How to improve walking, balance and social participation following stroke: a comparison of the long term effects of two walking aids--canes and an orthosis TheraTogs--on the recovery of gait following acute stroke. A study protocol for a multi-centre, single blind, randomised control trial

Could Self-Control and Emotion Influence Physical Ability and Functional Recovery after Stroke?

Background and Objectives: This study was conducted to determine whether self-control and emotions could influence patients' physical ability and functional recovery after stroke. Materials and Methods: Twenty-four patients within eight weeks after a stroke were included in this study (age: 54.04 ± 10.31; days after stroke: 42.66 ± 8.84). The subjects participated in tests at the baseline, four weeks later, and eight weeks later. Subjects were asked to complete the following: (1) self-control level test, (2) positive and negative emotion test, (3) knee muscle strength testing, (4) static balance test, (5) gait measurement, and (6) activities of daily living evaluation. Results: The muscle strength of the knee, static balance, gait ability, and the Functional Independence Measure score increased significantly in the stroke patients over time. A significant correlation was noted between the emotion and physical variables in stroke patients. The self-control level was significantly associated with the change in the physical variables in stroke patients over time. Conclusions: The self-control level was positively related to the increases in functional recovery of stroke patients with time, while the emotions were related more to the physical abilities.

Interventions for reducing sedentary behaviour in people with stroke

BACKGROUND

Stroke survivors are often physically inactive as well as sedentary,and may sit for long periods of time each day. This increases cardiometabolic risk and has impacts on physical and other functions. Interventions to reduce or interrupt periods of sedentary time, as well as to increase physical activity after stroke, could reduce the risk of secondary cardiovascular events and mortality during life after stroke.

OBJECTIVES

To determine whether interventions designed to reduce sedentary behaviour after stroke, or interventions with the potential to do so, can reduce the risk of death or secondary vascular events, modify cardiovascular risk, and reduce sedentary behaviour.

SEARCH METHODS

In December 2019, we searched the Cochrane Stroke Trials Register, CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, Conference Proceedings Citation Index, and PEDro. We also searched registers of ongoing trials, screened reference lists, and contacted experts in the field.

SELECTION CRITERIA

Randomised trials comparing interventions to reduce sedentary time with usual care, no intervention, or waiting-list control, attention control, sham intervention or adjunct intervention. We also included interventions intended to fragment or interrupt periods of sedentary behaviour.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected studies and performed 'Risk of bias' assessments. We analyzed data using random-effects meta-analyses and assessed the certainty of the evidence with the GRADE approach.

MAIN RESULTS

We included 10 studies with 753 people with stroke. Five studies used physical activity interventions, four studies used a multicomponent lifestyle intervention, and one study used an intervention to reduce and interrupt sedentary behaviour. In all studies, the risk of bias was high or unclear in two or more domains. Nine studies had high risk of bias in at least one domain. The interventions did not increase or reduce deaths (risk difference (RD) 0.00, 95% confidence interval (CI) -0.02 to 0.03; 10 studies, 753 participants; low-certainty evidence), the incidence of recurrent cardiovascular or cerebrovascular events (RD -0.01, 95% CI -0.04 to 0.01; 10 studies, 753 participants; low-certainty evidence), the incidence of falls (and injuries) (RD 0.00, 95% CI -0.02 to 0.02; 10 studies, 753 participants; low-certainty evidence), or incidence of other adverse events (moderate-certainty evidence). Interventions did not increase or reduce the amount of sedentary behaviour time (mean difference (MD) +0.13 hours/day, 95% CI -0.42 to 0.68; 7 studies, 300 participants; very low-certainty evidence). There were too few data to examine effects on patterns of sedentary behaviour. The effect of interventions on cardiometabolic risk factors allowed very limited meta-analysis.

