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Rössler R, Rommers N, Kim EK, Iendra L, Sofios A, Giannouli E, Portegijs E, Rantanen T, Infanger D, Bridenbaugh S, Engelter ST, Schmidt-Trucksäss A, Weibel R, Peters N, Hinrichs T. Timed up-and-go performance is associated with objectively measured life space in patients 3 months after ischemic stroke: a cross-sectional observational study. J Neurol 2023; 270:1999-2009. [PMID: 36547716 PMCID: PMC9772599 DOI: 10.1007/s00415-022-11524-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/07/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Stroke is a common cause of mobility limitation, including a reduction in life space. Life space is defined as the spatial extent in which a person moves within a specified period of time. We aimed to analyze patients' objective and self-reported life space and clinical stroke characteristics. METHODS MOBITEC-Stroke is a prospective observational cohort study addressing poststroke mobility. This cross-sectional analysis refers to 3-month data. Life space was assessed by a portable tracking device (7 consecutive days) and by self-report (Life-Space Assessment; LSA). We analysed the timed up-and-go (TUG) test, stroke severity (National Institutes of Health Stroke Scale; NIHSS), and the level of functional outcome (modified Rankin Scale; mRS) in relation to participants' objective (distance- and area-related life-space parameters) and self-reported (LSA) life space by multivariable linear regression analyses, adjusted for age, sex, and residential area. RESULTS We included 41 patients, mean age 70.7 (SD11.0) years, 29.3% female, NIHSS score 1.76 (SD1.68). We found a positive relationship between TUG performance and maximum distance from home (p = 0.006), convex hull area (i.e. area enclosing all Global Navigation Satellite System [GNSS] fixes, represented as a polygon linking the outermost points; p = 0.009), perimeter of the convex hull area (i.e. total length of the boundary of the convex hull area; p = 0.008), as well as the standard ellipse area (i.e. the two-dimensional ellipse containing approximately 63% of GNSS points; p = 0.023), in multivariable regression analyses. CONCLUSION The TUG, an easily applicable bedside test, seems to be a useful indicator for patients' life space 3 months poststroke and may be a clinically useful measure to document the motor rehabilitative process.
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Affiliation(s)
- Roland Rössler
- Department of Sport, Exercise, and Health, University of Basel, Grosse Allee 6, 4052, Basel, Switzerland.
- Basel Mobility Center, Department of Geriatric Medicine Felix Platter, Basel, Switzerland.
| | - Nikki Rommers
- Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Eun-Kyeong Kim
- Department of Geography, University of Zurich, Zurich, Switzerland
- University Research Priority Program (URPP) Dynamics of Healthy Aging, University of Zurich, Zurich, Switzerland
- Department of Urban Development and Mobility, Luxembourg Institute of Socio-Economic Research (LISER), Esch-sur-Alzette, Luxembourg
| | - Laura Iendra
- Neurology und Neurorehabilitation, University Department of Geriatric Medicine Felix Platter, Basel, Switzerland
- Department of Neurology & Stroke Center, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Alexander Sofios
- Department of Geography, University of Zurich, Zurich, Switzerland
- University Research Priority Program (URPP) Dynamics of Healthy Aging, University of Zurich, Zurich, Switzerland
| | - Eleftheria Giannouli
- Department of Sport, Exercise, and Health, University of Basel, Grosse Allee 6, 4052, Basel, Switzerland
- Department of Health Sciences & Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
| | - Erja Portegijs
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Taina Rantanen
- Faculty of Sport and Health Sciences & Gerontology Research Center, University of Jyvaskyla, Jyvaskyla, Finland
| | - Denis Infanger
- Department of Sport, Exercise, and Health, University of Basel, Grosse Allee 6, 4052, Basel, Switzerland
| | - Stephanie Bridenbaugh
- Basel Mobility Center, Department of Geriatric Medicine Felix Platter, Basel, Switzerland
| | - Stefan T Engelter
- Neurology und Neurorehabilitation, University Department of Geriatric Medicine Felix Platter, Basel, Switzerland
- Department of Neurology & Stroke Center, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Arno Schmidt-Trucksäss
- Department of Sport, Exercise, and Health, University of Basel, Grosse Allee 6, 4052, Basel, Switzerland
| | - Robert Weibel
- Department of Geography, University of Zurich, Zurich, Switzerland
| | - Nils Peters
- Neurology und Neurorehabilitation, University Department of Geriatric Medicine Felix Platter, Basel, Switzerland
- Department of Neurology & Stroke Center, University Hospital Basel, University of Basel, Basel, Switzerland
- Neurology and Stroke Center, Klinik Hirslanden, Zurich, Switzerland
| | - Timo Hinrichs
- Department of Sport, Exercise, and Health, University of Basel, Grosse Allee 6, 4052, Basel, Switzerland
