Grip Strength on the Unaffected Side as an Independent Predictor of Functional Improvement After Stroke

Self-perceived upper extremity motor function predicts health-related quality of life in chronic stroke survivors

PURPOSE

To examine whether the Upper Extremity Functional Index (UEFI) score independently contributes to the Stroke Impact Scale (SIS) score and quantified its relative contribution to SIS scores in chronic stroke survivors.

MATERIALS AND METHODS

A cross-sectional study in a university-based rehabilitation centre with people with chronic stroke (N = 95) aged ≥ 50 years. The outcome measures included paretic hand grip strength, Fugl-Meyer Upper Extremity Assessment (FMA-UE), Wolf Motor Function Test (WMFT), UEFI, and SIS.

RESULTS

Correlation analysis revealed that paretic hand grip strength, FMA-UE, UEFI, and WMFT scores exhibited a significant moderate positive correlation with SIS scores (r = 0.544-0.687, p < 0.001). The results of a regression model indicated that after adjustment for demographic factors and stroke-related impairments, the UEFI scores remained independently associated with SIS scores, accounting for 18.8% of the variance. The entire model explained 60.3% of the variance in SIS scores.

CONCLUSIONS

Self-perceived UE motor function is a crucial component to be included in rehabilitation programmes aimed at enhancing quality of life and participation among chronic stroke survivors.

Effect of sarcopenia on mortality in acute stroke patients receiving endovascular treatment

BACKGROUND

To investigate the effect of sarcopenia on mortality in patients with acute ischemic stroke caused by anterior circulation large artery occlusion who underwent endovascular treatment.

METHODS

Acute ischemic stroke patients (n = 194) treated with mechanical thrombectomy who underwent chest computed tomography between 2019 and 2022 (median age, 69 [interquartile range: 61-77], 95 females, 99 males) were evaluated retrospectively. The cross-sectional area and density of the pectoralis muscle [pectoralis muscle area (PMA) and pectoralis muscle density (PMD)] at the level of the aortic arch and the erector spinae muscle at the T12 level [erector spinae muscle area (ESMA) and erector spinae muscle density (ESMD)] were measured. The association between skeletal muscle parameters and mortality outcomes was investigated using the receiver operating characteristic (ROC) curve and multivariable logistic regression analyses.

RESULTS

The 90-day mortality rate was 32% in the study population (n = 62). The ROC analysis revealed that ESMD [area under the curve (AUC): 0.765] and PMD (AUC: 0.759) performed best in the prediction of 90-day mortality. In the multivariable logistic regression analysis, PMD [odds ratio (OR): 0.896; 95% confidence interval (CI): 0.846-0.948; p < 0.001], ESMA (OR: 0.929; 95% CI: 0.878-0.983; p = 0.011), and ESMD (OR: 0.947; 95% CI: 0.913-0.983; p = 0.004), but not PMA, were independent risk factors for 90-day mortality.

CONCLUSION

PMD, ESMA, and ESMD may be risk factors for 90-day mortality after mechanical thrombectomy for acute ischemic stroke.

Top-Down and Bottom-Up Mechanisms of Motor Recovery Poststroke

Stroke remains a leading cause of disability. Motor recovery requires the interaction of top-down and bottom-up mechanisms, which reinforce each other. Injury to the brain initiates a biphasic neuroimmune process, which opens a window for spontaneous recovery during which the brain is particularly sensitive to activity. Physical activity during this sensitive period can lead to rapid recovery by potentiating anti-inflammatory and neuroplastic processes. On the other hand, lack of physical activity can lead to early closure of the sensitive period and downstream changes in muscles, such as sarcopenia, muscle stiffness, and reduced cardiovascular capacity, and blood flow that impede recovery.

GripAble: Interrater reliability and normative grip strength of UK population

BACKGROUND

Hand grip strength is an established indicator of individual health status and is used as a biomarker for predicting mortality, disability, and disease risks. GripAble hand grip dynamometer offers a modernized approach to measuring grip strength with its digital and high-accuracy measurement system.

PURPOSE

This study aimed to (1) assess the interrater reliability of maximum grip strength (MGS) measurement and (2) establish GripAble's own gender-, age group- and hand-stratified normative MGS reference values of the adult UK population.

STUDY DESIGN

Cross-sectional study design.

