabilitation Sciences, Faculty of Allied Health Sciences, Kansai University of Welfare Sciences, Japan
| | - Fumio Hirao
- Ueno Hospital, General Incorporated Foundation Shigisan Hospital, Japan
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Nozoe M, Kubo H, Furuichi A, Kanai M, Takashima S, Shimada S, Mase K. Validity of Quadriceps Muscle Thickness Measurement in Patients with Subacute Stroke during Hospitalization for Assessment of Muscle Wasting and Physical Function. J Stroke Cerebrovasc Dis 2017; 26:438-441. [DOI: 10.1016/j.jstrokecerebrovasdis.2016.10.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 09/22/2016] [Accepted: 10/10/2016] [Indexed: 11/29/2022] Open
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Lee SY, Sim MK, Do J, Jeong SY, Jeon JY. Pilot study of effective methods for measuring and stretching for pectoral muscle tightness in breast cancer patients. J Phys Ther Sci 2016; 28:3030-3035. [PMID: 27942114 PMCID: PMC5140794 DOI: 10.1589/jpts.28.3030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 07/19/2016] [Indexed: 12/01/2022] Open
Abstract
[Purpose] To evaluate differences in pectoral muscle tightness according to arm abduction
angle and to determine the best arm abduction angle for stretching of pectoral muscle
tightness in breast cancer patients. [Subjects and Methods] Horizontal abduction
differences of shoulders were measured bilaterally by arm abduction to 45°, 90°, and 135°
to determine the best arm abduction angle for measuring pectoral muscle tightness.
Thirty-two patients were divided into three pectoral muscle stretching groups (A: 45°, B:
90°, and C: 135°). We measured the shoulder range of motion, scores of the Disabilities of
the Arm, Shoulder, and Hand, European Organization for Research and Treatment of Cancer
Quality of Life Questionnaire and the Breast Module, and pain levels (using a visual
analog scale) before and after therapy. [Results] The differences in degree of horizontal
abduction between shoulders were significantly larger for arm abduction to 90° and 135°
than that to 45°. Groups B and C showed greater improvements in horizontal abduction
limitations than group A. [Conclusion] Horizontal abduction differences between shoulders
are prominent when arms are abducted to 90° and 135°. The appropriate arm abduction angle
for measuring horizontal abduction and effective stretching of pectoral muscle tightness
may be >90°.
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Affiliation(s)
- So Young Lee
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Republic of Korea; Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Republic of Korea
| | - Mi Kyung Sim
- Ilsan Median Rehabilitation Hospital, Republic of Korea; Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Republic of Korea
| | - Junghwa Do
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea
| | - Soon Young Jeong
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea
| | - Jae Yong Jeon
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea
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Gorgon EJR, Lazaro RT. Measurement properties of the upright motor control test for adults with stroke: a systematic review. Arch Physiother 2016; 6:13. [PMID: 29340194 PMCID: PMC5759892 DOI: 10.1186/s40945-016-0027-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 10/31/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The Upright Motor Control Test (UMCT) has been used in clinical practice and research to assess functional strength of the hemiparetic lower limb in adults with stroke. It is unclear if evidence is sufficient to warrant its use. The purpose of this systematic review was to synthesize available evidence on the measurement properties of the UMCT for stroke rehabilitation. METHODS Electronic databases that indexed biomedical literature were systematically searched from inception until October 2015 (week 4): Embase, PubMed, Web of Science, CINAHL, PEDro, Cochrane Library, Scopus, ScienceDirect, SPORTDiscus, LILACS, DOAJ, and Google Scholar. All studies that had used the UMCT in the time period covered underwent hand searching for any additional study. Observational studies involving adults with stroke that explored any measurement property of the UMCT were included. The COnsensus-based Standards for the selection of health Measurement INstruments was used to assess the methodological quality of included studies. The CanChild Outcome Measures Rating Form was used for extracting data on measurement properties and clinical utility. RESULTS The search yielded three methodologic studies that addressed criterion-related validity and contruct validity. Two studies of fair methodological quality demonstrated moderate-level evidence that Knee Extension and Knee Flexion subtest scores were predictive of community-level and household-level ambulation. One study of fair methodological quality provided limited-level evidence for the correlation of Knee Extension subtest scores with a laboratory measure of ground reaction forces. No published studies formally assessed reliability, responsiveness, or clinical utility. Limited information on responsiveness and clinical utility dimensions could be inferred from the included studies. CONCLUSIONS The UMCT is a practical assessment tool for voluntary control or functional strength of the hemiparetic lower limb in standing in adults with stroke. Although different levels of evidence suggest that the Knee Extension and Knee Flexion subtests may possess criterion and construct validity, the lack of published literature examining content validity, reliability, and responsiveness raises questions regarding the use of the UMCT in routine clinical practice. These key findings highlight the need to further investigate the UMCT's measurement properties toward enhancing its standardization.
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Affiliation(s)
- Edward James R. Gorgon
- Department of Physical Therapy, College of Allied Medical Professions, University of the Philippines, Pedro Gil Street, Malate, Manila 1004 Philippines
| | - Rolando T. Lazaro
- Department of Physical Therapy, Samuel Merritt University, 450 30th Street 3726, Oakland, CA 94609 USA
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Timed Up and Go test: Comparison of kinematics between patients with chronic stroke and healthy subjects. Gait Posture 2016; 49:258-263. [PMID: 27472822 DOI: 10.1016/j.gaitpost.2016.06.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 06/08/2016] [Accepted: 06/17/2016] [Indexed: 02/02/2023]
Abstract
Understanding locomotor behavior is important to guide rehabilitation after stroke. This study compared lower-limb kinematics during the walking and turning sub-tasks of the Timed Up and Go (TUG) test in stroke patients and healthy subjects. We also determined the parameters which explain TUG sub-task performance time in healthy subjects. Biomechanical parameters were recorded during the TUG in standardized conditions in 25 healthy individuals and 29 patients with chronic stroke using a 3D motion-analysis system. Parameters were compared between groups and a stepwise regression was used to indicate parameters which explained performance time in the healthy subjects. The percentage difference in step length between the last and first steps was calculated, during walking sub-tasks for each group. Speed, cadence, step length, percentage paretic single support phase, percentage non-paretic swing phase, peak hip extension, knee flexion and ankle dorsiflexion were significantly reduced in the Stroke group compared to the Healthy group (p<0.05). In the Healthy group, step length and cadence explained 91% of variance for Go and 86% for Return (walking sub-tasks), and none of the parameters explained the Turn. Previous study in patients with stroke showed that the same parameters explained the variance during the walking sub-tasks and balance-related parameters explained the Turn. The present results showed that step length was differently modulated in each group. Thus the locomotor behavior of patients with stroke during obstacle circumvention is quite specific in light of the results obtained in healthy subjects.
