1
|
Teasell R, Fleet JL, Harnett A. Post Stroke Exercise Training: Intensity, Dosage, and Timing of Therapy. Phys Med Rehabil Clin N Am 2024; 35:339-351. [PMID: 38514222 DOI: 10.1016/j.pmr.2023.06.025] [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] [Indexed: 03/23/2024]
Abstract
More intense, earlier exercise in rehabilitation results in improved motor outcomes following stroke. Timing and intensity of therapy delivery vary from study to study. For more intensive therapies, there are practical challenges in implementation. However, there are also opportunities for high intensity treatment through innovative approaches and new technologies. Timing of rehabilitation is important. As time post stroke increases, the dosage of therapy required to improve motor recovery outcomes increases. Very early rehabilitation may improve motor outcomes but should be delayed for at least 24 hours post stroke.
Collapse
Affiliation(s)
- Robert Teasell
- Parkwood Institute Research, Parkwood Institute, D4-101A, 550 Wellington Road, London, Canada; St. Joseph's Health Care London, London, Canada; Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada.
| | - Jamie L Fleet
- Parkwood Institute Research, Parkwood Institute, D4-101A, 550 Wellington Road, London, Canada; St. Joseph's Health Care London, London, Canada; Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
| | - Amber Harnett
- Parkwood Institute Research, Parkwood Institute, B3-123, 550 Wellington Road, London, Ontario N6C 0A7, Canada
| |
Collapse
|
2
|
Cao S, Ko M, Li CY, Brown D, Wang X, Hu F, Gan Y. Single-Belt Versus Split-Belt: Intelligent Treadmill Control via Microphase Gait Capture for Poststroke Rehabilitation. IEEE TRANSACTIONS ON HUMAN-MACHINE SYSTEMS 2023; 53:1006-1016. [PMID: 38601093 PMCID: PMC11006014 DOI: 10.1109/thms.2023.3327661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
Stroke is the leading long-term disability and causes a significant financial burden associated with rehabilitation. In poststroke rehabilitation, individuals with hemiparesis have a specialized demand for coordinated movement between the paretic and the nonparetic legs. The split-belt treadmill can effectively facilitate the paretic leg by slowing down the belt speed for that leg while the patient is walking on a split-belt treadmill. Although studies have found that split-belt treadmills can produce better gait recovery outcomes than traditional single-belt treadmills, the high cost of split-belt treadmills is a significant barrier to stroke rehabilitation in clinics. In this article, we design an AI-based system for the single-belt treadmill to make it act like a split-belt by adjusting the belt speed instantaneously according to the patient's microgait phases. This system only requires a low-cost RGB camera to capture human gait patterns. A novel microgait classification pipeline model is used to detect gait phases in real time. The pipeline is based on self-supervised learning that can calibrate the anchor video with the real-time video. We then use a ResNet-LSTM module to handle temporal information and increase accuracy. A real-time filtering algorithm is used to smoothen the treadmill control. We have tested the developed system with 34 healthy individuals and four stroke patients. The results show that our system is able to detect the gait microphase accurately and requires less human annotation in training, compared to the ResNet50 classifier. Our system "Splicer" is boosted by AI modules and performs comparably as a split-belt system, in terms of timely varying left/right foot speed, creating a hemiparetic gait in healthy individuals, and promoting paretic side symmetry in force exertion for stroke patients. This innovative design can potentially provide cost-effective rehabilitation treatment for hemiparetic patients.
Collapse
Affiliation(s)
- Shengting Cao
- Electrical and Computer Engineering, University of Alabama, Tuscaloosa, AL 35487 USA
| | - Mansoo Ko
- University of Texas Medical Branch, Mountain Brook, TX 77555-0128 USA
| | - Chih-Ying Li
- University of Texas Medical Branch, Mountain Brook, TX 77555-0128 USA
| | - David Brown
- University of Texas Medical Branch, Mountain Brook, TX 77555-0128 USA
| | - Xuefeng Wang
- Department of Advanced Manufacturing and Robotics, College of Engineering, Peking University, Beijing 100871, China
| | - Fei Hu
- Electrical and Computer Engineering, University of Alabama, Tuscaloosa, AL 35487 USA
| | - Yu Gan
- Biomedical Engineering Department, Stevens Institute of Technology, Hoboken, NJ 07030 USA
| |
Collapse
|
3
|
Lee K. Balance Training with Weight Shift-Triggered Electrical Stimulation for Stroke Patients: A Randomized Controlled Trial. Brain Sci 2023; 13:brainsci13020225. [PMID: 36831768 PMCID: PMC9954639 DOI: 10.3390/brainsci13020225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/17/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023] Open
Abstract
This study aimed to determine the effects of balance training with weight shift-triggered electrical stimulation to improve balance, lower-extremity motor function, and activities of daily living in patients with stroke. The participants were randomly allocated to the balance training with electrical stimulation group (BT-ESG, n = 29) or the balance training group (BTG, n = 30). Both groups were trained 5 times per week for 6 weeks for 50 min per session. To evaluate static balance, postural sway was assessed and dynamic balance was assessed using the Berg Balance Scale (BBS), Timed Up and Go (TUG) test, and functional reach test (FRT). Lower-extremity motor function was assessed using the Fugl-Meyer assessment. Daily activities were assessed using the Modified Barthel Index. As for static balance, BT-ESG showed a significant improvement compared to BTG in postural swat in both the eyes-open (velocity moment; effect size, 0.88; 95% confidence interval, -1.16 to -1.30), or eyes-closed state (velocity moment; effect size, 0.81; 95% confidence interval, -1.22 to -0.27). Dynamic balance, which includes TUG (effect size, 0.90; 95% confidence interval, -4.67 to -1.25), BBS (effect size, 1.26; 95% confidence interval, -2.84 to 6.83), and FRT (effect size, 1.45; 95% confidence interval, 1.92 to 4.08), in addition to lower-extremity motor function (effect size, 1.38; 95% confidence interval, 2.25 to 4.97), and activities of daily living (effect size, 2.04; 95% confidence interval, 2.04 to 937), showed significant improvement in BT-ESG compared to BTG. These results suggest that balance training with weight shift-triggered electrical stimulation effectively improves balance, lower-extremity motor function, and activities of daily living in patients with stroke.
Collapse
Affiliation(s)
- Kyeongjin Lee
- Department of Physical Therapy, College of Health Science, Kyungdong University, Wonju 24764, Republic of Korea
| |
Collapse
|
4
|
Mah SM, Goodwill AM, Seow HC, Teo WP. Evidence of High-Intensity Exercise on Lower Limb Functional Outcomes and Safety in Acute and Subacute Stroke Population: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:153. [PMID: 36612471 PMCID: PMC9819111 DOI: 10.3390/ijerph20010153] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/07/2022] [Accepted: 12/10/2022] [Indexed: 06/17/2023]
Abstract
This systematic review investigated the effects of high-intensity exercise (HIE) on lower limb (LL) function in acute and subacute stroke patients. A systematic electronic search was performed in PubMed, CINAHL and the Web of Science from inception to 30 June 2022. Outcomes examined included LL function and measures of activities of daily living such as the Barthel index, 6 min walk test (6MWT), gait speed and Berg balance scale (BBS), adverse events and safety outcomes. The methodological quality and the quality of evidence for each study was assessed using the PEDro scale and the Risk of Bias 2 tool (RoB 2). HIE was defined as achieving at least 60% of the heart rate reserve (HRR) or VO2 peak, 70% of maximal heart rate (HRmax), or attaining a score of 14 or more on the rate of perceived exertion Borg scale (6-20 rating scale). This study included randomized controlled trials (RCTs) which compared an intervention group of HIE to a control group of lower intensity exercise, or no intervention. All participants were in the acute (0-3 months) and subacute (3-6 months) stages of stroke recovery. Studies were excluded if they were not RCTs, included participants from a different stage of stroke recovery, or if the intervention did not meet the pre-defined HIE criteria. Overall, seven studies were included that used either high-intensity treadmill walking, stepping, cycling or overground walking exercises compared to either a low-intensity exercise (n = 4) or passive control condition (n = 3). Three studies reported significant improvements in 6MWT and gait speed performance, while only one showed improved BBS scores. No major adverse events were reported, although minor incidents were reported in only one study. This systematic review showed that HIE improved LL functional task performance, namely the 6MWT and gait speed. Previously, there was limited research demonstrating the efficacy of HIE early after stroke. This systematic review provides evidence that HIE may improve LL function with no significant adverse events report for stroke patients in their acute and subacute rehabilitation stages. Hence, HIE should be considered for implementation in this population, taking into account the possible benefits in terms of functional outcomes, as compared to lower intensity interventions.
Collapse
Affiliation(s)
- Shi Min Mah
- Physical Education and Sports Science Academic Group, National Institute of Education, Nanyang Technological University, Singapore 639798, Singapore
- Department of Physiotherapy, Sengkang General Hospital, Singapore 544886, Singapore
| | - Alicia M. Goodwill
- Physical Education and Sports Science Academic Group, National Institute of Education, Nanyang Technological University, Singapore 639798, Singapore
| | - Hui Chueng Seow
- Department of Physiotherapy, Singapore General Hospital, Singapore 168753, Singapore
| | - Wei-Peng Teo
- Physical Education and Sports Science Academic Group, National Institute of Education, Nanyang Technological University, Singapore 639798, Singapore
| |
Collapse
|
5
|
Wang D, Li L, Pan H, Huang L, Sun X, He C, Wei Q. Comparison of the Effects of Constraint-Induced Movement Therapy and Unconstraint Exercise on Oxidative Stress and Limb Function-A Study on Human Patients and Rats with Cerebral Infarction. Brain Sci 2022; 13:brainsci13010004. [PMID: 36671986 PMCID: PMC9856592 DOI: 10.3390/brainsci13010004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 11/25/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
Most conventional post-stroke rehabilitation treatments do not involve imposed constraints of the unaffected limb. In contrast, Constraint-Induced Movement Therapy (CIMT) is comprised of massed task practice with the affected limb and constraint of the unaffected limb. CIMT is a promising rehabilitation technique used for motor recovery of affected limbs after stroke, but its effectiveness and mechanism are not fully understood. We compared the effects of the two exercise modes on limb function post-stroke in animal models and human subjects, and investigated whether oxidative stress response was involved in regulating the effects. We first conducted a randomized controlled trial (RCT), in which 84 subjects with cerebral infarction were assigned to dose-matched constraint-induced movement therapy (CIMT), or unconstraint exercise (UE), or conventional rehabilitation treatment. Motor functions of the limb are primary outcomes of the RCT measured using Brief Fugl-Meyer upper extremity score (FMA-UE), Ashworth score, and Barthel scale. Psychological influence of CIMT and UE was also examined using Self-Rating Depression Scale (SDS). Next, we investigated the effects of CIMT and UE in rats undergoing middle cerebral artery occlusion and reperfusion (MCAO/R). Motor function, infarct volume, and pathohistological changes were investigated by mNSS, MRI, and histological studies. The role of Keap1-Nrf2-ARE was investigated using qRT-PCR, Western blot, immunochemistry, immunofluorescence, and ELISA experiments. In RCT, patients taking CIMT had a higher score in FMA-UE, Barthel index, and SDS, and a lower score in modified Ashworth, compared to those taking UE. In rats receiving CIMT, motor function was increased, and infarct volume was decreased compared to those receiving UE. The expression of Keap1 protein and mRNA in the peri-infarct tissue was decreased, and Nrf2 and ARE protein and mRNA were increased in rats receiving CIMT compared with UE. Nrf2 agonist t-BHQ increased the benefits of CIMT. In conclusion, CIMT is more effective than UE in improving upper limb motor function, reducing muscle spasm in patients with cerebral infarction compared to UE, but patients receiving CIMT may feel depressed. Moreover, both CIMT and UE are beneficial to limb function recovery and limit the infarct expansion in MCAO/R rats, but CIMT was more effective than UE. Oxidative stress reaction has an essential role in regulating the CIMT induced benefits.