METHODS

Interrater reliability among three raters assessing 30 participants across diverse age groups was measured using the intraclass correlation. In the second study, 11 investigators gathered MGS data from 907 participants across diverse age groups and gender. The average, standard deviation, minimum, median, maximum, and percentiles of MGS were computed for each gender, age group, and hand (L/R). The relationship between MGS and age was examined using quantile regression analysis. Additionally, generalized linear model regression analysis was conducted to explore the influence of participants' demographics (gender, hand [L/R], hand length, hand circumference, age, weight, and height) on MGS.

RESULTS

MGS measurements between raters showed excellent agreement (ICC(2,1) = 0.991, 95% confidence interval [0.98, 1.0]). The MGS and age relationship follows a curvilinear pattern, reaching a peak median MGS values of up to 20 kg between 30 and 49 years for females and up to 35 kg between 30 and 59 years for males. Subsequently, MGS declined as age advanced. Gender and hand (L/R) emerged as the primary factors influencing MGS, followed by hand length, hand circumference, age, weight, and height.

CONCLUSIONS

The presented normative MGS reference values can be used for interpreting MGS measurements obtained from adults in the United Kingdom using GripAble. This study, along with previous studies on GripAble devices, confirms GripAble as a reliable and valid tool for measuring MGS.

Muscle weakness is more strongly associated with functional outcomes in patients with stroke than sarcopenia or muscle wasting: an observational study

BACKGROUND

Stroke-related sarcopenia is an important prognosis factor and an intervention target for improving outcomes in patients with stroke.

AIM

This study aimed to identify the association between sarcopenia, possible sarcopenia, muscle weakness, muscle mass and calf circumference, and the functional outcomes 3 months after stroke.

METHODS

In this single-centre prospective observational study, muscle strength, muscle mass, and calf circumference were measured in patients with acute stroke at hospital discharge. Diagnosis of sarcopenia, possible sarcopenia, muscle weakness, low muscle mass, and low calf circumference were defined according to the 2019 Asian Working Group for Sarcopenia criteria. The primary outcome measure was the modified Rankin Scale (mRS) score at 3 months, with an mRS score of 3 or higher indicating a poor outcome. Logistic regression analysis was conducted to examine independent associations between each assessment and functional outcomes.

RESULTS

A total of 247 patients (median age: 73 years) were included in this study. The prevalence of sarcopenia was 28% (n = 70), and in the adjusted model, sarcopenia (aOR = 2.60, 95% CI 1.07-6.31, p = 0.034), muscle weakness (aOR = 3.40, 95% CI 1.36-8.52, p = 0.009), and low muscle mass (aOR = 2.61, 95% CI 1.04-6.52) were significantly associated with poor functional outcome. Nevertheless, other evaluations did not demonstrate an independent association with the outcome.

CONCLUSION

Sarcopenia, muscle weakness, and low muscle mass were found to be independently associated with functional outcomes 3 months after stroke, and muscle weakness exhibited the strongest association with outcomes among them.

Anorexia assessment using the Simplified Nutritional Appetite Questionnaire and its association with activities of daily living in patients with stroke

OBJECTIVE

This study aimed to validate the assessment of anorexia in patients with acute stroke using the Simplified Nutritional Appetite Questionnaire.

METHODS

This cross-sectional observational study assessed appetite using the Simplified Nutritional Appetite Questionnaire in patients with acute stroke at discharge from an acute care hospital. Additionally, the relationship between the Simplified Nutritional Appetite Questionnaire and Mini Nutritional Assessment, Mini Nutritional Assessment - Short Form scores, skeletal muscle mass, muscle strength, and activities of daily living measured using the Functional Independence Measures for the motor domain was investigated. A multiple regression analysis was conducted with the Functional Independence Measure for the motor domain as the dependent variable and the Simplified Nutritional Appetite Questionnaire and other confounding factors as explanatory variables to evaluate the association between the Simplified Nutritional Appetite Questionnaire and functional outcomes.

RESULTS

Among the 234 patients with stroke analyzed in this study, the median Simplified Nutritional Appetite Questionnaire score was 15 (IQR = 13-16) points. The Simplified Nutritional Appetite Questionnaire score significantly correlated with weight change, Functional Independence Measure for the motor domain, nutritional assessment index, and energy and protein intake. However, no significant differences in body mass index, muscle mass, or muscle strength were observed. In the multiple regression analysis adjusted for confounders, the Simplified Nutritional Appetite Questionnaire score (β = 0.106; P = 0.007) was independently associated with the Functional Independence Measure for the motor domain (adjusted R2 = 0.662).

