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Kamper D, Bansal N, Barry A, Seo NJ, Celian C, Vidakovic L, Stoykov ME, Roth E. Combining Cyproheptadine Hydrochloride With Targeted Muscle Activation Training to Treat Upper Extremity Stroke: A Randomized, Placebo-Controlled Trial. Arch Phys Med Rehabil 2024:S0003-9993(24)01125-0. [PMID: 39033950 DOI: 10.1016/j.apmr.2024.06.022] [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: 12/21/2023] [Revised: 06/11/2024] [Accepted: 06/30/2024] [Indexed: 07/23/2024]
Abstract
OBJECTIVE To examine a treatment for upper extremity impairment in stroke survivors that combines administration of cyproheptadine hydrochloride with repetitive practice focused on control of muscle activation patterns. DESIGN Double-blind, randomized controlled trial. SETTINGS Laboratory within a free-standing rehabilitation hospital. PARTICIPANTS A total of 94 stroke survivors with severe, chronic hand impairment were randomly assigned to 1 of 4 treatment groups. INTERVENTIONS Participants received either a placebo or cyproheptadine hydrochloride in identical pill form. The daily dosage of cyproheptadine/placebo was gradually increased from 8 to 24 mg/d over 3 weeks and then maintained over the next 6 weeks while participants completed 18 therapy sessions. Therapy consisted of either (1) active practice of muscle activation patterns to play "serious" computer games or control a custom hand exoskeleton or (2) passive, cyclical finger stretching imposed by the exoskeleton. MAIN OUTCOME MEASURES Hand control was evaluated with the primary outcome measure of time to complete the Graded Wolf Motor Function Test (GWMFT) and secondary outcome measures including finger strength and spasticity. RESULTS Across the 88 participants who completed the study, a repeated-measures analysis of variance revealed a significant effect of GroupxEvaluation interaction on GWMFT (F=1.996, P=.026). The 3 groups receiving cyproheptadine and/or actively practicing muscle activation pattern control exhibited significant reduction in mean time to complete the GWMFT tasks; roughly one-third of these participants experienced at least a 10% reduction in completion time. Gains were maintained at the 1-month follow-up evaluation. The group receiving placebo and passive stretching did not show improvement. No significant differences among groups were observed in terms of changes in strength or spasticity. CONCLUSIONS Despite chronic, severe impairment, stroke survivors were able to complete the therapy focused on muscle activations and achieved statistically significant improvement in hand motor control. Cyproheptadine hydrochloride is a potential complementary treatment modality for stroke survivors with hand impairment.
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Affiliation(s)
- Derek Kamper
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC; Joint Department of Biomedical Engineering, North Carolina State University, Raleigh, NC.
| | - Naveen Bansal
- Department of Mathematical and Statistical Sciences, Marquette University, Milwaukee, WI
| | | | - Na Jin Seo
- Department of Rehabilitation Sciences, Medical University of South Carolina, Charleston, SC
| | | | | | - Mary Ellen Stoykov
- Shirley Ryan AbilityLab, Chicago, IL; Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Elliot Roth
- Shirley Ryan AbilityLab, Chicago, IL; Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL
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Ma MK, Cho T, Lee JW, Moon HI. Torque Onset Angle of the Knee Extensor as a Predictor of Walking Related Balance in Stroke Patients. Ann Rehabil Med 2023; 47:291-299. [PMID: 37644715 PMCID: PMC10475816 DOI: 10.5535/arm.23061] [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: 05/13/2023] [Revised: 07/21/2023] [Accepted: 07/24/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVE To investigate the relationship between the torque onset angle (TOA) of the isokinetic test for knee extensors in the paretic side and walking related balance in subacute stroke patients. METHODS We retrospectively reviewed patients with first-ever strokes who have had at least two isokinetic tests within 6 months of onset. 102 patients satisfied the inclusion criteria. The characteristics of walking related balance were measured with the Berg Balance Scale sub-score (sBBS), Timed Up and Go test (TUG), 10-m Walk Test (10MWT) and Functional Independence Measure sub-score (sFIM). The second isokinetic test values of the knee extensor such as peak torque, peak torque to weight ratio, hamstring/quadriceps ratio, TOA, torque stop angle, torque at 30 degrees, and peak torque asymmetry ratio between paretic and non-paretic limb were also taken into account. Pearson's correlation, simple regression and multiple regression analysis were used to analyze the correlation between TOA and walking related balance. RESULTS TOA of the knee extensor of the paretic limb showed significant correlations with BBS, sBBS, TUG, 10MWT, and sFIM according to Pearson's correlation analysis. TOA also had moderate to good correlations with walking related balance parameters in partial correlation analysis. In multiple regression analysis, TOA of the paretic knee extensor was significantly associated with walking related balance parameters. CONCLUSION This study demonstrated that TOA of the paretic knee extensor is a predictable parameter of walking related balance. Moreover, we suggest that the ability to recruit muscle quickly is important in walking related balance.
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Affiliation(s)
- Min Kyeong Ma
- Department of Rehabilitation Medicine, Bundang Jesaeng Hospital, Seongnam, Korea
| | - TaeHwan Cho
- Department of Rehabilitation Medicine, Gwangju Veterans Hospital, Gwangju, Korea
| | - Joo Won Lee
- Department of Rehabilitation Medicine, Bundang Jesaeng Hospital, Seongnam, Korea
| | - Hyun Im Moon
- Department of Rehabilitation Medicine, Bundang Jesaeng Hospital, Seongnam, Korea
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Aze OD, Ojardias E, Akplogan B, Giraux P, Calmels P. Structural and pathophysiological muscle changes up to one year after post-stroke hemiplegia: a systematic review. Eur J Phys Rehabil Med 2023; 59:474-487. [PMID: 37695037 PMCID: PMC10548887 DOI: 10.23736/s1973-9087.23.07844-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 05/31/2023] [Accepted: 07/17/2023] [Indexed: 09/12/2023]
Abstract
INTRODUCTION Muscle changes after stroke cannot be explained solely on the basis of corticospinal bundle damage. Muscle-specific changes contribute to limited functional recovery but have been poorly characterized. EVIDENCE ACQUISITION We conducted a systematic review of muscular changes occurring at the histological, neuromuscular and functional levels during the first year after the onset of post-stroke hemiplegia. A literature search was performed on PubMed, Embase and CINHAL databases up to November 2022 using a keyword combination comprising cerebral stroke, hemiplegic, atrophy, muscle structure, paresis, skeletal muscle fiber type, motor unit, oxidative stress, strength, motor control. EVIDENCE SYNTHESIS Twenty-seven trial reports were included in the review, out of 12,798 articles screened. Structural modifications described on the paretic side include atrophy, transformation of type II fibers into type I fibers, decrease in fiber diameter and apparent myofilament disorganization from the first week post-stroke up to the fourth month. Reported biochemical changes comprise the abnormal presence of lipid droplets and glycogen granules in the subsarcolemmal region during the first month post-stroke. At the neurophysiological level, studies indicate an early decrease in the number and activity of motor units, correlated with the degree of motor impairment. All these modifications were present to a lesser degree on the non-paretic side. Although only sparse data concerning the subacute stage are available, these changes seem to appear during the first two weeks post-stroke and continue up to the third or fourth month. CONCLUSIONS Considering these early pathophysiological changes on both the paretic and non-paretic sides, it seems crucial to promptly stimulate central and also peripheral muscular activation after stroke through specific rehabilitation programs focused on the maintenance of muscle capacities associated with neurological recovery or plasticity.
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Affiliation(s)
- Oscar D Aze
- Interuniversity Lab of Motricity Biology, Savoie Mont-Blanc University, Jean Monnet Saint-Etienne Universities, CHU Saint-Etienne, Lyon1, Saint-Etienne, France
- Impairments, Adapted Physical Activities and Rehabilitation Research Unit (UR-DAPAR), National Institute of Youth, Physical Education, and Sports, Abomey-Calavi University (INJEPS-UAC), Porto-Novo, Benin
- Service of Physical Medicine and Readaptation, CHU Saint-Etienne, Saint-Etienne, France
| | - Etienne Ojardias
- Service of Physical Medicine and Readaptation, CHU Saint-Etienne, Saint-Etienne, France -
- Inserm UMR-S 1028, Lyon Neuroscience Research Center, Lyon1 and Saint-Etienne Universities, Saint-Etienne, France
| | - Barnabé Akplogan
- Impairments, Adapted Physical Activities and Rehabilitation Research Unit (UR-DAPAR), National Institute of Youth, Physical Education, and Sports, Abomey-Calavi University (INJEPS-UAC), Porto-Novo, Benin
| | - Pascal Giraux
- Service of Physical Medicine and Readaptation, CHU Saint-Etienne, Saint-Etienne, France
- Inserm UMR-S 1028, Lyon Neuroscience Research Center, Lyon1 and Saint-Etienne Universities, Saint-Etienne, France
| | - Paul Calmels
- Interuniversity Lab of Motricity Biology, Savoie Mont-Blanc University, Jean Monnet Saint-Etienne Universities, CHU Saint-Etienne, Lyon1, Saint-Etienne, France
- Service of Physical Medicine and Readaptation, CHU Saint-Etienne, Saint-Etienne, France
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4
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Pan H, Ng SSM, Liu TW, Tsoh J, Wong TWL. Psychometric properties of the Chinese (Cantonese) version of the Upper Extremity Functional Index in people with chronic stroke. Front Neurol 2023; 14:989403. [PMID: 36908608 PMCID: PMC9998711 DOI: 10.3389/fneur.2023.989403] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 02/03/2023] [Indexed: 03/14/2023] Open
Abstract
Objective To culturally adapt and examine the psychometric properties of the Chinese (Cantonese) version of the Upper Extremity Functional Index (C-UEFI) in people with chronic stroke. Design Cross-sectional study. Settings University-affiliated neurorehabilitation research laboratory. Participants The participants (N = 151) were people with chronic stroke (N = 101) and healthy controls (n = 50). Main outcome measures We assessed the C-UEFI, Fugl-Meyer Assessment for Upper Extremity (FMA-UE), Wolf Motor Function Test (WMFT), Six-Minute Walk Test (6MWT), Motor Activity Log (MAL), Activity-Specific Balance Confidence (ABC) scale, Lawton Instrumental Activities of Daily Living (IADL) scale, Survey of Activities and Fear of Falling in the Elderly (SAFFE), Stroke Impact Scale (SIS) and Community Integration Measure (CIM) as outcome measures. Results The C-UEFI items demonstrated good test-retest reliability (intraclass correlation coefficient [ICC]3, 1 = 0.872) and excellent internal consistency (Cronbach's α = 0.922). People with chronic stroke had poorer C-UEFI scores than the healthy controls. The overall C-UEFI mean score of 101 people with stroke was significantly correlated with the mean scores of the FMA-UE, WMFT, MAL, ABC scale, IADL scale, SAFFE, SIS and CIM and the distance covered in the 6MWT. The C-UEFI cut-off score to distinguish between people with chronic stroke and healthy older adults according to upper extremity function was 57.5 out of 59 (sensitivity: 88.1%; specificity: 84%). The C-UEFI had good content validity, with an acceptable fit to the two-factor structure model. Conclusions The C-UEFI is reliable and valid for assessing functional recovery of upper extremity activity in Chinese people with chronic stroke.