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Wu JM, Chen HS, Chen HH, Cheng BW, Huang CW, Chung MH. Enhancing patient self-management after a first stroke: An application of the wearable devices and the health management platform. Disabil Health J 2023; 16:101392. [PMID: 36333265 DOI: 10.1016/j.dhjo.2022.101392] [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: 03/09/2022] [Revised: 09/30/2022] [Accepted: 10/01/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Post-stroke disability restricts a patient's physical activity, affects the patient's quality of life, and leads to higher medical costs. Therefore, it is essential to promote patients' continuous exercise during this period of recovery. OBJECTIVE This study aimed to verify the effectiveness of applying a health management platform combined with wearable devices to enhance stroke patients' self-management of recovery and to allow comparisons with active care intervention management. METHOD This quasi-experimental study aimed at examining those participants who had sustained a stroke for the first time. A 90-day experiment was implemented with the intervention of monitoring and active care from the researchers who also interviewed the selected participants at the end of the study. A total of 26 participants were examined (14 in the experimental group and 12 in the control group). RESULT The participants in the experimental group made significant progress between the pre- and post-tests. Firstly, their six-minute walking distance improved by 89.5 m (p < 0.001). Secondly, their sit-to-stand transfers in 60 s improved 2.85 times (p = 0.017), and their Berg balance test improved by 6.36 points (p = 0.003). Finally, the Partners in Health scale (PIH) scores also improved. According to the data collected in the interviews, the researchers' intervention improved the patients' self-management ability. CONCLUSION The short-term physical performance in the experimental group after the intervention was better than that in the control group. In clinical practice, it is suggested that continuous interaction between medical staff and patients be sustained while applying wearable devices to promote the patient's self-management ability.
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Affiliation(s)
- Jia-Min Wu
- Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, No.123 University Road, Section 3, Douliou, Yunlin City 64002, Taiwan, ROC
| | - Hsin-Shui Chen
- PhD Program for Aging, College of Medicine, China Medical University, No. 100, Sec. 1, Jingmao Rd, Beitun Dist, Taichung City 406040, Taiwan, ROC; Department of Physical Medicine & Rehabilitation, National Taiwan University Hospital Yunlin Branch, No.579, Sec. 2, Yunlin Rd, Douliu City, Yunlin County 640, Taiwan, ROC; School of Medicine, China Medical University, No. 91, Xueshi Rd, North District, Taichung City 404333, Taiwan, ROC.
| | - Hsin-Han Chen
- Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, No.123 University Road, Section 3, Douliou, Yunlin City 64002, Taiwan, ROC
| | - Bor-Wen Cheng
- Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, No.123 University Road, Section 3, Douliou, Yunlin City 64002, Taiwan, ROC
| | - Chiu-Wen Huang
- Department of Physical Medicine & Rehabilitation, National Taiwan University Hospital Yunlin Branch, No.579, Sec. 2, Yunlin Rd, Douliu City, Yunlin County 640, Taiwan, ROC
| | - Ming-Hung Chung
- Department of Physical Medicine & Rehabilitation, National Taiwan University Hospital Yunlin Branch, No.579, Sec. 2, Yunlin Rd, Douliu City, Yunlin County 640, Taiwan, ROC
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Long J, Zhang Y, Liu X, Jin X. Effects of sling exercise therapy on post-stroke walking impairment: a systematic review and meta-analysis. Int J Rehabil Res 2022; 45:12-23. [PMID: 34726197 DOI: 10.1097/mrr.0000000000000505] [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
Walking impairment is a common consequence of stroke, resulting in long-term disability. Trunk muscle strength has been proven to be associated with post-stroke walking performance. As a type of trunk training, sling exercise therapy (SET) has been widely used to improve the trunk function in stroke patients. The purpose of this systematic review was to investigate the efficacy of SET on post-stroke walking impairment. Seven databases were systematically searched for eligible studies from their inception to 1 August 2021. Review Manager 5.3 software was used for this meta-analysis. The overall quality of included studies was evaluated by the physiotherapy evidence database scale. Twenty-five randomized controlled trials involving 1504 patients were included (23 in China and two in South Korea). In summary, SET more effectively improved the walking ability of post-stroke patients than conventional physical therapy or trunk training. The pooled analysis demonstrated that SET had positive effects on the 10 m maximum walking speed, integrated electromyography value of rectus femoris, biceps femoris and gastrocnemius, functional ambulation category, timed up and go test, and step length. At least in East Asia, our findings support SET to manage the post-stroke walking impairment.