CONCLUSIONS

This study's results found a significant correlation between Simplified Nutritional Appetite Questionnaire scores and nutritional status as well as an independent association with functional outcomes in patients with stroke. These findings suggest that the Simplified Nutritional Appetite Questionnaire can be a valuable tool for evaluating anorexia in this patient population.

Comparing the contribution of each clinical indicator in predictive models trained on 980 subacute stroke patients: a retrospective study

Post-stroke disability affects patients' lifestyles after discharge, and it is essential to predict functional recovery early in hospitalization to allow time for appropriate decisions. Previous studies reported important clinical indicators, but only a few clinical indicators were analyzed due to insufficient numbers of cases. Although review articles can exhaustively identify many prognostic factors, it remains impossible to compare the contribution of each predictor. This study aimed to determine which clinical indicators contribute more to predicting the functional independence measure (FIM) at discharge by comparing standardized coefficients. In this study, 980 participants were enrolled to build predictive models with 32 clinical indicators, including the stroke impairment assessment set (SIAS). Trunk function had the most significant standardized coefficient of 0.221. The predictive models also identified easy FIM sub-items, SIAS, and grip strength on the unaffected side as having positive standardized coefficients. As for the predictive accuracy of this model, R² was 0.741. This is the first report that included FIM sub-items separately in post-stroke predictive models with other clinical indicators. Trunk function and easy FIM sub-items were included in the predictive model with larger positive standardized coefficients. This predictive model may predict prognosis with high accuracy, fewer clinical indicators, and less effort to predict.

A biomedical decision support system for meta-analysis of bilateral upper-limb training in stroke patients with hemiplegia

The purpose of this study is to investigate the efficacy of bilateral upper-limb training (BULT) in helping people with upper-limb impairments due to stroke or brain illness regain their previous level of function. Patients recuperating from a stroke or cerebral disease were given the option of undergoing BULT or conventional training to enhance their upper-limb function. Participants were randomly allocated to one of the several different fitness programs. Results from the action research arm test, Box and block test, Wolf motor function test, Fugal-Meyer evaluation, and any other tests administered were taken into account. Some researchers have found that exercising with BULT for just 30 min per day for 6 weeks yields significant results. There were a total of 1,411 individuals from 10 randomized controlled trials included in this meta-analysis. Meta-analysis findings revealed that biofeedback treatment outperformed conventional rehabilitation therapy in reducing lower leg muscular strain, complete spasm scale score, electromyography score, and inactive ankle joint range of motion. An analysis of the literature found that BULT improved limb use in people who had suffered a stroke and hemiplegia but it did not provide any additional benefit over unilateral training.

Obesity Impairs Functional Recovery of Older Stroke Patients with Possible Sarcopenia: A Retrospective Cohort Study

The functional prognosis of older patients with coexisting obesity and possible sarcopenia remains uncertain following acute stroke. This study aimed to determine whether coexisting obesity independently affects activities of daily living (ADL) and balance ability at discharge in older patients with possible sarcopenia admitted to a stroke rehabilitation ward. A total of 111 patients aged 65 years or older with possible sarcopenia were included, of whom 36 (32.4%) had coexisting obesity. Possible sarcopenia was diagnosed based on low handgrip strength without reduced muscle mass, while obesity was determined by body fat percentage (≥25% for men, ≥30% for women). Multivariate linear regression analysis revealed that compared to patients without obesity, patients with obesity had a higher likelihood of poorer ADL (b = -0.169; p = 0.02) and balance ability (b = -0.14; p = 0.04) performance at discharge following a 4-week period of inpatient rehabilitation. These findings suggest that obesity may be a modifiable risk factor in the rehabilitation of older patients with possible sarcopenia and should be considered in the assessment of decreased muscle strength.

Strength Training of the Nonhemiplegic Side Promotes Motor Function Recovery in Patients With Stroke: A Randomized Controlled Trial

OBJECTIVE

To observe the effect of strength training of the nonhemiplegic side (NHS) on balance function, mobility, and muscle strength of patients with stroke.

DESIGN

A single-blinded (evaluator) randomized controlled trial.

SETTING

A tertiary hospital rehabilitation center.