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Affiliation(s)
- Hong Pan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Shamay S M Ng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Tai Wa Liu
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, Hong Kong SAR, China
| | - Joshua Tsoh
- Department of Psychiatry, Prince of Wales Hospital and Shatin Hospital, Hong Kong, Hong Kong SAR, China
| | - Thomson W L Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
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Schils S, Ober T. Functional Electrical Stimulation (FES) in the Diagnosis and Treatment of Musculoskeletal and Neuromuscular Control Abnormalities in Horses - Selected Case Studies. J Equine Vet Sci 2022; 117:104078. [PMID: 35830906 DOI: 10.1016/j.jevs.2022.104078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 07/01/2022] [Accepted: 07/05/2022] [Indexed: 10/17/2022]
Abstract
When diagnosing neuromuscular injury and pain, the use of biomechanical evaluations to assess the mechanics of movement patterns has been useful in the human population. Functional electrical stimulation (FES) is a technology that can create action potentials to produce musculoskeletal movement that is almost indistinguishable from the voluntary kinematics produced by the nervous system. To create controlled and precise musculoskeletal movements in humans and in horses, FES has been shown to be effective. In humans, the kinematic information obtained from FES data has been utilized to direct further diagnostics, and/or to assist in the development of specific treatment protocols. In addition, since FES creates dynamic movement while in a static position, the ability to isolate the regions of dysfunction improves without the confounding factors of over-the-ground movement and other artifacts caused by environmental stimuli. This paper explores the transfer of the use of FES in human diagnostics to clinical use in horses. Three equine case studies discuss how FES was employed as a tool in the diagnosis and treatment of equine musculoskeletal and neuromuscular control disorders.
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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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7
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Garcia SA, Rodriguez KM, Brown SR, Palmieri-Smith RM, Krishnan C. Estimates of voluntary activation in individuals with anterior cruciate ligament reconstruction: Effects of type of stimulator, number of stimuli, and quantification technique. JOURNAL OF SPORT AND HEALTH SCIENCE 2022; 11:85-93. [PMID: 32692315 PMCID: PMC8847978 DOI: 10.1016/j.jshs.2019.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 10/15/2019] [Accepted: 11/12/2019] [Indexed: 06/11/2023]
Abstract
BACKGROUND Accurate quantification of voluntary activation is important for understanding the extent of quadriceps dysfunction in individuals with anterior cruciate ligament reconstruction (ACLR). Voluntary activation has been quantified using both percent activation derived from the interpolated twitch technique and central activation ratio (CAR) derived from the burst superimposition technique, as well as by using different types of electrical stimulators and pulse train conditions. However, it is unclear how these parameters affect voluntary activation estimates in individuals with ACLR. This study was performed to fill this important knowledge gap in the anterior cruciate ligament literature. METHODS Quadriceps strength and voluntary activation were examined in 18 ACLR participants (12 quadriceps/patellar tendon graft, 6 hamstring tendon graft; time since ACLR: 1.06 ± 0.82 years, mean ± SD) at 90° of knee flexion using 2 stimulators (Digitimer and Grass) and pulse train conditions (3-pulse and 10-pulse). Voluntary activation was quantified by calculating both CAR and percent activation. RESULTS Results indicated that voluntary activation was significantly overestimated by CAR when compared with percent activation (p < 0.001). Voluntary activation estimates were not affected by pulse train conditions when using percent activation; however, 3-pulse stimuli resulted in greater overestimation than 10-pulse stimuli when using CAR (p = 0.003). Voluntary activation did not differ between stimulators (p > 0.05); however, the Digitimer evoked greater torque at rest than the Grass (p < 0.001). CONCLUSION These results indicate that percent activation derived from the interpolated twitch technique provides superior estimates of voluntary activation than CAR derived from burst superimposition and is less affected by pulse train conditions or stimulators in individuals with ACLR.
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Affiliation(s)
- Steven A Garcia
- School of Kinesiology, University of Michigan, Ann Arbor, MI 48109, USA
| | | | - Scott R Brown
- Neuromuscular and Rehabilitation Robotics Laboratory (NeuRRo Lab), Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI 48108, USA
| | - Riann M Palmieri-Smith
- School of Kinesiology, University of Michigan, Ann Arbor, MI 48109, USA; Department of Orthopaedic Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Chandramouli Krishnan
- School of Kinesiology, University of Michigan, Ann Arbor, MI 48109, USA; Neuromuscular and Rehabilitation Robotics Laboratory (NeuRRo Lab), Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI 48108, USA; Robotics Institute, University of Michigan, Ann Arbor, MI 48109, USA.
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8
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Dorsch S, Ada L, Sorial T, Fanayan E. The Relationship Between Strength of the Affected Leg and Walking Speed After Stroke Varies According to the Level of Walking Disability: A Systematic Review. Phys Ther 2021; 101:6381996. [PMID: 34636921 DOI: 10.1093/ptj/pzab233] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 05/11/2021] [Accepted: 08/01/2021] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The objectives of this review were to determine the relationship between muscle strength of the affected leg and walking speed after stroke and whether this relationship varied according to muscle group or level of walking disability. METHODS This systematic review with meta-analysis focused on observational studies of adult survivors of stroke. Muscle strength had to be measured as maximum voluntary force production during an isometric contraction of the affected leg. Walking had to be measured as walking speed. Studies had to report correlations between muscle strength and walking speed. RESULTS Thirty studies involving 1001 participants were included. Pooled mean correlations between muscle strength of the affected leg and walking speed was 0.51 (95% CI = 0.45 to 0.57). Pooled correlations between the strength of individual muscle groups and walking speed ranged from 0.42 (for the hip abductors) to 0.57 (for the ankle dorsiflexors). The correlation between level of walking disability and the mean correlation between muscle strength and walking speed was -0.70 (95% CI = -0.42 to -0.86). CONCLUSION After stroke, there is a strong relationship between strength of the affected leg and walking speed, with little variability across individual muscle groups. However, the level of walking disability of people with stroke does make a difference such that the more disabled people are, the stronger the relationship is between strength of the affected leg and walking speed. IMPACT This study suggests that the strength of all muscles of the affected leg is important for walking after stroke. It appears that increasing strength in the affected leg could be most important in people who are more disabled. LAY SUMMARY After stroke, the speed at which a person can walk is highly associated with the muscle strength of their affected leg. In people whose walking speed is severely affected, this association is stronger, and the physical therapist might focus on strengthening that leg so the individual can walk faster.
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Affiliation(s)
- Simone Dorsch
- The School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Sydney, Australia.,The StrokeEd Collaboration, Sydney, Australia
| | - Louise Ada
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Tiffany Sorial
- Physiotherapy Department, Westmead Hospital, Sydney, Australia
| | - Emma Fanayan
- The School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Sydney, Australia
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9
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Abal del Blanco J, Taboada-Iglesias Y. Effects of resistance exercise in patients with spasticity: Systematic review. APUNTS SPORTS MEDICINE 2021. [DOI: 10.1016/j.apunsm.2021.100356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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10
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Cullins MJ, Russell JA, Booth ZE, Connor NP. Central activation deficits contribute to post stroke lingual weakness in a rat model. J Appl Physiol (1985) 2021; 130:964-975. [PMID: 33600285 DOI: 10.1152/japplphysiol.00533.2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Lingual weakness frequently occurs after stroke and is associated with deficits in speaking and swallowing. Chronic weakness after stroke has been attributed to both impaired central activation of target muscles and reduced force-generating capacity within muscles. How these factors contribute to lingual weakness is not known. We hypothesized that lingual weakness due to middle cerebral artery occlusion (MCAO) would manifest as reduced muscle force capacity and reduced muscle activation. Rats were randomized into MCAO or sham surgery groups. Maximum volitional tongue forces were quantified 8 wk after surgery. Hypoglossal nerve stimulation was used to assess maximum stimulated force, muscle twitch properties, and force-frequency response. The central activation ratio was determined by maximum volitional/maximum stimulated force. Genioglossus muscle fiber type properties and neuromuscular junction innervation were assessed. Maximum volitional force and the central activation ratio were significantly reduced with MCAO. Maximum stimulated force was not significantly different. No significant differences were found for muscle twitch properties, unilateral contractile properties, muscle fiber type percentages, or fiber size. However, the twitch/tetanus ratio was significantly increased in the MCAO group relative to sham. A small but significant increase in denervated neuromuscular junctions (NMJs) and fiber-type grouping occurred in the contralesional genioglossus. Results suggest that the primary cause of chronic lingual weakness after stroke is impaired muscle activation rather than a deficit of force-generating capacity in lingual muscles. Increased fiber type grouping and denervated NMJs in the contralesional genioglossus suggest that partial reinnervation of muscle fibers may have preserved force-generating capacity, but not optimal activation patterns.NEW & NOTEWORTHY Despite significant reductions in maximum volitional forces, the intrinsic force-generating capacity of the protrusive lingual muscles was not reduced with unilateral cerebral ischemia. Small yet significant increases in denervated NMJs and fiber-type grouping of the contralesional genioglossus suggest that the muscle underwent denervation and reinnervation. Together these results suggest that spontaneous neuromuscular plasticity was sufficient to prevent atrophy, yet central activation deficits remain and contribute to chronic lingual weakness after stroke.
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Affiliation(s)
- Miranda J Cullins
- Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin
| | - John A Russell
- Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin
| | - Zoe E Booth
- Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin
| | - Nadine P Connor
- Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin.,Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, Wisconsin
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11
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Reliability of Tibialis Anterior Muscle Voluntary Activation Using the Interpolated Twitch Technique and the Central Activation Ratio in People with Stroke. Brain Sci 2021; 11:brainsci11020176. [PMID: 33535411 PMCID: PMC7912757 DOI: 10.3390/brainsci11020176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 01/24/2021] [Accepted: 01/26/2021] [Indexed: 12/04/2022] Open
Abstract
Voluntary activation (VA) is measured by applying supramaximal electrical stimulation to a muscle during a maximal voluntary contraction (MVC). The amplitude of the evoked muscle twitch is used to determine any VA deficit, and indicates incomplete central neural drive to the motor units. People with stroke experience VA deficits and greater levels of central fatigue, which is the decrease in VA that occurs following exercise. This study investigated the between-session reliability of VA and central fatigue of the tibialis anterior muscle (TA) in people with chronic stroke (n = 12), using the interpolated twitch technique (ITT), adjusted-ITT, and central activation ratio (CAR) methods. On two separate sessions, supramaximal electrical stimulation was applied to the TA when it was at rest and maximally activated, at the start and end of a 30-s isometric dorsiflexor MVC. The most reliable measures of VA were obtained using the CAR calculation on transformed data, which produced an ICC of 0.92, and a lower bound confidence interval in the good range (95% CI 0.77 to 0.98). Reliability was lower for the CAR calculation on non-transformed data (ICC 0.82, 95% CI 0.63 to 0.91) and the ITT and adjusted-ITT calculations on transformed data (ICCs 0.82, 95% CIs 0.51 to 0.94), which had lower bound confidence intervals in the moderate range. The two ITT calculations on non-transformed data demonstrated the poorest reliability (ICCs 0.62, 95% CI 0.25 to 0.74). Central fatigue measures demonstrated very poor reliability. Thus, the reliability for VA in people with chronic stroke ranged from good to poor, depending on the calculation method and statistical analysis method, whereas the reliability for central fatigue was very poor.