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Affiliation(s)
- Junzi Long
- School of Rehabilitation Medicine, Henan University of Chinese Medicine, Zhengzhou, Henan, China
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Peters DM, O'Brien ES, Kamrud KE, Roberts SM, Rooney TA, Thibodeau KP, Balakrishnan S, Gell N, Mohapatra S. Utilization of wearable technology to assess gait and mobility post-stroke: a systematic review. J Neuroeng Rehabil 2021; 18:67. [PMID: 33882948 PMCID: PMC8059183 DOI: 10.1186/s12984-021-00863-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 04/07/2021] [Indexed: 12/31/2022] Open
Abstract
Background Extremity weakness, fatigue, and postural instability often contribute to mobility deficits in persons after stroke. Wearable technologies are increasingly being utilized to track many health-related parameters across different patient populations. The purpose of this systematic review was to identify how wearable technologies have been used over the past decade to assess gait and mobility in persons with stroke. Methods We performed a systematic search of Ovid MEDLINE, CINAHL, and Cochrane databases using select keywords. We identified a total of 354 articles, and 13 met inclusion/exclusion criteria. Included studies were quality assessed and data extracted included participant demographics, type of wearable technology utilized, gait parameters assessed, and reliability and validity metrics. Results The majority of studies were performed in either hospital-based or inpatient settings. Accelerometers, activity monitors, and pressure sensors were the most commonly used wearable technologies to assess gait and mobility post-stroke. Among these devices, spatiotemporal parameters of gait that were most widely assessed were gait speed and cadence, and the most common mobility measures included step count and duration of activity. Only 4 studies reported on wearable technology validity and reliability metrics, with mixed results. Conclusion The use of various wearable technologies has enabled researchers and clinicians to monitor patients’ activity in a multitude of settings post-stroke. Using data from wearables may provide clinicians with insights into their patients’ lived-experiences and enrich their evaluations and plans of care. However, more studies are needed to examine the impact of stroke on community mobility and to improve the accuracy of these devices for gait and mobility assessments amongst persons with altered gait post-stroke. Supplementary Information The online version contains supplementary material available at 10.1186/s12984-021-00863-x.
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Affiliation(s)
- Denise M Peters
- Department of Rehabilitation and Movement Science, University of Vermont, 106 Carrigan Dr., Rowell 310, Burlington, VT, USA.
