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Kwon Y, Park C, Oh W, You JSH. Potential adverse effects of face mask use on cardiopulmonary function and thermoregulation in robotic stroke rehabilitation during the COVID-19 pandemic. NeuroRehabilitation 2024; 54:287-295. [PMID: 38143384 DOI: 10.3233/nre-230150] [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: 12/26/2023]
Abstract
BACKGROUND The coronavirus disease (COVID-19) pandemic led to the implementation of wearing face masks and social distancing in stroke rehabilitation to prevent airborne transmission and contain the virus. The use of masks causes hypoxia and dyspnea in patients with stroke, predisposing them to other harmful medical conditions. Despite the clinical importance of the potential risk of wearing masks during robotic stroke rehabilitation, no clinical evidence is available in the literature. OBJECTIVE To examine the effects of stroke robotic rehabilitation with and without using a face mask on cardiopulmonary fatigue, muscle fatigue, O2 saturation, pulse, blood pressure (BP), and temperature in healthy adults and patients with hemiparetic stroke. METHOD A total of 30 participants, comprising 20 males and 10 females, were enrolled in a case-control study and a cross-sectional randomized controlled trial conducted at the Center for Rehabilitation Hospital. The study population included 15 individuals with hemiparetic stroke (mean age: 57.26±8.69) and 15 healthy adult controls (mean age: 30.20±9.86). All participants underwent a 30-minute familiarization session, followed by experimental masked and unmasked robotic interactive gait training (RIGT) for at least 30 minutes. Clinical tests included the Borg Rating of Perceived Exertion, muscle fatigue via surface electromyography, O2 saturation, pulse, BP, and temperature. RESULTS An analysis of covariance showed that compared to RIGT without a mask, RIGT with a mask showed adverse effects on BRPE, O2 saturation, and right rectus femoris muscle fatigue (P < 0.05) in the control and experimental groups. CONCLUSION The clinical study revealed that compared to RIGT without a mask, RIGT with a mask affected cardiopulmonary fatigue, muscle fatigue, O2 saturation, pulse, and BP in healthy adults and participants with hemiparetic stroke.
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Affiliation(s)
- Yundae Kwon
- Department of Physical Therapy, Sports Movement Artificial-Intelligence Robotics Technology (SMART) Institute, Yonsei University, Wonju, South Korea
- Department of Physical Therapy, Yonsei University, Wonju, South Korea
| | - Chanhee Park
- Department of Physical Therapy, Sports Movement Artificial-Intelligence Robotics Technology (SMART) Institute, Yonsei University, Wonju, South Korea
- Department of Physical Therapy, Yonsei University, Wonju, South Korea
| | - Wonjun Oh
- Department of Physical Therapy, Sports Movement Artificial-Intelligence Robotics Technology (SMART) Institute, Yonsei University, Wonju, South Korea
- Department of Physical Therapy, Yonsei University, Wonju, South Korea
| | - Joshua Sung H You
- Department of Physical Therapy, Sports Movement Artificial-Intelligence Robotics Technology (SMART) Institute, Yonsei University, Wonju, South Korea
- Department of Physical Therapy, Yonsei University, Wonju, South Korea
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Avelino PR, Menezes KKP, Nascimento LR, Alvarenga MTM, de Paula Magalhães J, Teixeira-Salmela LF, Scianni AA. Walking speed, hip muscles strength, aerobic capacity, and self-perceived locomotion ability most explain walking confidence after stroke: a cross-sectional experimental study. Int J Rehabil Res 2022; 45:350-354. [PMID: 36237144 DOI: 10.1097/mrr.0000000000000550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Identifying the determinants of walking confidence can be crucial in therapeutic terms. On these bases, interventions to improve these factors could improve, in turn, walking confidence. Objective is to explore the relationship between motor impairments and activity limitation measures and walking confidence in people with chronic stroke. Walking confidence was assessed using the modified Gait Efficacy Scale. The independent variables were: strength of the hip flexors and knee flexors/extensors (measured with a dynamometer), lower limb coordination (assessed by the Lower Extremity Motor Coordination Test), dynamic balance (assessed by the Four-Square Step Test), walking speed (from the 10-m Walk Test), aerobic capacity (from the 6-Minute Walk Test), and self-perceived locomotion ability (assessed by the ABILOCO). Pearson correlation was used to explore the relationships between the variables, and multiple linear regression to identify the independent explainers of walking confidence after stroke. Ninety chronic stroke individuals (35 men), with a mean age of 68 (SD 13) years were assessed. All independent variables were significantly correlated with walking confidence. Regarding the regression analysis, these measures explained 44% ( F = 9.21; P < 0.001) of the variance in walking confidence; however, only walking speed, strength of the hip flexor muscles, aerobic capacity, and perceived locomotion ability showed significance. All motor impairment and activity limitation measures correlated with walking confidence. However, the regression analysis highlighted that only walking speed, aerobic capacity, the strength of the hip flexor muscles, and perceived locomotion were independent explainers of walking confidence after stroke.