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Thoumie P, Lamotte D, Cantalloube S, Faucher M, Amarenco G. Motor determinants of gait in 100 ambulatory patients with multiple sclerosis. Mult Scler 2016; 11:485-91. [PMID: 16042234 DOI: 10.1191/1352458505ms1176oa] [Citation(s) in RCA: 138] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A prospective analysis of gait and strength parameters was performed in 100 patients diagnosed with MS and pyramidal involvement admitted in a rehabilitation unit. The patients were divided into two groups based on their ability to walk in daily life (nonassisted or cane-assisted gait) and into four clinical subgroups depending on associated involvements such as sensory loss or cerebellar ataxia. Twenty healthy subjects were studied as a control group. Gait parameters were evaluated with a Locometre and muscle strength with an isokinetic dynamometer. The results showed that the average velocity and strength of the hamstring and quadriceps were strongly correlated and reduced in the MS group in comparison with the control, and in the cane-assisted group compared with the nonassisted group. Gait velocity tended to be more correlated to hamstring strength in the nonassisted group with a determination coefficient (r2) reaching a value of 0.44 in the sensory subgroup. These findings provide evidence that a correlation between strength reduction and gait impairment is obvious whatever the clinical form in patients with MS. This correlation is higher with hamstrings but may change depending on the disability level and the clinical form. This could be taken into account in the individual assessment of further rehabilitation programmes.
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Affiliation(s)
- P Thoumie
- Service de Rééducation Neuro-Orthopédique and Inserm U731, Paris, France.
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Kollen B, Kwakkel G, Lindeman E. Longitudinal robustness of variables predicting independent gait following severe middle cerebral artery stroke: a prospective cohort study. Clin Rehabil 2016; 20:262-8. [PMID: 16634346 DOI: 10.1191/0269215506cr910oa] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To determine within the first 10 weeks post onset the most robust variables in the prediction of recovery of independent gait at six months post stroke. Design: A prospective cohort study. Subjects: One hundred and one first ever ischaemic middle cerebral artery stroke patients. None of these patients were able to walk at onset and all suffered from a marked hemiplegia. Setting: Twenty-four determinants, possibly related to recovery of gait at six months, were measured within 14 days following stroke onset. Based on Functional Ambulation Categories (FAC) independent gait was classified into present (FAC ≥ 4) or absent (FAC < 4). Bivariate logistic regression analysis was used to select determinants. Only significant determinants during the entire 10-week period were used for further weekly multivariate logistic prediction modelling of independent gait at six months post stroke. Results: After six months post onset 62% ( N = 63) regained independent gait. Age, Barthel Index, Trunk Control Test, Motricity Index of arm and leg, Brunnstrom Fugl-Meyer stage of leg motor recovery, and type of intervention were significant determinants in bivariate analysis, but age of patient and Barthel Index were the most robust determinants in the final prediction model. Weekly re-evaluation produced sensitivity values between 89% and 96% and specificity values between 53% and 62%. Conclusion: In initially non-ambulatory stroke patients age and Barthel Index were the most robust variables during the first 10-week poststroke period in the prediction of independent walking at six months. However, prediction of non-ambulation at six months proved to be less accurate.
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Dorsch S, Ada L, Canning CG. Lower Limb Strength Is Significantly Impaired in All Muscle Groups in Ambulatory People With Chronic Stroke: A Cross-Sectional Study. Arch Phys Med Rehabil 2016; 97:522-527. [DOI: 10.1016/j.apmr.2015.10.106] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 07/31/2015] [Accepted: 10/28/2015] [Indexed: 11/26/2022]
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Mizukami M, Yoshikawa K, Kawamoto H, Sano A, Koseki K, Asakwa Y, Iwamoto K, Nagata H, Tsurushima H, Nakai K, Marushima A, Sankai Y, Matsumura A. Gait training of subacute stroke patients using a hybrid assistive limb: a pilot study. Disabil Rehabil Assist Technol 2016; 12:197-204. [PMID: 27017889 DOI: 10.3109/17483107.2015.1129455] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Purpose To determine whether gait training with a hybrid assistive limb (HAL) as an exoskeleton robotic device was safe and could increase functional mobility and gait ability in subacute stroke patients. Methods The participants were eight patients with post-stroke hemiparesis whose walking impairment and gait recovery curves had plateaued. The intervention program was gait training using HAL and a walker for 20 min daily 5 days a week for 5 weeks. The 10-m maximum walking speed (MWS), self-selected walking speed (SWS) and 2-min-walk test (2MT) without HAL were used as primary outcome measures to determine the effects of training. The Berg Balance Scale (BBS), Fugl-Meyer Assessment of Motor Recovery after Stroke (FMA) and functional ambulation category (FAC) were assessed as secondary outcomes. These measures were assessed before and after the 5-week intervention program and were analyzed statistically using a paired t-test. Results All eight participants completed the intervention program with no adverse events. There were significant increases in MWS, SWS and 2MT. BBS, FMA and FAC also increased, but not significantly. Conclusion The new HAL exoskeleton robotic device was efficient and safe for improving motor function and gait in patients in the subacute stage after stroke. Implications for Rehabilitation Gait training using HAL will improve gait ability of individuals with post stroke. The HAL achieve intensive gait training without increase spasticity and abnormal gait pattern.
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Affiliation(s)
- Masafumi Mizukami
- a Department of Physical Therapy , Ibaraki Prefectural University of Health Sciences , Ami , Ibaraki , Japan
| | - Kenichi Yoshikawa
- b Department of Physical Therapy , Ibaraki Prefectural University of Health Sciences Hospital , Ami , Ibaraki , Japan
| | - Hiroaki Kawamoto
- c Faculty of Systems and Information Engineering, University of Tsukuba , Tsukuba , Ibaraki , Japan
| | - Ayumu Sano
- b Department of Physical Therapy , Ibaraki Prefectural University of Health Sciences Hospital , Ami , Ibaraki , Japan
| | - Kazunori Koseki
- b Department of Physical Therapy , Ibaraki Prefectural University of Health Sciences Hospital , Ami , Ibaraki , Japan
| | - Yasutsugu Asakwa
- a Department of Physical Therapy , Ibaraki Prefectural University of Health Sciences , Ami , Ibaraki , Japan
| | - Koji Iwamoto
- a Department of Physical Therapy , Ibaraki Prefectural University of Health Sciences , Ami , Ibaraki , Japan
| | - Hiroshi Nagata
- d Center for Medical Sciences, Ibaraki Prefectural University of Health Sciences , Ami , Ibaraki , Japan
| | - Hideo Tsurushima
- e Faculty of Medicine, University of Tsukuba , Tsukuba , Ibaraki , Japan
| | - Kei Nakai
- e Faculty of Medicine, University of Tsukuba , Tsukuba , Ibaraki , Japan
| | - Aiki Marushima
- e Faculty of Medicine, University of Tsukuba , Tsukuba , Ibaraki , Japan
| | - Yoshiyuki Sankai
- c Faculty of Systems and Information Engineering, University of Tsukuba , Tsukuba , Ibaraki , Japan
| | - Akira Matsumura
- e Faculty of Medicine, University of Tsukuba , Tsukuba , Ibaraki , Japan
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Park KH, Kim DY, Kim TH. The effect of step climbing exercise on balance and step length in chronic stroke patients. J Phys Ther Sci 2015; 27:3515-8. [PMID: 26696728 PMCID: PMC4681935 DOI: 10.1589/jpts.27.3515] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 08/19/2015] [Indexed: 11/28/2022] Open
Abstract
[Purpose] The objective of this study was to examine the effect of step climbing exercise
on the walking ability of stroke patients. [Subjects and Methods] Among hospitalized
stroke patients, 24 were selected based on the study criteria and randomly divided into
two groups: an experimental group (12 patients) and a control group (12 patients). The
patients in both groups participated in 15-minute exercise sessions three times a week for
eight weeks. To analyze the effect of the exercise, muscle strength, the Timed Up and Go
test, and step length were measured before and after the exercise. [Results] step climbing
exercise improved the muscle strength in the lower limbs of the stroke patients, as well
as their Timed Up and Go results and step lengths. [Conclusion] The effects were similar
to a stair gait exercise, and thus, step climbing may be more broadly applied to the
treatment of stroke patients.