Collapse
Affiliation(s)
- Dong Wang
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 611135, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Sichuan University, Chengdu 611135, China
- Department of Rehabilitation Medicine, Affiliated Hospital of Chengdu University, Chengdu 610081, China
| | - Lijuan Li
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 611135, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Sichuan University, Chengdu 611135, China
| | - Hongxia Pan
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 611135, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Sichuan University, Chengdu 611135, China
| | - Liyi Huang
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 611135, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Sichuan University, Chengdu 611135, China
| | - Xin Sun
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 611135, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Sichuan University, Chengdu 611135, China
| | - Chengqi He
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 611135, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Sichuan University, Chengdu 611135, China
| | - Quan Wei
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 611135, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Sichuan University, Chengdu 611135, China
- Correspondence: ; Tel.: +86-2885422847
| |
Collapse
|
6
|
Awosika OO, Chan D, Rizik BA, Sucharew HJ, Boyne P, Bhattacharya A, Dunning K, Kissela BM. Serial Backward Locomotor Treadmill Training Improves Bidirectional Walking Performance in Chronic Stroke. Front Neurol 2022; 13:800757. [PMID: 35359661 PMCID: PMC8963981 DOI: 10.3389/fneur.2022.800757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 02/14/2022] [Indexed: 01/16/2023] Open
Abstract
Background and Research Question Walking impairment remains a major limitation to functional independence after stroke. Yet, comprehensive and effective strategies to improve walking function after stroke are presently limited. Backward Locomotor Treadmill Training (BLTT) is a promising training approach for improving walking function; however, little is known about its mechanism of effect or the relationship between backward walking training and resulting overground forward walking performance. This study aims to determine the effects of serial BLTT on spatial aspects of backward and forward walking in chronic post-stroke individuals with residual walking impairment. Methods Thirty-nine adults (>6 months post-stroke) underwent 6 days of BLTT (3 × /week) over 2 weeks. Outcome measures included PRE-POST changes in backward and forward walking speeds, paretic and non-paretic step lengths, and single-support center of pressure distances. To determine the association between BLTT and overground walking, correlation analyses comparing training-related changes in these variables were performed. Results We report an overall improvement in BLTT and overground walking speeds, bilateral step lengths, and single-support center of pressure distances over six training sessions. Further, there were weak positive associations between PRE-POST changes in BLTT speed, BLTT paretic step length, and overground forward walking speed. Conclusion and Significance Our findings suggest that individuals with chronic post-stroke walking impairment experience improvements in spatial walking measures during BLTT and overground. Therefore, BLTT may be a potential adjunctive training approach for post-stroke walking rehabilitation.
Collapse
Affiliation(s)
- Oluwole O Awosika
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Dorothy Chan
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Bridget A Rizik
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Heidi J Sucharew
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH, United States.,Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Pierce Boyne
- Department of Rehabilitation, Exercise and Nutrition Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Amit Bhattacharya
- Biomechanics-Ergonomics Research Laboratories, Department of Environmental Health, University of Cincinnati Medical College, Cincinnati, OH, United States
| | - Kari Dunning
- Department of Rehabilitation, Exercise and Nutrition Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Brett M Kissela
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH, United States
| |
Collapse
|
7
|
Lin B, Zhang Z, Mei Y, Liu L, Ping Z. The Influential Factors of Adherence to Physical Activity and Exercise among Community-Dwelling Stroke Survivors: A Path Analysis. J Clin Nurs 2021; 31:2632-2643. [PMID: 34664325 DOI: 10.1111/jocn.16091] [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: 05/16/2021] [Revised: 09/08/2021] [Accepted: 10/01/2021] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To investigate the status of physical activity and exercise (PAE) adherence and identify its influential factors among community-dwelling stroke survivors. BACKGROUND Regular PAE after stroke is essential for recovery and secondary prevention, while adherence to PAE and its influential factors are rarely studied. DESIGN A cross-sectional descriptive study. METHODS In total, 208 stroke survivors (70.25 ± 9.08 years) were randomly selected from three communities. The influential factors of PAE adherence and associations between these variables were explored using multiple linear regression and path analyses. This study adhered to the EQUATOR checklist, STROBE. RESULTS The mean adherence rate was moderate (62.00%), and stroke survivors tended to be more adherent to PAE than monitoring and seeking advice (70.30%>53.50%>48.30%). The regression results revealed that seven factors were significantly associated with PAE adherence, including knowledge, attitude, self-efficacy, social support, self-care ability, community rehabilitation experience and times since stroke. Furthermore, the path analysis showed that knowledge had a significant indirect positive influence on adherence with self-efficacy as a mediator, while attitude and social support impacted both directly and indirectly with self-efficacy as the mediator. Moreover, self-efficacy had the most substantial direct effect on community-dwelling stroke survivors' PAE adherence. These four variables accounted for a total of 67.00% of the variance in PAE adherence among community-dwelling stroke survivors. CONCLUSIONS The PAE adherence of community stroke survivors needs to be improved. Healthcare professionals should develop more effective interventions to promote PAE adherence through enhancing self-efficacy among this population. RELEVANCE TO CLINICAL PRACTICE Adherence to the recommended regimen is the most challenging dimension of stroke physical activity and exercise. This study contributes to exploring status and influential factors of PAE adherence, and self-efficacy was found to be a significant determinant. The results could be used to inspire future community-based intervention programs for stroke survivors.
Collapse
Affiliation(s)
- Beilei Lin
- Nursing and Health school of Zhengzhou University, Zhengzhou, China
| | - Zhenxiang Zhang
- Nursing and Health school of Zhengzhou University, Zhengzhou, China
| | - Yongxia Mei
- Nursing and Health school of Zhengzhou University, Zhengzhou, China
| | - Lamei Liu
- Nursing and Health school of Zhengzhou University, Zhengzhou, China
| | - Zhiguang Ping
- Public Health School of Zhengzhou University, Zhengzhou, China
| |
Collapse
|
8
|
Miller A, Reisman DS, Billinger SA, Dunning K, Doren S, Ward J, Wright H, Wagner E, Carl D, Gerson M, Awosika O, Khoury J, Kissela B, Boyne P. Moderate-intensity exercise versus high-intensity interval training to recover walking post-stroke: protocol for a randomized controlled trial. Trials 2021; 22:457. [PMID: 34271979 PMCID: PMC8284012 DOI: 10.1186/s13063-021-05419-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 07/02/2021] [Indexed: 12/12/2022] Open
Abstract
Background Stroke results in neurologic impairments and aerobic deconditioning that contribute to limited walking capacity which is a major barrier post-stroke. Current exercise recommendations and stroke rehabilitation guidelines recommend moderate-intensity aerobic training post-stroke. Locomotor high-intensity interval training is a promising new strategy that has shown significantly greater improvements in aerobic fitness and motor performance than moderate-intensity aerobic training in other populations. However, the relative benefits and risks of high-intensity interval training and moderate-intensity aerobic training remain poorly understood following stroke. In this study, we hypothesize that locomotor high-intensity interval training will result in greater improvements in walking capacity than moderate-intensity aerobic training. Methods Using a single-blind, 3-site randomized controlled trial, 50 chronic (> 6 months) stroke survivors are randomly assigned to complete 36 locomotor training sessions of either high-intensity interval training or moderate-intensity aerobic training. Main eligibility criteria are age 40–80 years, single stroke for which the participant received treatment (experienced 6 months to 5 years prior to consent), walking speed ≤ 1.0 m/s, able to walk at least 3 min on the treadmill at ≥ 0.13 m/s (0.3 mph), stable cardiovascular condition (American Heart Association class B), and the ability to walk 10 m overground without continuous physical assistance. The primary outcome (walking capacity) and secondary outcomes (self-selected and fast gait speed, aerobic fitness, and fatigue) are assessed prior to initiating training and after 4 weeks, 8 weeks, and 12 weeks of training. Discussion This study will provide fundamental new knowledge to inform the selection of intensity and duration dosing parameters for gait recovery and optimization of aerobic training interventions in chronic stroke. Data needed to justify and design a subsequent definitive trial will also be obtained. Thus, the results of this study will inform future stroke rehabilitation guidelines on how to optimally improve walking capacity following stroke. Trial registration ClinicalTrials.govNCT03760016. Registered on November 30, 2018.