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Affiliation(s)
- Patrick R Avelino
- NeuroGroup, Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte and
| | - Kênia K P Menezes
- NeuroGroup, Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte and
| | - Lucas R Nascimento
- Center of Health Sciences, Discipline of Physical Therapy, Universidade Federal do Espírito Santo, Vitória, Brazil
| | | | | | | | - Aline A Scianni
- NeuroGroup, Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte and
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Miller T, Stockley R, Drummond A, Watkins C, Georgiou R, Ahuja KDK, Bird ML. Online advice for the symptomatic management of post-stroke fatigue: A scoping review. J Psychosom Res 2022; 162:111039. [PMID: 36179422 DOI: 10.1016/j.jpsychores.2022.111039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 08/09/2022] [Accepted: 09/10/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Limited medical evidence for managing post-stroke fatigue leads stroke survivors to seek information through other sources. This scoping review aimed to identify and assess the range and quality of web-based recommendations for managing post-stroke fatigue. METHODS Publicly accessible websites providing advice for post-stroke fatigue management were considered for review using the Joanna Briggs Institute's methodology. Using the search term "fatigue stroke", the first two pages of results from each search engine (Google, Yahoo, and Bing) were assessed against predetermined criteria. Findings were reported in accordance with PRISMA-ScR checklist. Quality and readability were also assessed. RESULTS Fifty-seven websites were identified; 16 primary and 11 linked websites met the inclusion criteria and demonstrated moderate to high quality and high readability. Primary websites were curated by non-government organizations (n = 10/16), companies (n = 4/16) or were media and blog websites (n = 2/16). Additional resources were provided on linked websites. All websites provided non-pharmacological advice, with four also describing pharmacological management. Many websites included advice related to physical activity modification (n = 18/27) and energy conservation strategies (e.g. activity prioritization, planning, pacing) (n = 26/27). Direction to seek health professional advice appeared frequently (n = 16/27). CONCLUSIONS The quality of publicly available web-based advice for people with post-stroke fatigue was moderate to high in most websites, with high readability. Energy conservation strategies and physical activity modification appear frequently. The general nature of the advice provided on most websites is supported by direction to healthcare professionals (i.e., clinical referral) who may assist in the practical individualization of strategies for managing post-stroke fatigue.
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Affiliation(s)
- Tiev Miller
- International Collaboration on Repair Discoveries, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Rachel Stockley
- School of Nursing, Faculty of Health and Care, University of Central Lancashire, Lancashire, United Kingdom.
| | - Avril Drummond
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom.
| | - Caroline Watkins
- School of Nursing, Faculty of Health and Care, University of Central Lancashire, Lancashire, United Kingdom.
| | - Rachel Georgiou
- School of Nursing, Faculty of Health and Care, University of Central Lancashire, Lancashire, United Kingdom.
| | | | - Marie-Louise Bird
- School of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia; GF Strong Rehabilitation Research Program, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.
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Liu C, McNitt-Gray JL, Finley JM. Impairments in the mechanical effectiveness of reactive balance control strategies during walking in people post-stroke. Front Neurol 2022; 13:1032417. [PMID: 36388197 PMCID: PMC9659909 DOI: 10.3389/fneur.2022.1032417] [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: 08/30/2022] [Accepted: 10/11/2022] [Indexed: 01/26/2023] Open
Abstract
People post-stroke have an increased risk of falls compared to neurotypical individuals, partly resulting from an inability to generate appropriate reactions to restore balance. However, few studies investigated the effect of paretic deficits on the mechanics of reactive control strategies following forward losses of balance during walking. Here, we characterized the biomechanical consequences of reactive control strategies following perturbations induced by the treadmill belt accelerations. Thirty-eight post-stroke participants and thirteen age-matched and speed-matched neurotypical participants walked on a dual-belt treadmill while receiving perturbations that induced a forward loss of balance. We computed whole-body angular momentum and angular impulse using segment kinematics and reaction forces to quantify the effect of impulse generation by both the leading and trailing limbs in response to perturbations in the sagittal plane. We found that perturbations to the paretic limb led to larger increases in forward angular momentum during the perturbation step than perturbations to the non-paretic limb or to neurotypical individuals. To recover from the forward loss of balance, neurotypical individuals coordinated reaction forces generated by both legs to decrease the forward angular impulse relative to the pre-perturbation step. They first decreased the forward pitch angular impulse during the perturbation step. Then, during the first recovery step, they increased the backward angular impulse by the leading limb and decreased the forward angular impulse by the trailing limb. In contrast to neurotypical participants, people post-stroke did not reduce the forward angular impulse generated by the stance limb during the perturbed step. They also did not increase leading limb angular impulse or decrease the forward trailing limb angular impulse using their paretic limb during the first recovery step. Lastly, post-stroke individuals who scored poorer on clinical assessments of balance and had greater motor impairment made less use of the paretic limb to reduce forward momentum. Overall, these results suggest that paretic deficits limit the ability to recover from forward loss of balance. Future perturbation-based balance training targeting reactive stepping response in stroke populations may benefit from improving the ability to modulate paretic ground reaction forces to better control whole-body dynamics.
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Affiliation(s)
- Chang Liu
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, United States,*Correspondence: Chang Liu
| | - Jill L. McNitt-Gray
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, United States,Department of Biological Science, University of Southern California, Los Angeles, CA, United States
| | - James M. Finley
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, United States,Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, United States,Neuroscience Graduate Program, University of Southern California, Los Angeles, CA, United States,James M. Finley
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Sarkisian SV, Gunnell AJ, Bo Foreman K, Lenzi T. Knee Exoskeleton Reduces Muscle Effort and Improves Balance During Sit-to-Stand Transitions After Stroke: A Case Study. IEEE Int Conf Rehabil Robot 2022; 2022:1-6. [PMID: 36176078 DOI: 10.1109/icorr55369.2022.9896571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
After a stroke, the weight-bearing asymmetry often forces stroke survivors to compensate with overuse of the unaffected side muscles to stand up. Powered exoskeletons can address this problem by assisting the affected limb during sit-tostand transitions. However, there is currently no experimental evidence demonstrating the efficacy of this intervention with the target population. This study explores controlling a powered knee exoskeleton with EMG signals to assist a stroke patient during sit-to-stand transitions. Our results show decreased peak knee torques by 6.24% and 11.9% on their unaffected and affected sides, respectively, while wearing the exoskeleton. Additionally, the peak value of the EMG signal decreased by 29.3% and 21.9%, and the integrated EMG signal value decreased by 46.7% and 36.1% on their affected vastus medialis and lateralis while wearing the exoskeleton, respectively. Finally, our results indicate improved medial-lateral balance by 61.2%, 81.6%, and 70.0% based on the degree of asymmetry (DOA), the center of pressure (COP), and the center of mass (COM), respectively. These results support the efficacy of using powered exoskeletons for high-torque tasks such as sit-to-stand transitions with stroke survivors.