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Affiliation(s)
- Ki-Hyeon Park
- Department of Physical Therapy, College of Rehabilitation Science, Daegu University, Republic of Korea
| | - Da-Yeon Kim
- Department of Physical Therapy, College of Rehabilitation Science, Daegu University, Republic of Korea
| | - Tae-Ho Kim
- Department of Physical Therapy, College of Rehabilitation Science, Daegu University, Republic of Korea
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Watanabe M, Suzuki M, Sugimura Y, Kawaguchi T, Watanabe A, Shibata K, Fukuda M. The relationship between bilateral knee muscle strength and gait performance after stroke: the predictive value for gait performance. J Phys Ther Sci 2015; 27:3227-32. [PMID: 26644680 PMCID: PMC4668171 DOI: 10.1589/jpts.27.3227] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 07/16/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to assess the relationships between bilateral
knee extension strengths and gait performance in subjects with poststroke hemiparesis and
to predict gait performance by the paretic and nonparetic knee extension strength.
[Subjects and Methods] This was a correlational study in which 238 consecutive inpatients
with poststroke hemiparesis were enrolled. Knee extensor muscle strengths in paretic and
nonparetic lower limbs were measured with a handheld dynamometer, and the presence or
absence of impaired gait was also determined. [Results] The mean strength in the paretic
lower limb was 0.90 Nm/kg, and that in the nonparetic lower limb was 1.24 Nm/kg.
Discriminant analysis classified the difference between the possibility and impossibility
of gait by knee extensor muscle strength (standardized discriminant coefficient: paretic,
1.32; nonparetic, 0.55). Thus, paretic and nonparetic knee extension strengths were
integrated in the strength index. A threshold level of 2.0 provided the best balance
between positive and negative predictive values for the strength index. [Conclusion] The
results indicated that both paretic and nonparetic knee extension strengths were related
to gait performance. The strength index deduced from bilateral knee extension strengths
may serve as a clinically meaningful index for rehabilitation assessment and training.
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Affiliation(s)
- Makoto Watanabe
- School of Allied Health Sciences, Kitasato University, Japan
| | - Makoto Suzuki
- School of Allied Health Sciences, Kitasato University, Japan ; Graduate School of Medical Sciences, Kitasato University, Japan
| | - Yuko Sugimura
- Department of Rehabilitation Medicine, Kawasaki Municipal Tama Hospital, Japan
| | - Takayuki Kawaguchi
- School of Allied Health Sciences, Kitasato University, Japan ; Graduate School of Medical Sciences, Kitasato University, Japan
| | - Aki Watanabe
- School of Allied Health Sciences, Kitasato University, Japan ; Graduate School of Medical Sciences, Kitasato University, Japan
| | - Kazuhiko Shibata
- Graduate School of Medical Sciences, Kitasato University, Japan ; Department of Rehabilitation Medicine, Sagamihara Chuo Hospital, Japan
| | - Michinari Fukuda
- School of Allied Health Sciences, Kitasato University, Japan ; Graduate School of Medical Sciences, Kitasato University, Japan
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Hyun CW, Han EY, Im SH, Choi JC, Kim BR, Yoon HM, Lee YK. Hemiparetic Knee Extensor Strength and Balance Function Are Predictors of Ambulatory Function in Subacute Stroke Patients. Ann Rehabil Med 2015; 39:577-85. [PMID: 26361594 PMCID: PMC4564705 DOI: 10.5535/arm.2015.39.4.577] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 12/31/2014] [Indexed: 12/04/2022] Open
Abstract
Objective To identify the potential predictors of ambulatory function in subacute stroke patients, and to determine the contributing factors according to gait severity. Methods Fifty-three subacute stroke patents were enrolled. Ambulatory function was assessed by gait speed and endurance. Balance function was evaluated by the Berg Balance Scale score (BBS) and the Timed Up and Go test (TUG). The isometric muscular strengths of bilateral knee extensors and flexors were measured using an isokinetic dynamometer. Cardiovascular fitness was evaluated using an expired gas analyzer. Participants were assigned into the household ambulator group (<0.4 m/s) or the community ambulator group (≥0.4 m/s) based on gait severity. Results In the linear regression analyses of all patients, paretic knee isometric extensor strength (p=0.007) and BBS (p<0.001) were independent predictors of gait endurance (R2=0.668). TUG (p<0.001) and BBS (p=0.037) were independent predictors of gait speed (R2=0.671). Paretic isometric extensor strength was a predictor of gait endurance (R2=0.340, p=0.008). TUG was a predictor of gait speed (R2=0.404, p<0.001) in the household ambulator group, whereas BBS was a predictive factor of gait endurance (R2=0.598, p=0.008) and speed (R2=0.713, p=0.006). TUG was a predictor of gait speed (R2=0.713, p=0.004) in the community ambulator group. Conclusion Our results reveal that balance function and knee extensor isometric strength were strong predictors of ambulatory function in subacute stroke patients. However, they work differently according to gait severity. Therefore, a comprehensive functional assessment and a different therapeutic approach should be provided depending on gait severity in subacute stroke patients.
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Affiliation(s)
- Chul Woong Hyun
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Eun Young Han
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Sang Hee Im
- Department of Rehabilitation Medicine, CHA Bundang Hospital, Seongnam, Korea
| | - Jay Chol Choi
- Department of Neurology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Bo Ryun Kim
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Ho Min Yoon
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Yong Ki Lee
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
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Bonnyaud C, Pradon D, Vuillerme N, Bensmail D, Roche N. Spatiotemporal and Kinematic Parameters Relating to Oriented Gait and Turn Performance in Patients with Chronic Stroke. PLoS One 2015; 10:e0129821. [PMID: 26091555 PMCID: PMC4474885 DOI: 10.1371/journal.pone.0129821] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 05/13/2015] [Indexed: 11/19/2022] Open
Abstract
Background The timed up and go test (TUG) is a functional test which is increasingly used to evaluate patients with stroke. The outcome measured is usually global TUG performance-time. Assessment of spatiotemporal and kinematic parameters during the Oriented gait and Turn sub-tasks of the TUG would provide a better understanding of the mechanisms underlying patients’ performance and therefore may help to guide rehabilitation. The aim of this study was thus to determine the spatiotemporal and kinematic parameters which were most related to the walking and turning sub-tasks of TUG performance in stroke patients. Methods 29 stroke patients carried out the TUG test which was recorded using an optoelectronic system in two conditions: spontaneous and standardized condition (standardized foot position and instructed to turn towards the paretic side). They also underwent a clinical assessment. Stepwise regression was used to determine the parameters most related to Oriented gait and Turn sub-tasks. Relationships between explanatory parameters of Oriented gait and Turn performance and clinical scales were evaluated using Spearman correlations. Results Step length and cadence explained 82% to 95% of the variance for the walking sub-tasks in both conditions. Percentage single support phase and contralateral swing phase (depending on the condition) respectively explained 27% and 56% of the variance during the turning sub-task in the spontaneous and standardized conditions. Discussion and Conclusion Step length, cadence, percentage of paretic single support phase and non-paretic swing phase, as well as dynamic stability were the main parameters related to TUG performance and they should be targeted in rehabilitation.
