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Huber SK, Manser P, de Bruin ED. PEMOCS: theory derivation of a concept for PErsonalized MOtor-Cognitive exergame training in chronic Stroke-a methodological paper with an application example. Front Sports Act Living 2024; 6:1397949. [PMID: 38915297 PMCID: PMC11194322 DOI: 10.3389/fspor.2024.1397949] [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: 03/08/2024] [Accepted: 05/27/2024] [Indexed: 06/26/2024] Open
Abstract
Background Coping with residual cognitive and gait impairments is a prominent unmet need in community-dwelling chronic stroke survivors. Motor-cognitive exergames may be promising to address this unmet need. However, many studies have so far implemented motor-cognitive exergame interventions in an unstructured manner and suitable application protocols remain yet unclear. We, therefore, aimed to summarize existing literature on this topic, and developed a training concept for motor-cognitive exergame interventions in chronic stroke. Methods The development of the training concept for personalized motor-cognitive exergame training for stroke (PEMOCS) followed Theory Derivation procedures. This comprised (1.1) a thorough (narrative) literature search on long-term stroke rehabilitation; (1.2) a wider literature search beyond the topic of interest to identify analogies, and to induce creativity; (2) the identification of parent theories; (3) the adoption of suitable content or structure of the main parent theory; and (4) the induction of modifications to adapt it to the new field of interest. We also considered several aspects of the "Framework for Developing and Evaluating Complex Interventions" by the Medical Research Council. Specifically, a feasibility study was conducted, and refining actions based on the findings were performed. Results A training concept for improving cognitive functions and gait in community-dwelling chronic stroke survivors should consider the principles for neuroplasticity, (motor) skill learning, and training. We suggest using a step-based exergame training for at least 12 weeks, 2-3 times a week for approximately 45 min. Gentile's Taxonomy for Motor Learning was identified as suitable fundament for the personalized progression and variability rules, and extended by a third cognitive dimension. Concepts and models from related fields inspired further additions and modifications to the concept. Conclusion We propose the PEMOCS concept for improving cognitive functioning and gait in community-dwelling chronic stroke survivors, which serves as a guide for structuring and implementing motor-cognitive exergame interventions. Future research should focus on developing objective performance parameters that enable personalized progression independent of the chosen exergame type.
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Affiliation(s)
- Simone K. Huber
- Physiotherapy and Occupational Therapy Research Centre, Directorate of Research and Education, University Hospital Zurich, Zurich, Switzerland
- Motor Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Patrick Manser
- Motor Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Eling D. de Bruin
- Motor Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- Department of Health, OST—Eastern Swiss University of Applied Sciences, St. Gallen, Switzerland
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
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Kossi O, Bonnechère B, Agbetou M, Somasse R, Hokpo A, Houehanou YCN, Adoukonou T, Mandigout S. Relationships between cardiorespiratory fitness, physical activity practices, and functional outcomes one-year post-stroke in northern Benin: A case-control study. Top Stroke Rehabil 2024; 31:104-115. [PMID: 37120850 DOI: 10.1080/10749357.2023.2207286] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 04/22/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND Currently, little is known on the relationships between cardiorespiratory fitness (CF), physical activity (PA), and functional outcomes after stroke, especially in low- and middle-income countries. OBJECTIVES We examine the relationships between CF, PA, and functional outcomes in one-year poststroke in Benin, a lower middle-income country. METHODS A case-control study was carried out in northern Benin. Twenty-one participants with chronic strokes were matched to 42 controls according to sex and age. PA patterns and associated energy expenditure (EE) were assessed with a BodyMedia's senseWear armband. CF was evaluated with the Physical Working Capacity at 75% of the predicted maximal heart rate index. The functional outcomes were evaluated using the modified Rankin scale (mRS) and the ACTIVLIM-Stroke scale. RESULTS Both people with stroke and the healthy pairs spent much time in sedentary behavior (median [P25; P75]: 672 [460; 793] min vs 515 [287; 666] min, p = 0.006). Although people with chronic stroke performed fewer steps compared to healthy controls (median: 2767 vs 5524, p = 0.005), results showed that total EE was not statistically significant in either group (median: 7166 Kcal vs 8245 Kcal, p = 0.07). In addition, the mRS score (r = 0.47, p = 0.033) and the ACTIVLIM-Stroke measure (r = 0.52, p = 0.016) were moderately associated with the CF index of people with chronic stroke. CONCLUSION The study showed clear trends for lower levels of PA in both people with chronic stroke and health controls. A correlation exists between CF, disability, and functional outcomes among stroke patients.