PARTICIPANTS

139 patients with first stroke (N=139) were recruited and randomly separated into a trial (n=69) or control group (n=70).

INTERVENTIONS

The control group underwent usual rehabilitation training, including step training and trunk control training in standing position. The trial group underwent strength training of NHS on the basis of usual rehabilitation training. The strength training of NHS included lower limb stepping training with resisting elastic belt and upper limb pulling elastic belt training in standing position. The training for both groups was 45 min, once a day, 5 days a week for 6 weeks.

MAIN OUTCOME MEASURES

Balance evaluation was done with the Berg Balance Scale (BBS); mobility assessment with the 6-minute walk test (6-MWT); activities of daily life was examined via the modified Barthel Index (MBI); muscle strengths of the biceps brachii, iliopsoas, and quadriceps were measured via the isokinetic muscle strength testing system. All assessments were performed at baseline (T0) and after intervention (T1).

RESULTS

The trial group performed better than control group in BBS scores (adjusted mean difference: 6.83; 95% confidence interval [CI]: 4.71-8.94) and 6-MWT (adjusted mean difference: 50.32; 95% CI: 40.58-60.05) after intervention. In terms of muscle strength of the hemiplegic side, the trial group displayed greater gains in biceps brachii, iliopsoas, and quadriceps than control group after intervention.

CONCLUSION

Strength training of the NHS can promote recovery of balance, mobility, and muscle strength of the paretic side of patients with stroke.

Cerebral Hemodynamic Changes during Unaffected Handgrip Exercises in Stroke Patients: An fNIRS Study

This study aimed to assess the effect of the altered strength of the sound limb on the hemodynamics in the affected brain of stroke patients. We recruited 20 stroke patients to detect changes in the HbO concentrations in the bilateral prefrontal cortex (PFC), sensorimotor cortex (SMC), and occipital lobe (OL). We performed functional near-infrared spectroscopy (fNIRS) to detect changes in oxyhemoglobin (HbO) concentrations in regions of interest (ROIs) in the bilateral cerebral hemispheres of stroke patients while they performed 20%, 50%, and 80% maximal voluntary contraction (MVC) levels of handgrip tasks with the unaffected hands. The results suggest that when patients performed handgrip tasks with 50% of the MVC force, SMC in the affected cerebral hemisphere was strongly activated and the change in the HbO concentration was similar to that of the handgrip with 80% of MVC. When the force was 50% of MVC, the SMC in the affected hemisphere showed a more proportional activation than that at 80% MVC. Overall, this research suggests that stroke patients with a poor upper limb function should perform motor training with their sound hands at 50% of the MVC grip task to activate the ipsilesional hemisphere.

Does grip strength of the less-affected side of ischemic stroke survivors influences performance of self-care activities?

Background and aim

Adequate grip strength is needed to execute various self-care activities. This study was aimed to assess the influence of grip strength of the less-affected side of ischemic stroke survivors on performance of self-care activities, and also to determine the reference values of less-affected grip strength needed for independent performance of each of the self-care activities.

Methods

Seventy-three consenting patients with ischemic stroke participated in this cross-sectional study. Handheld dynamometer was used to measure grip strength of the less-affected hand, while functional independence measure was used to evaluate self-care activities (eating, grooming, bathing, dressing of upper body, dressing of lower body and toileting) as independent and dependent. Data was analyzed using inferential statistics of Pearson’s correlation, binomial logistic regression, and receiver operating characteristics. Alpha level was set at p < 0.05.

Results

The mean hand grip strength, functional independence measure and trunk control test scores were 23.8 kg, 29.9 kg, and 68.2 kg respectively. Grip strength was significantly associated with independence in all of the self-care activities (p < 0.05). Less-affected grip strength of 19.5 kg (sensitivity, 80.4%; specificity, 80.1%; area under curve, 0.85), 23.7 kg (sensitivity, 79%; specificity, 72.2%; area under curve, 0.79), 24.8 kg (sensitivity, 70.2%; specificity, 65.2%; area under curve, 0.75), 24.7 kg (sensitivity, 82.1%; specificity, 80.1%; area under curve, 0.84), 23.7 kg (sensitivity, 80.1%; specificity, 76.1%; area under curve, 0.84), and 19.9 kg (sensitivity, 76.9%; specificity, 76.2%; area under curve, 0.79) was needed for independent performance in eating, grooming, bathing, dressing of upper body, dressing of lower body, and toileting respectively.