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12
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Brown SR, Washabaugh EP, Dutt-Mazumder A, Wojtys EM, Palmieri-Smith RM, Krishnan C. Functional Resistance Training to Improve Knee Strength and Function After Acute Anterior Cruciate Ligament Reconstruction: A Case Study. Sports Health 2020; 13:136-144. [PMID: 33337984 DOI: 10.1177/1941738120955184] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Thigh muscle weakness after anterior cruciate ligament reconstruction (ACLR) can persist after returning to activity. While resistance training can improve muscle function, "nonfunctional" training methods are not optimal for inducing transfer of benefits to activities such as walking. Here, we tested the feasibility of a novel functional resistance training (FRT) approach to restore strength and function in an individual with ACLR. HYPOTHESIS FRT would improve knee strength and function after ACLR. STUDY DESIGN Case report. LEVEL OF EVIDENCE Level 5. METHODS A 15-year-old male patient volunteered for an 8-week intervention where he performed 30 minutes of treadmill walking, 3 times per week, while wearing a custom-designed knee brace that provided resistance to the thigh muscles of his ACLR leg. Thigh strength, gait mechanics, and corticospinal and spinal excitability were assessed before and immediately after the 8-week intervention. Voluntary muscle activation was evaluated immediately after the intervention. RESULTS Knee extensor and flexor strength increased in the ACLR leg from pre- to posttraining (130 to 225 N·m [+74%] and 44 to 88 N·m [+99%], respectively) and increases in between-limb extensor and flexor strength symmetry (45% to 92% [+74%] and 47% to 72% [+65%], respectively) were also noted. After the intervention, voluntary muscle activation in the ACLR leg was 72%, compared with the non-ACLR leg at 75%. Knee angle and moment during late stance phase decreased (ie, improved) in the ACLR leg and appeared more similar to the non-ACLR leg after FRT training (18° to 14° [-23.4] and 0.07 to -0.02 N·m·kg-1·m-1 [-122.8%], respectively). Corticospinal and spinal excitability in the ACLR leg decreased (3511 to 2511 [-28.5%] and 0.42 to 0.24 [-43.7%], respectively) from pre- to posttraining. CONCLUSION A full 8 weeks of FRT that targeted both quadriceps and hamstring muscles lead to improvements in strength and gait, suggesting that FRT may constitute a promising and practical alternative to traditional methods of resistance training. CLINICAL RELEVANCE FRT may serve as a viable approach to improve knee strength and function after ACL reconstruction.
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Affiliation(s)
- Scott R Brown
- Neuromuscular and Rehabilitation Robotics Laboratory (NeuRRo Lab), Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Edward P Washabaugh
- Neuromuscular and Rehabilitation Robotics Laboratory (NeuRRo Lab), Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan.,Biomedical Engineering, University of Michigan, Ann Arbor, Michigan
| | - Aviroop Dutt-Mazumder
- Neuromuscular and Rehabilitation Robotics Laboratory (NeuRRo Lab), Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Edward M Wojtys
- Department of Orthopaedic Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Riann M Palmieri-Smith
- Neuromuscular and Rehabilitation Robotics Laboratory (NeuRRo Lab), Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan.,Department of Orthopaedic Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan.,School of Kinesiology, University of Michigan, Ann Arbor, Michigan
| | - Chandramouli Krishnan
- Neuromuscular and Rehabilitation Robotics Laboratory (NeuRRo Lab), Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan.,Biomedical Engineering, University of Michigan, Ann Arbor, Michigan.,School of Kinesiology, University of Michigan, Ann Arbor, Michigan.,Michigan Robotics Institute, University of Michigan, Ann Arbor, Michigan
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13
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Negro F, Bathon KE, Nguyen JN, Bannon CG, Orizio C, Hunter SK, Hyngstrom AS. Impaired Firing Behavior of Individually Tracked Paretic Motor Units During Fatiguing Contractions of the Dorsiflexors and Functional Implications Post Stroke. Front Neurol 2020; 11:540893. [PMID: 33192970 PMCID: PMC7658471 DOI: 10.3389/fneur.2020.540893] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 09/25/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction: This study quantified stroke-related changes in the following: (1) the averaged discharge rate of motor units (individually tracked and untracked) identified from high-density electromyography (HD-EMG) recordings, (2) global muscle EMG properties of the dorsiflexors during a fatiguing contraction, and the relationship between task endurance and measures of leg function. Methods: Ten individuals with chronic stroke performed a sustained sub-maximal, isometric, fatiguing dorsiflexion contraction in paretic and non-paretic legs. Motor-unit firing behavior, task duration, maximal voluntary contraction strength (MVC), and clinical measures of leg function were obtained. Results: Compared to the non-paretic leg, the paretic leg task duration was shorter, and there was a larger exercise-related reduction in motor unit global rates, individually tracked discharge rates, and overall magnitude of EMG. Task duration of the paretic leg was more predictive of walking speed and lower extremity Fugl-Meyer scores compared to the non-paretic leg. Discussion: Paretic leg muscle fatigability is increased post stroke. It is characterized by impaired rate coding and recruitment and relates to measures of motor function.
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Affiliation(s)
- Francesco Negro
- Department of Clinical and Experimental Sciences, Research Center for Neuromuscular Function and Adapted Physical Activity "Teresa Camplani", Università degli Studi di Brescia, Brescia, Italy
| | - Kathleen E Bathon
- Uniformed Services, University of Health Sciences, Bethesda, MD, United States
| | - Jennifer N Nguyen
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Cassidy G Bannon
- Uniformed Services, University of Health Sciences, Bethesda, MD, United States
| | - Claudio Orizio
- Department of Clinical and Experimental Sciences, Research Center for Neuromuscular Function and Adapted Physical Activity "Teresa Camplani", Università degli Studi di Brescia, Brescia, Italy
| | - Sandra K Hunter
- Department of Physical Therapy, Marquette University, Milwaukee, WI, United States
| | - Allison S Hyngstrom
- Department of Physical Therapy, Marquette University, Milwaukee, WI, United States
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14
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Akbas T, Kim K, Doyle K, Manella K, Lee R, Spicer P, Knikou M, Sulzer J. Rectus femoris hyperreflexia contributes to Stiff-Knee gait after stroke. J Neuroeng Rehabil 2020; 17:117. [PMID: 32843057 PMCID: PMC7448457 DOI: 10.1186/s12984-020-00724-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 07/06/2020] [Indexed: 11/17/2022] Open
Abstract
Background Stiff-Knee gait (SKG) after stroke is often accompanied by decreased knee flexion angle during the swing phase. The decreased knee flexion has been hypothesized to originate from excessive quadriceps activation. However, it is unclear whether hyperreflexia plays a role in this activation. The goal of this study was to establish the relationship between quadriceps hyperreflexia and knee flexion angle during walking in post-stroke SKG. Methods The rectus femoris (RF) H-reflex was recorded in 10 participants with post-stroke SKG and 10 healthy controls during standing and walking at the pre-swing phase. In order to attribute the pathological neuromodulation to quadriceps muscle hyperreflexia and activation, healthy individuals voluntarily increased quadriceps activity using electromyographic (EMG) feedback during standing and pre-swing upon RF H-reflex elicitation. Results We observed a negative correlation (R = − 0.92, p = 0.001) between knee flexion angle and RF H-reflex amplitude in post-stroke SKG. In contrast, H-reflex amplitude in healthy individuals in presence (R = 0.47, p = 0.23) or absence (R = − 0.17, p = 0.46) of increased RF muscle activity was not correlated with knee flexion angle. We observed a body position-dependent RF H-reflex modulation between standing and walking in healthy individuals with voluntarily increased RF activity (d = 2.86, p = 0.007), but such modulation was absent post-stroke (d = 0.73, p = 0.296). Conclusions RF reflex modulation is impaired in post-stroke SKG. The strong correlation between RF hyperreflexia and knee flexion angle indicates a possible regulatory role of spinal reflex excitability in post-stroke SKG. Interventions targeting quadriceps hyperreflexia could help elucidate the causal role of hyperreflexia on knee joint function in post-stroke SKG.
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Affiliation(s)
- Tunc Akbas
- School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Kyoungsoon Kim
- Walker Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Kathleen Doyle
- Walker Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Kathleen Manella
- University of St. Augustine for Health Sciences, Austin, TX, USA
| | - Robert Lee
- St. David's Medical Center, Austin, TX, USA
| | - Patrick Spicer
- Seton Brain and Spine Institute, Ascension Texas, University of Texas at Austin, Austin, TX, USA
| | - Maria Knikou
- Graduate Center of the City University of New York and Physical Therapy Department, College of Staten Island, New York, NY, USA
| | - James Sulzer
- Walker Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX, USA.
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15
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Choi SH, Lim CG. Immediate Effects of Ankle Non-elastic Taping on Balance and Gait Ability in Patients With Chronic Stroke: A Randomized, Controlled Trial. J Manipulative Physiol Ther 2020; 43:922-929. [PMID: 32684325 DOI: 10.1016/j.jmpt.2019.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 12/09/2019] [Accepted: 12/10/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The purpose of this study was to determine the immediate effects of ankle non-elastic taping on balance and gait ability in patients with chronic stroke. METHODS Thirty patients (inpatients and outpatients) with stroke were randomly assigned to 2 groups: the non-elastic taping group (n = 15) and the placebo-taping group (n = 15). Patients in the non-elastic taping group received Endura sports taping for their ankle joint, and patients in the placebo-taping group received Endura fix tape for their ankle joint. The Balance System SD assessed balance, and the GAITRite system assessed gait ability. We recorded measurements before and after intervention. RESULTS The non-elastic taping group showed a significant improvement in static and dynamic standing balance (P ≤ .001) after intervention; in addition, this group showed significant increases in the velocity, cadence, step length, and stride length of gait (P ≤ .001) after intervention. However, the placebo-taping group showed no significant improvements in standing balance and gait ability after intervention (P >.05). Furthermore, significant differences in static and dynamic standing balance, cadence, and velocity were observed between the 2 groups after intervention (P ≤ .001). CONCLUSIONS Our results demonstrate that the application of ankle non-elastic taping is effective at improving balance and gait abilities in patients with stroke. Ankle non-elastic taping appears to be an effective method to facilitate active rehabilitation in patients with hemiplegia.
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Affiliation(s)
- Suk-Hun Choi
- Department of Physical Therapy, Gyeongin Rehabilitation Center Hospital, Incheon, South Korea
| | - Chae-Gil Lim
- Department of Physical Therapy, College of Health Science, Gachon University, Incheon, South Korea.