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Affiliation(s)
- Oyéné Kossi
- ENATSE, National School of Public Health and Epidemiology, University of Parakou, Parakou, Benin
- Unit of Neurology and NeuroRehabilitation, University Hospital of Parakou, Parakou, Benin
- REVAL, Rehabilitation Research Center, Hasselt University, Diepenbeek, Belgium
| | - Bruno Bonnechère
- REVAL, Rehabilitation Research Center, Hasselt University, Diepenbeek, Belgium
- Technology-Supported and Data-Driven Rehabilitation, Data Science Institute, Hasselt University, Diepenbeek, Belgium
| | - Mendinatou Agbetou
- Unit of Neurology and NeuroRehabilitation, University Hospital of Parakou, Parakou, Benin
- Department of Neurology, Faculty of Medicine, University of Parakou, Parakou, Benin
| | - Ruth Somasse
- Unit of Neurology and NeuroRehabilitation, University Hospital of Parakou, Parakou, Benin
| | - Athanase Hokpo
- Unit of Neurology and NeuroRehabilitation, University Hospital of Parakou, Parakou, Benin
| | | | - Thierry Adoukonou
- ENATSE, National School of Public Health and Epidemiology, University of Parakou, Parakou, Benin
- Unit of Neurology and NeuroRehabilitation, University Hospital of Parakou, Parakou, Benin
- Department of Neurology, Faculty of Medicine, University of Parakou, Parakou, Benin
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Thompson ED, Miller AE, Reisman DS. Characterizing the impact of multiple chronic conditions on return to participation in chronic stroke survivors. Top Stroke Rehabil 2024; 31:97-103. [PMID: 37057761 PMCID: PMC10576011 DOI: 10.1080/10749357.2023.2202018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 04/09/2023] [Indexed: 04/15/2023]
Abstract
BACKGROUND Each year, 795,000 Americans experience a stroke. As stroke mortality declines, more individuals are in the chronic phase of recovery (>6 months post-stroke). Over 80% of stroke survivors have multiple, chronic health conditions (MCC). While the relationship between MCC and mortality and function during acute recovery has been explored, less is known about how MCC burden affects participation in chronic stroke survivors. OBJECTIVE This study investigated whether MCC burden is related to participation in those with chronic stroke. METHODS Two hundred and sixty-six participants with chronic (≥6 months) stroke were included in this cross-sectional and retrospective analysis. Participants had a mean age of 62.2 ± 12.8 years, and time since stroke (TSS) of 36.0 ± 44.6 months (114F/152 M). Participants completed the 6-minute Walk Test (6MWT), Activities-Specific Balance Confidence Scale (ABC), Modified Cumulative Illness Rating Scale (MCIR) to quantify the presence and severity of chronic illness across 14 body systems, and the Stroke Impact Scale - Participation subscale (SIS-P). Participation (SIS-P) was the dependent variable. Independent variables were entered into a sequential regression model in three blocks: demographic variables, physical capacity (6MWT distance) and balance self-efficacy (ABC), and MCC burden (MCIR). RESULTS After adjusting for age, sex, and time since stroke, physical capacity and balance self-efficacy explained 31.4% (p < 0.001), and the MCC burden explained 2.0% (p = 0.004). Higher participation was related to lower MCC burden. CONCLUSIONS MCC burden is a significant contributor to variance in participation in chronic stroke survivors, above and beyond demographics, physical capacity, and self-efficacy, and therefore should be considered when creating rehabilitation programs to improve participation.
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Affiliation(s)
| | - Allison E Miller
- Department of Physical Therapy, University of Delaware, Newark, DE, USA
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Darcy S Reisman
- Department of Physical Therapy, University of Delaware, Newark, DE, USA
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Nedergård H, Sandlund M, Häger CK, Palmcrantz S. Users' experiences of intensive robotic-assisted gait training post-stroke - "a push forward or feeling pushed around?". Disabil Rehabil 2023; 45:3861-3868. [PMID: 36342771 DOI: 10.1080/09638288.2022.2140848] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/17/2022] [Accepted: 10/23/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE Robotic-assisted gait training (RAGT) is suggested to improve walking ability after stroke. The purpose of this study was to describe experiences of robotic-assisted gait training as part of a gait training intervention among persons in the chronic phase after stroke. MATERIALS AND METHODS Semi-structured interviews were performed with 13 participants after a 6-week intervention including treadmill gait training with the Hybrid Assistive Limb® (HAL) exoskeleton. Data were analysed using qualitative content analysis. RESULTS Four categories emerged: (1) A rare opportunity for potential improvements describes the mindset before the start of the intervention; (2) Being pushed to the limit represents the experience of engaging in intensive gait training; (3) Walking with both resistance and constraints reveals barriers and facilitators during HAL training; (4) Reaching the end and taking the next step alone illustrates feelings of confidence or concern as the intervention ended. CONCLUSIONS The gait training intervention including RAGT was considered demanding but appreciated. Support and concrete, individual feedback was crucial for motivation, whilst the lack of variation was a barrier. Results encourage further development of exoskeletons that are comfortable to wear and stimulate active participation by enabling smoothly synchronised movements performed during task-specific activities in different environments. IMPLICATIONS FOR REHABILITATIONWhen provided in a suitable context, the mental and physical challenges of intensive robotic-assisted gait training can be both inspiring and motivating.Support and engagement along with informative feedback from therapists are suggested crucial for motivation.Intensive task-specific gait training may preferably be performed in an enriched environment and combined with other physiotherapy treatments to stimulate engagement.