AUTHORS' CONCLUSIONS

Sedentary behaviour research in stroke seems important, yet the evidence is currently incomplete, and we found no evidence for beneficial effects. Current World Health Organization (WHO) guidelines recommend reducing the amount of sedentary time in people with disabilities, in general. The evidence is currently not strong enough to guide practice on how best to reduce sedentariness specifically in people with stroke. More high-quality randomised trials are needed, particularly involving participants with mobility limitations. Trials should include longer-term interventions specifically targeted at reducing time spent sedentary, risk factor outcomes, objective measures of sedentary behaviour (and physical activity), and long-term follow-up.

Gait training with auditory feedback improves trunk control, muscle activation and dynamic balance in patients with hemiparetic stroke: A randomized controlled pilot study

BACKGROUND

Auditory feedback enables an individual to identify and modify the differences between actual and intended movement during the motor learning process.

OBJECTIVE

We investigated the effects of gait training with auditory feedback on trunk control, muscle activation, and dynamic balance in patients with hemiparetic stroke.

METHODS

Twenty participants with hemiparetic stroke were recruited in this study and randomly assigned to the experimental (n= 10) or control (n= 10) group. The subjects in the experimental group participated in gait training with auditory feedback for 30 minutes, 5 times a week, for 4 weeks, whereas those in the control group received conventional gait training for 30 minutes, 5 times a week, for 4 weeks. During auditory feedback training, a beeping sound is produced every time a patient loaded weight that was higher than the preset threshold on the cane. Activation of the erector spinae muscle was measured using surface electromyography, and trunk control was evaluated using the Trunk Impairment Scale (TIS). Dynamic balance was measured using the Timed Up and Go (TUG) test.

RESULTS

Muscle activation was significantly higher in the experimental group than in the control group (6.6 ± 9.2% vs 1.4 ± 5.4% nonparetic peak activity). No significant difference was found in the TIS score between the experimental and control groups. Based on the TUG test, a significant improvement was observed in the experimental group compared to the control group (12.1 ± 11.4 vs 3.8 ± 4.7 s).

CONCLUSION

Our findings indicate that gait training with auditory feedback was beneficial for improving trunk control and muscle activation in patients with hemiparetic stroke.

A clinical single blind study to investigate the immediate effects of plantar vibration on balance in patients after stroke

Balance disorder is a very common cause of disability in patients after a stroke. Vibration therapy is one of the physiotherapeutic modalities used to improve balance.

OBJECTIVE

To investigate the immediate effects of plantar vibration on balance in patients with stroke.

METHODS

In this single blind comparative study, 22 patients with stroke (8 females, 14 males; age 55.82 ± 11.87 years old) participated. Patients underwent treatment, first with the placebo vibration and 1 week later with active vibration (frequency 100 HZ, 5 min). Mini-BESTest score, Modified Modified Ashworth Scale for plantar flexor spasticity, and ankle dorsiflexion passive range of motion (PROM) were evaluated before and immediately after the placebo or active vibration.

RESULTS

A significant clinical improvement in balance, ankle plantar flexor spasticity, and the ankle dorsiflexion PROM was observed following either placebo or active vibration. The improvements after active vibration were significantly greater for all outcome measures compared with placebo vibration. There was a large effect size (Cohen's d = 0.85) for balance after active vibration.

CONCLUSION

The vibration applied to the sole of the affected foot of patients after stroke was effective for improving balance, reducing ankle plantar flexor spasticity, and increasing ankle dorsiflexion PROM.

Gluteus maximus contraction velocity assessed by tensiomyography improves following arthroscopic treatment of femoroacetabular impingement

PURPOSE

Muscular impairment, particularly for the gluteus maximus (GM), has been observed in femoroacetabular impingement (FAI). The purpose of this study was to evaluate the tensiomyographic changes of the GM, rectus femoris (RF) and adductor longus (AL) before and after arthroscopic surgery for FAI. It was hypothesized that arthroscopic treatment of FAI would improve the preoperative muscular impairment.