| | - Emma S O'Brien
- Department of Rehabilitation and Movement Science, University of Vermont, 106 Carrigan Dr., Rowell 310, Burlington, VT, USA
| | - Kira E Kamrud
- Department of Rehabilitation and Movement Science, University of Vermont, 106 Carrigan Dr., Rowell 310, Burlington, VT, USA
| | - Shawn M Roberts
- Department of Rehabilitation and Movement Science, University of Vermont, 106 Carrigan Dr., Rowell 310, Burlington, VT, USA
| | - Talia A Rooney
- Department of Rehabilitation and Movement Science, University of Vermont, 106 Carrigan Dr., Rowell 310, Burlington, VT, USA
| | - Kristen P Thibodeau
- Department of Rehabilitation and Movement Science, University of Vermont, 106 Carrigan Dr., Rowell 310, Burlington, VT, USA
| | - Swapna Balakrishnan
- Department of Rehabilitation and Movement Science, University of Vermont, 106 Carrigan Dr., Rowell 310, Burlington, VT, USA
| | - Nancy Gell
- Department of Rehabilitation and Movement Science, University of Vermont, 106 Carrigan Dr., Rowell 310, Burlington, VT, USA
| | - Sambit Mohapatra
- Department of Rehabilitation and Movement Science, University of Vermont, 106 Carrigan Dr., Rowell 310, Burlington, VT, USA
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Nindorera F, Nduwimana I, Thonnard JL, Kossi O. Effectiveness of walking training on balance, motor functions, activity, participation and quality of life in people with chronic stroke: a systematic review with meta-analysis and meta-regression of recent randomized controlled trials. Disabil Rehabil 2021; 44:3760-3771. [PMID: 33715555 DOI: 10.1080/09638288.2021.1894247] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To review and quantify the effects of walking training for the improvement of various aspects of physical function of people with chronic stroke. METHODS We conducted a systematic search and meta-analysis of randomized controlled trials (RCTs) of chronic stroke rehabilitation interventions published from 2008 to 2020 in English or French. Of the 6476-screened articles collated from four databases, 15 RCTs were included and analyzed. We performed a meta-regression with the total training time as dependent variable in order to have a better understanding of how did the training dosage affect the effect sizes. RESULTS Treadmill walking training was more effective on balance and motor functions (standardized mean difference (SMD)=0.70[0.02, 1.37], p = 0.04) and 0.56[0.15, 0.96], p = 0.007 respectively). Overground walking training improved significantly walking endurance (SMD = 0.38[0.16, 0.59], p < 0.001), walking speed (MD = 0.12[0.05, 0.18], p < 0.001), participation (SMD = 0.35[0.02, 0.68], p = 0.04) and quality of life (SMD = 0.46[0.12, 0.80], p = 0.008). Aquatic training improved balance (SMD = 2.41[1.20, 3.62], p < 0.001). The Meta-regression analysis did not show significant effect of total training time on the effect sizes. CONCLUSION Treadmill and overground walking protocols consisting of ≥30 min sessions conducted at least 3 days per week for about 8 weeks are beneficial for improving motor impairments, activity limitations, participation, and quality of life in people with chronic stroke.Implications for rehabilitationTreadmill walking training is effective for improving balance and motor functions.Overground walking training improved significantly walking endurance, walking speed, participation and quality of life.Treadmill and overground walking protocols consisting of ≥30 min sessions conducted at least 3 days per week for about 8 weeks are beneficial for improving motor impairments, activity limitations, participation, and quality of life in patient with chronic stroke.
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Affiliation(s)
- Félix Nindorera
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium.,National Center for Physical Therapy and Rehabilitation (CNRKR), Bujumbura, Burundi
| | - Ildephonse Nduwimana
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium.,National Center for Physical Therapy and Rehabilitation (CNRKR), Bujumbura, Burundi
| | - Jean Louis Thonnard
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium.,National Center for Physical Therapy and Rehabilitation (CNRKR), Bujumbura, Burundi
| | - Oyéné Kossi
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium.,Unité de NeuroRehabilitation, Service de Neurologie, Hospital Universitaire de Parakou, Parakou, Benin.,ENATSE (Ecole Nationale des Techniciens Supérieurs en Santé Publique et Surveillance Epidémiologique), Université de Parakou, Parakou, Benin
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Chao YY, Zha P, Yang K, Dong X. Association between physical function and perceived stress among U.S. Chinese older adults. AMERICAN JOURNAL OF AGING SCIENCE AND RESEARCH 2020; 1:12-19. [PMID: 33135012 PMCID: PMC7595296 DOI: 10.46439/aging.1.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives Physical function impairment can cause great stress to older adults.
The purpose of the study is to investigate the association between
self-reported and directly-observed physical function on perceived stress
among U.S. Chinese older adults. Methods Data were from the Population Study of Chinese Elderly in Chicago
(PINE) of 3,157 Chinese older adults who were 60 and above in the Greater
Chicago Area. Self-reported and directly-observed physical function
measures, and Perceived Stress Scale were used. Results Participants had a mean age of 72.8 ± 8.3 years old (range
60–105). Higher scores of Katz activities of daily living impairments
(odds ratio [OR]=1.77), Lawton instrumental activities of daily living
impartments (OR=1.10, p<0.01), Rosow–Breslau
index of mobility scale (OR=1.39, p<0.05), and Nagi
index of basic physical activities scale (OR=1.19,
p<0.001) were associated with higher levels of
perceived stress. In addition, higher scores of directly-observed physical
function measurements, including chair stand (OR=0.93), tandem stand
(OR=0.71, p<0.05), timed walk (OR=0.73,
p<0.001), and the overall measurement (OR= 0.87,
p<0.01) were associated with lower level of
perceived stress. Discussion Findings suggested that poor physical function was associated with
perceived stress among U.S. Chinese older adults. Longitudinal studies are
needed to obtain a more comprehensive understanding of the pathways between
physical function and perceived stress. Implications for practice Health care professionals could provide personalized physical
activity interventions to encourage older adults to engage in regular
exercise in order to maintain and promote older adults’ physical
function and psychological well-being.