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16
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Surface Electromyographic Biofeedback and the Effortful Swallow Exercise for Stroke-Related Dysphagia and in Healthy Ageing. Dysphagia 2020; 36:281-292. [PMID: 32445060 PMCID: PMC8004490 DOI: 10.1007/s00455-020-10129-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 05/05/2020] [Indexed: 11/29/2022]
Abstract
Dysphagia is common after stroke, leading to adverse outcome. The Effortful Swallow (ES) is recommended to improve swallowing but it is not known if dysphagic patients can increase muscle activity during the exercise or if age affects performance. Providing surface electromyographic (sEMG) biofeedback during dysphagia therapy may enhance exercise completion, but this has not been investigated and the technique’s acceptability to patients is not known. Aims: To determine if age or post-stroke dysphagia affect the ability to increase submental muscle activity during the ES, if sEMG biofeedback improves ES performance and if sEMG is an acceptable addition to therapy. In a Phase I study submental sEMG amplitudes were measured from 15 people with dysphagia < 3 months post-stroke and 85 healthy participants aged 18–89 years during swallowing (NS) and when they performed the ES with and without sEMG biofeedback. Participant feedback was collected via questionnaire. Measurements were compared with repeated measures ANOVA and age effects were examined with linear regression. Both groups produced significantly greater muscle activity for the ES than NS (p < 0.001) and significantly increased activity with biofeedback (p < 0.001) with no effect of age. Participant feedback about sEMG was very positive; over 98% would be happy to use it regularly. The ES is a physiologically beneficial dysphagia exercise, increasing muscle activity during swallowing. sEMG biofeedback further enhances performance and is considered an acceptable technique by patients. These findings support the potential application of sEMG biofeedback and the ES in dysphagia therapy in stroke, justifying further investigation of patient outcome.
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17
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Olsen S, Signal N, Niazi IK, Rashid U, Alder G, Mawston G, Nedergaard RB, Jochumsen M, Taylor D. Peripheral Electrical Stimulation Paired With Movement-Related Cortical Potentials Improves Isometric Muscle Strength and Voluntary Activation Following Stroke. Front Hum Neurosci 2020; 14:156. [PMID: 32499686 PMCID: PMC7242792 DOI: 10.3389/fnhum.2020.00156] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 04/09/2020] [Indexed: 12/18/2022] Open
Abstract
Background Endogenous paired associative stimulation (ePAS) is a neuromodulatory intervention that has potential to aid stroke recovery. ePAS involves pairing endogenous electroencephalography (EEG) signals known as movement-related cortical potentials (MRCPs), with peripheral electrical stimulation. Previous studies have used transcranial magnetic stimulation (TMS) to demonstrate changes in corticomotor excitability following ePAS. However, the use of TMS as a measure in stroke research is limited by safety precautions, intolerance, and difficulty generating a measurable response in more severely affected individuals. We were interested in evaluating the effect of ePAS using more feasible measures in people with stroke. This study asks whether ePAS produces immediate improvements in the primary outcomes of maximal voluntary isometric contraction (MVIC) and total neuromuscular fatigue of the dorsiflexor muscles, and in the secondary outcomes of muscle power, voluntary activation (VA), central fatigue, peripheral fatigue, and electromyography activity. Method In this repeated-measures cross-over study, 15 participants with chronic stroke completed two interventions, ePAS and sham, in a randomized order. During ePAS, 50 repetitions of visually cued dorsiflexion were completed, while single pulses of electrical stimulation were delivered to the deep branch of the common peroneal nerve. Each somatosensory volley was timed to arrive in the primary motor cortex at the peak negativity of the MRCP. Univariate and multivariate linear mixed models were used to analyze the primary and secondary data, respectively. Results There was a statistically significant increase in dorsiflexor MVIC immediately following the ePAS intervention (mean increase 7 N), compared to the sham intervention (mean change 0 N) (univariate between-condition analysis p = 0.047). The multivariate analysis revealed a statistically significant effect of ePAS on VA of the tibialis anterior muscle, such that ePAS increased VA by 7 percentage units (95% confidence interval 1.3–12.7%). There was no statistically significant effect on total neuromuscular fatigue, muscle power, or other secondary measures. Conclusion A single session of ePAS can significantly increase isometric muscle strength and VA in people with chronic stroke. The findings confirm that ePAS has a central neuromodulatory mechanism and support further exploration of its potential as an adjunct to stroke rehabilitation. In addition, the findings offer alternative, feasible outcome measures for future research. Clinical trial registration Australia New Zealand Clinical Trials Registry ACTRN12617000838314 (www.anzctr.org.au), Universal Trial Number U111111953714.
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Affiliation(s)
- Sharon Olsen
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Nada Signal
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Imran K Niazi
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand.,Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland, New Zealand.,Center for Sensory-Motor Interaction, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Usman Rashid
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Gemma Alder
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Grant Mawston
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Rasmus B Nedergaard
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Mads Jochumsen
- Center for Sensory-Motor Interaction, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Denise Taylor
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
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18
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Ha SY, Sung YH. Effects of Fresnel prism glasses on balance and gait in stroke patients with hemiplegia: A randomized controlled trial pilot study. Technol Health Care 2020; 28:625-633. [PMID: 32280072 DOI: 10.3233/thc-191973] [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: 11/15/2022]
Abstract
BACKGROUND Fresnel prism shifts the field of view and converts object position in space, but its effect on stroke patients without unilateral neglect has not been examined. OBJECTIVE We aimed to investigate the effect of Fresnel prism glasses on balance and gait in stroke patients with hemiplegia. METHODS This study included 17 stroke patients with hemiplegia without unilateral neglect. Balance and gait training were applied in the control group (n= 9), and Fresnel prism glasses were applied with balance and gait training in the experimental group (n= 8). In all groups, interventions were done for 30 min/day for 5 times/week for 4 weeks. Motor-free visual perception test for visual perception (MVPT), Berg Balance Scale (BBS), and functional reach test (FRT) for dynamic balance ability, and gait were performed. Measurements were done before and after interventions. RESULTS MVPT showed no significant difference between the groups (p> 0.05). A significant increase in BBS and FRT results was found before and after interventions in the experimental group (p< 0.05). Gait variables showed significant difference in the experimental group (p< 0.05). CONCLUSION Fresnel prism glasses may effectively improve dynamic balance and gait functions by shifting body weight to the affected side of stroke patients with hemiplegia without vision loss.
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Affiliation(s)
- Sun-Young Ha
- Department of Physical Therapy, Graduate School, Kyungnam University, Korea
| | - Yun-Hee Sung
- Department of Physical Therapy, Graduate School, Kyungnam University, Korea.,Department of Physical Therapy, College of Health Sciences, Kyungnam University, Korea
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19
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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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20
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Murphy S, Durand M, Negro F, Farina D, Hunter S, Schmit B, Gutterman D, Hyngstrom A. The Relationship Between Blood Flow and Motor Unit Firing Rates in Response to Fatiguing Exercise Post-stroke. Front Physiol 2019; 10:545. [PMID: 31133877 PMCID: PMC6524339 DOI: 10.3389/fphys.2019.00545] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 04/17/2019] [Indexed: 11/22/2022] Open
Abstract
We quantified the relationship between the change in post-contraction blood flow with motor unit firing rates and metrics of fatigue during intermittent, sub-maximal fatiguing contractions of the knee extensor muscles after stroke. Ten chronic stroke survivors (>1-year post-stroke) and nine controls participated. Throughout fatiguing contractions, the discharge timings of individual motor units were identified by decomposition of high-density surface EMG signals. After five consecutive contractions, a blood flow measurement through the femoral artery was obtained using an ultrasound machine and probe designed for vascular measurements. There was a greater increase of motor unit firing rates from the beginning of the fatigue protocol to the end of the fatigue protocol for the control group compared to the stroke group (14.97 ± 3.78% vs. 1.99 ± 11.90%, p = 0.023). While blood flow increased with fatigue for both groups (p = 0.003), the magnitude of post-contraction blood flow was significantly greater for the control group compared to the stroke group (p = 0.004). We found that despite the lower magnitude of muscle perfusion through the femoral artery in the stroke group, blood flow has a greater impact on peripheral fatigue for the control group; however, we observed a significant correlation between change in blood flow and motor unit firing rate modulation (r2 = 0.654, p = 0.004) during fatigue in the stroke group and not the control group (r2 = 0.024, p < 0.768). Taken together, this data showed a disruption between motor unit firing rates and post-contraction blood flow in the stroke group, suggesting that there may be a disruption to common inputs to both the reticular system and the corticospinal tract. This study provides novel insights in the relationship between the hyperemic response to exercise and motor unit firing behavior for post-stroke force production and may provide new approaches for recovery by improving both blood flow and muscle activation simultaneously.
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Affiliation(s)
- Spencer Murphy
- Integrative Neural Engineering and Rehabilitation Laboratory, Department of Biomedical Engineering, Marquette University, Milwaukee, WI, United States
| | - Matthew Durand
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Francesco Negro
- Department of Clinical and Experimental Sciences, Università degli studi di Brescia, Brescia, Italy
| | - Dario Farina
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Sandra Hunter
- Department of Physical Therapy, Marquette University, Milwaukee, WI, United States
| | - Brian Schmit
- Integrative Neural Engineering and Rehabilitation Laboratory, Department of Biomedical Engineering, Marquette University, Milwaukee, WI, United States
| | - David Gutterman
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Allison Hyngstrom
- Integrative Neural Engineering and Rehabilitation Laboratory, Department of Biomedical Engineering, Marquette University, Milwaukee, WI, United States.,Department of Physical Therapy, Marquette University, Milwaukee, WI, United States
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21
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Lewek MD, Raiti C, Doty A. The Presence of a Paretic Propulsion Reserve During Gait in Individuals Following Stroke. Neurorehabil Neural Repair 2019; 32:1011-1019. [PMID: 30558525 DOI: 10.1177/1545968318809920] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The residual hemiparesis after stroke results in a unilateral reduction in propulsive force during gait. Prior work has suggested the presence of a propulsive reserve in the paretic limb. OBJECTIVE The purpose of this study was to quantify the paretic propulsive reserve in individuals poststroke and to determine the biomechanical mechanism underlying the generation of additional paretic propulsive limb force. METHODS Ten individuals with chronic hemiparesis poststroke walked on a treadmill against an impeding force (ascending 0% to 10% body weight [BW], in 2.5% BW increments, followed by descending 10% to 0% BW, also in 2.5% BW increments) applied to the body's center of mass. The resulting propulsive forces were measured bilaterally and compared between impeding force levels. We then assessed potential mechanisms (trailing limb angle and plantarflexion moment) underlying the changes in propulsion. RESULTS Overall, peak paretic propulsive force increased by 92% and the paretic propulsive impulse increased by 225%, resulting in a significant increase in the paretic limb's contribution to propulsion. Participants continued to produce increased paretic propulsion on removal of the impeding force. The trailing limb angle contributed significantly to the increase in paretic propulsion, whereas the plantarflexion moment did not. CONCLUSIONS Participants exhibited a robust propulsive reserve on the paretic limb, suggesting that there is untapped potential that can be exploited through rehabilitation to improve gait recovery. The increase in propulsive symmetry indicates that a greater response was observed by the paretic limb rather than increased compensation by the nonparetic limb.