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Archangeli D, Ishmael MK, Lenzi T. Assistive Powered Hip Exoskeleton Improves Self-Selected Walking Speed in One Individual with Hemiparesis: A Case Study. IEEE Int Conf Rehabil Robot 2022; 2022:1-6. [PMID: 36176109 DOI: 10.1109/icorr55369.2022.9896568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Most individuals suffering a stroke have permanent weakness on one side of the body (hemiparesis) that reduces their ability to ambulate. Autonomous powered exoskeletons have been proposed as a possible solution to this problem. Studies with healthy subjects show that assistive powered exoskeletons have the potential to improve gait, for example, by reducing the metabolic cost of walking. However, only a handful of studies have been conducted with individuals with hemiparesis. Thus, the ability of autonomous exoskeletons to improve gait in this population remains largely unknown. In this study, we assess self-selected walking speed with and without an autonomous powered hip exoskeleton in one individual with hemiparesis walking on level ground. Results show that the proposed exoskeleton improves self-selected walking speed by ~30%. The biomechanical analysis suggest that the increased walking speed is the result of the powered hip exoskeleton enabling the subject to take longer strides on the hemiparetic side. This case study provides important information to inform future exoskeleton development and clinical study design.
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Zhang X, Lu Y, Chien JH, Fu C, Zhou Z, Li H, Hu G, Sun T. The Effect of Inclines on Joint Angles in Stroke Survivors During Treadmill Walking. Front Neurol 2022; 13:850682. [PMID: 35481275 PMCID: PMC9037685 DOI: 10.3389/fneur.2022.850682] [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: 01/13/2022] [Accepted: 03/07/2022] [Indexed: 12/03/2022] Open
Abstract
Stroke severely affects the quality of life, specifically in walking independently. Thus, it is crucial to understand the impaired gait pattern. This gait pattern has been widely investigated when walking on a level treadmill. However, knowledge about the gait pattern when walking on inclines is scarce. Therefore, this study attempted to fulfill this knowledge gap. In this study, 15 stroke survivors and 15 age/height/weight healthy controls were recruited. The participants were instructed to walk on three different inclines: 0°, 3°, and 6°. The participants were required to walk on each incline for 2 min and needed to complete each incline two times. The dependent variables were the peak values for ankle/knee/hip joint angles and the respective variability of these peak values. The results showed that an increment of the incline significantly increased the peak of the hip flexion and the peak of the knee flexion but did not affect the peak values of the ankle joints in the paretic leg in these stroke survivors. In comparison with the healthy controls, lower hip extension, lower hip flexion, lower knee flexion, and lower ankle plantar flexion were observed in stroke survivors. A clinical application of this work might assist the physical therapists in building an effective treadmill training protocol.
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Affiliation(s)
- Xin Zhang
- Department of Rehabilitation, School of Medicine, Tongji University, Shanghai, China.,Shanghai Rehabilitation Center, Shanghai First Rehabilitation Hospital, Shanghai, China
| | - Yanting Lu
- Department of Rehabilitation, School of Medicine, Tongji University, Shanghai, China
| | | | - Chenlei Fu
- Shanghai Rehabilitation Center, Shanghai First Rehabilitation Hospital, Shanghai, China
| | - Zhe Zhou
- Nuerological Intensive Rehabilitation Department, Shanghai First Rehabilitation Hospital, Shanghai, China
| | - Hua Li
- Nuerological Intensive Rehabilitation Department, Shanghai First Rehabilitation Hospital, Shanghai, China
| | - Gongwei Hu
- Nuerological Intensive Rehabilitation Department, Shanghai First Rehabilitation Hospital, Shanghai, China
| | - Tianbao Sun
- Shanghai Rehabilitation Center, Shanghai First Rehabilitation Hospital, Shanghai, China
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Dorneles JR, Ribeiro Neto F, Gonçalves CW, Costa RRG, Carregaro RL. Response letter to "Gait & Posture: Fatigue, fatigability, and muscle torque reduction". Gait Posture 2021; 90:274-275. [PMID: 34536692 DOI: 10.1016/j.gaitpost.2021.09.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/09/2021] [Accepted: 09/12/2021] [Indexed: 02/02/2023]
Affiliation(s)
- Jefferson Rodrigues Dorneles
- Master Program in Rehabilitation Sciences, Universidade de Brasília (UnB), Campus UnB Ceilandia, Brasilia, Brazil; Spinal Cord Injury Department, Sarah Hospital Rehabilitation Network, Brasilia, Brazil.
| | | | | | | | - Rodrigo Luiz Carregaro
- Master Program in Rehabilitation Sciences, Universidade de Brasília (UnB), Campus UnB Ceilandia, Brasilia, Brazil
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Guzik A, Drużbicki M, Perenc L, Wolan-Nieroda A, Turolla A, Kiper P. Establishing the Minimal Clinically Important Differences for Sagittal Hip Range of Motion in Chronic Stroke Patients. Front Neurol 2021; 12:700190. [PMID: 34539552 PMCID: PMC8443407 DOI: 10.3389/fneur.2021.700190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 08/03/2021] [Indexed: 11/13/2022] Open
Abstract
Many researchers have pointed out that decreased sagittal range of motion (ROM) in the affected hip joint is a common consequence of stroke, and it adversely affects walking performance and walking speed. Nevertheless, the minimal clinically important differences (MCID) in hip-related kinematic gait parameters post-stroke have not yet been determined. The present study aimed to define MCID values for hip ROM in the sagittal plane i.e., flexion-extension (FE), for the affected and unaffected sides at a chronic stage post-stroke. Fifty participants with hemiparesis due to stroke were enrolled for the study. Four statistical methods were used to calculate MCID. According to the anchor-based approach, the mean change in hip FE ROM achieved by the MCID group on the affected/unaffected side amounted to 5.81°/2.86° (the first MCID estimate). The distribution-based analyses established that the standard error of measurement in the no-change group amounted to 1.56°/1.04° (the second MCID estimate). Measurements based on the third method established that a change of 4.09°/0.61° in the hip ROM corresponded to a 1.85-point change in the Barthel Index. The optimum cutoff value, based on ROC curve analysis, corresponded to 2.9/2.6° of change in the hip sagittal ROM for the affected/unaffected side (the fourth MCID estimate). To our knowledge, this is the first study to use a comprehensive set of statistical methods to determine the MCID for hip sagittal ROM for the affected and unaffected sides at a chronic stage post-stroke. According to our findings, the MCID of the hip FE ROM for the affected side amounts to 5.81° and for the unaffected side to 2.86°, in patients with chronic stroke. This indicator is extremely important because it allows clinical practitioners to assess the effects of interventions administered to patients, and to interpret the significance of improvements in sagittal kinematic parameters of the hip; ultimately, it may facilitate the process of designing effective gait reeducation programs.