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Affiliation(s)
- Heidi Nedergård
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Marlene Sandlund
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Charlotte K Häger
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Susanne Palmcrantz
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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Song YY, Sun WJ, Wang C, Tian YM, Liu H, Jiang Y. Effects of multicomponent exercise on quality of life, depression and anxiety among stroke survivors: A systematic review and meta-analysis. J Clin Nurs 2023; 32:7677-7690. [PMID: 37727891 DOI: 10.1111/jocn.16853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Current guidelines stress the importance of exercise, especially multicomponent exercise to older adults with chronic conditions. AIM To critically synthesise evidence that evaluates the effects of multicomponent exercise on quality of life, depression and anxiety after stroke. DESIGN Systematic review and meta-analysis followed the PRISMA 2020 statement. METHODS A systematic search of PubMed, Embase, Web of Science, Cochrane Library, CINAHL and PsycINFO from inception to 12 June 2023 was performed. Risk of bias was assessed using the Revised Cochrane risk-of-bias tool for randomised trials (RoB 2). Meta-analyses were conducted using Review Manager 5.4 and narrative syntheses were adopted whenever meta-analysis was inappropriate. The overall certainty of the evidence was rated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. RESULTS Of 15,351 records identified, nine were eligible and data were available for seven randomised controlled trials, three of which were identified as having a high risk of bias, one as low risk, and five as having some concerns. Subgroup pooled analyses indicated that multicomponent exercise engaged in longer exercise sessions (>60 min) was effective in improving quality of life immediately post-intervention and through 3-6 months post-intervention. However, multicomponent exercise did not significantly affect depression and anxiety. CONCLUSIONS Multicomponent exercise with longer duration of exercise sessions has promising effects on both short- to medium-term quality of life among stroke survivors. PATIENT OR PUBLIC CONTRIBUTION This does not apply to our work as it is a review paper. RELEVANCE TO CLINICAL PRACTICE Healthcare providers could consider encouraging the patients to participate in multicomponent exercise sessions for more than 60 min. It is important to note that stroke survivors should be supervised by trained personnel at the beginning of the training. REGISTRATION The protocol was registered on PROSPERO.
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Affiliation(s)
- Yuan-Yuan Song
- Department of Critical Care Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
- Evidence-based Nursing Center, West China Hospital, Sichuan University, Chengdu, China
| | - Wen-Jing Sun
- Department of Neurosurgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Cong Wang
- Evidence-based Nursing Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yong-Ming Tian
- Department of Critical Care Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Huan Liu
- Department of Critical Care Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Yan Jiang
- Evidence-based Nursing Center, West China Hospital, Sichuan University, Chengdu, China
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Daniel T, Spingler T, Hug A, Weidner N, Wensing M, Ullrich C. Current practice of outpatient rehabilitation services in patients with mobility-impaired paralysis due to stroke or spinal cord injury: a qualitative interview study in Germany. Disabil Rehabil 2023:1-14. [PMID: 37732606 DOI: 10.1080/09638288.2023.2259301] [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: 12/20/2022] [Accepted: 09/10/2023] [Indexed: 09/22/2023]
Abstract
PURPOSE When mobility deficits persist after stroke or spinal cord injury (SCI), outpatient neurorehabilitation services are required. This study aimed to explore the current practice of German outpatient neurorehabilitation services and identify factors associated to this practice. METHODS This was a qualitative observational study in which semi-structured interviews were conducted with professionals from outpatient neurorehabilitation services and mobility-impaired patients. A qualitative content analysis with a data-driven coding process was used. RESULTS Three general practitioners, five physical, five occupational, and one speech therapist, one neuropsychologist, two outpatient nurses, one rehabilitation technician, one social worker, two patient advocates (long-term survivors, each stroke and SCI), and 20 patients (10 after stroke, 10 after SCI, all first-ever affected since approximately one year) participated. The reported experiences ranged from high satisfaction to perceived deficits in participation-oriented, evidence-based, and coordinated care. Identified associated factors were: (a) availability of specialised therapists and professional education, (b) outpatient service catalogue, (c) cost coverage, (d) setting rehabilitation goals, and (e) physician as care coordinator. CONCLUSION Areas of improvement identified focused on: setting rehabilitation goals towards participation, training therapists on evidence-based treatments and shared decision-making, updating the outpatient service catalogue, and implementing coordination actions. Implementation of these recommendations should be evaluated.