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Affiliation(s)
- Michael D Lewek
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Cristina Raiti
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Amanda Doty
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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22
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The effects of proprioceptive neuromuscular facilitation lower-leg taping and treadmill training on mobility in patients with stroke. Int J Rehabil Res 2019; 41:343-348. [PMID: 30067555 DOI: 10.1097/mrr.0000000000000309] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The elastic-taping method of the proprioceptive neuromuscular facilitation (PNF) concept is nonexistent. Therefore, our study aimed to investigate the effect of treadmill training (TT) using PNF lower-leg taping (PNFLT) on walking and balance ability in patients with stroke. There were a total of 27 patients: a stroke allocated control group (n=13) and an experimental group (n=14). The control group performed the TT and the experimental group performed the TT using PNF taping five times a week for 6 weeks. Walking and balance ability were measured using the 6-min walk test (6MWT), the 10-m walking test (10MWT), and the timed up and go test (TUG). Before and after the intervention, a paired t-test was performed to compare different within-group differences. Independent t-tests were performed to compare different between-group differences. All statistical significance levels were set at α of 0.05. After intervention, 6MWT, 10MWT and TUG improved significantly in PNFLT-TT and TT group (P<0.01). After intervention, the PNFLT-TT group showed more effective changes that the TT group in 6MWT, 10MWT, and TUG (P<0.05 and <0.01) between PNFLT-TT and TT group. The intervention of PNFLT-TT was effective in improving walking and balance ability in patients with stroke. Basic elastic tape for the PNF concept and TT may be useful interventions as a program to improve walking and balance ability in patients with stroke.
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23
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de Sousa DG, Harvey LA, Dorsch S, Glinsky JV. Interventions involving repetitive practice improve strength after stroke: a systematic review. J Physiother 2018; 64:210-221. [PMID: 30245180 DOI: 10.1016/j.jphys.2018.08.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 07/31/2018] [Accepted: 08/09/2018] [Indexed: 12/29/2022] Open
Abstract
QUESTIONS Do interventions involving repetitive practice improve strength after stroke? Are any improvements in strength accompanied by improvements in activity? DESIGN Systematic review of randomised trials with meta-analysis. PARTICIPANTS Adults who have had a stroke. INTERVENTION Any intervention involving repetitive practice compared with no intervention or a sham intervention. OUTCOME MEASURES The primary outcome was voluntary strength in muscles trained as part of the intervention. The secondary outcomes were measures of lower limb and upper limb activity. RESULTS Fifty-two studies were included. The overall SMD of repetitive practice on strength was examined by pooling post-intervention scores from 46 studies involving 1928 participants. The SMD of repetitive practice on strength when the upper and lower limb studies were combined was 0.25 (95% CI 0.16 to 0.34, I2=44%) in favour of repetitive practice. Twenty-four studies with a total of 912 participants investigated the effects of repetitive practice on upper limb activity after stroke. The SMD was 0.15 (95% CI 0.02 to 0.29, I2=50%) in favour of repetitive practice on upper limb activity. Twenty studies with a total of 952 participants investigated the effects of repetitive practice on lower limb activity after stroke. The SMD was 0.25 (95% CI 0.12 to 0.38, I2=36%) in favour of repetitive practice on lower limb activity. CONCLUSION Interventions involving repetitive practice improve strength after stroke, and these improvements are accompanied by improvements in activity. REVIEW REGISTRATION PROSPERO CRD42017068658. [de Sousa DG, Harvey LA, Dorsch S, Glinsky JV (2018) Interventions involving repetitive practice improve strength after stroke: a systematic review. Journal of Physiotherapy 64: 210-221].
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Affiliation(s)
- Davide G de Sousa
- Graythwaite Rehabilitation Centre, Ryde Hospital; John Walsh Centre for Rehabilitation Research, Kolling Institute; Sydney Medical School Northern, University of Sydney
| | - Lisa A Harvey
- John Walsh Centre for Rehabilitation Research, Kolling Institute; Sydney Medical School Northern, University of Sydney
| | - Simone Dorsch
- Faculty of Health Sciences, Australian Catholic University, Sydney, Australia
| | - Joanne V Glinsky
- John Walsh Centre for Rehabilitation Research, Kolling Institute; Sydney Medical School Northern, University of Sydney
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Dorsch S, Ada L, Alloggia D. Progressive resistance training increases strength after stroke but this may not carry over to activity: a systematic review. J Physiother 2018; 64:84-90. [PMID: 29602748 DOI: 10.1016/j.jphys.2018.02.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 12/18/2017] [Accepted: 02/07/2018] [Indexed: 10/17/2022] Open
Abstract
QUESTION Does progressive resistance training improve strength and activity after stroke? Does any increase in strength carry over to activity? DESIGN Systematic review of randomised trials with meta-analysis. PARTICIPANTS Adults who have had a stroke. INTERVENTION Progressive resistance training compared with no intervention or placebo. OUTCOME MEASURES The primary outcome was change in strength. This measurement had to be of maximum voluntary force production and performed in muscles congruent with the muscles trained in the intervention. The secondary outcome was change in activity. This measurement had to be a direct measure of performance that produced continuous or ordinal data, or with scales that produced ordinal data. RESULTS Eleven studies involving 370 participants were included in this systematic review. The overall effect of progressive resistance training on strength was examined by pooling change scores from six studies with a mean PEDro score of 5.8, representing medium quality. The effect size of progressive resistance training on strength was 0.98 (95% CI 0.67 to 1.29, I2=0%). The overall effect of progressive resistance training on activity was examined by pooling change scores from the same six studies. The effect size of progressive resistance training on activity was 0.42 (95% CI -0.08 to 0.91, I2=54%). CONCLUSION After stroke, progressive resistance training has a large effect on strength compared with no intervention or placebo. There is uncertainty about whether these large increases in strength carry over to improvements in activity. REVIEW REGISTRATION PROSPERO CRD42015025401. [Dorsch S, Ada L, Alloggia D (2018) Progressive resistance training increases strength after stroke but this may not carry over to activity: a systematic review. Journal of Physiotherapy 64: 84-90].
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Affiliation(s)
- Simone Dorsch
- Faculty of Health Sciences, Australian Catholic University; Physiotherapy Department, Bankstown-Lidcombe Hospital
| | - Louise Ada
- Faculty of Health Sciences, The University of Sydney, Sydney, Australia
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Jeon HJ, Hwang BY. Effect of bilateral lower limb strengthening exercise on balance and walking in hemiparetic patients after stroke: a randomized controlled trial. J Phys Ther Sci 2018; 30:277-281. [PMID: 29545693 PMCID: PMC5851362 DOI: 10.1589/jpts.30.277] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 11/16/2017] [Indexed: 11/24/2022] Open
Abstract
[Purpose] To evaluate the effect of bilateral lower limb strengthening designed to
improve balance and walking in stroke patients. [Subjects and Methods] Twenty hemiparetic
stroke patients were divided into two groups: a unilateral therapy group (UTG) (n=10) and
a bilateral therapy group (BTG) (n=10). The UTG completed strength training only in the
paretic lower limb. The BTG completed strength training in the paretic and non-paretic
lower limbs. Assessment tools included the functional reach test (FRT), the Berg balance
scale (BBS), the timed up and go (TUG) test, and a 10-meter walk test (10MWT). [Results]
In both groups, the lower limb strengthening exercise for balance and walking
significantly improved the FRT, BBS, TUG, and 10MWT scores. Compared with UTG, the BTG
attained significantly improved FRT and BBS scores. [Conclusion] Bilateral therapy using
this lower limb strengthening exercise effectively promotes balance in hemiparetic stroke
patients.
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Affiliation(s)
- Hye Joo Jeon
- Department of Physical Therapy, Adult Rehabilitation Center, Bobath Memorial Hospital, Republic of Korea
| | - Byong Yong Hwang
- Department of Physical Therapy, College of Public Health and Welfare, Yong In University: 134 Yongindaehak-ro, Cheoin-gu, Yongin-si, Gyeonggi-do 449-714, Republic of Korea
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GROSPRÊTRE SIDNEY, GUEUGNEAU NICOLAS, MARTIN ALAIN, LEPERS ROMUALD. Central Contribution to Electrically Induced Fatigue depends on Stimulation Frequency. Med Sci Sports Exerc 2017; 49:1530-1540. [DOI: 10.1249/mss.0000000000001270] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Choi YK, Kim K, Choi JU. Effects of stair task training on walking ability in stroke patients. J Phys Ther Sci 2017; 29:235-237. [PMID: 28265147 PMCID: PMC5332978 DOI: 10.1589/jpts.29.235] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 11/02/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The aim of this study was to determine the effect of stair task training on
gait abilities by conducting stair task training. In this training, step training is
applied in various directions with hemiplegia patients. [Subjects and Methods] Thirty-six
patients with stroke were selected on the basis of inclusion and exclusion criteria, and
they were randomly divided into eighteen patients in the experimental group and eighteen
patients in the control group via draw. [Results] In this study, the Dartfish program was
used to measure gait capabilities. Experiment group showed a statistically significant
improvement in the swing phase time of the affected lower extremity compared to control
group. [Conclusion] It was found that the stair task training group had effective results
in the swing phase time of the affected lower extremity compared with the group that
applied weight support on the affected lower extremity and balance training.
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Affiliation(s)
- Yong-Kyu Choi
- Department of Physical Therapy, Graduate School of Physical Therapy, Daegu Universityo, Republic of Korea
| | - Kyoung Kim
- Department of Physical Therapy, Graduate School of Physical Therapy, Daegu Universityo, Republic of Korea
| | - Jin-Uk Choi
- Department of Physical Therapy, College of Rehabilitation Science, Daegu University, Republic of Korea
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Yoon SK, Kang SH. Effects of inclined treadmill walking training with rhythmic auditory stimulation on balance and gait in stroke patients. J Phys Ther Sci 2016; 28:3367-3370. [PMID: 28174453 PMCID: PMC5276762 DOI: 10.1589/jpts.28.3367] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 08/11/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to determine if an inclined treadmill with rhythmic auditory stimulation gait training can improve balance and gait ability in stroke patients. [Subjects and Methods] Thirty participants were randomly divided into three groups: inclined treadmill with rhythmic auditory stimulation training group (n=10), inclined treadmill training group (n=10), and treadmill training group (n=10). For all groups, the training was conducted for 4 weeks, 30 minutes per session, 5 times per week. Two subjects dropped out before study completion. [Results] All variables of balance and gait, except for the timed up and go test in the treadmill group, significantly improved in all groups. Moreover, all variables showed a more significant improvement in the inclined treadmill with rhythmic auditory stimulation group when compared with the other groups. Timed up and go test, Berg balance scale, 6 m walking test, walking speed, and symmetric index were significantly improved in the inclined treadmill group when compared with the treadmill group. [Conclusion] Thus, for stroke patients receiving gait training, inclined treadmill with rhythmic auditory stimulation training was more effective in maintaining balance and gait than inclined treadmill without rhythmic auditory stimulation or only treadmill training.
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Affiliation(s)
- Sung Kyeung Yoon
- Department of Physical Therapy, Korea National University of Transportation, Republic of Korea
| | - Soon Hee Kang
- Department of Physical Therapy, Korea National University of Transportation, Republic of Korea
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Park YH, Lee JH. Effects of proprioceptive sense-based Kinesio taping on walking imbalance. J Phys Ther Sci 2016; 28:3060-3062. [PMID: 27942119 PMCID: PMC5140799 DOI: 10.1589/jpts.28.3060] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 07/19/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The aim of this study was to determine how application of Kinesio tape to the
upper and lower limbs affects walking through stimulation of the proprioceptive sense.