Collapse
Affiliation(s)
- Allison Miller
- Department of Biomechanics and Movement Sciences Program, University of Delaware, Newark, DE, 19713, USA
| | - Darcy S Reisman
- Department of Biomechanics and Movement Sciences Program, University of Delaware, Newark, DE, 19713, USA.,Department of Physical Therapy, University of Delaware, Newark, DE, 19713, USA
| | - Sandra A Billinger
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - Kari Dunning
- Department of Rehabilitation, Exercise and Nutrition Sciences, University of Cincinnati, 3225 Eden Avenue, Cincinnati, OH, USA
| | - Sarah Doren
- Department of Rehabilitation, Exercise and Nutrition Sciences, University of Cincinnati, 3225 Eden Avenue, Cincinnati, OH, USA
| | - Jaimie Ward
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - Henry Wright
- Department of Physical Therapy, University of Delaware, Newark, DE, 19713, USA
| | - Erin Wagner
- Department of Rehabilitation, Exercise and Nutrition Sciences, University of Cincinnati, 3225 Eden Avenue, Cincinnati, OH, USA
| | - Daniel Carl
- Department of Rehabilitation, Exercise and Nutrition Sciences, University of Cincinnati, 3225 Eden Avenue, Cincinnati, OH, USA
| | - Myron Gerson
- Departments of Cardiology and Internal Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Oluwole Awosika
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Jane Khoury
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Brett Kissela
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Pierce Boyne
- Department of Rehabilitation, Exercise and Nutrition Sciences, University of Cincinnati, 3225 Eden Avenue, Cincinnati, OH, USA.
| |
Collapse
|
9
|
Awosika OO, Matthews S, Staggs EJ, Boyne P, Song X, Rizik BA, Sucharew HJ, Zhang C, Mungcal G, Moudgal R, Bhattacharya A, Dunning K, Woo D, Kissela BM. Backward locomotor treadmill training combined with transcutaneous spinal direct current stimulation in stroke: a randomized pilot feasibility and safety study. Brain Commun 2020; 2:fcaa045. [PMID: 32954299 PMCID: PMC7425394 DOI: 10.1093/braincomms/fcaa045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 02/13/2020] [Accepted: 02/19/2020] [Indexed: 11/17/2022] Open
Abstract
Walking impairment impacts nearly 66% of stroke survivors and is a rising cause of morbidity worldwide. Despite conventional post-stroke rehabilitative care, the majority of stroke survivors experience continued limitations in their walking speed, temporospatial dynamics and walking capacity. Hence, novel and comprehensive approaches are needed to improve the trajectory of walking recovery in stroke survivors. Herein, we test the safety, feasibility and preliminary efficacy of two approaches for post-stroke walking recovery: backward locomotor treadmill training and transcutaneous spinal direct current stimulation. In this double-blinded study, 30 chronic stroke survivors (>6 months post-stroke) with mild-severe residual walking impairment underwent six 30-min sessions (three sessions/week) of backward locomotor treadmill training, with concurrent anodal (N = 19) or sham transcutaneous spinal direct current stimulation (N = 11) over the thoracolumbar spine, in a 2:1 stratified randomized fashion. The primary outcomes were: per cent participant completion, safety and tolerability of these two approaches. In addition, we collected data on training-related changes in overground walking speed, cadence, stride length (baseline, daily, 24-h post-intervention, 2 weeks post-intervention) and walking capacity (baseline, 24-h post-intervention, 2 weeks post-intervention), as secondary exploratory aims testing the preliminary efficacy of these interventions. Eighty-seven per cent (N = 26) of randomized participants completed the study protocol. The majority of the study attrition involved participants with severe baseline walking impairment. There were no serious adverse events in either the backward locomotor treadmill training or transcutaneous spinal direct current stimulation approaches. Also, both groups experienced a clinically meaningful improvement in walking speed immediately post-intervention that persisted at the 2-week follow-up. However, in contrast to our working hypothesis, anodal-transcutaneous spinal direct current stimulation did not enhance the degree of improvement in walking speed and capacity, relative to backward locomotor treadmill training + sham, in our sample. Backward locomotor treadmill training and transcutaneous spinal direct current stimulation are safe and feasible approaches for walking recovery in chronic stroke survivors. Definitive efficacy studies are needed to validate our findings on backward locomotor treadmill training-related changes in walking performance. The results raise interesting questions about mechanisms of locomotor learning in stroke, and well-powered transcutaneous spinal direct current stimulation dosing studies are needed to understand better its potential role as a neuromodulatory adjunct for walking rehabilitation.
Collapse
Affiliation(s)
- Oluwole O Awosika
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Saira Matthews
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Emily J Staggs
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Pierce Boyne
- College of Allied Health and Sciences, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Xiao Song
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Bridget A Rizik
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Heidi J Sucharew
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Christina Zhang
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Gabrielle Mungcal
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Rohitha Moudgal
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Amit Bhattacharya
- Biomechanics-Ergonomics Research Laboratories, Department of Environmental Health, University of Cincinnati Medical College, USA
| | - Kari Dunning
- College of Allied Health and Sciences, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Daniel Woo
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Brett M Kissela
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
| |
Collapse
|
10
|
MacKay-Lyons M, Billinger SA, Eng JJ, Dromerick A, Giacomantonio N, Hafer-Macko C, Macko R, Nguyen E, Prior P, Suskin N, Tang A, Thornton M, Unsworth K. Aerobic Exercise Recommendations to Optimize Best Practices in Care After Stroke: AEROBICS 2019 Update. Phys Ther 2019; 100:149-156. [PMID: 31596465 PMCID: PMC8204880 DOI: 10.1093/ptj/pzz153] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 09/18/2018] [Accepted: 06/09/2019] [Indexed: 01/18/2023]
Abstract
Most stroke survivors have very low levels of cardiovascular fitness, which limits mobility and leads to further physical deconditioning, increased sedentary behavior, and heightened risk of recurrent stroke. Although clinical guidelines recommend that aerobic exercise be a part of routine stroke rehabilitation, clinical uptake has been suboptimal. In 2013, an international group of stroke rehabilitation experts developed a user-friendly set of recommendations to guide screening and prescription-the Aerobic Exercise Recommendations to Optimize Best Practices in Care after Stroke (AEROBICS 2013). The objective of this project was to update AEROBICS 2013 using the highest quality of evidence currently available. The first step was to conduct a comprehensive review of literature from 2012 to 2018 related to aerobic exercise poststroke. A working group of the original consensus panel members drafted revisions based on synthesis. An iterative process was used to achieve agreement among all panel members. Final revisions included: (1) addition of 115 new references to replace or augment those in the original AEROBICS document, (2) rewording of the original recommendations and supporting material, and (3) addition of 2 new recommendations regarding prescription. The quality of evidence from which these recommendations were derived ranged from low to high. The AEROBICS 2019 Update should make it easier for clinicians to screen for, and prescribe, aerobic exercise in stroke rehabilitation. Clinical implementation will not only help to narrow the gap between evidence and practice but also reduce current variability and uncertainty regarding the role of aerobic exercise in recovery after stroke.
Collapse
Affiliation(s)
| | - Sandra A Billinger
- Physical Therapy and Rehab Science, University of Kansas Medical Center, Kansas City, Kansas
| | - Janice J Eng
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alex Dromerick
- Department of Neurology, Pasquerilla Healthcare Center, Washington, DC
| | | | - Charlene Hafer-Macko
- Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Richard Macko
- Department Neurology, VA Maryland Health Care System, Baltimore, Maryland
| | | | - Peter Prior
- Department of Psychology, St. Joseph's Health Care London, London, Ontario, Canada
| | - Neville Suskin
- Department of Cardiology, Western University, London, Ontario, Canada
| | - Ada Tang
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | | | - Karen Unsworth
- Department of Cardiac Rehabilitation, St. Joseph's Health Care London, London, Ontario, Canada
| |
Collapse
|
11
|
Luo L, Meng H, Wang Z, Zhu S, Yuan S, Wang Y, Wang Q. Effect of high-intensity exercise on cardiorespiratory fitness in stroke survivors: A systematic review and meta-analysis. Ann Phys Rehabil Med 2019; 63:59-68. [PMID: 31465865 DOI: 10.1016/j.rehab.2019.07.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 07/04/2019] [Accepted: 07/30/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Knowledge of the optimal protocol and safety of particularly high-intensity exercise applied to individuals with stroke is lacking. OBJECTIVE This systematic review and meta-analysis aimed to investigate the effect of high-intensity exercise on cardiorespiratory fitness in stroke survivors. METHODS We performed a systematic electronic search for articles in MedLine via PubMed, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, CINAHL, and SPORTSDiscus up to April 1, 2019. Peak oxygen consumption (VO2peak), 6-min walk test (6MWT), fastest 10-m walk test (10MWT), and adverse events were assessed. The standardized mean difference (SMD), weighted mean difference (WMD), and odds ratios (ORs) were used to compute the effect size, and subgroup analysis was conducted to test the consistency of results as well as sensitivity analysis to assess the robustness of the results. The quality of evidence was assessed with the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. RESULTS We included 17 studies (PEDro score≥4) in the meta-analysis. Post-intervention, high-intensity exercise had a significant effect on peak oxygen uptake (VO2peak; SMD=0.56, P<0.01, I2=8%; WMD=2.53mL/kg/min; high quality of evidence) and 6MWT (SMD=0.26, P<0.01, I2=40%; WMD=17.08m; moderate quality of evidence) but not fastest 10MWT (SMD=0.33, P=0.27, I2=77%; WMD=0.05m/s; low quality of evidence). Subgroup analysis showed better effects of higher-intensity treadmill training (≥70% heart rate reserve/VO2peak) for a longer duration (≥12 weeks) on VO2peak and 6MWT in sub-acute or chronic stroke survivors. The high-intensity exercise and control groups did not differ in adverse events including falls [odds ratio (OR) 1.40, P=0.35, I2=11%; low quality of evidence], pain (OR 3.34, P=0.09, I2=0%; moderate quality of evidence), or skin injuries (OR 1.08, P=0.90, I2=0%; low quality of evidence). CONCLUSIONS Our meta-analysis suggests that high-intensity exercise is beneficial for cardiorespiratory fitness in stroke survivors and might be safe as a novel intervention in cardiopulmonary rehabilitation after stroke.