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Affiliation(s)
- Agnieszka Guzik
- Department of Physiotherapy, Institute of Health Sciences, Medical College, University of Rzeszów, Rzeszów, Poland
| | - Mariusz Drużbicki
- Department of Physiotherapy, Institute of Health Sciences, Medical College, University of Rzeszów, Rzeszów, Poland
| | - Lidia Perenc
- Department of Physiotherapy, Institute of Health Sciences, Medical College, University of Rzeszów, Rzeszów, Poland
| | - Andżelina Wolan-Nieroda
- Department of Physiotherapy, Institute of Health Sciences, Medical College, University of Rzeszów, Rzeszów, Poland
| | - Andrea Turolla
- Laboratory of Kinematics and Robotics IRCCS San Camillo Hospital, Venice, Italy
| | - Paweł Kiper
- Azienda Unità Locale Socio Sanitaria 3 Serenissima Physical Medicine and Rehabilitation Unit, Venice, Italy
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10
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Park S, Liu C, Sánchez N, Tilson JK, Mulroy SJ, Finley JM. Using Biofeedback to Reduce Step Length Asymmetry Impairs Dynamic Balance in People Poststroke. Neurorehabil Neural Repair 2021; 35:738-749. [PMID: 34060926 DOI: 10.1177/15459683211019346] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND People poststroke often walk with a spatiotemporally asymmetric gait, due in part to sensorimotor impairments in the paretic lower extremity. Although reducing asymmetry is a common objective of rehabilitation, the effects of improving symmetry on balance are yet to be determined. OBJECTIVE We established the concurrent validity of whole-body angular momentum as a measure of balance, and we determined if reducing step length asymmetry would improve balance by decreasing whole-body angular momentum. METHODS We performed clinical balance assessments and measured whole-body angular momentum during walking using a full-body marker set in a sample of 36 people with chronic stroke. We then used a biofeedback-based approach to modify step length asymmetry in a subset of 15 of these individuals who had marked asymmetry and we measured the resulting changes in whole-body angular momentum. RESULTS When participants walked without biofeedback, whole-body angular momentum in the sagittal and frontal plane was negatively correlated with scores on the Berg Balance Scale and Functional Gait Assessment supporting the validity of whole-body angular momentum as an objective measure of dynamic balance. We also observed that when participants walked more symmetrically, their whole-body angular momentum in the sagittal plane increased rather than decreased. CONCLUSIONS Voluntary reductions of step length asymmetry in people poststroke resulted in reduced measures of dynamic balance. This is consistent with the idea that after stroke, individuals might have an implicit preference not to deviate from their natural asymmetry while walking because it could compromise their balance. Clinical Trials Number: NCT03916562.
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Affiliation(s)
- Sungwoo Park
- University of Southern California, Los Angeles, CA, USA
| | - Chang Liu
- University of Southern California, Los Angeles, CA, USA
| | | | | | - Sara J Mulroy
- Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA
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Penedo T, Polastri PF, Rodrigues ST, Santinelli FB, Costa EDC, Imaizumi LFI, Barbieri RA, Barbieri FA. Motor strategy during postural control is not muscle fatigue joint-dependent, but muscle fatigue increases postural asymmetry. PLoS One 2021; 16:e0247395. [PMID: 33630950 PMCID: PMC7906473 DOI: 10.1371/journal.pone.0247395] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 02/06/2021] [Indexed: 11/29/2022] Open
Abstract
The aim of this study was to investigate the effects of ankle and hip muscle fatigue on motor adjustments (experiment 1) and symmetry (experiment 2) of postural control during a quiet standing task. Twenty-three young adults performed a bipedal postural task on separate force platforms, before and after a bilateral ankle and hip muscle fatigue protocol (randomized). Ankle and hip muscles were fatigued separately using a standing calf raise protocol (ankle fatigue) on a step and flexion and extension of the hip (hip fatigue) sitting on a chair, at a controlled movement frequency (0.5Hz), respectively. In both experiments, force, center of pressure, and electromyography parameters were measured. The symmetry index was used in experiment 2 to analyze the postural asymmetry in the parameters. Our main findings showed that muscle fatigue impaired postural stability, regardless of the fatigued muscle region (i.e., ankle or hip). In addition, young adults used an ankle motor strategy (experiment 1) before and after both the ankle and hip muscle fatigue protocols. Moreover, we found increased asymmetry between the lower limbs (experiment 2) during the quiet standing task after muscle fatigue. Thus, we can conclude that the postural motor strategy is not muscle fatigue joint-dependent and a fatigue task increases postural asymmetry, regardless of the fatigued region (hip or ankle). These findings could be applied in sports training and rehabilitation programs with the objective of reducing the fatigue effects on asymmetry and improving balance.