[Subjects and Methods] Twelve patients diagnosed with hemiplegia due to stroke were
selected as the subjects of the study. To ascertain the effects of Kinesio taping on
walking, all subjects performed a straight line walking test three times while barefoot.
In terms of the actual taping application, elastic Kinesio tape was used on the hemiplegic
side in all subjects. [Results] The results of testing showed a significant difference in
the values between before and after taping. In terms of left and right deviation according
to the site of the taping application, there were statistically significant differences
among the groups. [Conclusion] In conclusion, application of Kinesio taping for central
nerve injury was confirmed to be effective in reducing walking deviation.
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Affiliation(s)
- Young-Han Park
- Department of Physical Therapy, Korea National University of Transportation, Republic of Korea
| | - Jung-Ho Lee
- Department of Physical Therapy, Kyungdong University, Republic of Korea
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Aquatic Therapy Improves Outcomes for Subacute Stroke Patients by Enhancing Muscular Strength of Paretic Lower Limbs Without Increasing Spasticity. Am J Phys Med Rehabil 2016; 95:840-849. [DOI: 10.1097/phm.0000000000000512] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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de Sousa DG, Harvey LA, Dorsch S, Leung J, Harris W. Functional electrical stimulation cycling does not improve mobility in people with acquired brain injury and its effects on strength are unclear: a randomised trial. J Physiother 2016; 62:203-8. [PMID: 27637770 DOI: 10.1016/j.jphys.2016.08.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 07/26/2016] [Accepted: 08/05/2016] [Indexed: 10/21/2022] Open
Abstract
QUESTION Does 4 weeks of active functional electrical stimulation (FES) cycling in addition to usual care improve mobility and strength more than usual care alone in people with a sub-acute acquired brain injury caused by stroke or trauma? DESIGN Multi centre, randomised, controlled trial. PARTICIPANTS Forty patients from three Sydney hospitals with recently acquired brain injury and a mean composite strength score in the affected lower limb of 7 (SD 5) out of 20 points. INTERVENTION Participants in the experimental group received an incremental, progressive, FES cycling program five times a week over a 4-week period. All participants received usual care. OUTCOME MEASURES Outcome measures were taken at baseline and at 4 weeks. Primary outcomes were mobility and strength of the knee extensors of the affected lower limb. Mobility was measured with three mobility items of the Functional Independence Measure and strength was measured with a hand-held dynamometer. Secondary outcomes were strength of the knee extensors of the unaffected lower limb, strength of key muscles of the affected lower limb and spasticity of the affected plantar flexors. RESULTS All but one participant completed the study. The mean between-group differences for mobility and strength of the knee extensors of the affected lower limb were -0.3/21 points (95% CI -3.2 to 2.7) and 7.5 Nm (95% CI -5.1 to 20.2), where positive values favoured the experimental group. The only secondary outcome that suggested a possible treatment effect was strength of key muscles of the affected lower limb with a mean between-group difference of 3.0/20 points (95% CI 1.3 to 4.8). CONCLUSION Functional electrical stimulation cycling does not improve mobility in people with acquired brain injury and its effects on strength are unclear. TRIAL REGISTRATION ACTRN12612001163897. [de Sousa DG, Harvey LA, Dorsch S, Leung J, Harris W (2016) Functional electrical stimulation cycling does not improve mobility in people with acquired brain injury and its effects on strength are unclear: a randomised controlled trial.Journal of Physiotherapy62: 203-208].
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Affiliation(s)
- Davide G de Sousa
- Graythwaite Rehabilitation Centre, Ryde Hospital; John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District; Sydney Medical School Northern, University of Sydney
| | - Lisa A Harvey
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District; Sydney Medical School Northern, University of Sydney
| | - Simone Dorsch
- School of Physiotherapy, Australian Catholic University
| | | | - Whitney Harris
- Prince of Wales Hospital, South Eastern Sydney Local Health District, Sydney, Australia
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Dunn A, Marsden DL, Van Vliet P, Spratt NJ, Callister R. Independently ambulant, community-dwelling stroke survivors have reduced cardiorespiratory fitness, mobility and knee strength compared to an age- and gender-matched cohort. Top Stroke Rehabil 2016; 24:163-169. [PMID: 27670905 DOI: 10.1080/10749357.2016.1236482] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Most exercise interventions for stroke survivors are designed for those who have substantial motor and functional disabilities. There remains a group of well-recovered stroke survivors who have yet to be investigated in terms of their physical capacity and fitness levels. OBJECTIVE To assess and compare the physical capacities of independently ambulant, community-dwelling stroke survivors to age- and gender-matched comparison participants. METHODS Data were obtained from 17 stroke survivors participating in the How FITSS? Trial, all with functional ambulatory category of ≥4 and a self-selected walking speed ≥0.8 m s-1. An additional 17 healthy control participants were recruited. Cardiorespiratory fitness (CRF) was measured using oxygen consumption (VO2peak), and additional measures of walking speed (m s-1), leg strength and body composition were also assessed. Differences between groups were assessed by matched pairs t-tests. Effect sizes were calculated using Cohen's d. RESULTS There were no significant differences in age, BMI, muscle mass or body fat between groups (p > 0.05). Peak VO2 was lower in the stroke group for the shuttle walk test (p = 0.037) and progressive cycle test (p = 0.019), as were all CRF test performance measures (p < 0.05). Stroke survivors walked significantly (p < 0.001) slower at both self-selected and fast speeds. Effect sizes of group differences for all leg strength variables were medium to large, with peak torque lower in the stroke group for all trials. CONCLUSIONS Despite being independently ambulant and community dwelling, the CRF, walking speed and leg strength of this group were reduced compared to non-stroke comparison participants. These patients may benefit from undertaking targeted exercise programmes.
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Affiliation(s)
- Ashlee Dunn
- a Priority Research Centre for Physical Activity and Nutrition , University of Newcastle , Callaghan , New South Wales, Australia.,b Hunter Medical Research Institute , New Lambton Heights , New South Wales, Australia
| | - Dianne L Marsden
- a Priority Research Centre for Physical Activity and Nutrition , University of Newcastle , Callaghan , New South Wales, Australia.,b Hunter Medical Research Institute , New Lambton Heights , New South Wales, Australia.,c Hunter New England Local Health District , New Lambton Heights , New South Wales, Australia
| | - Paulette Van Vliet
- a Priority Research Centre for Physical Activity and Nutrition , University of Newcastle , Callaghan , New South Wales, Australia.,b Hunter Medical Research Institute , New Lambton Heights , New South Wales, Australia
| | - Neil J Spratt
- a Priority Research Centre for Physical Activity and Nutrition , University of Newcastle , Callaghan , New South Wales, Australia.,b Hunter Medical Research Institute , New Lambton Heights , New South Wales, Australia.,c Hunter New England Local Health District , New Lambton Heights , New South Wales, Australia
| | - Robin Callister
- a Priority Research Centre for Physical Activity and Nutrition , University of Newcastle , Callaghan , New South Wales, Australia.,b Hunter Medical Research Institute , New Lambton Heights , New South Wales, Australia
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Gabel CP, Rando N, Melloh M. Slacklining and stroke: A rehabilitation case study considering balance and lower limb weakness. World J Orthop 2016; 7:513-518. [PMID: 27622153 PMCID: PMC4990774 DOI: 10.5312/wjo.v7.i8.513] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 04/05/2016] [Accepted: 06/16/2016] [Indexed: 02/06/2023] Open
Abstract
To ascertain the effectiveness of slacklining as a supplementary therapy for elderly stroke patients who are functionally non-progressing. This case study involved an 18-mo prospective observation of the management of an 87-year-old female stroke-patient of the left hemisphere with reduced balance, reduced lower limb muscular activation, hypertonia, and concurrent postural deficits. This entailed the initial acute care phase through to discharge to home and 18-mo final status in her original independent living setting. The introduction of slacklining as an adjunct therapy was made 12 mo post incident. Slacklining involves balance retention on a tightened band where external environmental changes cause a whole-body dynamic response to retain equilibrium. It is a complex neuromechanical task enabling individualized self-developed response strategies to be learned and adapted. This facilitates the innate process of balance retention, lower-limb and core muscle activation, and stable posture through a combination of learned motor skills and neurological system down regulation. Individuals adopt and follow established sequential motor learning stages where the acquired balance skills are achieved in a challenging composite-chain activity. Slacklining could be considered an adjunct therapy for lower limb stroke rehabilitation where function is compromised due to decreased muscle recruitment, decreased postural control and compromised balance. Initial inpatient rehabilitation involved one-month acute-care, one-month rehabilitation, and one-month transitional care prior to home discharge. A further six months of intensive outpatient rehabilitation was provided with five hourly sessions per week including:supervised and self-managed hydrotherapy, plus one individual and two group falls’ prevention sessions. These were supported by daily home exercises. At 12 mo post incident, recovery plateaued, then regressed following three falls. Rehabilitation was subsequently modified with the hydrotherapy retained and the group sessions replaced with an additional individual session supplemented with slacklining. The slacklining followed stages one and two of a standardized five-stage protocol. Self-reported functional progression resumed with improvement by 14 mo which further increased and was sustained 18 mo (Students’t test P < 0.05). Slacklining’s external stimulations activate global-body responses through innate balance, optimal postural and potentially down-regulated reflex control. Incorporated into stroke rehabilitation programs, slacklining can provide measurable functional gains.
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Dias CP, Lanferdini FJ, Onzi EDS, Goulart NBA, Becker J, Gomes I, Vaz MA. The influence of hemiparesis on triceps surae morphological and mechanical properties in stroke survivors. ISOKINET EXERC SCI 2016. [DOI: 10.3233/ies-160613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Caroline Pieta Dias
- Exercise Research Laboratory, School of Physical Education, Physical Therapy and Dance, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- School of Physical Education, Faculty of Serra Gaúcha, Caxias do Sul, Brazil
| | - Fábio Juner Lanferdini
- Exercise Research Laboratory, School of Physical Education, Physical Therapy and Dance, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Eduardo dos Santos Onzi
- Exercise Research Laboratory, School of Physical Education, Physical Therapy and Dance, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Natalia Batista Albuquerque Goulart
- Exercise Research Laboratory, School of Physical Education, Physical Therapy and Dance, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Jefferson Becker
- Neurology Service, São Lucas Hospital, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Irênio Gomes
- Biomedical Gerontology and Neurology Department, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Marco Aurélio Vaz
- Exercise Research Laboratory, School of Physical Education, Physical Therapy and Dance, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Choi YK, Park YH, Lee JH. Effects of Kinesio taping and Mcconnell taping on balance and walking speed of hemiplegia patients. J Phys Ther Sci 2016; 28:1166-9. [PMID: 27190448 PMCID: PMC4868208 DOI: 10.1589/jpts.28.1166] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 12/23/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The aim of this study was to evaluate the overlap effect of the PNF following the application of Kinesio taping and the McConnell taping, and also the impact of the taping application method on the balance and walking speed of the patients with stroke. [Subjects and Methods] Thirty-six patients who were diagnosed with hemiplegia due to stroke were selected as subjects of this study. They were randomly and evenly divided into experiment group 1 (Kinesio taping group), experiment group 2 (McConnell taping group), and the control group; each group had 12 patients. [Results] The Berg balance scale (BBS) was used to evaluate balance, and the ability in this study. A 10 m walking test (10MWT) was performed to measure the walking speed. Experiment group 1 showed a statistically significant improvement in balance and walking speed compared to experiment group 2, and the control group in week 4 and week 8. [Conclusion] Application of Kinesio taping had a more beneficial effect on the balance and walking speed than joint-fixation taping of the patients with stroke.