Conclusion

The less-affected grip strength of patients with ischemic stroke influences their ability to independently perform self-care activities. The reference values of less-affected grip strength in association with other stroke-related characteristics may help clinicians to estimate independence in eating, grooming, bathing, dressing of upper body, dressing of lower body, and toileting among patients with ischemic stroke.

Impact of Sarcopenia on Functional Outcomes Among Patients With Mild Acute Ischemic Stroke and Transient Ischemic Attack: A Retrospective Study

Introduction

Sarcopenia, a age-related disease characterized by loss of muscle mass accompanied by loss of function, is associated with nutrition imbalance, physical inactivity, insulin resistance, inflammation, metabolic syndrome, and atherosclerosis which are risk factors for cardiovascular disease. However, its association with outcomes after ischemic stroke has not been well-established. This study investigated whether functional outcomes of patients with acute ischemic stroke is associated with sarcopenia.

Methods

Data were collected from 568 consecutive patients with acute ischemic stroke with National Institute of Health Stroke Scale 0–5 or transient ischemic attack who underwent bioelectrical impedance analysis between March 2018 and March 2021. Sarcopenia was defined, as low muscle mass, as measured by bioelectrical impedance analysis, and low muscle strength, as indicated by the Medical Research Council score. Unfavorable functional outcome was defined as mRS score of 2–6 at 90 days after discharge. The relationship between functional outcomes and the presence of sarcopenia or its components was determined.

Results

Of the 568 patients included (mean age 65.5 ± 12.6 years, 64.6% male), sarcopenia was detected in 48 (8.5%). After adjusting for potential confounders, sarcopenia was independently and significantly associated with unfavorable functional outcome (odds ratio 2.37, 95% confidence interval 1.15–4.73 for unfavorable functional outcome, odds ratio 2.10, 95% confidence interval 1.18–3.71 for an increase in the mRS score). Each component of sarcopenia was also independently associated with unfavorable functional outcome (odds ratio 1.76, 95% confidence interval 1.05–2.95 with low muscle mass, odds ratio 2.64, 95% confidence interval 1.64–4.23 with low muscle strength). The impact of low muscle mass was larger in men than in women, and in patients with lower muscle mass of the lower extremities than in those with lower muscle mass of the upper extremities.

Conclusions

In this study, the prevalence of sarcopenia in patients with stroke was lower than most of previous studies and patients with sarcopenia showed higher likelihood for unfavorable functional outcomes at 90 days after acute ischemic stroke or TIA. Further investigation of the interventions for treating sarcopenia and its impact on the outcome of ischemic stroke patients is needed.

Ipsilateral hand impairment predicts long-term outcome in patients with subacute stroke

BACKGROUND

Ipsilateral hand (ILH) impairment is documented following motor stroke, but its impact on long-term outcome remains unknown. We assessed ILH impairment in subacute stroke and tested whether ILH impairment predicted long-term outcome.

METHODS

We performed a longitudinal study in 209 consecutive patients with unilateral stroke and sensorimotor deficit at admission. ILH impairment was evaluated using Purdue Pegboard Test (PPT) and handgrip strength and defined as mild (z-score <-1) or moderate (z-score <-1.65). We used logistic regression (LR) to predict outcome assessed 9 (7-12) months post-stroke with the modified Rankin scale (mRS) categorized into good (mRS≤1) and poor outcome (mRS≥2). For internal validation, LR-bootstrapping, and cross-validation with Lasso and Random-Forest were performed.

RESULTS

ILH impairment assessed at 89.04 ±45.82 days post-stroke was moderate in 10.53% (95% CI, 6.7, 14.83) for PPT and 17.22% (95% CI, 11.96, 22.49) for grip, and mild in 21.05% (95% CI, 15.78, 26.79) for PPT and 35.89 (95% CI, 29.67, 42.58) for grip. Good outcome was predicted by ILH-PPT (B=1.03 [95% CI, 0.39, 3.31]), ILH-grip (B=1.16 [95% CI, 0.54, 3.53]), low NIHSS-discharge (B=-1.57, [95% CI, -4.0, -1.19]), and no depression (B=-0.62, [95% CI, -1.63, -0.43]), accounting for stroke delay (B=-0.011, [95% CI, -0.06, 0.01]). Model efficiency was 91.6% (AUC=0.977, 95%CI, 0.959, 0.996). Lasso and Random-Forest methods provided similar results, confirming the LR model robustness.