Collapse
Affiliation(s)
- Lu Luo
- Department of Rehabilitation Medicine, Qingdao University, Qingdao, China; Department of Rehabilitation Medicine, Fudan University, Shanghai, China
| | - Haining Meng
- Department of Special Medicine, School of Basic Medical College, Qingdao University, Qingdao, China
| | - Ziwei Wang
- The Ohio State University, Columbus, OH, United States
| | - Shiqiang Zhu
- Department of Rehabilitation Medicine, Ningxia Medical University, Ningxia, China
| | - Song Yuan
- Department of Rehabilitation Medicine, Taihe Hospital, Hubei, China
| | - Yuyang Wang
- Department of Rehabilitation Medicine, The Affiliated Hospital of Qingdao University, 1677, Wutaishan Road, Huangdao District, 266000 Qingdao, Shandong, China
| | - Qiang Wang
- Department of Rehabilitation Medicine, The Affiliated Hospital of Qingdao University, 1677, Wutaishan Road, Huangdao District, 266000 Qingdao, Shandong, China.
| |
Collapse
|
12
|
Wiener J, McIntyre A, Janssen S, Chow JTY, Batey C, Teasell R. Effectiveness of High‐Intensity Interval Training for Fitness and Mobility Post Stroke: A Systematic Review. PM R 2019; 11:868-878. [DOI: 10.1002/pmrj.12154] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 02/28/2019] [Indexed: 12/31/2022]
Affiliation(s)
- Joshua Wiener
- Parkwood Institute ResearchLawson Health Research Institute London ON Canada
| | - Amanda McIntyre
- Parkwood Institute ResearchLawson Health Research Institute London ON Canada
| | - Scott Janssen
- Parkwood Institute ResearchLawson Health Research Institute London ON Canada
| | - Jeffrey TY Chow
- Parkwood Institute ResearchLawson Health Research Institute London ON Canada
| | - Cristina Batey
- Parkwood InstituteSt. Joseph's Health Care London London ON Canada
- Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Robert Teasell
- Parkwood Institute ResearchLawson Health Research Institute London ON Canada
- Parkwood InstituteSt. Joseph's Health Care London London ON Canada
- Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| |
Collapse
|
13
|
Aaron SE, Vanderwerker CJ, Embry AE, Newton JH, Lee SCK, Gregory CM. FES-assisted Cycling Improves Aerobic Capacity and Locomotor Function Postcerebrovascular Accident. Med Sci Sports Exerc 2018; 50:400-406. [PMID: 29461462 DOI: 10.1249/mss.0000000000001457] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE After a cerebrovascular accident (CVA) aerobic deconditioning contributes to diminished physical function. Functional electrical stimulation (FES)-assisted cycling is a promising exercise paradigm designed to target both aerobic capacity and locomotor function. This pilot study aimed to evaluate the effects of an FES-assisted cycling intervention on aerobic capacity and locomotor function in individuals post-CVA. METHODS Eleven individuals with chronic (>6 months) post-CVA hemiparesis completed an 8-wk (three times per week; 24 sessions) progressive FES-assisted cycling intervention. V˙O2peak, self-selected, and fastest comfortable walking speeds, gait, and pedaling symmetry, 6-min walk test (6MWT), balance, dynamic gait movements, and health status were measured at baseline and posttraining. RESULTS Functional electrical stimulation-assisted cycling significantly improved V˙O2peak (12%, P = 0.006), self-selected walking speed (SSWS, 0.05 ± 0.1 m·s, P = 0.04), Activities-specific Balance Confidence scale score (12.75 ± 17.4, P = 0.04), Berg Balance Scale score (3.91 ± 4.2, P = 0.016), Dynamic Gait Index score (1.64 ± 1.4, P = 0.016), and Stroke Impact Scale participation/role domain score (12.74 ± 16.7, P = 0.027). Additionally, pedal symmetry, represented by the paretic limb contribution to pedaling (paretic pedaling ratio [PPR]) significantly improved (10.09% ± 9.0%, P = 0.016). Although step length symmetry (paretic step ratio [PSR]) did improve, these changes were not statistically significant (-0.05% ± 0.1%, P = 0.09). Exploratory correlations showed moderate association between change in SSWS and 6-min walk test (r = 0.74), and moderate/strong negative association between change in PPR and PSR. CONCLUSIONS These results support FES-assisted cycling as a means to improve both aerobic capacity and locomotor function. Improvements in SSWS, balance, dynamic walking movements, and participation in familial and societal roles are important targets for rehabilitation of individuals after CVA. Interestingly, the correlation between PSR and PPR suggests that improvements in pedaling symmetry may translate to a more symmetric gait pattern.
Collapse
Affiliation(s)
- Stacey E Aaron
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC
| | - Catherine J Vanderwerker
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC
| | - Aaron E Embry
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC.,Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC.,Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC
| | - Jennifer H Newton
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC
| | - Samuel C K Lee
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC.,Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC
| | - Chris M Gregory
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC.,Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC.,Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC
| |
Collapse
|
14
|
SAP97 Binding Partner CRIPT Promotes Dendrite Growth In Vitro and In Vivo. eNeuro 2017; 4:eN-NWR-0175-17. [PMID: 29218323 PMCID: PMC5718245 DOI: 10.1523/eneuro.0175-17.2017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 10/30/2017] [Accepted: 10/30/2017] [Indexed: 01/15/2023] Open
Abstract
The dendritic tree is a key determinant of neuronal information processing. In the motor system, the dendritic tree of spinal cord neurons undergoes dramatic remodeling in an activity-dependent manner during early postnatal life. This leads to the proper segmental spinal cord connectivity that subserves normal locomotor behavior. One molecular system driving the establishment of dendrite architecture of mammalian motor neurons relies on AMPA receptors (AMPA-Rs) assembled with the GluA1 subunit, and this occurs in an NMDA receptor (NMDA-R)-independent manner. The dendrite growth promoting activity of GluA1-containing AMPA-Rs depends on its intracellular binding partner, SAP97, and SAP97's PDZ3 domain. We show here that cysteine-rich interactor of PDZ3 (CRIPT) is a bona fide SAP97 PDZ3-domain binding partner, localizes to synapses with GluA1 and SAP97 along the dendritic tree, and is a determinant of the dendritic growth of mammalian spinal cord neurons. We further show that CRIPT has a well-conserved ortholog in the nematode, Caenorhabditis elegans, and animals lacking CRIPT display decreased dendrite branching of the well-studied PVD neuron in vivo. The lack of CRIPT leads to a selective defect in touch perception, and this is rescued by expression of wild-type (WT) human CRIPT (hCRIPT) in the nervous system. This work brings new light into the molecular machinery that drives dendritic growth during development and may prove relevant to the promotion of nervous system plasticity following insult.
Collapse
|
15
|
Kim J, Yim J. Effects of an Exercise Protocol for Improving Handgrip Strength and Walking Speed on Cognitive Function in Patients with Chronic Stroke. Med Sci Monit 2017; 23:5402-5409. [PMID: 29131814 PMCID: PMC5699168 DOI: 10.12659/msm.904723] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Handgrip strength and walking speed predict and influence cognitive function. We aimed to investigate an exercise protocol for improving handgrip strength and walking speed, applied to patients with chronic stroke who had cognitive function disorder. Material/Methods Twenty-nine patients with cognitive function disorder participated in this study, and were randomly divided into one of two groups: exercise group (n=14) and control group (n=15). Both groups underwent conventional physical therapy for 60 minutes per day. Additionally, the exercise group followed an exercise protocol for handgrip using the hand exerciser, power web exerciser, Digi-Flex (15 minutes); and treadmill-based weight loading training on their less-affected leg (15 minutes) using a sandbag for 30 minutes, three times per day, for six weeks. Outcomes, including cognitive function and gait ability, were measured before and after the training. Results The Korean version of Montreal Cognitive Assessment (K-MoCA), Stroop test (both simple and interference), Trail Making-B, Timed Up and Go, and 10-Meter Walk tests (p<0.05) yielded improved results for the exercise group compared with the control group. Importantly, the K-MoCA, Timed Up and Go, and 10-Meter Walk test results were significantly different between the two groups (p<0.05). Conclusions The exercise protocol for improving handgrip strength and walking speed had positive effects on cognitive function in patients with chronic stroke.
Collapse
Affiliation(s)
- Jaeeun Kim
- Department of Physical Therapy, The Graduate School of Sahmyook University, Seoul, South Korea
| | - Jongeun Yim
- Department of Physical Therapy, Graduate School of Sahmyook University, Seoul, South Korea
| |
Collapse
|
16
|
Aerobic Exercise Prescription in Stroke Rehabilitation: A Web-Based Survey of US Physical Therapists. J Neurol Phys Ther 2017; 41:119-128. [PMID: 28263254 DOI: 10.1097/npt.0000000000000177] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Best practice recommendations indicate that aerobic exercise (AEX) should be incorporated into stroke rehabilitation. However, this may be challenging in clinical settings. The purpose of this study was to assess physical therapist (PT) AEX prescription for patients with stroke, including AEX utilization, barriers to AEX prescription, dosing parameters, and safety considerations. METHODS A cross-sectional Web-based survey study was conducted. Physical therapists with valid e-mail addresses on file with the state boards of Florida, New Jersey, Ohio, Texas, and Wyoming were eligible to participate. Survey invitations were e-mailed to all licensed PT in these states. Analysis focused on respondents who were currently involved with clinical stroke rehabilitation in common practice settings. RESULTS Results from 568 respondents were analyzed. Most respondents (88%) agreed that AEX should be incorporated into stroke rehabilitation, but 84% perceived at least one barrier. Median prescribed AEX volume varied between practice settings from 20- to 30-minute AEX sessions, 3 to 5 days per week for 2 to 8 weeks. Prescribed intensity was most commonly light or moderate; intensity was determined by the general response to AEX and patient feedback. Only 2% of respondents reported that the majority of their patients with stroke had stress tests. DISCUSSION AND CONCLUSIONS Most US PTs appear to recognize the importance of AEX for persons poststroke, but clinical implementation can be challenging. Future studies and consensus are needed to clarify best practices and to develop implementation interventions to optimize AEX utilization in stroke rehabilitation.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A167).
