Isocinétisme et rééducation de la marche de l'hémiplégique

Effect of training programs and exercise in adult stroke patients: literature review

INTRODUCTION

An increasing number of training programs are proposed for the rehabilitation of patients after stroke, with positive results published but without formal validation, and without recommendations regarding indications for specific techniques and procedures.

OBJECTIVE

To review data from the literature about training and exercise programs for stroke patients and to describe the efficacy, limitations, and effect of such programs on organ systems.

METHODS

A search of MedLINE and relevant medical journals for articles of clinical trials, meta-analyses, and literature reviews pertaining to physical training and exercise programs after stroke.

RESULTS

We found 58 articles reporting on various training and exercise techniques (walking, cardiovascular training, muscle strengthening, and others) and their results (on the cardiovascular, musculoskeletal, and neurologic systems, as well as functional status) in hemiplegic stroke patients.

DISCUSSION-CONCLUSION

Training and exercise programs have value in stroke rehabilitation, and published results are, in general, promising. However, differences in the populations tested, methods, and criteria for analysis do not allow for recommending specific procedures.

Réentraînement à l'effort chez l'hémiplégique vasculaire: revue de la littérature

INTRODUCTION

An increased number of physical retraining programs are available for the rehabilitation of stroke patient; generally positive results are observed, but no consensus in methodology exists (program characteristics, intensity, duration, frequency, etc.).

OBJECTIVE

To review the literature about training program characteristics for stroke patients and describe their efficacy, limits, and results.

METHODS

A search of the Medline database revealed 97 references, including 53 clinical studies examining protocols of physical training and 15 meta-analyses and literature reviews of physical training.

RESULTS

Three physical training protocols were found (walking, neuromuscular and 'force' training). Each training had specific effects: cardiovascular, functional, and muscular.

DISCUSSION-CONCLUSION

To obtain positive cardiovascular effects and/or walking improvement, classical rehabilitation and physical training programs need to be associated for rehabilitation of the stroke patient.

Relation entre les capacités de marche et les capacités maximales à l'effort, les capacités musculaires et la déficience motrice après hémiplégie vasculaire chez l'adulte

OBJECTIVE

To evaluate the relation between walking capacity and maximal exercise capacity, strength and motor deficiency in hemiplegic stroke patients.

DESIGN

Uncontrolled observational study.

SETTING

Physical medicine and rehabilitation unit in a teaching hospital.

PARTICIPANTS

Twenty hemiplegic stroke patients (17 men and 3 women) aged 18-70 years, whose stroke occurred more than 3 months before the study and who could walk independently with or without walking aids.

MAIN OUTCOME MEASURES

Peak oxygen uptake (VO(2peak)), maximal power output walking capacity (6-min walk test) and motor deficiency (Fugl-Meyer scale).

RESULTS

Walking capacity was correlated with both VO(2peak) and maximal power output (Pmax) [r=0.609, P<0.003 and r=0.868, P<0.0001, respectively] but also with strength (from r=0.640 to r=0.734; P=0.0018 to P=0.0001) and motor deficiency (r=0.6; P=0.004).

CONCLUSIONS

Aerobic capacity and walking capacity are correlated and decreased in hemiplegic stroke patients. These results underscore the need for future studies to confirm the role of fitness in relation to walking capacity and to evaluate the benefit of integrating aerobic training into more traditional rehabilitation programs after stroke.