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Affiliation(s)
- Céline Bonnyaud
- Inserm Unit 1179, Team 3: Technologies and Innovative Therapies Applied to Neuromuscular diseases, UVSQ, CIC 805, APHP Service de physiologie et d’exploration fonctionnelle, Hôpital Raymond Poincaré, 92380, Garches, France
- * E-mail:
| | - Didier Pradon
- Inserm Unit 1179, Team 3: Technologies and Innovative Therapies Applied to Neuromuscular diseases, UVSQ, CIC 805, APHP Service de physiologie et d’exploration fonctionnelle, Hôpital Raymond Poincaré, 92380, Garches, France
| | - Nicolas Vuillerme
- Univ. Grenoble Alpes Laboratoire AGIM, La Tronche, France
- Institut Universitaire de France, Paris, France
| | - Djamel Bensmail
- Inserm Unit 1179, Team 3: Technologies and Innovative Therapies Applied to Neuromuscular diseases, UVSQ, CIC 805, APHP Service de Médecine Physique et Réadaptation, Hôpital R. Poincaré, AP-HP, Garches, France
| | - Nicolas Roche
- Inserm Unit 1179, Team 3: Technologies and Innovative Therapies Applied to Neuromuscular diseases, UVSQ, CIC 805, APHP Service de physiologie et d’exploration fonctionnelle, Hôpital Raymond Poincaré, 92380, Garches, France
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Won JI, An CM. Knee Strength and Ankle Range of Motion Influencing Gait Velocity and Gait Asymmetry in Patients With Chronic Stroke. ACTA ACUST UNITED AC 2015. [DOI: 10.12674/ptk.2015.22.2.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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You YY, Chung SH. The effects of gait velocity on the gait characteristics of hemiplegic patients. J Phys Ther Sci 2015; 27:921-4. [PMID: 25931759 PMCID: PMC4395743 DOI: 10.1589/jpts.27.921] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 11/19/2014] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The present study investigated the effects of gait speed on temporal and
spatial gait characteristics of hemiplegic stroke patients. [Subjects and Methods] Twenty
post-stroke hemiplegic patients participated in the present study. To enhance the
reliability of the analysis of the gait characteristics, the assessments were conducted
three days per week at the same time every day. Each subject walked maintaining a
comfortable speed for the first minute, and measurement was conducted for 30 seconds at a
treadmill speed of 1 km/hour thereafter. Then, the subjects walked at a treadmill speed of
2 km/hour for 30 seconds after a 30-minute rest. The differences in the measurements were
tested for significance using the paired t-test. [Results] The measures of foot rotation,
step width, load response, mid stance, pre-swing, swing phase, and double stance phase
showed significant difference between the gait velocities. [Conclusion] The present study
provides basic data for gait velocity changes for hemiplegic patients.
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Affiliation(s)
- Young Youl You
- Department of Rehabilitation Medicine, Bronco Memorial Hospital, Republic of Korea
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Locomotion Improvement Using a Hybrid Assistive Limb in Recovery Phase Stroke Patients: A Randomized Controlled Pilot Study. Arch Phys Med Rehabil 2014; 95:2006-12. [DOI: 10.1016/j.apmr.2014.07.002] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 06/18/2014] [Accepted: 07/01/2014] [Indexed: 12/16/2022]
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Dyer JO, Maupas E, de Andrade Melo S, Bourbonnais D, Nadeau S, Forget R. Changes in activation timing of knee and ankle extensors during gait are related to changes in heteronymous spinal pathways after stroke. J Neuroeng Rehabil 2014; 11:148. [PMID: 25343962 PMCID: PMC4271343 DOI: 10.1186/1743-0003-11-148] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 10/12/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Extensor synergy is often observed in the paretic leg of stroke patients. Extensor synergy consists of an abnormal stereotyped co-activation of the leg extensors as patients attempt to move. As a component of this synergy, the simultaneous activation of knee and ankle extensors in the paretic leg during stance often affects gait pattern after stroke. The mechanisms involved in extensor synergy are still unclear. The first objective of this study is to compare the co-activation of knee and ankle extensors during the stance phase of gait between stroke and healthy individuals. The second objective is to explore whether this co-activation is related to changes in heteronymous spinal modulations between quadriceps and soleus muscles on the paretic side in post-stroke individuals. METHODS Thirteen stroke patients and ten healthy individuals participated in gait and heteronymous spinal modulation evaluations. Co-activation was measured using peak EMG activation intervals (PAI) and co-activation amplitude indexes (CAI) between knee and ankle extensors during the stance phase of gait in both groups. The evaluation of heteronymous spinal modulations was performed on the paretic leg in stroke participants and on one leg in healthy participants. This evaluation involved assessing the early facilitation and later inhibition of soleus voluntary EMG induced by femoral nerve stimulation. RESULTS All PAI were lower and most CAI were higher on the paretic side of stroke participants compared with the co-activation indexes among control participants. CAI and PAI were moderately correlated with increased heteronymous facilitation of soleus on the paretic side in stroke individuals. CONCLUSIONS Increased co-activation of knee and ankle extensors during gait is related to changes in intersegmental facilitative pathways linking quadriceps to soleus on the paretic side in stroke individuals. Malfunction of intersegmental pathways could contribute to abnormal timing of leg extensors during the stance phase of gait in hemiparetic individuals.
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Affiliation(s)
- Joseph-Omer Dyer
- Centre de recherche interdisciplinaire en réadaptation, Institut de réadaptation Gingras-Lindsay de Montréal, Montréal, Canada.