Collapse
|
17
|
In T, Jin Y, Jung K, Cho HY. Treadmill training with Thera-Band improves motor function, gait and balance in stroke patients. NeuroRehabilitation 2017; 40:109-114. [DOI: 10.3233/nre-161395] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Taesung In
- Department of Physical Therapy, Gimcheon University, Gimcheon, Republic of Korea
| | - Youngmi Jin
- Department of Physical Therapy, Kaiser Rehabilitation Hospital, Gyeonggi-do, Republic of Korea
| | - Kyoungsim Jung
- Institute for Life Sciences, Asan Medical Center, University of Ulsan college of Medicine, Seoul, Republic of Korea
| | - Hwi-young Cho
- Department of Physical Therapy, College of Health Science, Gachon University, Incheon, Republic of Korea
| |
Collapse
|
18
|
High-Intensity Interval Training and Moderate-Intensity Continuous Training in Ambulatory Chronic Stroke: Feasibility Study. Phys Ther 2016; 96:1533-1544. [PMID: 27103222 PMCID: PMC5046191 DOI: 10.2522/ptj.20150277] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 04/14/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Poststroke guidelines recommend moderate-intensity, continuous aerobic training (MCT) to improve aerobic capacity and mobility after stroke. High-intensity interval training (HIT) has been shown to be more effective than MCT among healthy adults and people with heart disease. However, HIT and MCT have not been compared previously among people with stroke. OBJECTIVE The purpose of this study was to assess the feasibility and justification for a definitive randomized controlled trial (RCT) comparing HIT and MCT in people with chronic stroke. DESIGN A preliminary RCT was conducted. SETTING The study was conducted in a cardiovascular stress laboratory and a rehabilitation research laboratory. PATIENTS Ambulatory people at least 6 months poststroke participated. INTERVENTION Both groups trained 25 minutes, 3 times per week, for 4 weeks. The HIT strategy involved 30-second bursts at maximum-tolerated treadmill speed alternated with 30- to 60-second rest periods. The MCT strategy involved continuous treadmill walking at 45% to 50% of heart rate reserve. MEASUREMENTS Measurements included recruitment and attendance statistics, qualitative HIT acceptability, adverse events, and the following blinded outcome variables: peak oxygen uptake, ventilatory threshold, metabolic cost of gait, fractional utilization, fastest treadmill speed, 10-Meter Walk Test, and Six-Minute Walk Test. RESULTS During the 8-month recruitment period, 26 participants consented to participate. Eighteen participants were enrolled and randomly assigned to either the HIT group (n=13) or the MCT group (n=5). Eleven out of the 13 HIT group participants attended all sessions. Participants reported that HIT was acceptable and no serious adverse events occurred. Standardized effect size estimates between groups were moderate to very large for most outcome measures. Only 30% of treadmill speed gains in the HIT group translated into overground gait speed improvement. LIMITATIONS The study was not designed to definitively test safety or efficacy. CONCLUSIONS Although further protocol optimization is needed to improve overground translation of treadmill gains, a definitive RCT comparing HIT and MCT appears to be feasible and warranted.
Collapse
|
19
|
Boyne P, Reisman D, Brian M, Barney B, Franke A, Carl D, Khoury J, Dunning K. Ventilatory threshold may be a more specific measure of aerobic capacity than peak oxygen consumption rate in persons with stroke. Top Stroke Rehabil 2016; 24:149-157. [PMID: 27454553 DOI: 10.1080/10749357.2016.1209831] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND After stroke, aerobic deconditioning can have a profound impact on daily activities. This is usually measured by the peak oxygen consumption rate achieved during exercise testing (VO2-peak). However, VO2-peak may be distorted by motor function. The oxygen uptake efficiency slope (OUES) and VO2 at the ventilatory threshold (VO2-VT) could more specifically assess aerobic capacity after stroke, but this has not been tested. OBJECTIVES To assess the differential influence of motor function on three measures of aerobic capacity (VO2-peak, OUES, and VO2-VT) and to evaluate the inter-rater reliability of VO2-VT determination post-stroke. METHODS Among 59 persons with chronic stroke, cross-sectional correlations with motor function (comfortable gait speed [CGS] and lower extremity Fugl-Meyer [LEFM]) were compared between the different aerobic capacity measures, after adjustment for covariates, in order to isolate any distorting effect of motor function. Reliability of VO2-VT determination between three raters was assessed with intra-class correlation (ICC). RESULTS CGS was moderately correlated with VO2-peak (r = 0.52, p < 0.0001) and weakly correlated with OUES (r = 0.41, p = 0.002) and VO2-VT (r = 0.37, p = 0.01). LEFM was weakly correlated with VO2-peak (r = 0.26, p = 0.055) and very weakly correlated with OUES (r = 0.19, p = 0.17) and VO2-VT (r = 0.14, p = 0.31). Compared to VO2-peak, VO2-VT was significantly less correlated with CGS (r difference = -0.16, p = 0.02). Inter-rater reliability of VO2-VT determination was high (ICC: 0.93, 95% CI: 0.89-0.96). CONCLUSIONS Motor dysfunction appears to artificially lower measured aerobic capacity. VO2-VT seemed to be less distorted than VO2-peak and had good inter-rater reliability, so it may provide more specific assessment of aerobic capacity post-stroke.
Collapse
Affiliation(s)
- Pierce Boyne
- a Department of Rehabilitation Sciences , College of Allied Health Sciences, University of Cincinnati , Cincinnati , OH , USA.,b Department of Environmental Health , College of Medicine, University of Cincinnati , Cincinnati , OH , USA
| | - Darcy Reisman
- c Department of Physical Therapy , College of Health Sciences, University of Delaware , Newark , DE , USA
| | - Michael Brian
- c Department of Physical Therapy , College of Health Sciences, University of Delaware , Newark , DE , USA
| | - Brian Barney
- a Department of Rehabilitation Sciences , College of Allied Health Sciences, University of Cincinnati , Cincinnati , OH , USA
| | - Ava Franke
- a Department of Rehabilitation Sciences , College of Allied Health Sciences, University of Cincinnati , Cincinnati , OH , USA
| | - Daniel Carl
- a Department of Rehabilitation Sciences , College of Allied Health Sciences, University of Cincinnati , Cincinnati , OH , USA
| | - Jane Khoury
- b Department of Environmental Health , College of Medicine, University of Cincinnati , Cincinnati , OH , USA.,d Division of Biostatistics and Epidemiology , Cincinnati Children's Hospital Medical Center , Cincinnati , OH , USA
| | - Kari Dunning
- a Department of Rehabilitation Sciences , College of Allied Health Sciences, University of Cincinnati , Cincinnati , OH , USA.,b Department of Environmental Health , College of Medicine, University of Cincinnati , Cincinnati , OH , USA
| |
Collapse
|
20
|
Wist S, Clivaz J, Sattelmayer M. Muscle strengthening for hemiparesis after stroke: A meta-analysis. Ann Phys Rehabil Med 2016; 59:114-24. [DOI: 10.1016/j.rehab.2016.02.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 02/08/2016] [Indexed: 10/22/2022]
|
21
|
Kim H, Choi W, Lee K, Song C. Virtual dual-task treadmill training using video recording for gait of chronic stroke survivors: a randomized controlled trial. J Phys Ther Sci 2016; 27:3693-7. [PMID: 26834334 PMCID: PMC4713773 DOI: 10.1589/jpts.27.3693] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 09/02/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The aim of this study was to examine the effects of virtual dual-task treadmill
training using a real-world video recording of the gait of individuals with chronic
stroke. [Subjects] Forty chronic stroke survivors were randomly divided into two groups of
20 subjects each. [Methods] The experimental group performed virtual dual-task treadmill
training using a video recording for 30 minutes per session, three times a week for 4
weeks, whereas the control group performed only treadmill training for 30 minutes per
session, three times a week for 4 weeks. A video recording was performed in a large
supermarket, and the subjects could walk at their favorable speed on a treadmill. The
temporospatial gait variables were measured to examine the training effect. [Results] The
experimental and control groups showed statistically significant improvements in the gait
variables after training. The enhancement of gait ability was statistically better in the
experimental group than in the control group. [Conclusion] Our findings suggest that
virtual dual-task treadmill training using a video recording can improve the gait
parameters of chronic stroke survivors.
Collapse
Affiliation(s)
- Hyunseung Kim
- Department of Physical Therapy, The Graduate of School, Sahmyook University, Republic of Korea
| | - Wonjae Choi
- Institute of Rehabilitation Science, Sahmyook University, Republic of Korea
| | - Kyeongjin Lee
- Motion Analysis Laboratory, Department of Kinesiology, Texas Woman's University, USA
| | - Changho Song
- Department of Physical Therapy, Sahmyook University, Republic of Korea
| |
Collapse
|
22
|
Effects of treadmill inclination on hemiparetic gait: controlled and randomized clinical trial. Am J Phys Med Rehabil 2015; 94:718-27. [PMID: 25357148 DOI: 10.1097/phm.0000000000000240] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to analyze the effects of inclined treadmill training on the kinematic characteristics of gait in subjects with hemiparesis. DESIGN A blind, randomized, controlled study was conducted with 28 subjects divided into two groups: the control group, submitted to partial body weight-support treadmill gait training with no inclination, and the experimental group, which underwent partial body weight-support treadmill training at 10% of inclination. All volunteers were assessed for functional independence, motor function, balance, and gait before and after the 12 training sessions. RESULTS Both groups showed posttraining alterations in balance (P < 0.001), motor function (P < 0.001), and functional independence (P = 0.002). Intergroup differences in spatiotemporal differences were observed, where only the experimental group showed posttraining alterations in velocity (P = 0.02) and paretic step length (P = 0.03). Angular variables showed no significant differences in either group. CONCLUSIONS In subjects with hemiparesis, the addition of inclination is a stimulus capable of enhancing the effects of partial body weight-support treadmill gait training.
Collapse
|
23
|
Boyne P, Buhr S, Rockwell B, Khoury J, Carl D, Gerson M, Kissela B, Dunning K. Predicting Heart Rate at the Ventilatory Threshold for Aerobic Exercise Prescription in Persons With Chronic Stroke. J Neurol Phys Ther 2015; 39:233-40. [PMID: 26371532 DOI: 10.1097/npt.0000000000000102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Treadmill aerobic exercise improves gait, aerobic capacity, and cardiovascular health after stroke, but a lack of specificity in current guidelines could lead to underdosing or overdosing of aerobic intensity. The ventilatory threshold (VT) has been recommended as an optimal, specific starting point for continuous aerobic exercise. However, VT measurement is not available in clinical stroke settings. Therefore, the purpose of this study was to identify an accurate method to predict heart rate at the VT (HRVT) for use as a surrogate for VT. METHODS A cross-sectional design was employed. Using symptom-limited graded exercise test (GXT) data from 17 subjects more than 6 months poststroke, prediction methods for HRVT were derived by traditional target HR calculations (percentage of HRpeak achieved during GXT, percentage of peak HR reserve [HRRpeak], percentage of age-predicted maximal HR, and percentage of age-predicted maximal HR reserve) and by regression analysis. The validity of the prediction methods was then tested among 8 additional subjects. RESULTS All prediction methods were validated by the second sample, so data were pooled to calculate refined prediction equations. HRVT was accurately predicted by 80% HRpeak (R, 0.62; standard deviation of error [SDerror], 7 bpm), 62% HRRpeak (R, 0.66; SDerror, 7 bpm), and regression models that included HRpeak (R, 0.62-0.75; SDerror, 5-6 bpm). DISCUSSION AND CONCLUSIONS Derived regression equations, 80% HRpeak and 62% HRRpeak, provide a specific target intensity for initial aerobic exercise prescription that should minimize underdosing and overdosing for persons with chronic stroke. The specificity of these methods may lead to more efficient and effective treatment for poststroke deconditioning.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A114).