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Affiliation(s)
- Ying-Yu Chao
- Clinical Assistant Professor, Rutgers, the State University of New Jersey, School of Nursing, 180 University Avenue, Newark, NJ 07102-1803, USA
| | - Peijia Zha
- Assistant Professor, Rutgers, the State University of New Jersey, School of Nursing, 180 University Avenue, Newark, NJ 07102-1803, USA
| | - Kyeongra Yang
- Associate Professor, Rutgers, the State University of New Jersey, School of Nursing, 65 Bergen Street, Room 1025E, Newark, NJ 07107, USA
| | - XinQi Dong
- Director, Rutgers Institute for Health, Health Care Policy and Aging Research, 112 Paterson St, New Brunswick, NJ, 08901, USA
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Recovery of mobility function and life-space mobility after ischemic stroke: the MOBITEC-Stroke study protocol. BMC Neurol 2020; 20:348. [PMID: 32938425 PMCID: PMC7493846 DOI: 10.1186/s12883-020-01920-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 09/07/2020] [Indexed: 11/10/2022] Open
Abstract
Background Stroke is a major cause of disability and stroke incidence increases with age. Stroke frequently results in permanent limitations of mobility, and, consequently, the need for the help of others in activities of daily living. In order to optimize rehabilitative efforts and their functional outcomes, detailed knowledge of the functional recovery process, regarding mobility, is needed. Objectives of the MOBITEC-Stroke study are: 1.) To characterize mobility, including lower extremity physical function (LEPF) and life space (the geospatial extent of all of a person’s movements), and changes in mobility within the first year after stroke. 2.) To identify and characterize subgroups with different mobility trajectories. 3.) To evaluate whether changes in LEPF are associated with changes in life-space. 4.) To evaluate participants’ reasons for going outdoors, transportation use, and assistance needed for outdoor movement. Methods Patients with incident first stroke who live in their own homes (target N = 59, based on sample size calculation) will be included in this cohort study. At 3, 6, 9, and 12 months after stroke a battery of mobility tests will be performed at the study centre, including laboratory-based tests of balance and strength, and quantitative gait analysis. Life-space assessment (including 1-week GPS measurements) will be performed in participants’ real life. Semantic information on visited locations (reasons for going outdoors, transportation use, assistance needed) will be collected by using interactive digital maps. Linear mixed effects models will be used to model the trajectories of mobility measures for the total sample and for predefined subgroups. As an exploratory analysis, growth mixture models (GMMs) will be used to identify relevant subgroups with different trajectories. Linear mixed effect models will be used to test whether changes in LEPF parameters are associated with changes in life-space. Participants’ motivation for going outdoors, transportation use, and assistance needed for outdoor mobility will be analysed descriptively. Discussion A comprehensive and detailed knowledge of recovery patterns will enable the planning of targeted and adaptively tailored rehabilitation measures. Information about patients’ reasons for outdoor mobility will provide the opportunity to define individualized and patient-oriented rehabilitation goals. Trial registration ISRCTN85999967 (on 13 August 2020; retrospectively).