METHODS

All patients undergoing arthroscopic treatment of FAI between January and July 2015 were approached for eligibility. Patients included had a tensiomyography (TMG) evaluation including maximal displacement (Dm) and contraction time (Tc) of these muscles in both lower extremities. TMG values between the injured and healthy sides were compared at the preoperative and post-operative (3, 6 and 12 months after surgery) periods.

RESULTS

There were no significant differences for the RF and AL, and Dm of the GM for any of the comparisons (n.s.). However, GM Tc was significantly lower at 3 (p = 0.016), 6 (p = 0.008), and 12 (p = 0.049) months after surgery in the injured side compared to preoperatively. GM Tc of the healthy side was significantly lower than the injured side at the preoperative period (p = 0.004) and at 3 (p = 0.024) and 6 (p = 0.028) months after surgery, but these significant differences were no longer observed at 12 months after surgery (n.s.). There was a significant reduction of pain in the GM area at 1 year after surgery compared to preoperatively (p < 0.0001).

CONCLUSIONS

Arthroscopic treatment of FAI and the subsequent rehabilitation improves contraction velocity of the GM of the injured side. Despite Tc is elevated in the GM of the injured compared to the healthy side preoperatively and at 3 and 6 months after surgery, differences in Tc between both sides are no longer significant at 12 months. Athletes with FAI participating in sports with great involvement of GM may benefit from arthroscopic treatment and its subsequent rehabilitation. TMG can be used as an objective measurement to monitor muscular improvements of the GM after surgery in these patients.

LEVEL OF EVIDENCE

II.

Effects and mechanism of the HECT study (hybrid exercise-cognitive trainings) in mild ischemic stroke with cognitive decline: fMRI for brain plasticity, biomarker and behavioral analysis

Purpose

Cognitive decline after stroke is highly associated with functional disability. Empirical evidence shows that exercise combined cognitive training may induce neuroplastic changes that modulate cognitive function. However, it is unclear whether hybridized exercise-cognitive training can facilitate cortical activity and physiological outcome measures and further influence on the cognitive function after stroke. This study will investigate the effects of two hybridized exercise-cognitive trainings on brain plasticity, physiological biomarkers and behavioral outcomes in stroke survivors with cognitive decline.

Methods and significance

This study is a single-blind randomized controlled trial. A target sample size of 75 participants is needed to obtain a statistical power of 95% with a significance level of 5%. Stroke survivors with mild cognitive decline will be stratified by Mini-Mental State Examination scores and then randomized 1:1:1 to sequential exercise-cognitive training, dual-task exercise-cognitive training or control groups. All groups will undergo training 60 min/day, 3 days/week, for a total of 12 weeks. The primary outcome is the resting-state functional connectivity and neural activation in the frontal, parietal and occipital lobes in functional magnetic resonance imaging. Secondary outcomes include physiological biomarkers, cognitive functions, physical function, daily functions and quality of life. This study may differentiate the effects of two hybridized trainings on cognitive function and health-related conditions and detect appropriate neurological and physiological indices to predict training effects. This study capitalizes on the groundwork for a non-pharmacological intervention of cognitive decline after stroke.

A novel one arm motorized walker for hemiplegic stroke survivors: a feasibility study

BACKGROUND

A hemiplegic stroke survivor with a moderate to severe gait disturbance may have difficulty walking using a one-arm walker. This study aimed to test the safety and feasibility of a prototype one-arm motorized walker that uses a power-driven device to provide gait assistance to hemiplegic stroke survivors with moderate to severe gait disturbances.

METHODS

A one-arm motorized walker with a power-driven device was developed and tested with respect to 10 distinct variables, including weight, degrees of freedom, handle, handle substitution function, two-sided use function, variable handle height, redirecting function, electric moving parts through the handle control, brake function using the handle control, folding chairs, and design stability. Its safety and feasibility were tested in 19 hemiplegic stroke individuals using the Likert scale and a simple interview.