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Affiliation(s)
- Tiago Penedo
- Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Graduate Program in Human Movement, School of Sciences, São Paulo State University (UNESP), Bauru, São Paulo, Brazil
| | - Paula Favaro Polastri
- Department of Physical Education, Laboratory of Information, Vision and Action (LIVIA), Graduate Program in Human Movement, School of Sciences, São Paulo State University (UNESP), Bauru, São Paulo, Brazil
| | - Sérgio Tosi Rodrigues
- Department of Physical Education, Laboratory of Information, Vision and Action (LIVIA), Graduate Program in Human Movement, School of Sciences, São Paulo State University (UNESP), Bauru, São Paulo, Brazil
| | - Felipe Balistieri Santinelli
- Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Graduate Program in Human Movement, School of Sciences, São Paulo State University (UNESP), Bauru, São Paulo, Brazil
| | - Elisa de Carvalho Costa
- Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Graduate Program in Human Movement, School of Sciences, São Paulo State University (UNESP), Bauru, São Paulo, Brazil
| | - Luis Felipe Itikawa Imaizumi
- Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Graduate Program in Human Movement, School of Sciences, São Paulo State University (UNESP), Bauru, São Paulo, Brazil
| | - Ricardo Augusto Barbieri
- Centro Universitário Estácio de Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil
- Graduate Program in Physical Education and Sport at School of Physical Education and Sport of Ribeirao Preto (EEFERP), University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil
| | - Fabio Augusto Barbieri
- Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Graduate Program in Human Movement, School of Sciences, São Paulo State University (UNESP), Bauru, São Paulo, Brazil
- * E-mail:
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Negro F, Bathon KE, Nguyen JN, Bannon CG, Orizio C, Hunter SK, Hyngstrom AS. Impaired Firing Behavior of Individually Tracked Paretic Motor Units During Fatiguing Contractions of the Dorsiflexors and Functional Implications Post Stroke. Front Neurol 2020; 11:540893. [PMID: 33192970 PMCID: PMC7658471 DOI: 10.3389/fneur.2020.540893] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 09/25/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction: This study quantified stroke-related changes in the following: (1) the averaged discharge rate of motor units (individually tracked and untracked) identified from high-density electromyography (HD-EMG) recordings, (2) global muscle EMG properties of the dorsiflexors during a fatiguing contraction, and the relationship between task endurance and measures of leg function. Methods: Ten individuals with chronic stroke performed a sustained sub-maximal, isometric, fatiguing dorsiflexion contraction in paretic and non-paretic legs. Motor-unit firing behavior, task duration, maximal voluntary contraction strength (MVC), and clinical measures of leg function were obtained. Results: Compared to the non-paretic leg, the paretic leg task duration was shorter, and there was a larger exercise-related reduction in motor unit global rates, individually tracked discharge rates, and overall magnitude of EMG. Task duration of the paretic leg was more predictive of walking speed and lower extremity Fugl-Meyer scores compared to the non-paretic leg. Discussion: Paretic leg muscle fatigability is increased post stroke. It is characterized by impaired rate coding and recruitment and relates to measures of motor function.
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Affiliation(s)
- Francesco Negro
- Department of Clinical and Experimental Sciences, Research Center for Neuromuscular Function and Adapted Physical Activity "Teresa Camplani", Università degli Studi di Brescia, Brescia, Italy
| | - Kathleen E Bathon
- Uniformed Services, University of Health Sciences, Bethesda, MD, United States
| | - Jennifer N Nguyen
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Cassidy G Bannon
- Uniformed Services, University of Health Sciences, Bethesda, MD, United States
| | - Claudio Orizio
- Department of Clinical and Experimental Sciences, Research Center for Neuromuscular Function and Adapted Physical Activity "Teresa Camplani", Università degli Studi di Brescia, Brescia, Italy
| | - Sandra K Hunter
- Department of Physical Therapy, Marquette University, Milwaukee, WI, United States
| | - Allison S Hyngstrom
- Department of Physical Therapy, Marquette University, Milwaukee, WI, United States
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Dorneles JR, Neto FR, Gonçalves CW, Costa RRG, Carregaro RL. Does prolonged walking cause greater muscle fatigability in individuals with incomplete spinal cord injury compared with matched-controls? Gait Posture 2020; 78:65-71. [PMID: 32268249 DOI: 10.1016/j.gaitpost.2020.03.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 03/17/2020] [Accepted: 03/22/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Individuals with incomplete spinal cord injury (iSCI) might show muscle fatigability during walking, primarily over long distances. The cause can be related to the motor impairment and walking compensations identified in this population. However, evidence on the occurrence of muscle fatigability after prolonged walking in individuals with iSCI is conflicting. RESEARCH QUESTION Does prolonged walking cause higher muscle fatigability in individuals with iSCI compared with matched-controls? METHODS We adopted a repeated measures design, in which maximal voluntary isometric contractions were performed before and after a walking test to induce the fatigability, in 24 individuals with iSCI and 24 matched-controls. Body weight-normalized peak torque (PT/BW), rate of force development (RFD), root mean square (RMS) and neuromuscular efficiency were used to assess the muscle fatigability. A mixed model ANOVA (2 × 2) was used for between-group and within-group comparisons. The significance was set in 5%. RESULTS Individuals with iSCI showed a greater decline in the PT/BW and RMS after the walking test. However, the RFD presented a greater decrease in the control group. SIGNIFICANCE Our results showed that prolonged walking caused higher muscle fatigability in individuals with iSCI compared to healthy individuals. Therefore, muscle fatigability should be considered during the rehabilitation planning and in activities of daily living of individuals with iSCI. Moreover, the identification of muscle fatigability in individuals with iSCI might be useful to prevent high levels of physical exertion and, possibly, the risk of fall.
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Affiliation(s)
- Jefferson Rodrigues Dorneles
- Master Program in Rehabilitation Sciences, Universidade De Brasília (UnB), Campus UnB Ceilândia, Brasília, Brazil; Spinal Cord Injury Department, Sarah Hospital Rehabilitation Network, Brasilia, Brazil
| | | | | | | | - Rodrigo Luiz Carregaro
- Master Program in Rehabilitation Sciences, Universidade De Brasília (UnB), Campus UnB Ceilândia, Brasília, Brazil.