Collapse
Affiliation(s)
- Pierce Boyne
- Department of Rehabilitation Sciences (P.B., S.B., B.R., D.C., K.D.), Department of Environmental Health (P.B., J.K., K.D.), Departments of Internal Medicine and Cardiology (M.G.), and Department of Neurology and Rehabilitation Medicine (B.K.), University of Cincinnati, Cincinnati, Ohio; and Division of Biostatistics and Epidemiology (J.K.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | | | | | | | | | | | | |
Collapse
|
24
|
Boyne P, Dunning K, Carl D, Gerson M, Khoury J, Kissela B. Within-session responses to high-intensity interval training in chronic stroke. Med Sci Sports Exerc 2015; 47:476-84. [PMID: 24977698 DOI: 10.1249/mss.0000000000000427] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
UNLABELLED Poststroke hemiparesis often leads to a vicious cycle of limited activity, deconditioning, and poor cardiovascular health. Accumulating evidence suggests that exercise intensity is a critical factor determining gains in aerobic capacity, cardiovascular protection, and functional recovery after stroke. High-intensity interval training (HIT) is a strategy that augments exercise intensity using bursts of concentrated effort alternated with recovery periods. However, there was previously no stroke-specific evidence to guide HIT protocol selection. PURPOSE This study aimed to compare within-session exercise responses among three different HIT protocols for persons with chronic (>6 months after) stroke. METHODS Nineteen ambulatory persons with chronic stroke performed three different 1-d HIT sessions in a randomized order, approximately 1 wk apart. HIT involved repeated 30-s bursts of treadmill walking at maximum tolerated speed, alternated with rest periods. The three HIT protocols were different on the basis of the length of the rest periods, as follows: 30 s (P30), 60 s (P60), or 120 s (P120). Exercise tolerance, oxygen uptake (V˙O2), HR, peak treadmill speed, and step count were measured. RESULTS P30 achieved the highest mean V˙O2, HR, and step count but with reduced exercise tolerance and lower treadmill speed than P60 or P120 (P30: 70.9% V˙O2peak, 76.1% HR reserve (HRR), 1619 steps, 1.03 m·s(-1); P60: 63.3% V˙O2peak, 63.1% HRR, 1370 steps, 1.13 m·s(-1); P120: 47.5% V˙O2peak, 46.3% HRR, 1091 steps, 1.10 m·s(-1)). P60 achieved treadmill speed and exercise tolerance similar to those in P120, with higher mean V˙O2, HR, and step count. CONCLUSIONS For treadmill HIT in chronic stroke, a combination of P30 and P60 may optimize aerobic intensity, treadmill speed, and stepping repetition, potentially leading to greater improvements in aerobic capacity and gait outcomes in future studies.
Collapse
Affiliation(s)
- Pierce Boyne
- 1Department of Rehabilitation Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH; 2Departments of Internal Medicine and Cardiology, College of Medicine, University of Cincinnati, Cincinnati, OH; 3Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; 4Department of Neurology, Physical Medicine and Rehabilitation, College of Medicine, University of Cincinnati, Cincinnati, OH
| | | | | | | | | | | |
Collapse
|
25
|
Chua KSG, Chee J, Wong CJ, Lim PH, Lim WS, Hoo CM, Ong WS, Shen ML, Yu WS. A pilot clinical trial on a Variable Automated Speed and Sensing Treadmill (VASST) for hemiparetic gait rehabilitation in stroke patients. Front Neurosci 2015. [PMID: 26217170 PMCID: PMC4498099 DOI: 10.3389/fnins.2015.00231] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Impairments in walking speed and capacity are common problems after stroke which may benefit from treadmill training. However, standard treadmills, are unable to adapt to the slower walking speeds of stroke survivors and are unable to automate training progression. This study tests a Variable Automated Speed and Sensing Treadmill (VASST) using a standard clinical protocol. VASST is a semi-automated treadmill with multiple sensors and micro controllers, including wireless control to reposition a fall-prevention harness, variable pre-programmed exercise parameters and laser beam foot sensors positioned on the belt to detect subject's foot positions. MATERIALS AND METHODS An open-label study with assessor blinding was conducted in 10 community-dwelling chronic hemiplegic patients who could ambulate at least 0.1 m/s. Interventions included physiotherapist-supervised training on VASST for 60 min three times per week for 4 weeks (total 12 h). Outcome measures of gait speed, quantity, balance, and adverse events were assessed at baseline, 2, 4, and 8 weeks. RESULTS Ten subjects (8 males, mean age 55.5 years, 2.1 years post stroke) completed VASST training. Mean 10-m walk test speed was 0.69 m/s (SD = 0.29) and mean 6-min walk test distance was 178.3 m (84.0). After 4 weeks of training, 70% had significant positive gains in gait speed (0.06 m/s, SD = 0.08 m/s, P = 0.037); and 90% improved in walking distance. (54.3 m, SD = 30.9 m, P = 0.005). There were no adverse events. DISCUSSION AND CONCLUSION This preliminary study demonstrates the initial feasibility and short-term efficacy of VASST for walking speed and distance for people with chronic post-stroke hemiplegia.
Collapse
Affiliation(s)
- Karen S G Chua
- Department of Rehabilitation Medicine, Tan Tock Seng Hospital Rehabilitation Centre Singapore, Singapore
| | - Johnny Chee
- Division of Electronic and Computer Engineering, Biomedical Engineering Centre, Ngee Ann Polytechnic Singapore
| | - Chin J Wong
- Department of Rehabilitation Medicine, Tan Tock Seng Hospital Rehabilitation Centre Singapore, Singapore
| | - Pang H Lim
- Department of Rehabilitation Medicine, Tan Tock Seng Hospital Rehabilitation Centre Singapore, Singapore
| | - Wei S Lim
- Department of Rehabilitation Medicine, Tan Tock Seng Hospital Rehabilitation Centre Singapore, Singapore
| | - Chuan M Hoo
- Division of Electronic and Computer Engineering, Biomedical Engineering Centre, Ngee Ann Polytechnic Singapore
| | - Wai S Ong
- Division of Electronic and Computer Engineering, Biomedical Engineering Centre, Ngee Ann Polytechnic Singapore
| | - Mira L Shen
- Clinical Research Unit, Tan Tock Seng Hospital Singapore, Singapore
| | - Wei S Yu
- Division of Electronic and Computer Engineering, Biomedical Engineering Centre, Ngee Ann Polytechnic Singapore
| |
Collapse
|
26
|
Functional Electrical Stimulation–Assisted Active Cycling—Therapeutic Effects in Patients With Hemiparesis From 7 Days to 6 Months After Stroke: A Randomized Controlled Pilot Study. Arch Phys Med Rehabil 2015; 96:188-96. [DOI: 10.1016/j.apmr.2014.09.033] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 09/24/2014] [Accepted: 09/25/2014] [Indexed: 11/21/2022]
|
27
|
Time course of functional and biomechanical improvements during a gait training intervention in persons with chronic stroke. J Neurol Phys Ther 2014; 37:159-65. [PMID: 24189337 DOI: 10.1097/npt.0000000000000020] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE In rehabilitation, examining how variables change over time can help define the minimal number of training sessions required to produce a desired change. The purpose of this study was to identify the time course of changes in gait biomechanics and walking function in persons with chronic stroke. METHODS Thirteen persons who were more than 6 months poststroke participated in 12 weeks of fast treadmill training combined with plantar- and dorsiflexor muscle functional electrical stimulation (FastFES). All participants completed testing before the start of intervention, after 4, 8, and 12 weeks of FastFES locomotor training. RESULTS Peak limb paretic propulsion, paretic limb propulsive integral, peak paretic limb knee flexion (P < 0.05 for all), and peak paretic trailing limb angle (P < 0.01) improved from pretraining to 4 weeks but not between 4 and 12 weeks. Self-selected walking speed and 6-minute walk test distance improved from pretraining to 4 weeks and from 4 to 12 weeks (P < 0.01 and P < 0.05, respectively for both). Timed Up & Go test time did not improve between pretraining and 4 weeks, but improved by 12 weeks (P = 0.24 and P < 0.01, respectively). DISCUSSION AND CONCLUSIONS The results demonstrate that walking function improves with a different time course compared with gait biomechanics in response to a locomotor training intervention in persons with chronic stroke. Thirty-six training sessions were necessary to achieve an increase in walking speed that exceeded the minimally clinically important difference. These findings should be considered when designing locomotor training interventions after stroke.Video Abstract available (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A63) for more insights from the authors.
Collapse
|
28
|
Lee CW, Kim SG, Yong MS. Effects of hippotherapy on recovery of gait and balance ability in patients with stroke. J Phys Ther Sci 2014; 26:309-11. [PMID: 24648655 PMCID: PMC3944312 DOI: 10.1589/jpts.26.309] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 09/22/2013] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The aim of this study was to examine the the effects of hippotherapy on gait
and balance ability in patients with stroke. [Subjects and Methods] Thirty stroke patients
were randomly divided into a hippotherapy group and a treadmill group and they conducted
exercise for eight weeks. [Results] Berg Balance Scale score, gait velocity, and step
length asymmetry ratio were significantly improved in the group receiving hippotherapy
training. However, in the group receiving treadmill training, only step length asymmetry
ratio was significantly improved. In the comparison between the hippotherapy group and
treadmill group, there was no significant difference in Berg Balance Scale score, but a
significant difference was found in gait velocity and step length asymmetry ratio.
[Conclusion] The results of this study indicated that hippotherapy is a helpful treatment
for stroke patients.