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Affiliation(s)
- Tiziana Daniel
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
| | - Tamara Spingler
- Spinal Cord Injury Centre, Heidelberg University Hospital, Heidelberg, Germany
| | - Andreas Hug
- Spinal Cord Injury Centre, Heidelberg University Hospital, Heidelberg, Germany
| | - Norbert Weidner
- Spinal Cord Injury Centre, Heidelberg University Hospital, Heidelberg, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
| | - Charlotte Ullrich
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
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7
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Lyu T, Yan K, Lyu J, Zhao X, Wang R, Zhang C, Liu M, Xiong C, Liu C, Wei Y. Comparative efficacy of gait training for balance outcomes in patients with stroke: A systematic review and network meta-analysis. Front Neurol 2023; 14:1093779. [PMID: 37077566 PMCID: PMC10106590 DOI: 10.3389/fneur.2023.1093779] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 03/01/2023] [Indexed: 04/05/2023] Open
Abstract
BackgroundGrowing evidence suggests that gait training can improve stroke patients’ balance outcomes. However, it remains unclear which type of gait training is more effective in improving certain types of balance outcomes in patients with stroke. Thus, this network meta-analysis (NMA) included six types of gait training (treadmill, body-weight-supported treadmill, virtual reality gait training, robotic-assisted gait training, overground walking training, and conventional gait training) and four types of balance outcomes (static steady-state balance, dynamic steady-state balance, proactive balance, and balance test batteries), aiming to compare the efficacy of different gait training on specific types of balance outcomes in stroke patients and determine the most effective gait training.MethodWe searched PubMed, Embase, Medline, Web of Science, and Cochrane Library databases from inception until 25 April 2022. Randomized controlled trials (RCTs) of gait training for the treatment of balance outcomes after stroke were included. RoB2 was used to assess the risk of bias in the included studies. Frequentist random-effects network meta-analysis (NMA) was used to evaluate the effect of gait training on four categories of balance outcomes.ResultA total of 61 RCTs from 2,551 citations, encompassing 2,328 stroke patients, were included in this study. Pooled results showed that body-weight-support treadmill (SMD = 0.30, 95% CI [0.01, 0.58]) and treadmill (SMD = 0.25, 95% CI [0.00, 0.49]) could improve the dynamic steady-state balance. Virtual reality gait training (SMD = 0.41, 95% CI [0.10, 0.71]) and body-weight-supported treadmill (SMD = 0.41, 95% CI [0.02, 0.80]) demonstrated better effects in improving balance test batteries. However, none of included gait training showed a significant effect on static steady-state balance and proactive balance.ConclusionGait training is an effective treatment for improving stroke patients’ dynamic steady-state balance and balance test batteries. However, gait training had no significant effect on static steady-state balance and proactive balance. To achieve maximum efficacy, clinicians should consider this evidence when recommending rehabilitation training to stroke patients. Considering body-weight-supported treadmill is not common for chronic stroke patients in clinical practice, the treadmill is recommended for those who want to improve dynamic steady-state balance, and virtual reality gait training is recommended for those who want to improve balance test batteries.LimitationMissing evidence in relation to some types of gait training is supposed to be taken into consideration. Moreover, we fail to assess reactive balance in this NMA since few included trials reported this outcome.Systematic Review RegistrationPROSPERO, identifier CRD42022349965.