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Murphy S, Durand M, Negro F, Farina D, Hunter S, Schmit B, Gutterman D, Hyngstrom A. The Relationship Between Blood Flow and Motor Unit Firing Rates in Response to Fatiguing Exercise Post-stroke. Front Physiol 2019; 10:545. [PMID: 31133877 PMCID: PMC6524339 DOI: 10.3389/fphys.2019.00545] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 04/17/2019] [Indexed: 11/22/2022] Open
Abstract
We quantified the relationship between the change in post-contraction blood flow with motor unit firing rates and metrics of fatigue during intermittent, sub-maximal fatiguing contractions of the knee extensor muscles after stroke. Ten chronic stroke survivors (>1-year post-stroke) and nine controls participated. Throughout fatiguing contractions, the discharge timings of individual motor units were identified by decomposition of high-density surface EMG signals. After five consecutive contractions, a blood flow measurement through the femoral artery was obtained using an ultrasound machine and probe designed for vascular measurements. There was a greater increase of motor unit firing rates from the beginning of the fatigue protocol to the end of the fatigue protocol for the control group compared to the stroke group (14.97 ± 3.78% vs. 1.99 ± 11.90%, p = 0.023). While blood flow increased with fatigue for both groups (p = 0.003), the magnitude of post-contraction blood flow was significantly greater for the control group compared to the stroke group (p = 0.004). We found that despite the lower magnitude of muscle perfusion through the femoral artery in the stroke group, blood flow has a greater impact on peripheral fatigue for the control group; however, we observed a significant correlation between change in blood flow and motor unit firing rate modulation (r2 = 0.654, p = 0.004) during fatigue in the stroke group and not the control group (r2 = 0.024, p < 0.768). Taken together, this data showed a disruption between motor unit firing rates and post-contraction blood flow in the stroke group, suggesting that there may be a disruption to common inputs to both the reticular system and the corticospinal tract. This study provides novel insights in the relationship between the hyperemic response to exercise and motor unit firing behavior for post-stroke force production and may provide new approaches for recovery by improving both blood flow and muscle activation simultaneously.
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Affiliation(s)
- Spencer Murphy
- Integrative Neural Engineering and Rehabilitation Laboratory, Department of Biomedical Engineering, Marquette University, Milwaukee, WI, United States
| | - Matthew Durand
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Francesco Negro
- Department of Clinical and Experimental Sciences, Università degli studi di Brescia, Brescia, Italy
| | - Dario Farina
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Sandra Hunter
- Department of Physical Therapy, Marquette University, Milwaukee, WI, United States
| | - Brian Schmit
- Integrative Neural Engineering and Rehabilitation Laboratory, Department of Biomedical Engineering, Marquette University, Milwaukee, WI, United States
| | - David Gutterman
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Allison Hyngstrom
- Integrative Neural Engineering and Rehabilitation Laboratory, Department of Biomedical Engineering, Marquette University, Milwaukee, WI, United States.,Department of Physical Therapy, Marquette University, Milwaukee, WI, United States
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15
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Wasser JG, Vincent KR, Herman DC, Vincent HK. Potential lower extremity amputation-induced mechanisms of chronic low back pain: role for focused resistance exercise. Disabil Rehabil 2019; 42:3713-3721. [DOI: 10.1080/09638288.2019.1610507] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Joseph G. Wasser
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Kevin R. Vincent
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Daniel C. Herman
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Heather K. Vincent
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
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Murphy SA, Negro F, Farina D, Onushko T, Durand M, Hunter SK, Schmit BD, Hyngstrom A. Stroke increases ischemia-related decreases in motor unit discharge rates. J Neurophysiol 2018; 120:3246-3256. [PMID: 30379629 DOI: 10.1152/jn.00923.2017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Following stroke, hyperexcitable sensory pathways, such as the group III/IV afferents that are sensitive to ischemia, may inhibit paretic motor neurons during exercise. We quantified the effects of whole leg ischemia on paretic vastus lateralis motor unit firing rates during submaximal isometric contractions. Ten chronic stroke survivors (>1 yr poststroke) and 10 controls participated. During conditions of whole leg occlusion, the discharge timings of motor units were identified from decomposition of high-density surface electromyography signals during repeated submaximal knee extensor contractions. Quadriceps resting twitch responses and near-infrared spectroscopy measurements of oxygen saturation as an indirect measure of blood flow were made. There was a greater decrease in paretic motor unit discharge rates during the occlusion compared with the controls (average decrease for stroke and controls, 12.3 ± 10.0% and 0.1 ± 12.4%, respectively; P < 0.001). The motor unit recruitment thresholds did not change with the occlusion (stroke: without occlusion, 11.68 ± 5.83%MVC vs. with occlusion, 11.11 ± 5.26%MVC; control: 11.87 ± 5.63 vs. 11.28 ± 5.29%MVC). Resting twitch amplitudes declined similarly for both groups in response to whole leg occlusion (stroke: 29.16 ± 6.88 vs. 25.75 ± 6.78 Nm; control: 38.80 ± 13.23 vs 30.14 ± 9.64 Nm). Controls had a greater exponential decline (lower time constant) in oxygen saturation compared with the stroke group (stroke time constant, 22.90 ± 10.26 min vs. control time constant, 5.46 ± 4.09 min; P < 0.001). Ischemia of the muscle resulted in greater neural inhibition of paretic motor units compared with controls and may contribute to deficient muscle activation poststroke. NEW & NOTEWORTHY Hyperexcitable inhibitory sensory pathways sensitive to ischemia may play a role in deficient motor unit activation post stroke. Using high-density surface electromyography recordings to detect motor unit firing instances, we show that ischemia of the exercising muscle results in greater inhibition of paretic motor unit firing rates compared with controls. These findings are impactful to neurophysiologists and clinicians because they implicate a novel mechanism of force-generating impairment poststroke that likely exacerbates baseline weakness.