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Hidayah R, Bishop L, Jin X, Chamarthy S, Stein J, Agrawal SK. Gait Adaptation Using a Cable-Driven Active Leg Exoskeleton (C-ALEX) With Post-Stroke Participants. IEEE Trans Neural Syst Rehabil Eng 2020; 28:1984-1993. [PMID: 32746320 DOI: 10.1109/tnsre.2020.3009317] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Individuals with chronic hemiparesis post-stroke exhibit gait impairments that require functional rehabilitation through training. Exoskeletal robotic assistive devices can provide a user with continuous assistance but impose movement restrictions. There are currently devices that allow unrestricted movement but provide assistance only intermittently at specific points of the gait cycle. Our design, a cable-driven active leg exoskeleton (C-ALEX), allows the user both unrestricted movement and continuous force assistance throughout the gait cycle to assist the user in new walking patterns. In this study, we assessed the ability of C-ALEX to induce a change in the walking patterns of ten post-stroke participants using a single-session training protocol. The ability of C-ALEX to accurately provide forces and torques in the desired directions was also evaluated to compare its design performance to traditional rigid-link designs. Participants were able to reach 91% ± 12% of their target step length and 89% ± 13% of their target step height. The achieved step parameters differed significantly from participant baselines ( ). To quantify the performance, the forces in each cable's out of the plane movements were evaluated relative to the in-plane desired cable tension magnitudes. This corresponded to an error of under 2Nm in the desired controlled joint torques. This error magnitude is low compared to the system command torques and typical adult biological torques during walking (2-4%). These results point to the utility of using non-restrictive cable-driven architectures in gait retraining, in which future focus can be on rehabilitating gait pathologies seen in stroke survivors.
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Khatkova SE, Kostenko EV, Akulov MA, Diagileva VP, Nikolaev EA, Orlova AS. [Modern aspects of the pathophysiology of walking disorders and their rehabilitation in post-stroke patients]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 119:43-50. [PMID: 32207717 DOI: 10.17116/jnevro201911912243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The problem of rehabilitation of post-stroke patients with motor deficit remains relevant with growing prevalence of disability and decreasing mortality, despite all measures aimed at stroke prevention and morbidity reduction. One of the most common consequences of stroke is gait impairment as a result of spastic paresis of the lower limb (decreased gait velocity, shortened step, excessive loading of intact limb etc.), which leads to significant maladaptation, increased risk of falls, decrease in quality of life. The article presents a detailed review of motor action in normal and pathologic conditions, analysis of neuronal structures involved into a movement act in healthy individuals and in stroke patients, current aspects of gait pathophysiology, characteristics of post-stroke gait (speed and asymmetry of gain, balance control impairment). A separate paragraph is devoted to gait recovery after stroke with analysis of existing and developing strategies of rehabilitation, aimed at the improvement of vertical posture, balance control and movement, condition, tone and functioning of skeletal muscles. Authors also analyze new research information on the efficacy of botulinum toxin preparations and programs of Guided Self-Rehabilitation Contracts (GSC), present the results of clinical trials demonstrating the efficacy of combination of these two methods.
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Affiliation(s)
- S E Khatkova
- Medical and Rehabilitation Center, Moscow, Russia; State Research Center - Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency, Moscow, Russia
| | - E V Kostenko
- Burdenko National Scientific and Practical Centre for Neurosurgery, Moscow, Russia
| | - M A Akulov
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - V P Diagileva
- Medical and Rehabilitation Center, Moscow, Russia; State Research Center - Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency, Moscow, Russia
| | - E A Nikolaev
- Medical and Rehabilitation Center, Moscow, Russia; State Research Center - Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency, Moscow, Russia
| | - A S Orlova
- Sechenov First Moscow State Medical University, Moscow, Russia
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Saunders DH, Sanderson M, Hayes S, Johnson L, Kramer S, Carter DD, Jarvis H, Brazzelli M, Mead GE. Physical fitness training for stroke patients. Cochrane Database Syst Rev 2020; 3:CD003316. [PMID: 32196635 PMCID: PMC7083515 DOI: 10.1002/14651858.cd003316.pub7] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Levels of physical activity and physical fitness are low after stroke. Interventions to increase physical fitness could reduce mortality and reduce disability through increased function. OBJECTIVES The primary objectives of this updated review were to determine whether fitness training after stroke reduces death, death or dependence, and disability. The secondary objectives were to determine the effects of training on adverse events, risk factors, physical fitness, mobility, physical function, health status and quality of life, mood, and cognitive function. SEARCH METHODS In July 2018 we searched the Cochrane Stroke Trials Register, CENTRAL, MEDLINE, Embase, CINAHL, SPORTDiscus, PsycINFO, and four additional databases. We also searched ongoing trials registers and conference proceedings, screened reference lists, and contacted experts in the field. SELECTION CRITERIA Randomised trials comparing either cardiorespiratory training or resistance training, or both (mixed training), with usual care, no intervention, or a non-exercise intervention in stroke survivors. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, assessed quality and risk of bias, and extracted data. We analysed data using random-effects meta-analyses and assessed the quality of the evidence using the GRADE approach. Diverse outcome measures limited the intended analyses. MAIN RESULTS We included 75 studies, involving 3017 mostly ambulatory participants, which comprised cardiorespiratory (32 studies, 1631 participants), resistance (20 studies, 779 participants), and mixed training interventions (23 studies, 1207 participants). Death was not influenced by any intervention; risk differences were all 0.00 (low-certainty evidence). There were few deaths overall (19/3017 at end of intervention and 19/1469 at end of follow-up). None of the studies assessed death or dependence as a composite outcome. Disability scores were improved at end of intervention by cardiorespiratory training (standardised mean difference (SMD) 0.52, 95% CI 0.19 to 0.84; 8 studies, 462 participants; P = 0.002; moderate-certainty evidence) and mixed training (SMD 0.23, 95% CI 0.03 to 0.42; 9 studies, 604 participants; P = 0.02; low-certainty evidence). There were too few data to assess the effects of resistance training on disability. Secondary outcomes showed multiple benefits for physical fitness (VO2 peak and strength), mobility (walking speed) and physical function (balance). These physical effects tended to be intervention-specific with the evidence mostly low or moderate certainty. Risk factor data were limited or showed no effects apart from cardiorespiratory fitness (VO2 peak), which increased after cardiorespiratory training (mean difference (MD) 3.40 mL/kg/min, 95% CI 2.98 to 3.83; 9 studies, 438 participants; moderate-certainty evidence). There was no evidence of any serious adverse events. Lack of data prevents conclusions about effects of training on mood, quality of life, and cognition. Lack of data also meant benefits at follow-up (i.e. after training had stopped) were unclear but some mobility benefits did persist. Risk of bias varied across studies but imbalanced amounts of exposure in control and intervention groups was a common issue affecting many comparisons. AUTHORS' CONCLUSIONS Few deaths overall suggest exercise is a safe intervention but means we cannot determine whether exercise reduces mortality or the chance of death or dependency. Cardiorespiratory training and, to a lesser extent mixed training, reduce disability during or after usual stroke care; this could be mediated by improved mobility and balance. There is sufficient evidence to incorporate cardiorespiratory and mixed training, involving walking, within post-stroke rehabilitation programmes to improve fitness, balance and the speed and capacity of walking. The magnitude of VO2 peak increase after cardiorespiratory training has been suggested to reduce risk of stroke hospitalisation by ˜7%. Cognitive function is under-investigated despite being a key outcome of interest for patients. Further well-designed randomised trials are needed to determine the optimal exercise prescription, the range of benefits and any long-term benefits.
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Affiliation(s)
- David H Saunders
- University of EdinburghPhysical Activity for Health Research Centre (PAHRC)St Leonards LandHolyrood RoadEdinburghMidlothianUKEH8 8AQ
| | - Mark Sanderson
- University of the West of ScotlandInstitute of Clinical Exercise and Health ScienceRoom A071A, Almada BuildingHamiltonUKML3 0JB
| | - Sara Hayes
- University of LimerickSchool of Allied Health, Ageing Research Centre, Health Research InstituteLimerickIreland
| | - Liam Johnson
- University of MelbourneThe Florey Institute of Neuroscience and Mental HealthHeidelbergAustralia3084
| | - Sharon Kramer
- University of MelbourneThe Florey Institute of Neuroscience and Mental HealthHeidelbergAustralia3084
| | - Daniel D Carter
- University of LimerickSchool of Allied Health, Faculty of Education and Health SciencesLimerickIreland
| | - Hannah Jarvis
- Manchester Metropolitan UniversityResearch Centre for Musculoskeletal Science and Sports Medicine, Faculty of Science and EngineeringJohn Dalton BuildingChester StreetManchesterUKM1 5GD
| | - Miriam Brazzelli
- University of AberdeenHealth Services Research UnitHealth Sciences BuildingForesterhillAberdeenUKAB25 2ZD
| | - Gillian E Mead
- University of EdinburghCentre for Clinical Brain SciencesRoom S1642, Royal InfirmaryLittle France CrescentEdinburghUKEH16 4SA
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Calabrò RS, Billeri L, Andronaco VA, Accorinti M, Milardi D, Cannavò A, Aliberti E, Militi A, Bramanti P, Naro A. Walking on the Moon: A randomized clinical trial on the role of lower body positive pressure treadmill training in post-stroke gait impairment. J Adv Res 2020; 21:15-24. [PMID: 31641534 PMCID: PMC6796731 DOI: 10.1016/j.jare.2019.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 09/09/2019] [Accepted: 09/18/2019] [Indexed: 12/14/2022] Open
Abstract
The effects of LBPP on locomotion in neurologic patients are poorly predictable. The mechanisms through which LPBB acts on gait are partially unknown. Gait training using AlterG improves functional gait in post-stroke patients. AlterG increases muscle activation and/or phasic muscle activation in post-stroke. This knowledge may be useful to plan patient-tailored LBPP locomotor training.