CONCLUSIONS

ILH impairment is frequent after motor stroke and predicts long-term outcome. We propose to integrate ILH impairment in rehabilitation programs to improve recovery and serve research interventions such as neuromodulation.

Adaptive Admittance Control Scheme with Virtual Reality Interaction for Robot-Assisted Lower Limb Strength Training

Muscle weakness is the primary impairment causing mobility difficulty among stroke survivors. Millions of people are unable to live normally because of mobility difficulty every year. Strength training is an effective method to improve lower extremity ability but is limited by the shortage of medical staff. Thus, this paper proposes a robot-assisted active training (RAAT) by an adaptive admittance control scheme with virtual reality interaction (AACVRI). AACVRI consists of a stiffness variable admittance controller, an adaptive controller, and virtual reality (VR) interactions. In order to provide human-robot reality interactions corresponding to virtual scenes, an admittance control law with variable stiffness term was developed to define the mechanics property of the end effector. The adaptive controller improves tracking performances by compensating interaction forces and dynamics model deviations. A virtual training environment including action following, event feedback, and competition mechanism is utilized for improving boring training experience and engaging users to maintain active state in cycling training. To verify controller performances and the feasibility of RAAT, experiments were conducted with eight subjects. Admittance control provides desired variable interactions along the trajectory. The robot responds to different virtual events by changing admittance parameters according to trigger feedbacks. Adaptive control ensures tracking errors at a low level. Subjects were maintained in active state during this strength training. Their physiological signals significantly increased, and interaction forces were at a high level. RAAT is a feasible approach for lower limb strength training, and users can independently complete high-quality active strength training under RAAT.

Upper limbs cycle ergometer increases muscle strength, trunk control and independence of acute stroke subjects: A randomized clinical trial

BACKGROUND

Studies demonstrate the benefits of upper limbs cycle ergometer (ULCE) in subacute and chronic stroke subjects, but the literature still needs to explore the acute phase of the disease.

OBJECTIVE

Verify the effects of ULCE on muscular strength, trunk control and independence of post-stroke subjects in hospital acute phase.

METHODS

In this randomized clinical trial participants were allocated into two groups. The control group (CG) performed two daily sessions of conventional physiotherapy, while the intervention group (IG) had one daily session of conventional physiotherapy and one of ULCE. The interventions were carried out for 20 minutes for five days. Both groups were assessed before and after the treatment for upper limbs strength by manual dynamometer, trunk control by Trunk Impairment Scale and level of independence by the Modified Rankin Scale.

RESULTS

Twenty subjects with mean ages of 63.5±4.5 were enrolled. There was a significant intra-group difference of palmar grip, shoulder abductors, elbow flexor and wrist extensor strength, trunk control and functional independence only in IG. Inter-group difference for all variables showed superiority in IG.

CONCLUSIONS

ULCE is an effective device for increasing muscle strength, trunk control and consequently improving the independence of post-stroke subjects in the acute hospital phase.

Quantifying upper limb motor impairment in chronic stroke: a physiological profiling approach

Upper limb motor impairments, such as muscle weakness, loss of dexterous movement, and reduced sensation, are common after a stroke. The extent and severity of these impairments differ among individuals, depending on the anatomical location and size of lesions. Identifying impairments specific to the individual is critical to optimize their functional recovery. The upper limb Physiological Profile Assessment (PPA) provides quantitative measures of key physiological domains required for adequate function in the upper limbs. The present study investigates the use of the upper limb PPA in a chronic stroke population. Fifty participants with chronic stroke completed all tests of the upper limb PPA with both their affected and less affected upper limbs. Performance in each test was compared to that of 50 age- and sex-matched control subjects with no history of a stroke. Correlations between test performance and validated measures of stroke, sensorimotor function, and disability were examined. Compared with control subjects, people with stroke demonstrated substantially impaired upper limb PPA performance for both their affected and less affected limbs. Performance in the upper limb PPA was associated with validated measures of sensorimotor function specific to the stroke population (Fugl-Meyer Assessment) and stroke-related disability (Stroke Impact Scale). The upper limb PPA shows good concurrent validity as a means to quantify upper limb function in a chronic stroke population. These tests identify domain-specific deficits and could be further tailored to an individual patient by the clinician to inform rehabilitation and track recovery.NEW & NOTEWORTHY Upper limb motor impairment is a common manifestation after stroke, compromising independence in fundamental daily activities involving the ability to reach, grasp, and manipulate objects. The upper limb Physiological Profile Assessment (PPA) offers a means of quantifying performance of the individual sensorimotor domains that are essential for upper limb function. Establishing individual performance profiles based on age- and sex-based normative scores may facilitate individualized treatment decisions by identifying the stroke patient's specific strengths and limitations.