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Affiliation(s)
- Spencer A Murphy
- Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Francesco Negro
- Department of Clinical and Experimental Sciences, University of Brescia , Brescia , Italy
| | - Dario Farina
- Department of Bioengineering, Imperial College of London , London , United Kingdom
| | - Tanya Onushko
- Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Matthew Durand
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Sandra K Hunter
- Department of Physical Therapy, Marquette University , Milwaukee, Wisconsin
| | - Brian D Schmit
- Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Allison Hyngstrom
- Department of Physical Therapy, Marquette University , Milwaukee, Wisconsin
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Park SW, Son SM, Lee NK. Exercise-induced muscle fatigue in the unaffected knee joint and its influence on postural control and lower limb kinematics in stroke patients. Neural Regen Res 2017; 12:765-769. [PMID: 28616033 PMCID: PMC5461614 DOI: 10.4103/1673-5374.206647] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study aimed to investigate the effects of exercise-induced muscle fatigue in the unaffected knee joint on postural control and kinematic changes in stroke patients. Forty participants (20 stroke patients, 20 age-matched healthy participants) were recruited. To induce fatigue, maximum voluntary isometric contractions were performed in the unaffected knee joint in a Leg Extension Rehab exercise machine using the pneumatic resistance. We measured static and dynamic balance and lower-limb kinematics during gait. Changes in postural control parameters anteroposterior sway speed and total center of pressure distance differed significantly between the stroke and control groups. In addition, changes in gait kinematic parameters knee and ankle angles of initial contact differed significantly between stroke (paretic and non-paretic) and control groups. Muscle fatigue in the unaffected knee and ankle impaired postural control and debilitates kinematic movement of ipsilateral and contralateral lower limbs, and may place the fatigued stroke patients at greater risk for falls.
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Affiliation(s)
- Sun Wook Park
- Department of Physical Therapy, Faculty of Health Science, Eulji University, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Sung Min Son
- Department of Physical Therapy, College of Health Science, Cheongju University, Cheongju-si, Chungbuk, Republic of Korea
| | - Na Kyung Lee
- Department of Physical Therapy, College of Rehabilitation Science, Daegu University, Gyeongsan-si, Kyeongbuk, Republic of Korea
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Sex Differences in Neuromuscular Fatigability of the Knee Extensors Post-Stroke. Brain Sci 2017; 7:brainsci7010008. [PMID: 28085089 PMCID: PMC5297297 DOI: 10.3390/brainsci7010008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 12/19/2016] [Accepted: 01/06/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND PURPOSE Despite the implications of optimizing strength training post-stroke, little is known about the differences in fatigability between men and women with chronic stroke. The purpose of this study was to determine the sex differences in knee extensor muscle fatigability and potential mechanisms in individuals with stroke. METHODS Eighteen participants (10 men, eight women) with chronic stroke (≥6 months) and 23 (12 men, 11 women) nonstroke controls participated in the study. Participants performed an intermittent isometric contraction task (6 s contraction, 3 s rest) at 30% of maximal voluntary contraction (MVC) torque until failure to maintain the target torque. Electromyography was used to determine muscle activation and contractile properties were assessed with electrical stimulation of the quadriceps muscles. RESULTS Individuals with stroke had a briefer task duration (greater fatigability) than nonstroke individuals (24.1 ± 17 min vs. 34.9 ± 16 min). Men were more fatigable than women for both nonstroke controls and individuals with stroke (17.9 ± 9 min vs. 41.6 ± 15 min). Individuals with stroke had less fatigue-related changes in muscle contractile properties and women with stroke differed in their muscle activation strategy during the fatiguing contractions. CONCLUSIONS Men and women fatigue differently post-stroke and this may be due to the way they neurally activate muscle groups.
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Ivey FM, Prior SJ, Hafer-Macko CE, Katzel LI, Macko RF, Ryan AS. Strength Training for Skeletal Muscle Endurance after Stroke. J Stroke Cerebrovasc Dis 2016; 26:787-794. [PMID: 27865696 DOI: 10.1016/j.jstrokecerebrovasdis.2016.10.018] [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] [Received: 08/22/2016] [Revised: 10/05/2016] [Accepted: 10/19/2016] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND AND PURPOSE Initial studies support the use of strength training (ST) as a safe and effective intervention after stroke. Our previous work shows that relatively aggressive, higher intensity ST translates into large effect sizes for paretic and non-paretic leg muscle volume, myostatin expression, and maximum strength post-stroke. An unanswered question pertains to how our unique ST model for stroke impacts skeletal muscle endurance (SME). Thus, we now report on ST-induced adaptation in the ability to sustain isotonic muscle contraction. METHODS Following screening and baseline testing, hemiparetic stroke participants were randomized to either ST or an attention-matched stretch control group (SC). Those in the ST group trained each leg individually to muscle failure (20 repetition sets, 3× per week for 3 months) on each of three pneumatic resistance machines (leg press, leg extension, and leg curl). Our primary outcome measure was SME, quantified as the number of submaximal weight leg press repetitions possible at a specified cadence. The secondary measures included one-repetition maximum strength, 6-minute walk distance (6MWD), 10-meter walk speeds, and peak aerobic capacity (VO2 peak). RESULTS ST participants (N = 14) had significantly greater SME gains compared with SC participants (N = 16) in both the paretic (178% versus 12%, P < .01) and non-paretic legs (161% versus 12%, P < .01). These gains were accompanied by group differences for 6MWD (P < .05) and VO2 peak (P < .05). CONCLUSION Our ST regimen had a large impact on the capacity to sustain submaximal muscle contraction, a metric that may carry more practical significance for stroke than the often reported measures of maximum strength.
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Affiliation(s)
- Frederick M Ivey
- Department of Veterans Affairs and Veterans Affairs Medical Center, Maryland Exercise and Robotics Center of Excellence (MERCE), Geriatric Research, Education and Clinical Center (GRECC), University of Maryland School of Medicine, Baltimore, Maryland; Department of Neurology.