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Affiliation(s)
- Yong-Kyu Choi
- Department of Physical Therapy, Graduate School of Physical Therapy, Daegu University, Republic of Korea
| | - Young-Han Park
- Department of Physical Therapy, Korea National University of Transportation, Republic of Korea
| | - Jung-Ho Lee
- Department of Physical Therapy, KyungdongUniversity, Republic of Korea
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Dorsch S, Ada L, Canning CG. Lower Limb Strength Is Significantly Impaired in All Muscle Groups in Ambulatory People With Chronic Stroke: A Cross-Sectional Study. Arch Phys Med Rehabil 2016; 97:522-527. [DOI: 10.1016/j.apmr.2015.10.106] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 07/31/2015] [Accepted: 10/28/2015] [Indexed: 11/26/2022]
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Saunders DH, Sanderson M, Hayes S, Kilrane M, Greig CA, Brazzelli M, Mead GE. Physical fitness training for stroke patients. Cochrane Database Syst Rev 2016; 3:CD003316. [PMID: 27010219 PMCID: PMC6464717 DOI: 10.1002/14651858.cd003316.pub6] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Levels of physical fitness are low after stroke. It is unknown whether improving physical fitness after stroke reduces disability. OBJECTIVES To determine whether fitness training after stroke reduces death, dependence, and disability and to assess the effects of training with regard to adverse events, risk factors, physical fitness, mobility, physical function, quality of life, mood, and cognitive function. Interventions to improve cognitive function have attracted increased attention after being identified as the highest rated research priority for life after stroke. Therefore we have added this class of outcomes to this updated review. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (last searched February 2015), the Cochrane Central Register of Controlled Trials (CENTRAL 2015, Issue 1: searched February 2015), MEDLINE (1966 to February 2015), EMBASE (1980 to February 2015), CINAHL (1982 to February 2015), SPORTDiscus (1949 to February 2015), and five additional databases (February 2015). We also searched ongoing trials registers, handsearched relevant journals 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 trials, assessed quality and risk of bias, and extracted data. We analysed data using random-effects meta-analyses. Diverse outcome measures limited the intended analyses. MAIN RESULTS We included 58 trials, involving 2797 participants, which comprised cardiorespiratory interventions (28 trials, 1408 participants), resistance interventions (13 trials, 432 participants), and mixed training interventions (17 trials, 957 participants). Thirteen deaths occurred before the end of the intervention and a further nine before the end of follow-up. No dependence data were reported. Diverse outcome measures restricted pooling of data. Global indices of disability show moderate improvement after cardiorespiratory training (standardised mean difference (SMD) 0.52, 95% confidence interval (CI) 0.19 to 0.84; P value = 0.002) and by a small amount after mixed training (SMD 0.26, 95% CI 0.04 to 0.49; P value = 0.02); benefits at follow-up (i.e. after training had stopped) were unclear. There were too few data to assess the effects of resistance training.Cardiorespiratory training involving walking improved maximum walking speed (mean difference (MD) 6.71 metres per minute, 95% CI 2.73 to 10.69), preferred gait speed (MD 4.28 metres per minute, 95% CI 1.71 to 6.84), and walking capacity (MD 30.29 metres in six minutes, 95% CI 16.19 to 44.39) at the end of the intervention. Mixed training, involving walking, increased preferred walking speed (MD 4.54 metres per minute, 95% CI 0.95 to 8.14), and walking capacity (MD 41.60 metres per six minutes, 95% CI 25.25 to 57.95). Balance scores improved slightly after mixed training (SMD 0.27, 95% CI 0.07 to 0.47). Some mobility benefits also persisted at the end of follow-up. The variability, quality of the included trials, and lack of data prevents conclusions about other outcomes and limits generalisability of the observed results. AUTHORS' CONCLUSIONS 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 the speed and tolerance of walking; some improvement in balance could also occur. There is insufficient evidence to support the use of resistance training. The effects of training on death and dependence after stroke are still unclear but these outcomes are rarely observed in physical fitness training trials. 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 and identify long-term benefits.
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Affiliation(s)
- David H Saunders
- Institute for Sport, Physical Education and Health Sciences (SPEHS), University of EdinburghMoray House School of EducationSt Leonards LandHolyrood RoadEdinburghUKEH8 2AZ
| | - Mark Sanderson
- University of the West of ScotlandInstitute of Clinical Exercise and Health ScienceRoom A071A, Almada BuildingHamiltonUKML3 0JB
| | - Sara Hayes
- University of LimerickDepartment of Clinical TherapiesLimerickIreland
| | - Maeve Kilrane
- Royal Infirmary of EdinburghDepartment of Stroke MedicineWard 201 ‐ Stroke UnitLittle FranceEdinburghUKEH16 4SA
| | - Carolyn A Greig
- University of BirminghamSchool of Sport, Exercise and Rehabilitation Sciences, MRC‐ARUK Centre for Musculoskeletal Ageing ResearchEdgbastonBirminghamUKB15 2TT
| | - 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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Hoffmann G, Conrad MO, Qiu D, Kamper DG. Contributions of voluntary activation deficits to hand weakness after stroke. Top Stroke Rehabil 2016; 23:384-392. [PMID: 26427599 DOI: 10.1179/1945511915y.0000000023] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Hemiparetic stroke survivors often exhibit profound weakness in the digits of the paretic hand, but the relative contribution of potential biomechanical and neurological impairment mechanisms is not known. Establishing sources of impairment would help in guiding treatment. OBJECTIVE The present study sought to quantify the role of diminished capacity to voluntarily active finger flexor and extensor muscles as one possible neurological mechanism. METHODS Two groups of stroke survivors with "severe" (N = 9) or "moderate" (N = 9) hand impairment and one group of neurologically intact individuals (N = 9) participated. Subjects were asked to create isometric flexion force and extension force, respectively, with the tip of the middle finger. The maximum voluntary force (MVF) and the maximum stimulated force (MSF) produced by an applied train of electrical current pulses (MSF) were recorded for flexion and extension. Percent voluntary activation (PVA) was computed from MVF and MSF. RESULTS Significant deficits in both MVF and PVA were observed for stroke subjects compared to control subjects. For example, activation deficits were >80% for extensor digitorum communis (EDC) for the "severe" group. Maximum voluntary force and PVA deficits were greater for EDC than for flexor digitorum superficialis (FDS) for stroke subjects with severe impairment. Maximum voluntary force and PVA correlated significantly for stroke subjects but not for control subjects. CONCLUSIONS Although extrinsic finger muscles could be successfully recruited electrically, voluntary excitation of these muscles was substantially limited in stroke survivors. Thus, finger weakness after stroke results predominantly from the inability to fully activate the muscle voluntarily.
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Affiliation(s)
- Gilles Hoffmann
- a Sensory Motor Performance Program , Rehabilitation Institute of Chicago , IL , USA
| | - Megan O Conrad
- a Sensory Motor Performance Program , Rehabilitation Institute of Chicago , IL , USA
| | - Dan Qiu
- b Illinois Institute of Technology , Biomedical Engineering , Chicago , IL , USA
| | - Derek G Kamper
- a Sensory Motor Performance Program , Rehabilitation Institute of Chicago , IL , USA.,b Illinois Institute of Technology , Biomedical Engineering , Chicago , IL , USA
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Effects of Vibration Intensity, Exercise, and Motor Impairment on Leg Muscle Activity Induced by Whole-Body Vibration in People With Stroke. Phys Ther 2015; 95:1617-27. [PMID: 26023219 DOI: 10.2522/ptj.20140507] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 05/20/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Whole-body vibration (WBV) has increasingly been used as an adjunct treatment in neurological rehabilitation. However, how muscle activation level changes during exposure to different WBV protocols in individuals after stroke remains understudied. OBJECTIVE The purpose of this study was to examine the influence of WBV intensity on the magnitude of biceps femoris (BF) and tibialis anterior (TA) muscle activity and its interaction with exercise and with severity of motor impairment and spasticity among individuals with chronic stroke. METHODS Each of the 36 individuals with chronic stroke (mean age=57.3 years, SD=10.7) performed 8 different static exercises under 3 WBV conditions: (1) no WBV, (2) low-intensity WBV (frequency=20 Hz, amplitude=0.60 mm, peak acceleration=0.96g), and (3) high-intensity WBV (30 Hz, 0.44 mm, 1.61g). The levels of bilateral TA and BF muscle activity were recorded using surface electromyography (EMG). RESULTS The main effect of intensity was significant. Exposure to the low-intensity and high-intensity protocols led to a significantly greater increase in normalized BF and TA muscle electromyographic magnitude in both legs compared with no WBV. The intensity × exercise interaction also was significant, suggesting that the WBV-induced increase in EMG activity was exercise dependent. The EMG responses to WBV were similar between the paretic and nonparetic legs and were not associated with level of lower extremity motor impairment and spasticity. LIMITATIONS Leg muscle activity was measured during static exercises only. CONCLUSIONS Adding WBV during exercise significantly increased EMG activity in the TA and BF muscles. The EMG responses to WBV in the paretic and nonparetic legs were similar and were not related to degree of motor impairment and spasticity. The findings are useful for guiding the design of WBV training protocols for people with stroke.
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Nam CW, Lee JH, Cho SH. The effect of non-elastic taping on balance and gait function in patients with stroke. J Phys Ther Sci 2015; 27:2857-60. [PMID: 26504310 PMCID: PMC4616111 DOI: 10.1589/jpts.27.2857] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 06/09/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study investigated the influence of exercise on balance ability and gait
function in stroke patients after applying non-elastic tape, which can stabilize muscles
and joints, to the lower extremities of the affected side. [Subjects and Methods] The
subjects were 30 patients diagnosed with stroke. They were divided into an experimental
group (n = 15) and a control group (n = 15). The experimental group performed mat and
treadmill exercises three times a week for six weeks with non-elastic tape applied to the
lower extremities of the affected side. The control group performed the same exercises but
without taping. [Results] The intervention significantly improved Berg balance scale
scores and timed up and go (TUG) test scores as well as reduced stance duration and stride
duration in the experimental group. In the control group, statistically significant
improvements were observed in TUG test scores. [Conclusion] Although some differences did
not reach the level of statistical significance, the application of non-elastic tape
stabilized the joints of the lower extremities, thereby increasing balance and reducing
stance duration and one step duration, which resulted in a reduction of overall gait
duration.