RESULTS

The walker consists of a frame platform including a handle, electric motor for driving, one wheel for driving, two wheels for turning, unlocking sensor, driving button, and turning buttons. The walker is programmed so that a touch sensor in the handle can unlock the locking system. Furthermore, it is programmed so that a user can propel it by pushing the handle downward or pressing a button and can control directions for turning right or left by pressing buttons. Safety and performance testing was achieved for 10 separate variables, and a Likert scale score of 3.5 of 5 was recorded.

CONCLUSION

This walker's novel design was developed for hemiplegic stroke survivors with moderate to severe gait disturbances. Our findings indicate that the walker is both safe and feasible for providing walking assistance to hemiplegic stroke survivors and establish the potential advantages of the one-arm motorized walker.

Family caregivers' experience of activities of daily living handling in older adult with stroke: a qualitative research in the Iranian context

BACKGROUND

Patients with stroke require additional support from family to live independently in the area of activities of daily living. Family members are usually the main caregivers of stroke patients. Comprehensive explanation of ADL handling from family caregivers' view is lacking.

AIM

This study explores and describes family caregivers' experiences about the strategies to handle activities of daily living (ADL) dependency of elderly patient with stroke in the Iranian context.

METHOD

A qualitative content analysis approach was conducted to analyse data. Nineteen family caregivers participated in the study from multiple physiotherapy clinics of physiotherapy in Sari (Iran) between September 2013 and May 2014. Data were generated through in-depth interviews, and content analysis method was used to analyse the data and determine themes.

FINDINGS

The findings show that family caregivers manage the ADL dependency of their elderly stroke patients through seven strategies including encouraging physical movements, providing personal hygiene, nutritional consideration, facilitating religious activities, filling leisure time, and facilitating transfer and assisting in financial issues.

CONCLUSION

Family has an important role in handling of elderly stroke patients' ADL dependency. Health practitioners can take benefit from the findings to help the stroke families play more active role in the handling ADL dependency of their patients after stroke.

Bodyweight-supported treadmill training for retraining gait among chronic stroke survivors: A randomized controlled study

OBJECTIVE

To evaluate the role of bodyweight-supported treadmill training (BWSTT) for chronic stroke survivors.

DESIGN

Prospective, randomized controlled study.

METHODS

Patients with a first episode of supratentorial arterial stroke of more than 3months' duration were randomly allocated to 3 groups: overground gait training, treadmill training without bodyweight support, and BWSTT (20 sessions, 30min/day, 5days/week for 4weeks). The primary outcome was overground walking speed and endurance and secondary outcome was improvement by the Scandinavian Stroke Scale (SSS) and locomotion by the Functional Ambulation Category (FAC). We analyzed data within groups (pre-training vs post-training and pre-training vs 3-month follow-up) and between groups (at post-training and 3-month follow-up).

RESULTS

We included 45 patients (36 males, mean post-stroke duration 16.51±15.14months); 40 (89.9%) completed training and 34 (75.5%) were followed up at 3months. All primary and secondary outcome measures showed significant improvement (P<0.05) in the 3 groups at the end of training, which was sustained at 3-month follow-up (other than walking endurance in group I). Outcomes were better with BWSTT but not significantly (P>0.05).

CONCLUSION

BWSTT offers improvement in gait but has no significant advantage over conventional gait-training strategies for chronic stroke survivors.

Gluteus maximus impairment in femoroacetabular impingement: a tensiomyographic evaluation of a clinical fact

INTRODUCTION

the aim of the present study is to evaluate the mechanical and contractile properties of the gluteus maximus (GM) muscle in patients with femoroacetabular impingement (FAI). Our hypothesis is that the clinical observation of GM pain would be evidenced by tensiomyographic impairment in muscle function.