| | - Steven J Prior
- Department of Veterans Affairs and Veterans Affairs Medical Center, Maryland Exercise and Robotics Center of Excellence (MERCE), Geriatric Research, Education and Clinical Center (GRECC), University of Maryland School of Medicine, Baltimore, Maryland; Department of Medicine, Division of Gerontology and Geriatric Medicine
| | - Charlene E Hafer-Macko
- Department of Veterans Affairs and Veterans Affairs Medical Center, Maryland Exercise and Robotics Center of Excellence (MERCE), Geriatric Research, Education and Clinical Center (GRECC), University of Maryland School of Medicine, Baltimore, Maryland; Department of Neurology
| | - Leslie I Katzel
- Department of Veterans Affairs and Veterans Affairs Medical Center, Maryland Exercise and Robotics Center of Excellence (MERCE), Geriatric Research, Education and Clinical Center (GRECC), University of Maryland School of Medicine, Baltimore, Maryland; Department of Medicine, Division of Gerontology and Geriatric Medicine
| | - Richard F Macko
- Department of Veterans Affairs and Veterans Affairs Medical Center, Maryland Exercise and Robotics Center of Excellence (MERCE), Geriatric Research, Education and Clinical Center (GRECC), University of Maryland School of Medicine, Baltimore, Maryland; Department of Neurology
| | - Alice S Ryan
- Department of Veterans Affairs and Veterans Affairs Medical Center, Maryland Exercise and Robotics Center of Excellence (MERCE), Geriatric Research, Education and Clinical Center (GRECC), University of Maryland School of Medicine, Baltimore, Maryland; Department of Medicine, Division of Gerontology and Geriatric Medicine
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20
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Papa EV, Hassan M, Bugnariu N. The Effects of Performance Fatigability on Postural Control and Rehabilitation in the Older Patient. CURRENT GERIATRICS REPORTS 2016; 5:172-178. [PMID: 28154794 DOI: 10.1007/s13670-016-0179-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Fatigue is common in older adults and has a significant effect on quality of life. Despite the high prevalence of fatigue in older individuals, several aspects are poorly understood. It is important to differentiate subjective fatigue complaints from fatigability of motor performance because the two are independent constructs with potentially distinct consequences on mobility. Performance fatigability is the magnitude of change in a performance criterion over a given time of task performance. Performance fatigability is a compulsory element of any strength training program, yet strength training is an important component of rehabilitation programs for older adults. The consequences of fatigability for older adults suggest that acute exercise of various types may result in acute impairments in postural control. The effects of performance fatigability on postural control in older adults are evaluated here to aid the rehabilitation clinician in making recommendations for evaluation of fall risks and exercise prescription.
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Affiliation(s)
- Evan V Papa
- University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX 76107, USA
| | - Mahdi Hassan
- University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX 76107, USA
| | - Nicoleta Bugnariu
- University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX 76107, USA
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Kumar VK, Chakrapani M, Kedambadi R. Motor Imagery Training on Muscle Strength and Gait Performance in Ambulant Stroke Subjects-A Randomized Clinical Trial. J Clin Diagn Res 2016; 10:YC01-4. [PMID: 27134985 DOI: 10.7860/jcdr/2016/16254.7358] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 12/31/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The ultimate goal of physiotherapy in stroke rehabilitation is focused towards physical independence and to restore their functional ability during activities of daily living (ADLs). Motor imagery (MI) is an active process during which a specific action is reproduced within working memory without any actual movements. MI training enhances motor learning, neural reorganization and cortical activation in stroke. The efficacy of MI training involving lower extremity mobility tasks need to be assessed. AIM To evaluate the effects of combining motor imagery with physical practice in paretic Lower Extremity Muscles Strength and Gait Performance in Ambulant Stroke subjects. MATERIALS AND METHODS A Randomized Clinical Trial was conducted in Department of Physical Therapy, Tertiary Care Hospitals, Mangalore, India which includes 40 hemi paretic subjects (>3 months post-stroke) who were ambulant with good imagery ability in both KVIQ-20 ≥ 60 and Time dependent MI screening test were recruited and randomly allocated into task-oriented training group (n=20) and task-oriented training group plus MI group (n=20). Subjects in both groups underwent task orientated training for lower extremity 45-60 minutes, 4 days per week for 3 weeks. In addition, the experimental group received 30 minutes of audio-based lower extremity mobility tasks for MI practice. Isometric muscle strength of Hip, Knee and Ankle using a hand-held dynamometer and self-selected 10 m gait speed were assessed before and after 3 weeks of intervention. RESULTS Both the groups had found a significant change for all the outcome measures following 3 weeks of interventions with p <.05. The experimental group had shown a significant improvement in paretic hip muscles (both flexors and extensors), knee extensors and ankle dorsiflexors and gait speed compare to control group with p < .05 between group analyses. CONCLUSION Additional task specific MI training improves paretic muscle strength and gait performance in ambulant stroke patients.
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Affiliation(s)
- Vijaya K Kumar
- Associate Professor, Department of Physiotherapy, Kasturba Medical College , Mangalore, Manipal University, Karnataka, India
| | - M Chakrapani
- Associate, Dean and Professor, Department of Medicine, Kasturba Medical College, Mangalore , Manipal University, Karnataka, India
| | - Rakshith Kedambadi
- Associate Professor and Incharge, Department of Neurology, Kasturba Medical College , Mangalore, Manipal University, Karnataka, India
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Kuhnen HR, Rybar MM, Onushko T, Doyel RE, Hunter SK, Schmit BD, Hyngstrom AS. Stroke-related effects on maximal dynamic hip flexor fatigability and functional implications. Muscle Nerve 2015; 51:446-8. [PMID: 25399720 DOI: 10.1002/mus.24520] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2014] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Stroke-related changes in maximal dynamic hip flexor muscle fatigability may be more relevant functionally than isometric hip flexor fatigability. METHODS Ten chronic stroke survivors performed 5 sets of 30 hip flexion maximal dynamic voluntary contractions (MDVC). A maximal isometric voluntary contraction (MIVC) was performed before and after completion of the dynamic contractions. Both the paretic and nonparetic legs were tested. RESULTS Reduction in hip flexion MDVC torque in the paretic leg (44.7%) was larger than the nonparetic leg (31.7%). The paretic leg had a larger reduction in rectus femoris EMG (28.9%) between the first and last set of MDVCs than the nonparetic leg (7.4%). Reduction in paretic leg MDVC torque was correlated with self-selected walking speed (r2=0.43), while reduction in MIVC torque was not (r2=0.11). CONCLUSIONS Reductions in maximal dynamic torque of paretic hip flexors may be a better predictor of walking function than reductions in maximal isometric contractions.
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Affiliation(s)
- Henry R Kuhnen
- Department of Biomedical Engineering, Marquette University, Milwaukee, Wisconsin, USA
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