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Affiliation(s)
- Tianyi Lyu
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Kang Yan
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Jiaxuan Lyu
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Xirui Zhao
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Ruoshui Wang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Chaoyang Zhang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Meng Liu
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Chao Xiong
- L3 & Maintenance Solutions, SUSE Software (Beijing) Co., Ltd., Beijing, China
| | - Chengjiang Liu
- Department of General Medicine, Affiliated Anqing First People’s Hospital of Anhui Medical University, HeFei, Anhui, China
| | - Yulong Wei
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
- *Correspondence: Yulong Wei,
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Noukpo SI, Triccas LT, Bonnechère B, Adoukonou T, Feys P, Kossi O. Physical Activity Level, Barriers, and Facilitators for Exercise Engagement for Chronic Community-Dwelling Stroke Survivors in Low-Income Settings: A Cross-Sectional Study in Benin. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20031784. [PMID: 36767151 PMCID: PMC9914131 DOI: 10.3390/ijerph20031784] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/12/2023] [Accepted: 01/15/2023] [Indexed: 05/16/2023]
Abstract
After a stroke incident, physical inactivity is common. People with stroke may perceive several barriers to performing physical activity (PA). This study aimed to document the PA level and understand the barriers and facilitators to engaging in PA for community-dwelling stroke survivors in Benin, a lower middle-income country. A cross-sectional study was conducted in three hospitals in Benin. Levels of PA were recorded by means of the Benin version of the International Physical Activity Questionnaire long form (IPAQ-LF-Benin), which is validated for stroke survivors in Benin. The perceived exercise facilitators and barriers were assessed by the Stroke Exercise Preference Inventory-13 (SEPI-13). A descriptive analysis and associations were performed with a Confidence Interval of 95% and <0.05 level of significance. A total of 87 participants (52 men, mean age of 53 ± 10 years, mean time after a stroke of 11 (IQR: 15) months and an average of 264.5 ± 178.9 m as distance on the 6 min walking test (6MWT) were included. Overall, stroke survivors in Benin reached a total PA of 985.5 (IQR: 2520) metabolic equivalent (METs)-minutes per week and were least active at work, domestic, and leisure domains with 0 MET-minutes per week. The overview of PA level showed that 52.9% of participants performed low PA intensity. However, 41.4% performed moderate PA or walking per day for at least five days per week. Important perceived barriers were lack of information (45.3%), hard-to-start exercise (39.5%), and travelling to places to exercise (29.9%). The preference for exercise was with family or friends, outdoors, for relaxation or enjoyment (90.2%), and receiving feedback (78.3%). Several socio-demographic, clinical, and community factors were significantly associated with moderate or intense PA (p < 0.05) in stroke survivors in this study. Our findings show that the PA level among chronic stroke survivors in Benin is overall too low relative to their walking capacity. Cultural factors in terms of the overprotection of the patients by their entourage and/or the low health literacy of populations to understand the effect of PA on their health may play a role. There is a need for new approaches that consider the individual barriers and facilitators to exercise.
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Affiliation(s)
- Sènadé Inès Noukpo
- Unit of Neurology and NeuroRehabilitation, University Hospital of Parakou, Parakou 01 BP 02, Benin
- REVAL, Rehabilitation Research Center, Hasselt University, 3590 Diepenbeek, Belgium
| | - Lisa Tedesco Triccas
- REVAL, Rehabilitation Research Center, Hasselt University, 3590 Diepenbeek, Belgium
| | - Bruno Bonnechère
- REVAL, Rehabilitation Research Center, Hasselt University, 3590 Diepenbeek, Belgium
- Technology-Supported and Data-Driven Rehabilitation, Data Science Institute, Hasselt University, 3590 Diepenbeek, Belgium
| | - Thierry Adoukonou
- Unit of Neurology and NeuroRehabilitation, University Hospital of Parakou, Parakou 01 BP 02, Benin
- ENATSE, National School of Public Health and Epidemiology, University of Parakou, Parakou 03 BP 10, Benin
- Department of Neurology, Faculty of Medicine, University of Parakou, Parakou 03 BP 10, Benin
| | - Peter Feys
- REVAL, Rehabilitation Research Center, Hasselt University, 3590 Diepenbeek, Belgium
| | - Oyéné Kossi
- Unit of Neurology and NeuroRehabilitation, University Hospital of Parakou, Parakou 01 BP 02, Benin
- REVAL, Rehabilitation Research Center, Hasselt University, 3590 Diepenbeek, Belgium
- ENATSE, National School of Public Health and Epidemiology, University of Parakou, Parakou 03 BP 10, Benin