Malondialdehyde as a Useful Biomarker of Low Hand Grip Strength in Community-Dwelling Stroke Patients

The assessment of muscle strength by hand grip strength (HGS) is used to evaluate muscle weakness and wasting among stroke patients. This study aimed to investigate the association of oxidative stress/oxidative damage and inflammatory biomarkers with muscle strength and wasting, as evaluated by HGS, among community-dwelling post-stroke patients. The HGS of both paretic and non-paretic limbs was negatively associated with modified Rankin scale (mRS) values. The serum levels of catalase activity and malondialdehyde (MDA), and plasma tumor necrosis factor (TNF)-α levels were significantly increased in post-stroke patients compared with non-stroke controls. Further analysis highlighted that hydrogen peroxide was positively correlated with HGS in the paretic limbs. Interestingly, an elevated MDA level, excluding advanced age and high mRS, increased the risk of low HGS in the non-paretic limbs of stroke patients. This study suggests that there is a detrimental association between MDA and muscle strength and early muscle wasting among post-stroke patients. Hence, MDA is a potentially useful biomarker of muscle weakness and wasting in post-stroke patients living in the community.

Muscle changes after stroke and their impact on recovery: time for a paradigm shift? Review and commentary

In stroke rehabilitation there is a growing body of evidence that not all patients have the same potential to recover. Understanding the processes that give rise to the heterogeneous treatment responses in stroke survivors will lay foundations for any conceivable advance in future rehabilitation interventions. This review was set out to shine new light on the debate of biomarkers in stroke rehabilitation by linking fundamental insights from biogerontological sciences to neurorehabilitation sciences. In particular, skeletal muscle changes and inflammation are addressed as two potential constructs from which biomarkers for stroke rehabilitation can be derived. Understanding the interplay between these constructs as well as their relation to recovery could enhance stroke rehabilitation in the future. The rationale for the selection of these constructs is three-fold: first, recent stroke literature emphasizes the importance of identifying muscle wasting (also called stroke-induced muscle wasting) in stroke patients, a concept that is widely investigated in geriatrics but less in the stroke population. Second, insights from transdisciplinary research domains such as gerontology have shown that inflammation has severe catabolic effects on muscles, which may impede rehabilitation outcomes such as gait recovery. Last, it has been proven that (high-intensity) muscle strengthening exercises have strong anti-inflammatory effects in a non-stroke population. Therefore, an evidence-based rationale is presented for developing research on individual changes of muscle and inflammation after a stroke.

Non-paretic lower limb muscle wasting during acute phase is associated with dependent ambulation in patients with stroke

BACKGROUND

Muscle wasting in patients with stroke is a factor for a poor functional outcome. However, there have been few studies on the relationships between lower limb muscle wasting during the acute phase and dependent ambulation. This study examined whether lower limb muscle wasting during the acute phase is associated with the dependent ambulation status at 3 months after stroke.

METHODS

In this observational cohort study, we measured the quadriceps muscle thickness in the paretic and non-paretic limbs within 1 and 3 weeks after admission using ultrasonography in non-ambulatory patients with acute stroke. Patients were categorized into two groups based on their ambulation ability: dependent, functional ambulation category (FAC) 0-3 and independent, FAC 4-5) at 3 months after stroke.

RESULTS

In total, 55 patients were included and completed follow-up, and 28 patients (51%) had an ambulation status of dependent at 3 months after stroke. Significant differences in muscle wasting were observed in the non-paretic limb (-5.5% [8.7%] : -16.8% [13.6%], independent group: dependent group, respectively, P < 0.001), but not in the paretic limb (-15.0% [14.3%] : -18.7% [15.1%], P = 0.36). Even after adjusting for covariates, muscle wasting in the non-paretic limb was a significant independent predictor of dependent ambulation (adjusted odds ratio, 0.87; 95% confidence interval, 0.76-0.99, P = 0.033).