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Nonparetic knee extensor strength is the determinant of exercise capacity of community-dwelling stroke survivors. ScientificWorldJournal 2014; 2014:769875. [PMID: 25197712 PMCID: PMC4150499 DOI: 10.1155/2014/769875] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Accepted: 08/01/2014] [Indexed: 11/17/2022] Open
Abstract
Objective. To investigate the relationship among walking speed, exercise capacity, and leg strength in community dwelling stroke subjects and to evaluate which one was the leading determinant factor of them. Design. This is a descriptive, cross-sectional study. Thirty-five chronic stroke patients who were able to walk independently in their community were enrolled. Walking speed was evaluated by using the 12-meter walking test. A maximal exercise test was used to determine the stroke subjects' exercise capacity. Knee extensor strength, measured as isokinetic torque, was assessed by isokinetic dynamometer. Results. The main walking speed of our subjects was 0.52 m/s. Peak oxygen uptake (VO2 peak) was 1.21 ± 0.43 L/min. Knee extensor strength, no matter whether paretic or nonparetic side, was significantly correlated to 12-meter walking speed and exercise capacity. Linear regression also showed the strength of the affected knee extensor was the determinant of walking speed and that of the nonparetic knee extensor was the determinant of exercise capacity in community dwelling stroke subjects. Conclusions. Walking speed and peak oxygen uptake were markedly decreased after stroke. Knee extensor strength of nonparetic leg was the most important determinant of exercise capacity of the community-dwelling stroke subjects. Knee extensor strengthening should be emphasized to help stroke patient to achieve optimal community living.
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Clinical and biomechanical factors which predict timed up and down stairs test performance in hemiparetic patients. Gait Posture 2013; 38:466-70. [PMID: 23433546 DOI: 10.1016/j.gaitpost.2013.01.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 11/30/2012] [Accepted: 01/18/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND PURPOSE The ability to ascend and descend a flight of stairs is considered as one of the best predictors of free-living activity and is correlated with domestic extrinsic activity in hemiparetic patients. However, the relationship between timed-stair performance and clinical and biomechanical parameters has never been studied this population. The aim of this study was to determine if performance on the Timed Up and Down Stairs (TUDS) test was related to clinical variables (maximal gait speed, strength and spasticity) and to biomechanical gait parameters (spatio-temporal, kinematic and kinetic gait parameters) in hemiparetic patients. METHODS Sixty hemiparetic patients performed the TUDS test, underwent 3D gait-analysis and a clinical assessment. Pearson's correlations and two stepwise multiple linear regression analyses were carried out to identify the parameters which were the most highly correlated with TUDS test performance among the clinical variables and gait parameters on the paretic side. RESULTS Maximal walking speed on the 10-m walk test and strength of the ankle dorsiflexors were the clinical variables that were the most related to TUDS test performance (63% of variance explained). The percentage of single support phase on the paretic side was the biomechanical gait parameter which was the most related to TUDS test performance (58% of variance explained). CONCLUSION The results of this study identified three parameters which predicted the performance to ascend and descend a flight of stairs as fast as possible in hemiparetic patients. Rehabilitation programs which aim to improve stair performance and independence in daily life activities should focus on these three parameters.
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Comparative study: Parameters of gait in Down syndrome versus matched obese and healthy children. EGYPTIAN JOURNAL OF MEDICAL HUMAN GENETICS 2013. [DOI: 10.1016/j.ejmhg.2012.11.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Lee JH, Kim HJ. Effect of exercise program using mirrors for stroke patients. INTERNATIONAL JOURNAL OF CONTENTS 2013. [DOI: 10.5392/ijoc.2013.9.1.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Capó-Lugo CE, Mullens CH, Brown DA. Maximum walking speeds obtained using treadmill and overground robot system in persons with post-stroke hemiplegia. J Neuroeng Rehabil 2012; 9:80. [PMID: 23057500 PMCID: PMC3539927 DOI: 10.1186/1743-0003-9-80] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Accepted: 10/01/2012] [Indexed: 11/18/2022] Open
Abstract
Background Previous studies demonstrated that stroke survivors have a limited capacity to increase their walking speeds beyond their self-selected maximum walking speed (SMWS). The purpose of this study was to determine the capacity of stroke survivors to reach faster speeds than their SMWS while walking on a treadmill belt or while being pushed by a robotic system (i.e. “push mode”). Methods Eighteen chronic stroke survivors with hemiplegia were involved in the study. We calculated their self-selected comfortable walking speed (SCWS) and SMWS overground using a 5-meter walk test (5-MWT). Then, they were exposed to walking at increased speeds, on a treadmill and while in “push mode” in an overground robotic device, the KineAssist, until they were tested at a speed that they could not sustain without losing balance. We recorded the time and number of steps during each trial and calculated gait speed, average cadence and average step length. Results Maximum walking speed in the “push mode” was 13% higher than the maximum walking speed on the treadmill and both were higher (“push mode”: 61%; treadmill: 40%) than the maximum walking speed overground. Subjects achieved these faster speeds by initially increasing both step length and cadence and, once individuals stopped increasing their step length, by only increasing cadence. Conclusions With post-stroke hemiplegia, individuals are able to walk at faster speeds than their SMWS overground, when provided with a safe environment that provides external forces that requires them to attempt dynamic stability maintenance at higher gait speeds. Therefore, this study suggests the possibility that, given the appropriate conditions, people post-stroke can be trained at higher speeds than previously attempted.
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Affiliation(s)
- Carmen E Capó-Lugo
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL 60611, USA.
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Pennycott A, Wyss D, Vallery H, Klamroth-Marganska V, Riener R. Towards more effective robotic gait training for stroke rehabilitation: a review. J Neuroeng Rehabil 2012; 9:65. [PMID: 22953989 PMCID: PMC3481425 DOI: 10.1186/1743-0003-9-65] [Citation(s) in RCA: 110] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Accepted: 08/29/2012] [Indexed: 01/19/2023] Open
Abstract
Background Stroke is the most common cause of disability in the developed world and can severely degrade walking function. Robot-driven gait therapy can provide assistance to patients during training and offers a number of advantages over other forms of therapy. These potential benefits do not, however, seem to have been fully realised as of yet in clinical practice. Objectives This review determines ways in which robot-driven gait technology could be improved in order to achieve better outcomes in gait rehabilitation. Methods The literature on gait impairments caused by stroke is reviewed, followed by research detailing the different pathways to recovery. The outcomes of clinical trials investigating robot-driven gait therapy are then examined. Finally, an analysis of the literature focused on the technical features of the robot-based devices is presented. This review thus combines both clinical and technical aspects in order to determine the routes by which robot-driven gait therapy could be further developed. Conclusions Active subject participation in robot-driven gait therapy is vital to many of the potential recovery pathways and is therefore an important feature of gait training. Higher levels of subject participation and challenge could be promoted through designs with a high emphasis on robotic transparency and sufficient degrees of freedom to allow other aspects of gait such as balance to be incorporated.