Collapse
Affiliation(s)
- Chae-Woo Lee
- Department of Hippotherapy, Sungduk College, Republic of Korea
| | - Seong Gil Kim
- Department of Rehabilitation Science, Graduate School, Daegu University, Republic of Korea
| | - Min Sik Yong
- Department of Rehabilitation Science, Graduate School, Daegu University, Republic of Korea
| |
Collapse
|
29
|
Molecular mechanisms of treadmill therapy on neuromuscular atrophy induced via botulinum toxin A. Neural Plast 2013; 2013:593271. [PMID: 24327926 PMCID: PMC3845528 DOI: 10.1155/2013/593271] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 09/13/2013] [Accepted: 10/01/2013] [Indexed: 01/09/2023] Open
Abstract
Botulinum toxin A (BoNT-A) is a bacterial zinc-dependent endopeptidase that acts specifically on neuromuscular junctions. BoNT-A blocks the release of acetylcholine, thereby decreasing the ability of a spastic muscle to generate forceful contraction, which results in a temporal local weakness and the atrophy of targeted muscles. BoNT-A-induced temporal muscle weakness has been used to manage skeletal muscle spasticity, such as poststroke spasticity, cerebral palsy, and cervical dystonia. However, the combined effect of treadmill exercise and BoNT-A treatment is not well understood. We previously demonstrated that for rats, following BoNT-A injection in the gastrocnemius muscle, treadmill running improved the recovery of the sciatic functional index (SFI), muscle contraction strength, and compound muscle action potential (CMAP) amplitude and area. Treadmill training had no influence on gastrocnemius mass that received BoNT-A injection, but it improved the maximal contraction force of the gastrocnemius, and upregulation of GAP-43, IGF-1, Myo-D, Myf-5, myogenin, and acetylcholine receptor (AChR) subunits α and β was found following treadmill training. Taken together, these results suggest that the upregulation of genes associated with neurite and AChR regeneration following treadmill training may contribute to enhanced gastrocnemius strength recovery following BoNT-A injection.
Collapse
|
30
|
Boyne P, Dunning K, Carl D, Gerson M, Khoury J, Kissela B. High-intensity interval training in stroke rehabilitation. Top Stroke Rehabil 2013; 20:317-30. [PMID: 23893831 DOI: 10.1310/tsr2004-317] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
After stroke, people with weakness enter a vicious cycle of limited activity and deconditioning that limits functional recovery and exacerbates cardiovascular risk factors. Conventional aerobic exercise improves aerobic capacity, function, and overall cardiometabolic health after stroke. Recently, a new exercise strategy has shown greater effectiveness than conventional aerobic exercise for improving aerobic capacity and other outcomes among healthy adults and people with heart disease. This strategy, called high-intensity interval training (HIT), uses bursts of concentrated effort alternated with recovery periods to maximize exercise intensity. Three poststroke HIT studies have shown preliminary effectiveness for improving functional recovery. However, these studies were varied in approach and the safety of poststroke HIT has received little attention. The objectives of this narrative review are to (1) propose a framework for categorizing HIT protocols; (2) summarize the safety and effectiveness evidence of HIT among healthy adults and people with heart disease and stroke; (3) discuss theoretical mechanisms, protocol selection, and safety considerations for poststroke HIT; and (4) provide directions for future research.
Collapse
Affiliation(s)
- Pierce Boyne
- Department of Rehabilitation Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, USA
| | | | | | | | | | | |
Collapse
|
31
|
Tanabe S, Saitoh E, Ohtsuka K, Teranishi T, Tomita Y, Muraoka Y. Simple method to reduce the effect of patient positioning variation on three-dimensional motion analysis during treadmill gait. Clin Pract 2013; 3:e30. [PMID: 24765518 PMCID: PMC3981261 DOI: 10.4081/cp.2013.e30] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 09/21/2013] [Accepted: 09/24/2013] [Indexed: 11/22/2022] Open
Abstract
Recently, three-dimensional (3D) closed curve trajectories of markers placed at strategic body locations, called cyclograms or Lissajous-like graphs, are used for treadmill gait analysis. A simple method is presented to reduce the effect of patient positioning variation. After breaking down movement into three components (anterior-posterior, medial-lateral and superior-inferior), the time-series data and time-inverted data are serially concatenated. A fast Fourier transform (FFT) is done, and a high-pass filter (except 0 Hz) is applied to the anterior-posterior and medial-lateral components. Next an inverse FFT is executed, and the posterior half of the outcome, corresponding to time-inverted data, is deleted. The 3D closed curve is then reconstructed. Results showed that the proposed method was able to reduce the effect of patient positioning variation. Since the adjusted curve is simply a symbolized gait pattern, the method might be useful as an adjunct tool in observational gait analysis.
Collapse
Affiliation(s)
- Shigeo Tanabe
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University
| | - Eiichi Saitoh
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University
| | - Kei Ohtsuka
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University
| | - Toshio Teranishi
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University
| | - Yutaka Tomita
- Fujita Memorial Nanakuri Institute, Fujita Health University , Japan
| | - Yoshihiro Muraoka
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University
| |
Collapse
|
32
|
Li L, Rong W, Ke Z, Hu X, Tong KY. The effects of training intensities on motor recovery and gait symmetry in a rat model of ischemia. Brain Inj 2013; 27:408-16. [DOI: 10.3109/02699052.2012.750750] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
33
|
Abstract
This chapter addresses the important and undertreated problem of balance disorders. The chapter has a simplified summary of the physiology of balance problems in order to set the scene. The issue of assessment is next addressed with discussion of important tests including the Berg Balance Scale and the Get Up and Go Test, and others. Posturography is discussed as well as assessment of the gravitional vertical. The assessment of vestibular function is of key importance and discussed in some detail. The focus of the chapter is on balance rehabilitation. Re-training of postural alignment and of sensory strategies are key but adaptation of the environment and re-training of cognitive strategies are also helpful in individual cases. Vestibular exercises can also be used. The chapter then critically analyses the efficacy of these treatments in specific balance disorders such as in stroke, Parkinson disease, polyneuropathies, multiple sclerosis, and vestibular disorders. Overall, there is a growing body of evidence that balance rehabilitation improves symptoms, function, and quality of life for those troubled by these disabling problems.
Collapse
|
34
|
Sions JM, Tyrell CM, Knarr BA, Jancosko A, Binder-Macleod SA. Age- and stroke-related skeletal muscle changes: a review for the geriatric clinician. J Geriatr Phys Ther 2012; 35:155-61. [PMID: 22107952 PMCID: PMC3290755 DOI: 10.1519/jpt.0b013e318236db92] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Independently, aging and stroke each have a significant negative impact on skeletal muscle, but the potential cumulative effects of aging and stroke have not been explored. Optimal interventions for individuals post stroke may include those that specifically target skeletal muscle. Addressing changes in muscles may minimize activity limitations and enhance participation post stroke. This article reviews the impact of aging and stroke on muscle morphology and composition, including fiber atrophy, reductions in muscle cross-sectional area, changes in muscle fiber distributions, and increases in intramuscular fat. Relationships between changes in muscle structure, muscle function, and physical mobility are reviewed. Clinical recommendations that preserve and enhance skeletal muscle in the aging adult and individuals post stroke are discussed. Future research directions that include systematic comparison of the differences in skeletal muscle between younger and older adults who have sustained a stroke are suggested.
Collapse
Affiliation(s)
- Jaclyn Megan Sions
- Biomechanics and Movement Science Program, University of Delaware, Newark, USA.
| | | | | | | | | |
Collapse
|
35
|
Stoller O, de Bruin ED, Knols RH, Hunt KJ. Effects of cardiovascular exercise early after stroke: systematic review and meta-analysis. BMC Neurol 2012; 12:45. [PMID: 22727172 PMCID: PMC3495034 DOI: 10.1186/1471-2377-12-45] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Accepted: 05/17/2012] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Previous studies have shown the beneficial effects of aerobic exercise in chronic stroke. Most motor and functional recovery occurs in the first months after stroke. Improving cardiovascular capacity may have potential to precipitate recovery during early stroke rehabilitation. Currently, little is known about the effects of early cardiovascular exercise in stroke survivors. The aim of this systematic review was to evaluate the effectiveness of cardiovascular exercise early after stroke. METHODS A systematic literature search was performed. For this review, randomized and non-randomized prospective controlled cohort studies using a cardiovascular, cardiopulmonary or aerobic training intervention starting within 6 months post stroke were considered. The PEDro scale was used to detect risk of bias in individual studies. Inter-rater agreement was calculated (kappa). Meta-analysis was performed using a random-effects model. RESULTS A total of 11 trials were identified for inclusion. Inter-rater agreement was considered to be "very good" (Kappa: 0.81, Standard Error: 0.06, CI95%: 0.70-0.92), and the methodological quality was "good" (7 studies) to "fair" (4 studies). Peak oxygen uptake data were available for 155 participants. Pooled analysis yielded homogenous effects favouring the intervention group (standardised mean difference (SMD) = 0.83, CI95% = 0.50-1.16, Z = 4.93, P < 0.01). Walking endurance assessed with the 6 Minute Walk Test comprised 278 participants. Pooled analysis revealed homogenous effects favouring the cardiovascular training intervention group (SMD = 0.69, CI95% = 0.45-0.94, Z = 5.58, P < 0.01). Gait speed, measured in 243 participants, did not show significant results (SMD = 0.51, CI95% = -0.25-1.26, Z = 1.31, P = 0.19) in favour of early cardiovascular exercise. CONCLUSION This meta-analysis shows that stroke survivors may benefit from cardiovascular exercise during sub-acute stages to improve peak oxygen uptake and walking distance. Thus, cardiovascular exercise should be considered in sub-acute stroke rehabilitation. However, concepts to influence and evaluate aerobic capacity in severely affected individuals with sub-acute stroke, as well as in the very early period after stroke, are lacking.Further research is needed to develop appropriate methods for cardiovascular rehabilitation early after stroke and to evaluate long-term effects of cardiovascular exercise on aerobic capacity, physical functioning, and quality-of-life.