- Correspondence:
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9
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Amanzonwé ER, Tedesco Triccas L, Codjo L, Hansen D, Feys P, Kossi O. Exercise dosage to facilitate the recovery of balance, walking, and quality of life after stroke. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2023; 79:1846. [PMID: 36873960 PMCID: PMC9982519 DOI: 10.4102/sajp.v79i1.1846] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 12/09/2022] [Indexed: 02/05/2023] Open
Abstract
Background Although aerobic training (AT) and resistance training (RT) are recommended after stroke, the optimal dosage of these interventions and their effectiveness on balance, walking capacity, and quality of life (QoL) remain conflicting. Objectives Our study aimed to quantify the effects of different modes, dosages and settings of exercise therapy on balance, walking capacity, and QoL in stroke survivors. Method PubMed, CINHAL, and Hinari databases were searched for randomised controlled trials (RCTs) evaluating the effects of AT and RT on balance, walking, and QoL in stroke survivors. The treatment effect was computed by the standard mean differences (SMDs). Results Twenty-eight trials (n = 1571 participants) were included. Aerobic training and RT interventions were ineffective on balance. Aerobic training interventions were the most effective in improving walking capacity (SMD = 0.37 [0.02, 0.71], p = 0.04). For walking, capacity, a higher dosage (duration ≥ 120 min/week; intensity ≥ 60% heart rate reserve) of AT interventions demonstrated a significantly greater effect (SMD = 0.58 [0.12, 1.04], p = 0.01). Combined AT and RT improved QoL (SMD = 0.56 [0.12, 0.98], p = 0.01). Hospital located rehabilitation setting was effective for improving walking capacity (SMD = 0.57 [0.06, 1.09], p = 0.03) compared with home and/or community and laboratory settings. Conclusion Our findings showed that neither AT nor RT have a significant effect on balance. However, AT executed in hospital-located settings with a higher dose is a more effective strategy to facilitate walking capacity in chronic stroke. In contrast, combined AT and RT is beneficial for improving QoL. Clinical implications A high dosage of aerobic exercise, duration ≥ 120 min/week; intensity ≥ 60% heart rate reserve is beneficial for improving walking capacity.
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Affiliation(s)
- Elogni R Amanzonwé
- Unit of NeuroRehabilitation, Department of Neurology NeuroRehabilitation, University of Parakou, Parakou, Benin.,REVAL, Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Lisa Tedesco Triccas
- REVAL, Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Léopold Codjo
- Department of Cardiology, Faculty of Medicine, University of Parakou, Parakou, Benin
| | - Dominique Hansen
- REVAL, Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium.,Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Peter Feys
- REVAL, Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Oyéné Kossi
- REVAL, Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium.,Unit of NeuroRehabilitation, Department of Neurology NeuroRehabilitation, University Hospital of Parakou, Parakou, Benin.,ENATSE, National School of Public Health and Epidemiology, University of Parakou, Parakou, Benin
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10
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Ma Y, Luo J, Wang XQ. The effect and mechanism of exercise for post-stroke pain. Front Mol Neurosci 2022; 15:1074205. [PMID: 36533131 PMCID: PMC9755671 DOI: 10.3389/fnmol.2022.1074205] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 11/18/2022] [Indexed: 08/30/2023] Open
Abstract
One of the common negative effects of a stroke that seriously lowers patients' quality of life is post-stroke pain (PSP). Thus, exercise in PSP management has become a hot research topic. The main advantages of exercise therapy are affordability and ease of acceptance by patients compared to other treatment methods. Therefore, this article reviews the effectiveness and possible mechanisms of exercise interventions for PSP. Exercise training for patients with PSP not only improves physical function but also effectively reduces pain intensity and attenuates the behavioral response to pain. In addition, exercise therapy can improve brain function and modulate levels of pro-inflammatory and neurotrophic factors to exert specific analgesic effects. Potential mechanisms for exercise intervention include modulation of synaptic plasticity in the anterior cingulate gyrus, modulation of endogenous opioids in vivo, reversal of brain-derived neurotrophic factor overexpression, inhibition of purinergic receptor (P2X4R, P2X7R) expression, and inhibition of microglia activation. However, current research on exercise for PSP remains limited, and the sustainable benefits of exercise interventions for PSP need to be further investigated.