CONCLUSION

Post-stroke muscle wasting in the non-paretic lower limb during the acute phase is independently associated with dependent ambulation after stroke.

Effect of Decreased Skeletal Muscle Index and Hand Grip Strength on Functional Recovery in Subacute Ambulatory Stroke Patients

Objective

To investigate the effect of decreased Skeletal Muscle Index (SMI) and hand grip strength on functional recovery in subacute ambulatory stroke patients.

Methods

Subacute stroke patients who were referred to the rehabilitation center were recruited. Decreased SMI and hand grip strength were diagnosed according to the Asian Working Group on Sarcopenia. Diagnostic criteria were decreased SMI and decreased unaffected hand grip strength. SMI was measured by bioelectrical impedance analysis. Unaffected hand grip strength was measured with a hand dynamometer. Patients were divided into two groups, decreased group (DG) and not-decreased group (NDG), according to the presence of decreased SMI and hand grip strength. Both groups received conventional stroke rehabilitation for 3 weeks. All patients were evaluated at the baseline and at 3 weeks after treatment. Functional status was evaluated with 4-meter walk test (4MWT), 6-minute walk test (6MWT), Timed Up and Go test (TUG), and Modified Barthel Index (MBI).

Results

Both groups showed improvement in 4MWT, TUG, and MBI. NDG showed improvement in 6MWT. Comparing improvements between the two groups, NDG showed more improvement in 6MWT and TUG than DG.

Conclusion

The presence of decreased SMI and hand grip strength had negative effects on functional recovery in subacute ambulatory stroke patients.

Can initial sarcopenia affect poststroke rehabilitation outcome?

This study investigated the association between the presence of sarcopenia, measured by nonhemiplegic grip strength, and the level of functional recovery, measured by the modified Rankin Scale (mRS) at six months after stroke. We performed a retrospective cohort analysis of a prospectively maintained database of 194 hemiplegic poststroke patients, who had been admitted to the Department of Rehabilitation Medicine of a university-affiliated hospital. At 6 months after stroke, 72.2% of patients had mRS score >3, with more women (81.0% vs. 66.0%, p = 0.024) showing poor recovery. Both men (51.3% vs. 35.9%, p = 0.041) and women (42.2% vs. 6.7%, p = 0.022) with mRS score >3 had a higher rate of sarcopenia. Univariate analysis revealed that the presence of sarcopenia was associated with a 2.71-fold higher risk of poor recovery at six months. In addition, women had a 2.18-fold higher risk of poor outcome. Multivariable logistic regression analysis revealed that the presence of sarcopenia was associated with poor functional outcome (odds ratio [OR] = 2.61, 95% confidence interval [CI]: 1.14-5.98, p = 0.024) in men, but this association was notably stronger in women (OR = 9.93, 95% CI: 1.22-81.19, p = 0.032). This study suggests that the presence of sarcopenia two weeks after stroke may increase the risk of poor functional outcome six months after stroke. Most notably, women with sarcopenia within 2 weeks from stroke onset were more significantly likely to have a poor modified Rankin Scale after 6 months.

Manual function of the unaffected upper extremity can affect functional outcome after stroke

Traditionally, motor deficits of ipsilesional side, generally considered as the unaffected side, have been investigated less and the influence of the impairment is unknown. To evaluate the association between the manual function test (MFT) of nonparetic limb and poststroke functional outcome. We conducted a retrospective analysis of 71 hemiplegic patients with stroke. MFT on both sides was routinely measured at admission and 1 month later after admission by an experienced occupational therapist. The parameters of functional outcome after stroke were measured with the total score of functional independence measure (FIM) and the self-care subscore of FIM. Age, initial cognitive function, and MFT of the affected hand and unaffected hand were each significant factors for independently predicting short-term functional outcome after stroke. Linear regression analysis showed that initial MFT score of unaffected side is a significant predictor for 1 month follow-up subscore FIM (P<0.0001) and total FIM score (P<0.0001). Our findings suggests that initial MFT score of the nonparetic side has a significant correlation with functional outcome. Therefore, it is important to conduct MFT on the nonparetic side as well as the paretic side. Furthermore, it is necessary to undergo rehabilitation therapy on the nonparetic side.