MATERIALS AND METHODS

A prospective, cross-sectional, intra-group comparative study was conducted to assess the neuromuscular changes of lower extremity muscles in patients with FAI. Fifty-one patients with clinical and radiographic diagnosis of FAI for at least 3 months were included. The rectus femoris (RF), adductor magnus (AM), and GM of both lower extremities of all patients were evaluated with tensiomyography (TMG). The values of TMG of the affected lower extremity were compared to those of the healthy contralateral side. The parameters obtained in this study were maximal displacement (Dm), and contraction time (Tc).

RESULTS

The Tc of the injured GM was significantly higher compared to the healthy side (p = 0.01). There were no significant side-to-side differences in the Dm of the GM (p = 0.13), either in the Tc and Dm of the RF (p = 0.15 and p = 0.8, respectively) and AM (p = 0.25 and p = 0.75, respectively).

CONCLUSIONS

FAI is associated with impairment of contraction time in the GM of the injured compared to the healthy side. Impairment of the GM may be monitored to evaluate response to conservative or surgical treatment.

Between-day reliability of triceps surae responses to standing perturbations in people post-stroke and healthy controls: A high-density surface EMG investigation

The reliability of triceps surae electromyographic responses to standing perturbations in people after stroke and healthy controls is unknown. High-Density surface Electromyography (HDsEMG) is a technique that records electromyographic signals from different locations over a muscle, overcoming limitations of traditional surface EMG such as between-day differences in electrode placement. In this study, HDsEMG was used to measure responses from soleus (SOL, 18 channels) and medial and lateral gastrocnemius (MG and LG, 16 channels each) in 10 people after stroke and 10 controls. Timing and amplitude of the response were estimated for each channel of the grids. Intraclass Correlation Coefficient (ICC) and normalized Standard Error of Measurement (SEM%) were calculated for each channel individually (single-channel configuration) and on the median of each grid (all-channels configuration). Both timing (single-channel: ICC=0.75-0.96, SEM%=5.0-9.1; all-channels: ICC=0.85-0.97; SEM%=3.5-6.2%) and amplitude (single-channel: ICC=0.60-0.91, SEM%=25.1-46.6; ICC=0.73-0.95, SEM%=19.3-42.1) showed good-to-excellent reliability. HDsEMG provides reliable estimates of EMG responses to perturbations both in individuals after stroke and in healthy controls; reliability was marginally better for the all-channels compared to the single-channel configuration.

Effects of gait training with a cane and an augmented pressure sensor for enhancement of weight bearing over the affected lower limb in patients with stroke: a randomized controlled pilot study

OBJECTIVE

The purpose of this study was to examine the effect of gait training when using a cane with an augmented pressure sensor for enhancement of weight-bearing over the affected lower limb on the peak pressure force of the cane, muscle activation, and gait in patients with stroke.

DESIGN

Randomized controlled pilot study.

SETTING

Inpatient rehabilitation center.

PARTICIPANTS

A total of 22 hemiparetic stroke patients were recruited and randomly divided into an experimental group (n = 11) and control group, which later had a drop-out (n = 10).

INTERVENTIONS

Subjects in the experimental group participated in gait training with auditory feedback for 30 minutes, five times a week for four weeks, whereas those in the control group received gait training without auditory feedback for the same amount of time.

MAIN MEASURES

The peak force of cane, muscle activation of gluteus medius, and vastus medialis oblique, single limb support phase of the affected leg, and gait speed before and after training were collected.

RESULTS

Significant improvement in the peak force of cane, muscle activation of gluteus medius and vastus medialis oblique, single limb support phase of the affected leg, and gait speed were observed in the experimental group (13.5 ±9.5 cm/s) compared with the control group (3.7 ±8.4 cm/s) (p < 0.05).

CONCLUSION

Gait training using a cane with an augmented pressure sensor to enhance weight bearing over the affected lower limb is beneficial and effective in improving the peak force of cane, muscle activation, and gait in stroke patients.