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Affiliation(s)
- Chan-Woo Nam
- Department of Physical Therapy, College of Rehabilitation Science, Daegu University, Republic of Korea
| | - Jung-Ho Lee
- Department of Physical Therapy, Kyungdong University, Republic of Korea
| | - Sung-Hyoun Cho
- Department of Physical Therapy, Nambu University, Republic of Korea
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Rozand V, Grosprêtre S, Stapley PJ, Lepers R. Assessment of Neuromuscular Function Using Percutaneous Electrical Nerve Stimulation. J Vis Exp 2015. [PMID: 26436986 DOI: 10.3791/52974] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Percutaneous electrical nerve stimulation is a non-invasive method commonly used to evaluate neuromuscular function from brain to muscle (supra-spinal, spinal and peripheral levels). The present protocol describes how this method can be used to stimulate the posterior tibial nerve that activates plantar flexor muscles. Percutaneous electrical nerve stimulation consists of inducing an electrical stimulus to a motor nerve to evoke a muscular response. Direct (M-wave) and/or indirect (H-reflex) electrophysiological responses can be recorded at rest using surface electromyography. Mechanical (twitch torque) responses can be quantified with a force/torque ergometer. M-wave and twitch torque reflect neuromuscular transmission and excitation-contraction coupling, whereas H-reflex provides an index of spinal excitability. EMG activity and mechanical (superimposed twitch) responses can also be recorded during maximal voluntary contractions to evaluate voluntary activation level. Percutaneous nerve stimulation provides an assessment of neuromuscular function in humans, and is highly beneficial especially for studies evaluating neuromuscular plasticity following acute (fatigue) or chronic (training/detraining) exercise.
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Affiliation(s)
- Vianney Rozand
- INSERM U1093, Faculty of Sport Sciences, Univ. Bourgogne Franche-Comté;
| | - Sidney Grosprêtre
- INSERM U1093, Faculty of Sport Sciences, Univ. Bourgogne Franche-Comté
| | - Paul J Stapley
- Neural Control of Movement Laboratory, School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong
| | - Romuald Lepers
- INSERM U1093, Faculty of Sport Sciences, Univ. Bourgogne Franche-Comté
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Kuhnen HR, Rybar MM, Onushko T, Doyel RE, Hunter SK, Schmit BD, Hyngstrom AS. Stroke-related effects on maximal dynamic hip flexor fatigability and functional implications. Muscle Nerve 2015; 51:446-8. [PMID: 25399720 DOI: 10.1002/mus.24520] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2014] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Stroke-related changes in maximal dynamic hip flexor muscle fatigability may be more relevant functionally than isometric hip flexor fatigability. METHODS Ten chronic stroke survivors performed 5 sets of 30 hip flexion maximal dynamic voluntary contractions (MDVC). A maximal isometric voluntary contraction (MIVC) was performed before and after completion of the dynamic contractions. Both the paretic and nonparetic legs were tested. RESULTS Reduction in hip flexion MDVC torque in the paretic leg (44.7%) was larger than the nonparetic leg (31.7%). The paretic leg had a larger reduction in rectus femoris EMG (28.9%) between the first and last set of MDVCs than the nonparetic leg (7.4%). Reduction in paretic leg MDVC torque was correlated with self-selected walking speed (r2=0.43), while reduction in MIVC torque was not (r2=0.11). CONCLUSIONS Reductions in maximal dynamic torque of paretic hip flexors may be a better predictor of walking function than reductions in maximal isometric contractions.
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Affiliation(s)
- Henry R Kuhnen
- Department of Biomedical Engineering, Marquette University, Milwaukee, Wisconsin, USA
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Aloraini SM, Gäverth J, Yeung E, MacKay-Lyons M. Assessment of spasticity after stroke using clinical measures: a systematic review. Disabil Rehabil 2015; 37:2313-23. [DOI: 10.3109/09638288.2015.1014933] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Logan LR. Rehabilitation Techniques to Maximize Spasticity Management. Top Stroke Rehabil 2015; 18:203-11. [DOI: 10.1310/tsr1803-203] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Mentiplay BF, Adair B, Bower KJ, Williams G, Tole G, Clark RA. Associations between lower limb strength and gait velocity following stroke: A systematic review. Brain Inj 2014; 29:409-22. [DOI: 10.3109/02699052.2014.995231] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Bowden JL, Taylor JL, McNulty PA. Voluntary Activation is Reduced in Both the More- and Less-Affected Upper Limbs after Unilateral Stroke. Front Neurol 2014; 5:239. [PMID: 25477862 PMCID: PMC4237055 DOI: 10.3389/fneur.2014.00239] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 11/04/2014] [Indexed: 12/04/2022] Open
Abstract
Objective: Measurement of voluntary activation gives an indication of neural drive to the muscle. This study aimed to identify the site of impairment in neural drive during voluntary contractions post-stroke. Methods: Elbow-flexor voluntary activation was assessed bilaterally for 10 stroke patients (mean 61.2 ± 12.3 years) and 6 age-matched controls (61.3 ± 14.0 years) by stimulating either the peripheral nerve or the motor cortex during maximal voluntary contractions. Any additional evoked force during maximal contractions implies neural drive is incomplete. Peripheral stimulation can detect deficits at or above the stimulation level, while cortical stimulation can identify suboptimal supraspinal output. Results: Impairments were apparent on the less-affected side in addition to the more-affected side after stroke in voluntary activation, torque, and electromyographic activity (EMG) response. Maximal torque was reduced by 44% on the more-affected and 31% on the less-affected side compared to healthy controls (p < 0.001). Peripheral voluntary activation was reduced to 81% on the more-affected side and 86% on the less-affected side, with healthy subjects at 96% (p < 0.05). Although EMG was bilaterally impaired after stroke, the pattern of response was different between sides. Voluntary activation could not be calculated for cortical stimulation post-stroke due to variability in the evoked force, but EMG results from cortical stimulation showed significant differences in the neural drive to each side. Conclusion: Voluntary activation is impaired bilaterally in the upper-limb after stroke, with reduced cortical connectivity on the more-affected side. Significance: Although the muscle itself did not change post-stroke, altered descending drive and connectivity were the critical factors explaining post-stroke paresis.
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Affiliation(s)
- Jocelyn L Bowden
- Neuroscience Research Australia , Sydney, NSW , Australia ; University of New South Wales , Sydney, NSW , Australia
| | - Janet L Taylor
- Neuroscience Research Australia , Sydney, NSW , Australia ; University of New South Wales , Sydney, NSW , Australia
| | - Penelope A McNulty
- Neuroscience Research Australia , Sydney, NSW , Australia ; University of New South Wales , Sydney, NSW , Australia
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Fröhlich-Zwahlen A, Casartelli N, Item-Glatthorn J, Maffiuletti N. Validity of resting myotonometric assessment of lower extremity muscles in chronic stroke patients with limited hypertonia: A preliminary study. J Electromyogr Kinesiol 2014; 24:762-9. [DOI: 10.1016/j.jelekin.2014.06.007] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 05/26/2014] [Accepted: 06/16/2014] [Indexed: 11/30/2022] Open
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Rosa MCN, Marques A, Demain S, Metcalf CD. Knee posture during gait and global functioning post-stroke: a theoretical ICF framework using current measures in stroke rehabilitation. Disabil Rehabil 2014; 37:904-13. [DOI: 10.3109/09638288.2014.948132] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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McNulty PA, Lin G, Doust CG. Single motor unit firing rate after stroke is higher on the less-affected side during stable low-level voluntary contractions. Front Hum Neurosci 2014; 8:518. [PMID: 25100969 PMCID: PMC4102083 DOI: 10.3389/fnhum.2014.00518] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 06/26/2014] [Indexed: 01/10/2023] Open
Abstract
Muscle weakness is the most common outcome after stroke and a leading cause of adult-acquired motor disability. Single motor unit properties provide insight into the mechanisms of post-stroke motor impairment. Motor units on the more-affected side are reported to have lower peak firing rates, reduced discharge variability and a more compressed dynamic range than healthy subjects. The activity of 169 motor units was discriminated from surface electromyography in 28 stroke patients during sustained voluntary contractions 10% of maximal and compared to 110 units recorded in 16 healthy subjects. Motor units were recorded in three series: ankle dorsiflexion, wrist flexion and elbow flexion. Mean firing rates after stroke were significantly lower on the more-affected than the less-affected side (p < 0.001) with no differences between dominant and non-dominant sides for healthy subjects. When data were combined, firing rates on the less-affected side were significantly higher than those either on the more-affected side or healthy subjects (p < 0.001). Motor unit mean firing rate was higher in the upper-limb than the lower-limb (p < 0.05). The coefficient of variation of motor unit discharge rate was lower for motor units after stroke compared to controls for wrist flexion (p < 0.05) but not ankle dorsiflexion. However the dynamic range of motor units was compressed only for motor units on the more-affected side during wrist flexion. Our results show that the pathological change in motor unit firing rate occurs on the less-affected side after stroke and not the more-affected side as previously reported, and suggest that motor unit behavior recorded in a single muscle after stroke cannot be generalized to muscles acting on other joints even within the same limb. These data emphasize that the less-affected side does not provide a valid control for physiological studies on the more-affected side after stroke and that both sides should be compared to data from age- and sex-matched healthy subjects.
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Affiliation(s)
- Penelope A McNulty
- Neuroscience Research Australia Sydney, NSW, Australia ; School of Medical Sciences, UNSW Australia Sydney, NSW, Australia
| | - Gaven Lin
- Neuroscience Research Australia Sydney, NSW, Australia
| | - Catherine G Doust
- Neuroscience Research Australia Sydney, NSW, Australia ; School of Medical Sciences, UNSW Australia Sydney, NSW, Australia
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Muscle atrophy, voluntary activation disturbances, and low serum concentrations of IGF-1 and IGFBP-3 are associated with weakness in people with chronic stroke. Phys Ther 2014; 94:957-67. [PMID: 24578521 DOI: 10.2522/ptj.20130322] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND The muscle weakness that is exhibited poststroke is due to a multifactorial etiology involving the central nervous system and skeletal muscle changes. Insulinlike growth factor 1 (IGF-1) and IGF binding protein 3 (IGFBP-3) have been described as biomarkers of neuromuscular performance in many conditions. However, no information about these biomarkers is available for people with chronic hemiparesis. OBJECTIVE The purpose of this study was to investigate possible factors involved in muscle weakness, such as IGF-1 and IGFBP-3 serum concentrations, muscle volume, and neuromuscular performance of the knee flexors and extensors, in people with chronic hemiparesis poststroke. DESIGN This was a cross-sectional study. METHODS A cross-sectional study was performed on 14 individuals poststroke who were paired with healthy controls. Mobility, function, balance, and quality of life were recorded as outcome measures. Knee flexor and extensor muscle volumes and neuromuscular performance were measured using nuclear magnetic resonance imaging, dynamometry, and electromyography. The serum concentrations of IGF-1 and IGFBP-3 were quantified by enzyme-linked immunosorbent assay (ELISA). RESULTS The hemiparetic group had low serum concentrations of IGF-1 (25%) and IGFBP-3 (40%); reduced muscle volume in the vastus medialis (32%), vastus intermedius (29%), biceps femoris (16%), and semitendinosus and semimembranosus (12%) muscles; reduced peak torque, power, and work of the knee flexors and extensors; and altered agonist and antagonist muscle activation compared with controls. CONCLUSIONS Low serum concentrations of IGF-1 and IGFBP-3, deficits in neuromuscular performance, selective muscle atrophy, and decreased agonist muscle activation were found in the group with chronic hemiparesis poststroke. Both hemorrhagic and ischemic stroke were considered, and the data reflect a chronic poststroke population with good function.
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