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Affiliation(s)
- Yue Ma
- Department of Sport Rehabilitation, Xi’an Physical Education University, Xi’an, China
| | - Jing Luo
- Department of Sport Rehabilitation, Xi’an Physical Education University, Xi’an, China
| | - Xue-Qiang Wang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
- Department of Rehabilitation Medicine, Shanghai Shangti Orthopaedic Hospital, Shanghai, China
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Procópio C, Da Silva BC, Rodrigues-Machado M, Polese JC. Arterial stiffness and functional capacity in individuals with chronic stroke: a cross-sectional study. Physiother Theory Pract 2022; 39:912-917. [PMID: 35105257 DOI: 10.1080/09593985.2022.2031364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To investigate the association between arterial stiffness and functional capacity in individuals with chronic stroke and compare the arterial stiffness between individuals with better and poor functional capacity. DESIGN Cross-sectional study. PARTICIPANTS Individuals after chronic stroke have their arterial stiffness index evaluated by augmentation index heart rate adjusted for 75 bpm (AIx@75), assessed by Mobil-O-Graph® device (IEM, Stolberg, Germany), in percent, on the paretic upper limb. Functional capacity was assessed with the Duke Activity Status Index (DASI) in metabolic equivalent (METS). The individuals were assigned into two groups: better (DASI ≥ 31.95) and poor (DASI < 31.95) functional capacity. Pearson's correlation and t test were used for analysis. RESULTS Twenty-eight individuals (arterial stiffness 23.8 ± 10% and functional capacity 29 ± 19 METS) were included. The association between arterial stiffness and functional capacity was negative and statistically significant, with moderate magnitude (r = -0.53, p < .001). Individuals who had better functional capacity have lower arterial stiffness indices (AIx@75 = 17.4% versus 27.4% in better and lower functional capacity, respectively) (p = .01). CONCLUSION Arterial stiffness of the paretic upper limb has a negative association with functional capacity.
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Affiliation(s)
- Cleucia Procópio
- Post-Graduate Program of Health Sciences, Faculdade de Ciências Médicas de Minas Gerais, Centro, Brazil.,Department of Physiotherapy, Faculdade Ciências Médicas de Minas Gerais, Centro, Brazil
| | - Brenno Cordeiro Da Silva
- Post-Graduate Program of Health Sciences, Faculdade de Ciências Médicas de Minas Gerais, Centro, Brazil.,Department of Physiotherapy, Faculdade Ciências Médicas de Minas Gerais, Centro, Brazil
| | - Maria Rodrigues-Machado
- Post-Graduate Program of Health Sciences, Faculdade de Ciências Médicas de Minas Gerais, Centro, Brazil.,Department of Physiotherapy, Faculdade Ciências Médicas de Minas Gerais, Centro, Brazil
| | - Janaine Cunha Polese
- Post-Graduate Program of Health Sciences, Faculdade de Ciências Médicas de Minas Gerais, Centro, Brazil.,Department of Physiotherapy, Faculdade Ciências Médicas de Minas Gerais, Centro, Brazil
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Ravesloot C, Myers A, Santasier A, Ward B. Effects of an Exercise Intervention on Participation Reported by People with Disabilities: A Mixed Methods Randomized Trial. Disabil Health J 2022; 15:101272. [DOI: 10.1016/j.dhjo.2022.101272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 01/10/2022] [Accepted: 01/10/2022] [Indexed: 11/03/2022]
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Kossi O, Agbetou M, Noukpo SI, Triccas LT, Dossou-Yovo DE, Amanzonwe ER, Adoukonou T. Factors associated with balance impairments amongst stroke survivors in northern Benin: A cross-sectional study. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2021; 77:1559. [PMID: 34693069 PMCID: PMC8517725 DOI: 10.4102/sajp.v77i1.1559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/28/2021] [Indexed: 11/04/2022] Open
Abstract
Background Balance impairment is the predominant risk factor for falls in stroke survivors. A fear of falling after stroke can contribute to sedentary lifestyles, increased disability and risk of recurrence, leading to poor quality of life. Objective To determine the frequency and factors associated with balance impairments amongst stroke survivors at the University Hospital of Parakou. Method This cross-sectional study included adult stroke survivors. Stroke survivors after discharge were enrolled at the University Hospital of Parakou between 01 January 2020 and 30 September 2020. Balance impairments were measured by using the Berg Balance Scale (BBS), the Timed Up and Go (TUG) and the Get Up and Go (GUG) tests. Results A total of 54 stroke survivors were included, with a mean age of 58.37 ± 12.42 years and a male predominance of 68.52%. The mean BBS score was 36.87 ± 14.34 with a minimum and a maximum of 10 and 56, respectively. Thirteen (24.07%) had balance impairments (BBS score ≤ 20), 34 (62.96%) had a TUG score ≥ 14 s (abnormal), 9 (16.67%) presented a moderate risk of falling and 6 (11.11%) presented high risk of fall with the GUG test. Post-stroke duration (odds ratio [OR] = 0.04; 95% CI: 0.04–0.30; p < 0.01), severity of disability (OR = 8.33; 95% CI: 1.03–67.14; p = 0.03) and the number of physiotherapy sessions (OR = 0.18; 95% CI: 0.03–0.93; p = 0.02) were significantly associated with balance impairments. Conclusion Our results showed that almost one quarter of stroke survivors after discharge at the University Hospital of Parakou had balance impairments. Post-stroke duration, severity of disability and the number of physiotherapy sessions were significantly associated with balance impairments. Clinical implications [AQ1] Balance should be regularly assessed in people post-stroke. Further studies should document the content of rehabilitation and any rehabilitative efforts to improve balance in people post-stroke in Benin.