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Miura M, Seki K, Ito O, Handa Y, Kohzuki M. Functional Changes in the Care-needing Elderly after Surface Electrical Stimulation to the Abdomen. JOURNAL OF THE JAPANESE PHYSICAL THERAPY ASSOCIATION 2012; 15:15-20. [PMID: 25792897 DOI: 10.1298/jjpta.vol15_003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Accepted: 09/13/2012] [Indexed: 11/23/2022]
Abstract
BACKGROUND Strength of the trunk muscles is a key component of motor control, but it declines easily with the process of aging and/or disuse. OBJECTIVES To investigate the effects of surface electrical stimulation (ES) to the abdominal muscles and the motor performance for care-needing elderly. DESIGN Controlled trial. PARTICIPANTS Twenty-one elderly people (60-90 years) with care-needing, who were admitted to a nursing home or hospital for daily care and their score of Barthel Index had been stable from 55.3 ± 19.4 to 55.3 ± 19.8 during 3 months before intervention. INTERVENTION Common physical/occupational therapy was performed for all of the subjects during the study period. ES was applied to the abdomen of 15 subjects (ES group) twice a day for 8 weeks. MEASUREMENTS Functional measurements were performed before and after beginning of the study with some parameters as follows: grip strength; movement time for sitting up (MSU); maximum walking speed (WS). RESULTS No significant differences between two groups were noted for characteristics at baseline. In the ES group, MSU (from 21.1 ± 21.4 to 10.4 ± 8.3 sec) significantly improved (p < 0.05) after 8weeks. WS (from 17.7 ± 12.1 to 24.3 ± 15.3 m/min) were also improved (p < 0.05) after 8 weeks. LIMITATIONS A limitation of this study was the small sample size. CONCLUSIONS ES to the abdominal area has the potential to improve motor function in the care-needing elderly through reinforcement of the abdominal muscles.
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Affiliation(s)
- Misa Miura
- Department of Internal Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Osamu Ito
- Department of Internal Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yasunobu Handa
- Division of Developmental Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masahiro Kohzuki
- Department of Internal Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai, Japan
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Doğğan A, MengüllüoĞĞlu M, Özgirgin N. Evaluation of the effect of ankle-foot orthosis use on balance and mobility in hemiparetic stroke patients. Disabil Rehabil 2011; 33:1433-9. [DOI: 10.3109/09638288.2010.533243] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Regaining poststroke mobility is considered a primary goal of the stroke patient in early rehabilitation. Predictive recovery of poststroke mobility is clinically important, and provides important information to healthcare professionals, patients and their families. We conducted a systematic review aimed at identifying the predictive or associated baseline factors, assessed within one-week of stroke onset, and the recovery of poststroke mobility within 30 days. A comprehensive search strategy was applied to all major electronic databases to identify potentially relevant studies. Included in the review are two studies that evaluate the predictive value of baseline factors by developing a prognostic model, and three studies that assess the baseline factors that were associated with the outcome by univariate analysis. Walking is the most commonly assessed mobility outcome; age, the severity of paresis, reduced leg power, presence of hemianopia, size of brain lesion and type of stroke were shown to be predictive or associated with walking within 30 days poststroke. This review has identified the potential predictors of the recovery of mobility poststroke. There is a need to explore and validate these predictors in other patient cohorts, and consider additional factors believed to be associated with mobility. The recovery of mobility other than walking also needs investigation. In order to move prognostic research in stroke forward, a collaborative approach to sharing and collecting data is recommended.
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Affiliation(s)
- Louise E. Craig
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Olivia Wu
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Julie Bernhardt
- National Stroke Research Institute (part of Florey Neuroscience Institutes), Melbourne, Australia
| | - Peter Langhorne
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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40
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Lee G, Song C, Lee Y, Cho H, Lee S. Effects of Motor Imagery Training on Gait Ability of Patients with Chronic Stroke. J Phys Ther Sci 2011. [DOI: 10.1589/jpts.23.197] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- GyuChang Lee
- Department of Physical Therapy, Sahmyook University
| | - ChangHo Song
- Department of Physical Therapy, Sahmyook University
| | - YongWoo Lee
- Department of Physical Therapy, Sahmyook University
| | - HwiYoung Cho
- Department of Physical Therapy, Sahmyook University
| | - SeungWon Lee
- Department of Physical Therapy, Sahmyook University
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Nasciutti-Prudente C, Oliveira FG, Houri SF, de Paula Goulart FR, Neto MH, Teixeira-Salmela LF. Relationships between muscular torque and gait speed in chronic hemiparetic subjects. Disabil Rehabil 2009; 31:103-8. [DOI: 10.1080/09638280701818055] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Nardone A, Godi M, Grasso M, Guglielmetti S, Schieppati M. Stabilometry is a predictor of gait performance in chronic hemiparetic stroke patients. Gait Posture 2009; 30:5-10. [PMID: 19318253 DOI: 10.1016/j.gaitpost.2009.02.006] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2008] [Revised: 02/11/2009] [Accepted: 02/14/2009] [Indexed: 02/02/2023]
Abstract
In patients with spastic hemiparesis, centre of foot pressure (CoP) is shifted toward the unaffected limb during quiet stance. We hypothesised that abnormal gait features would correlate with the degree of asymmetry during stance. In 15 patients and 17 normals we recorded CoP and body sway by a force platform and measured spatial-temporal variables of gait with pedobarography. In patients CoP was shifted toward the unaffected limb and sway was larger than in normals. CoP position was associated with the decrease in strength of the affected lower-limb muscles. Spatio-temporal variables of gait were also affected by the disease. Cadence and velocity were decreased, duration of single support on the unaffected limb and of double support were increased with respect to normals. The degree of impairment of gait variables correlated with CoP. We found a negative relationship between velocity or cadence and CoP, and a positive relationship between duration of single support and CoP in the unaffected but not in the affected limb. Duration of double support correlated positively with CoP. CoP asymmetry during both standing and walking suggests that postural and gait problems share some common neural origin in hemiparetic patients. This asymmetry affects gait performance by increasing the time and effort needed to shift body weight toward the affected limb. The degree of postural asymmetry measured by stabilometry is associated with the level of impairment of gait variables.
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Affiliation(s)
- Antonio Nardone
- Fondazione Salvatore Maugeri (IRCCS), Scientific Institute of Veruno (NO), Posture and Movement Laboratory, 28010 Veruno (No), Italy
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Jonsdottir J, Recalcati M, Rabuffetti M, Casiraghi A, Boccardi S, Ferrarin M. Functional resources to increase gait speed in people with stroke: strategies adopted compared to healthy controls. Gait Posture 2009; 29:355-9. [PMID: 19211250 DOI: 10.1016/j.gaitpost.2009.01.008] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Revised: 09/16/2008] [Accepted: 01/08/2009] [Indexed: 02/02/2023]
Abstract
Thirty-nine adult individuals with stroke in the stable phase were asked to walk at their preferred speed and then as fast as possible. A set of gait indexes were computed, including spatial temporal parameters, ankle and hip mechanical work, and timing of ankle push-off onset, for comparison with normal velocity-dependent profiles. Algorithms were used to classify the resulting gait patterns when the patients walked at their preferred speed and fast and to identify the patients' strategies to maximise speed. Patients' strategies were characterised by a variation in the parameters, which were reduced, equal or increased, in relation to normal patterns. At both speeds, stroke individuals tended to walk at higher cadence and with shorter stride length. At the preferred speed the investigated parameters for all patients were mostly within the normal profile (71.8-94.9%). The exception was the finding of positive work at the ankle where 64% of the stroke individuals showed reduced work production. At fast speed (increments to 36%BH/s) fewer patients presented values within the normal profile for all the parameters (17.9-74.4%), with the exception of negative work at the ankle and hip. The parameter variations showed a more consistently abnormal picture. The results indicate that, in order to increase gait speed, patients with hemiparesis have different functional resources on which to draw, and these vary from individual to individual. Thus, gait analysis at different gait speed should be adopted to develop individualised programs that will improve quality of life for the patients.