Body weight–supported treadmill training (BWSTT) can be usefully employed to facilitate gait recovery in patients with neurological injuries. Specifically, lower body positive pressure support system (LBPPSS) decreases weight-bearing and ground reaction forces with potentially positive effects on qualitative gait indices. However, which gait features are being shaped by LBPPSS in post-stroke patients is yet poorly predictable. A pilot study on the effects of LBPPSS on qualitative and quantitative gait indices was carried out in patients with hemiparesis due to stroke in the chronic phase. Fifty patients, who suffered from a first, single, ischemic, supra-tentorial stroke that occurred at least 6 months before study inclusion, were enrolled in the study. They were provided with 24 daily sessions of gait training using either the AlterG device or conventional treadmill gait training (TGT). These patients were compared with 25 age-matched healthy controls (HC), who were provided with the same amount of AlterG. Qualitative and quantitative gait features, including Functional Ambulation Categories, gait cycle features, and muscle activation patterns were analyzed before and after the training. It was found that AlterG provided the patients with higher quantitative but not qualitative gait features, as compared to TGT. In particular, AlterG specifically shaped muscle activation phases and gait cycle features in patients, whereas it increased only overall muscle activation in HC. These data suggest that treadmill gait training equipped with LBPPSS specifically targets the gait features that are abnormal in chronic post-stroke patients. It is hypothesizable that the specificity of AlterG effects may depend on a selective reshape of gait rhythmogenesis elaborated by the locomotor spinal circuits receiving a deteriorated corticospinal drive. Even though further studies are warranted to clarify the role of treadmills equipped with LBPPSS in gait training of chronic post-stroke patients, the knowledge of the exact gait pattern during weight-relief is potentially useful to plan patient-tailored locomotor training.
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Affiliation(s)
- Rocco Salvatore Calabrò
- Robotic Neurorehabilitation Unit, IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
- Corresponding author at: Rocco Salvatore Calabrò, IRCCS Centro Neurolesi Bonino Pulejo; via Palermo, SS 113, ctr. Casazza, 98124 Messina, Italy.
| | - Luana Billeri
- Robotic Neurorehabilitation Unit, IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
| | | | - Maria Accorinti
- Robotic Neurorehabilitation Unit, IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
| | - Demetrio Milardi
- Robotic Neurorehabilitation Unit, IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
- Department of Biomorphology and Biotechnologies, University of Messina, Messina, Italy
| | - Antonino Cannavò
- Robotic Neurorehabilitation Unit, IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
| | - Enrico Aliberti
- Department of Motor Sciences, University of Messina, Messina, Italy
| | - Angela Militi
- Department of Motor Sciences, University of Messina, Messina, Italy
| | - Placido Bramanti
- Robotic Neurorehabilitation Unit, IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
| | - Antonino Naro
- Robotic Neurorehabilitation Unit, IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
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The effect of low-intensity aerobic training on cognitive functions of severely deconditioned subacute and chronic stroke patients: a randomized, controlled pilot study. Int J Rehabil Res 2019; 42:275-279. [DOI: 10.1097/mrr.0000000000000346] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Comments on: 'Effects of walking trainings on walking function among stroke survivors: a systematic review'. Int J Rehabil Res 2018; 41:186. [PMID: 29708946 DOI: 10.1097/mrr.0000000000000281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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