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Affiliation(s)
- Oyéné Kossi
- National School of Public Health and Epidemiological Surveillance (ENATSE), University of Parakou, Parakou, Benin.,Unit of Neuro Rehabilitation, Department of Neurology, University Hospital of Parakou, Parakou, Benin.,REVAL, Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Mendinatou Agbetou
- Department of Neurology, Faculty of Medicine, University of Parakou, Parakou, Benin
| | - Sènadé I Noukpo
- Unit of Neuro Rehabilitation, Department of Neurology, University Hospital of Parakou, Parakou, Benin
| | - Lisa T Triccas
- REVAL, Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Daniel-Eude Dossou-Yovo
- National School of Public Health and Epidemiological Surveillance (ENATSE), University of Parakou, Parakou, Benin
| | - Elogni R Amanzonwe
- REVAL, Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Thierry Adoukonou
- National School of Public Health and Epidemiological Surveillance (ENATSE), University of Parakou, Parakou, Benin.,Department of Neurology, Faculty of Medicine, University of Parakou, Parakou, Benin
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Park SH, Hsu CJ, Dee W, Roth EJ, Rymer WZ, Wu M. Enhanced error facilitates motor learning in weight shift and increases use of the paretic leg during walking at chronic stage after stroke. Exp Brain Res 2021; 239:3327-3341. [PMID: 34477919 DOI: 10.1007/s00221-021-06202-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 08/18/2021] [Indexed: 12/22/2022]
Abstract
The purpose of this study was to determine whether the application of lateral pelvis pulling force toward the non-paretic side during the stance phase of the paretic leg would enhance forced use of the paretic leg and increase weight shift toward the paretic side in stroke survivors. Eleven chronic stroke survivors participated in two experimental sessions, which consisted of (1) treadmill walking with the application of "pelvis resistance" or "pelvis assistance" and (2) overground walking. During the treadmill walking, the laterally pulling force was applied during the stance phase of the paretic leg toward the non-paretic side for the "pelvis resistance" condition or toward the paretic side for the "pelvis assistance" condition during the stance phase of the paretic leg. After force release, the "pelvis resistance" condition exhibited greater enhancement in muscle activation of hip ABD, ADD, and SOL and greater improvement in lateral weight shift toward the paretic side, compared with the effect of the "pelvis assistance" condition (P < 0.03). This improved lateral weight shift was associated with the enhanced muscle activation of hip ABD and ADD (R2 = 0.67, P = 0.01). The pelvis resistance condition also improved overground walking speed and stance phase symmetry when measured 10 min after the treadmill walking (P = 0.004). In conclusion, applying pelvis resistance forces to increase error signals may facilitate motor learning of weight shift toward the paretic side and enhance use of the paretic leg in chronic stroke survivors. Results from this study may be utilized to develop an intervention approach to improve walking in stroke survivors.
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Affiliation(s)
- Seoung Hoon Park
- Legs and Walking Lab, Shirley Ryan AbilityLab, 355 E. Erie Street, 23rd floor, Chicago, IL, 60611, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - Chao-Jung Hsu
- Legs and Walking Lab, Shirley Ryan AbilityLab, 355 E. Erie Street, 23rd floor, Chicago, IL, 60611, USA
| | - Weena Dee
- Legs and Walking Lab, Shirley Ryan AbilityLab, 355 E. Erie Street, 23rd floor, Chicago, IL, 60611, USA
| | - Elliot J Roth
- Legs and Walking Lab, Shirley Ryan AbilityLab, 355 E. Erie Street, 23rd floor, Chicago, IL, 60611, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - William Z Rymer
- Legs and Walking Lab, Shirley Ryan AbilityLab, 355 E. Erie Street, 23rd floor, Chicago, IL, 60611, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - Ming Wu
- Legs and Walking Lab, Shirley Ryan AbilityLab, 355 E. Erie Street, 23rd floor, Chicago, IL, 60611, USA.
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA.
- Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, IL, USA.
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