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Affiliation(s)
- J Jonsdottir
- Fondazione Don C. Gnocchi ONLUS, IRCCS S. Maria Nascente, Milano, Italy
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Fujisawa T, Takuma S, Koseki H, Kimura K, Fukushima K. Study on the usefulness of precise and simple dynamic balance tests for the evaluation of recovery from intravenous sedation with midazolam and propofol. Eur J Anaesthesiol 2006; 24:425-30. [PMID: 17156507 DOI: 10.1017/s0265021506001876] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND AND OBJECTIVE Dynamic balance involving movement of the centre of gravity is important for the evaluation of street fitness after sedation. The purpose of this study was to compare the recovery of dynamic balance after intravenous sedation with propofol or midazolam, and to investigate the usefulness of simple dynamic balance tests in evaluating the recovery. METHODS Fourteen young male volunteers underwent intravenous sedation with propofol and midazolam for 1 h each at an interval of more than 1 week. Computerized dynamic posturography using a multi-axial tilting platform, the 10-m maximum-speed walking test and the timed 'up & go' test (subjects stand up from a chair, walk 5 m and back with maximum speed and sit down again) were performed before and after sedation. The increase in each variable of the tests described above represents a reduction of function. RESULTS The score of the computerized dynamic posturography was significantly lower in propofol sedation than that in midazolam sedation until 40 min after the end of sedation (P = 0.006). The scores of maximum-speed walking test and timed 'up & go' test were significantly lower in propofol sedation than those in midazolam sedation till 60 min after the end of sedation, respectively (P = 0.035 and 0.042). The timed 'up & go' and maximum-speed walking tests were well and significantly correlated with computerized dynamic posturography in midazolam sedation (timed 'up & go' test vs. computerized dynamic posturography: r = 0.66, P < 0.01; and maximum-speed walking test vs. computerized dynamic posturography: r = 0.53, P < 0.01). CONCLUSION The timed 'up & go' and maximum-speed walking tests are useful simple dynamic balance tests well correlated with precise computerized dynamic posturography for the evaluation of the recovery of dynamic balance from midazolam sedation in younger adults.
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Affiliation(s)
- T Fujisawa
- Hokkaido University, Graduate School of Dental Medicine, Department of Dental Anesthesiology, Sapporo, Japan.
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Flansbjer UB, Downham D, Lexell J. Knee Muscle Strength, Gait Performance, and Perceived Participation After Stroke. Arch Phys Med Rehabil 2006; 87:974-80. [PMID: 16813786 DOI: 10.1016/j.apmr.2006.03.008] [Citation(s) in RCA: 119] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2005] [Revised: 02/13/2006] [Accepted: 03/06/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To assess the relation between knee muscle strength, gait performance, and perceived participation in subjects with chronic mild to moderate poststroke hemiparesis. DESIGN Descriptive analysis of convenience sample. SETTING University hospital. PARTICIPANTS Fifty men and women (mean age, 58+/-6.4y) 6 to 46 months poststroke. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Isokinetic concentric knee extension and flexion strength was measured at 60 degrees /s. Gait performance was assessed by Timed Up & Go, comfortable and fast gait speed, stair climbing ascend and descend, and 6-minute walk test. Perceived participation was assessed with the Stroke Impact Scale. RESULTS There was a significant correlation (P < .01) between knee muscle strength and gait performance for the paretic but not for the nonparetic lower limb. Strength for the paretic limb explained 34% to 50% of the variance in gait performance; the addition of strength for the nonparetic limb explained at most a further 11% of the variance in gait performance. There was a significant correlation (P < .01) between gait performance and perceived participation; gait performance explained 28% to 40% of the variance in perceived participation. CONCLUSIONS Knee muscle strength is a moderate to strong predictor of walking ability in individuals with chronic mild to moderate poststroke hemiparesis. Walking ability influences perceived participation, but the strengths of the relations indicate that other factors are also important.
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Lin SI. Motor function and joint position sense in relation to gait performance in chronic stroke patients. Arch Phys Med Rehabil 2005; 86:197-203. [PMID: 15706543 DOI: 10.1016/j.apmr.2004.05.009] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To determine the association between joint position sense (JPS) and motor function of the lower extremity and gait performance of patients with chronic stroke. DESIGN Single-group cross-sectional design. SETTING University gait laboratory. PARTICIPANTS Twenty-one patients with stroke onset of more than 6 months. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The isometric strength, Fugl-Meyer Assessment (FMA) motor status, and JPS of the lower extremity were tested. Spatiotemporal gait characteristics were measured using a 6-camera motion analysis system, with patients walking at their comfortable speeds while using their usual devices. RESULTS Lower-extremity muscle strength and FMA motor score correlated significantly with the spatiotemporal characteristics of gait and contributed significantly to the variance in gait velocity, stride length, and double-stance time. The JPS was not related to gait performance, except that the ankle JPS contributed significantly to the variance in gait velocity and stride length. CONCLUSIONS For patients with chronic stroke, motor function was significantly related to gait performance. Although the JPS was not, that of the ankle joint made a significant contribution. When enhancing gait performance is desired, improving the motor function is recommended, and the role of JPS should also be taken into consideration.
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Affiliation(s)
- Sang-I Lin
- Department of Physical Therapy, National Cheng Kung University, Tainan.
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Newsam CJ, Baker LL. Effect of an electric stimulation facilitation program on quadriceps motor unit recruitment after stroke. Arch Phys Med Rehabil 2005; 85:2040-5. [PMID: 15605345 DOI: 10.1016/j.apmr.2004.02.029] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To compare maximum voluntary isometric torque (MVIT) and motor unit recruitment of the quadriceps after an electric stimulation facilitation program in persons affected by cerebrovascular accident (CVA). DESIGN Three-week, randomized controlled trial with an electric stimulation facilitation program added to standard care. SETTING Inpatient rehabilitation center. PARTICIPANTS Twenty patients receiving rehabilitation for first-time CVA (51.8+/-15.2 y; days post-CVA, 38.4+/-40.0 d). Patients were randomly assigned to study and control groups. INTERVENTIONS All patients received standard physical therapy (PT) care. In addition, the study group received an electric stimulation facilitation program during weight-bearing and ambulatory activities of the PT program. MAIN OUTCOME MEASURES MVIT and motor unit recruitment measured by interpolated twitch testing. A 2 x 4 repeated-measures analysis of variance was performed on measurements at 4 intervals: pretest, 1 week, 2 weeks, and 3 weeks. RESULTS MVIT increased by 77% in patients receiving electric stimulation, compared with a 31% increase for the control group. There was a significant effect for assessment time only. Motor unit recruitment increased from 35% to 53% for the study group, whereas the control group recorded no change in recruitment ability. A significant interaction was recorded, indicating improved motor unit recruitment for the study group. CONCLUSIONS A brief and dynamic electric stimulation facilitation program significantly improved motor unit recruitment in persons after CVA.