Collapse
Affiliation(s)
- Oliver Stoller
- Institute for Rehabilitation and Performance Technology, Bern University of Applied Sciences, Burgdorf, Switzerland
- Department of Epidemiology, Maastricht University and Caphri Research School, Maastricht, Netherlands
| | - Eling D de Bruin
- Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
| | - Ruud H Knols
- Physiotherapy Occupational Therapy Research, Center for Clinical Research, University Hospital Zurich, Zurich, Switzerland
| | - Kenneth J Hunt
- Institute for Rehabilitation and Performance Technology, Bern University of Applied Sciences, Burgdorf, Switzerland
| |
Collapse
|
36
|
|
37
|
Jin H, Jiang Y, Wei Q, Wang B, Ma G. Intensive aerobic cycling training with lower limb weights in Chinese patients with chronic stroke: discordance between improved cardiovascular fitness and walking ability. Disabil Rehabil 2012; 34:1665-71. [PMID: 22376194 DOI: 10.3109/09638288.2012.658952] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To evaluate the effect of aerobic cycling training with lower limb weights on cardiovascular fitness (peak VO(2)) and walking ability in chronic stroke survivors, and to investigate the relationship between changes in these parameters. METHODS 133 Chinese patients with chronic hemiparetic stroke (mean age 58 years) were randomized to either 8-week (5×/week) aerobic cycling training with lower limb weights group (n = 68) or a low-intensity overground walking group (n = 65). Peak VO(2), 6-minute walk distance (6MWD), knee muscle strength, balance and spasticity were measured before and after intervention. RESULTS Cycling training increased peak VO(2) (24% vs. 3%, p < 0.001), 6MWD (2.7% vs. 0.5%, p < 0.001), paretic (11% vs. 1.6%, p < 0.001) and nonparetic knee strength (16% vs. 1.0%, p < 0.001). In the cycling group, percent changes in peak VO(2) were positively associated with those in paretic (r = 0.491, p < 0.001) and nonparetic knee strength (r = 0.432, p < 0.001). Increased 6MWD correlated significantly with improved balance, spasticity and paretic knee strength by the stepwise regression analysis (r(2) = 0.342, p = 0.004), but not fitness gains. CONCLUSIONS The enhanced cardiovascular fitness after aerobic cycling training in Chinese patients with chronic stroke is not associated with the increased walking ability. Unparallel improvements in these parameters related different determinants may have implications for intervention strategy.
Collapse
Affiliation(s)
- Hong Jin
- Department of Cardiology, Zhongda Hospital, Southeast University, Nanjing, China.
| | | | | | | | | |
Collapse
|
38
|
Kang HK, Kim Y, Chung Y, Hwang S. Effects of treadmill training with optic flow on balance and gait in individuals following stroke: randomized controlled trials. Clin Rehabil 2011; 26:246-55. [PMID: 21971754 DOI: 10.1177/0269215511419383] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study examined the effects of treadmill training with optic flow on the functional recovery of balance and gait in stroke patients. DESIGN Randomized controlled experimental study. PARTICIPANTS Thirty patients following stroke were divided randomly into the treadmill with optic flow group (n = 10), treadmill group (n = 10) and control group (n = 10). INTERVENTIONS The subjects in the experimental group wore a head-mounted display to receive speed-modulated optic flow during treadmill training for 30 minutes, while those in the treadmill group and control group received treadmill training and regular therapy for the same time, three times a week for four weeks. MAIN MEASURES The data were collected using timed up-and-go test, functional reach test, 10-m walk test, and six-minute walk test before and after treatment. RESULTS The timed up-and-go test in the treadmill with optic flow group (5.55 ± 2.04) improved significantly greater than the treadmill (1.50 ± 0.93) and control (0.40 ± 0.84) groups. The functional reach test in the treadmill with optic flow group (2.78 ± 1.44) was significantly higher than the control group (0.20 ± 0.16) only. The gait velocity in the treadmill with optic flow group (0.21 ± 0.06) showed a significant decrease compared to the treadmill (0.03 ± 0.02) and control (0.01 ± 0.02) groups. Finally, the six-minute walk test in the treadmill with optic flow group (24.49 ± 11.00) showed significant improvement compared to the treadmill training (4.65 ± 3.25) and control (1.79 ± 3.08) groups. CONCLUSION Treadmill using optic flow speed modulation improves the balance and gait significantly in patients with stroke who are able to participate in physical gait training.
Collapse
Affiliation(s)
- Hyung-Kyu Kang
- Department of Physical Therapy, The Graduate School, Sahmyook University, Seoul, Republic of Korea
| | | | | | | |
Collapse
|
39
|
Stuart M, Papini D, Benvenuti F, Nerattini M, Roccato E, Macellari V, Stanhope S, Macko R, Weinrich M. Methodological issues in monitoring health services and outcomes for stroke survivors: a case study. Disabil Health J 2011; 3:271-81. [PMID: 21057665 DOI: 10.1016/j.dhjo.2009.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Obtaining comprehensive health outcomes and health services utilization data on stroke patients has been difficult. This research grew out of a memorandum of understanding between the NIH and the ISS (its Italian equivalent) to foster collaborative research on rehabilitation. OBJECTIVE The purpose of this study was to pilot a methodology using administrative data to monitor and improve health outcomes for stroke survivors in Tuscany. METHODS This study used qualitative and quantitative methods to study health resources available to and utilized by stroke survivors during the first 12 months post-stroke in two Italian health authorities (AUSL10 and 11). Mortality rates were used as an outcome measure. RESULTS Number of inpatient days, number of prescriptions, and prescription costs were significantly higher for patients in AUSL 10 compared to AUSL 11. There was no significant difference between mortality rates. CONCLUSION Using administrative data to monitor process and outcomes for chronic stroke has the potential to save money and improve outcomes. However, measures of functional impairment and more sensitive outcome measures than mortality are important. Additional recommendations for enhanced data collection and reporting are discussed.
Collapse
Affiliation(s)
- Mary Stuart
- Health Administration and Policy Program, University of Maryland, Baltimore County, Baltimore, Maryland, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Lee JH, Moon JY, Park KC, Kim MY. Establishing Chronic Stroke Rat Models by MCA Occlusion Using Intraluminal Filament. BRAIN & NEUROREHABILITATION 2011. [DOI: 10.12786/bn.2011.4.1.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Jae-Hyuk Lee
- Department of Rehabilitation Medicine, CHA University College of Medicine, Korea
| | - Ja-Young Moon
- Department of Rehabilitation Medicine, Seoul Eunpyeong Hospital, Korea
| | - Ki-Chul Park
- Department of Rehabilitation Medicine, CHA University College of Medicine, Korea
| | - Min-Young Kim
- Department of Rehabilitation Medicine, CHA University College of Medicine, Korea
| |
Collapse
|
41
|
Kojović J, Miljković N, Janković MM, Popović DB. Recovery of motor function after stroke: A polymyography-based analysis. J Neurosci Methods 2011; 194:321-8. [DOI: 10.1016/j.jneumeth.2010.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2010] [Revised: 09/30/2010] [Accepted: 10/07/2010] [Indexed: 10/18/2022]
|
42
|
Ada L, Dean CM, Vargas J, Ennis S. Mechanically assisted walking with body weight support results in more independent walking than assisted overground walking in non-ambulatory patients early after stroke: a systematic review. J Physiother 2010; 56:153-61. [PMID: 20795921 DOI: 10.1016/s1836-9553(10)70020-5] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
QUESTION Does mechanically assisted walking with body weight support result in more independent walking and is it detrimental to walking speed or capacity in non-ambulatory patients early after stroke? DESIGN Systematic review with meta-analysis of randomised trials. PARTICIPANTS Non-ambulatory adult patients undergoing inpatient rehabilitation up to 3 months after stroke. INTERVENTION Mechanically assisted walking (eg, treadmill, electromechanical gait trainer, robotic device, servo-motor) with body weight support (eg, harness with or without handrail, but not handrail alone) versus assisted overground walking of longer than 15 min duration. OUTCOME MEASURES The primary outcome was the proportion of participants achieving independent walking. Secondary outcomes were walking speed measured as m/s during the 10-m Walk Test and walking capacity measured as distance in m during the 6-min Walk Test. RESULTS Six studies comprising 549 participants were identified and included in meta-analyses. Mechanically assisted walking with body weight support resulted in more people walking independently at 4 weeks (RD 0.23, 95% CI 0.15 to 0.30) and at 6 months (RD 0.23, 95% CI 0.07 to 0.39), faster walking at 6 months (MD 0.12 m/s, 95% CI 0.02 to 0.21), and further walking at 6 months (MD 55 m, 95% CI 15 to 96) than assisted overground walking. CONCLUSION Mechanically assisted walking with body weight support is more effective than overground walking at increasing independent walking in non-ambulatory patients early after stroke. Furthermore, it is not detrimental to walking speed or capacity and clinicians should therefore be confident about implementing this intervention.
Collapse
Affiliation(s)
- Louise Ada
- The University of Sydney, Sydney, NSW, Australia.
| | | | | | | |
Collapse
|
43
|
Alon G, Conroy VM, Donner TW. Intensive training of subjects with chronic hemiparesis on a motorized cycle combined with functional electrical stimulation (FES): a feasibility and safety study. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2010; 16:81-91. [PMID: 21110414 DOI: 10.1002/pri.475] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Revised: 03/23/2010] [Accepted: 04/01/2010] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND PURPOSE This study tested the safety and ability of subjects with chronic hemiplegia to tolerate intensive training using a motorized cycle combined with functional electrical stimulation (FES) system. METHODS A case series of 10 subjects with chronic stroke participated in 30-minute three times per week cycling on a stationary motorized cycling system combined with FES (RT300(TM) ). The stimulation activated the dorsal and plantar flexors, the quadriceps and the hamstrings using four channels and a stimulation pattern that assisted cycling motion of the paretic lower limb. Patients were instructed to cycle as close as possible to 60 rpm and the resistance to cycling was gradually increased using a computer-based algorithm. The training lasted eight weeks. RESULTS All 10 participants completed the training without adverse reactions to the training or the FES. The kcal utilized during the training increased significantly (p = 0.0003) between session 1 (2.2 ± 0.47), session 12 (4.3 ± 1.2) and session 24 (7.5 ± 1.8). Peak pedaling power increased from 6.5 ± 0.5 W pre-training to 18.0 ± 5.4 W post-training. Locomotion variables that improved significantly were time to complete the get up and go test (45.4 ± 54.9 seconds vs. 34.0 ± 31.8 seconds) a 24.6% improvement (p = 0.03) and gait velocity, which increased 25.0% from 0.4 ± 0.3 m/sec to 0.5 ± 0.4 m/sec (p = 0.01). CONCLUSION Using a motorized cycle combined with FES intensive training appears safe and can be tolerated by patients with chronic stroke of wide age range, diverse severity of cardio-pulmonary deconditioning, motor loss and locomotor deficits.
Collapse
Affiliation(s)
- Gad Alon
- Physical Therapy and Rehabilitation Sciences, University of Maryland, School of Medicine, MD 21201, USA.
| | | | | |
Collapse
|
44
|
Assessment of compliance with prescribed activity by hemiplegic stroke patients after an exercise programme and physical activity education. Ann Phys Rehabil Med 2010; 53:250-7, 257-65. [DOI: 10.1016/j.rehab.2010.03.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Accepted: 02/22/2010] [Indexed: 11/19/2022]
|
45
|
|