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Affiliation(s)
- Craig J Newsam
- Pathokinesiology Laboratory, Rancho Los Amigos National Rehabilitation Center, Downy, CA, USA
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Abstract
Abstract
Background and Purpose. Reports have described the contribution of motor imagery (MI) practice for improving upper-extremity functions in patients with hemiparesis following stroke. The purpose of this case report is to describe the use of MI practice to attempt to improve walking in an individual with hemiparesis. Case Description. A 69-year-old man with left hemiparesis received MI gait practice for 6 weeks. Intervention focused on task-oriented gait and on impairments of the affected lower limb. Preintervention, midterm, postintervention, and follow-up measurements of temporal-distance stride parameters and sagittal kinematics of the knee joint were taken. Main Outcomes. At 6 weeks postintervention, the patient had a 23% increase in gait speed and a 13% reduction in double-support time. An increase in range of motion of the knees also was observed. No changes in gait symmetry were noted. Discussion. The outcomes suggest that MI may be useful for the enhancement of walking ability in patients following stroke. Because improvement was mainly in temporal-distance gait variables and knee movement, imagery practice probably should focus on its specific impairments during gait in order to affect the performance of the paretic lower extremity.
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Affiliation(s)
- Ruth Dickstein
- R Dickstein, PT, DSc, is Associate Professor, Department of Physical Therapy, Faculty of Social Welfare and Health Studies, The University of Haifa, Mount Carmel, Haifa 31905, Israel and Flieman Geriatric Rehabilitation Center, Haifa POB 2263, Israel
| | - Ayelet Dunsky
- A Dunsky, MS, is a doctoral student, Graduate Studies Authority, The University of Haifa
| | - Emanuel Marcovitz
- E Markovitz, MD, is Specialist in Physical Medicine and Rehabilitation, Flieman Geriatric Rehabilitation Center
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Hendricks HT, Pasman JW, van Limbeek J, Zwarts MJ. Motor evoked potentials of the lower extremity in predicting motor recovery and ambulation after stroke: a cohort study 11No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated. Arch Phys Med Rehabil 2003; 84:1373-9. [PMID: 13680577 DOI: 10.1016/s0003-9993(03)00237-5] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the prognostic value of motor evoked potentials (MEPs) in the lower extremity with respect to motor recovery and functional recovery in stroke patients. DESIGN Cohort study. SETTING The department of neurology at a university hospital. PARTICIPANTS Thirty-eight acute-stroke patients with complete paralysis (paralysis subgroup) or severe paresis (paresis subgroup) of the lower extremity. MEPs of the vastus medialis and the tibialis anterior muscles were recorded between days 3 and 10 after stroke onset. INTERVENTIONS Not applicable. Main outcome measures A separate proximal leg motor score (maximum, 16 points) and crural motor score (maximum, 2 points) were defined within the lower-limb subset of the original Fugl-Meyer Motor Assessment to evaluate the motor performance at regular intervals until 6 months after stroke. The transfer item of the Barthel Index and the Functional Ambulation Categories scores were used to assess transfer and walking ability. RESULTS For the paralysis subgroup (n=30), the follow-up was complete in 27 patients (2 patients died, 1 patient underwent above-knee amputation). At 26 weeks, 20 patients experienced proximal motor recovery (mean score +/- standard deviation, 11.70+/-4.48), and 12 of them also showed crural motor recovery (mean score, 1.40+/-.51). Nine patients (33%) could perform an independent transfer safely, and 7 (26%) had learned to walk independently. Analysis revealed significant relationships for tibialis anterior muscle MEPs and motor recovery of crural leg muscles (odds ratio [OR]=18.00; 95% confidence interval [CI], 1.31-894.40), but not for vastus medialis muscle MEPs and proximal motor recovery (OR=6.00; 95% CI,.53-303.00). We found no association between vastus medialis muscle MEPs and recovery of ambulation. However, tibialis anterior muscle MEPs seemed to provide a test with prognostic value for the ability to perform independent transfers (OR=17.50; 95% CI, 1.36-267.00), but not for walking (OR=5.25; 95% CI,.40-77.57). Patients in the paresis subgroup experienced more favorable motor and functional recovery than did those in the paralysis subgroup. CONCLUSIONS Tibialis anterior muscle MEPs registered in subacute phase after stroke may provide important prognostic information, both for motor recovery of the crural muscles and for the ability to perform independent transfers in patients with initial complete paralysis of the lower extremity. Vastus medialis muscle MEPs were not predictive for motor and functional recovery.
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Affiliation(s)
- Henk T Hendricks
- Department of Rehabilitation Medicine, Univerisity Medical Center ST Radboud, Nijmegen, The Netherland.
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Hsu AL, Tang PF, Jan MH. Analysis of impairments influencing gait velocity and asymmetry of hemiplegic patients after mild to moderate stroke. Arch Phys Med Rehabil 2003; 84:1185-93. [PMID: 12917858 DOI: 10.1016/s0003-9993(03)00030-3] [Citation(s) in RCA: 378] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To identify the most important impairments determining gait velocity and asymmetry in patients with mild to moderate stroke. DESIGN Descriptive analysis of convenience sample. SETTING Outpatient rehabilitation clinic of a hospital in Taiwan. PARTICIPANTS Twenty-six subjects with mild to moderate spastic hemiparesis after a single onset of stroke, all able to walk independently without any assistance or device. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Subjects' maximal muscle strength (isokinetic peak torque, total work), motor and sensation function, and ankle plantarflexor spasticity of the affected lower extremity were examined using the Cybex 6000 dynamometry, Fugl-Meyer Assessment, and Modified Ashworth Scale, respectively. Gait velocity, as well as temporal and spatial asymmetry, were evaluated when subjects walked at their comfortable and fast speeds by using the GaitMatII. RESULTS Regression analyses revealed that the total work isokinetic measures of the affected hip flexors and knee extensors were the most important independent determinants of the comfortable and fast gait velocities, respectively (R(2)=.57, R(2)=.72). Spasticity of the affected plantarflexors was the most important independent determinant of temporal and spatial gait asymmetry during comfortable-speed (R(2)=.76 for temporal asymmetry; R(2)=.46 for spatial asymmetry) and fast-speed (R(2)=.75 for temporal asymmetry; R(2)=.45 for spatial asymmetry) walking. CONCLUSIONS Gait velocity and asymmetry of patients with mild to moderate stroke were affected by different physical impairments. Whereas gait velocity was mainly affected by weakness of the affected hip flexors and knee extensors, gait asymmetry was influenced primarily by the degree of the spasticity of the affected ankle plantarflexors. Therapeutic interventions aiming to improve different aspects of gait performance of these patients may emphasize treatment of different impairments.
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Affiliation(s)
- An-Lun Hsu
- Department of Physical Therapy, Mackay Memorial Hospital, Taipei, Taiwan, ROC
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