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Mizuno E, Ogasawara T, Mukaino M, Yamaguchi M, Tsukada S, Sonoda S, Otaka Y. Highlighting Unseen Activity Through 48-Hour Continuous Measurement in Subacute Stroke Rehabilitation: Preliminary Cohort Study. JMIR Form Res 2024; 8:e51546. [PMID: 38809596 PMCID: PMC11170042 DOI: 10.2196/51546] [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: 08/08/2023] [Revised: 02/25/2024] [Accepted: 02/26/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Motor impairments not only lead to a significant reduction in patient activity levels but also trigger a further deterioration in motor function due to deconditioning, which is an issue that is particularly pronounced during hospitalization. This deconditioning can be countered by sustaining appropriate activity levels. Activities that occur outside of scheduled programs, often overlooked, are critical in this context. Wearable technology, such as smart clothing, provides a means to monitor these activities. OBJECTIVE This study aimed to observe activity levels in patients who had strokes during the subacute phase, focusing on both scheduled training sessions and other nontraining times in an inpatient rehabilitation environment. A smart clothing system is used to simultaneously measure heart rate and acceleration, offering insights into both the amount and intensity of the physical activity. METHODS In this preliminary cohort study, 11 individuals undergoing subacute stroke rehabilitation were enrolled. The 48-hour continuous measurement system, deployed at admission and reassessed 4 weeks later, monitored accelerometry data for physical activity (quantified with a moving SD of acceleration [MSDA]) and heart rate for intensity (quantified with percent heart rate reserve). The measurements were performed using a wearable activity monitoring system, the hitoe (NTT Corporation and Toray Industries, Inc) system comprising a measuring garment (wear or strap) with integrated electrodes, a data transmitter, and a smartphone. The Functional Independence Measure was used to assess the patients' daily activity levels. This study explored factors such as differences in activity during training and nontraining periods, correlations with activities of daily living (ADLs) and age, and changes observed after 4 weeks. RESULTS A significant increase was found in the daily total MSDA after the 4-week program, with the average percent heart rate reserve remaining consistent. Physical activity during training positively correlated with ADL levels both at admission (ρ=0.86, P<.001) and 4 weeks post admission (ρ=0.96, P<.001), whereas the correlation between age and MSDA was not significant during training periods at admission (ρ=-0.41, P=.21) or 4 weeks post admission (ρ=-0.25, P=.45). Conversely, nontraining activity showed a negative correlation with age, with significant negative correlations with age at admission (ρ=-0.82, P=.002) and 4 weeks post admission (ρ=-0.73, P=.01). CONCLUSIONS Inpatient rehabilitation activity levels were positively correlated with ADL levels. Further analysis revealed a strong positive correlation between scheduled training activities and ADL levels, whereas nontraining activities showed no such correlation. Instead, a negative correlation between nontraining activities and age was observed. These observations suggest the importance of providing activity opportunities for older patients, while it may also suggest the need for adjusting the activity amount to accommodate the potentially limited fitness levels of this demographic. Future studies with larger patient groups are warranted to validate and further elucidate these findings.
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Affiliation(s)
- Emi Mizuno
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
- Department of Rehabilitation Medicine II, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Takayuki Ogasawara
- NTT Basic Research Laboratories and Bio-medical Informatics Research Center, NTT Corporation, Atsugi, Japan
| | - Masahiko Mukaino
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
- Department of Rehabilitation Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Masumi Yamaguchi
- NTT Basic Research Laboratories and Bio-medical Informatics Research Center, NTT Corporation, Atsugi, Japan
| | - Shingo Tsukada
- NTT Basic Research Laboratories and Bio-medical Informatics Research Center, NTT Corporation, Atsugi, Japan
| | - Shigeru Sonoda
- Department of Rehabilitation Medicine II, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Yohei Otaka
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
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Levin C, Bachar-Kirshenboim Y, Rand D. Daily steps, walking tests, and functioning in chronic stroke; comparing independent walkers to device-users. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2024; 29:e2035. [PMID: 37432302 DOI: 10.1002/pri.2035] [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: 03/02/2023] [Revised: 06/04/2023] [Accepted: 06/26/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND AND PURPOSE Community mobility post-stroke is important for gaining independence in daily activities. Walking devices can facilitate mobility, but it remains unclear whether individuals who use a walking device walk as many daily steps as those who do not require a device. It is also unclear whether these groups differ in their independence in daily living. This study aimed (1) to compare daily steps, walking tests, and independence in basic and instrumental activities of daily living (IADL) six months post-stroke between individuals who walk independently and individuals who use a walking device, (2) within each group to assess correlations between daily steps and walking tests, independence in basic and IADL. METHODS Thirty-seven community-dwelling individuals with chronic stroke; 22 participants used a walking-device and 15 participants walked independently. Daily steps were calculated as a 3-day mean by hip accelerometers. Clinical walking tests included the 10-m-walk-test, Timed Up & Go and 'Walking While Talking'. Daily living was assessed using the Functional-Independence Measure and the IADL questionnaire. RESULTS Daily steps of the device-users were significantly lower than the independent-walkers (195-8068 versus 147-14010 steps/day) but independence in daily living was not significantly different. Different walking tests correlated with daily steps for device-users and independent-walkers. CONCLUSIONS This preliminary investigation in chronic stroke revealed that device-users walk significantly fewer daily steps but are as independent in daily living as independent-walkers. Clinicians should differentiate between individuals with and without a walking device and the use of different clinical walking tests to explain daily steps should be considered. Further research is needed to assess the impact of a walking device post-stroke.
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Affiliation(s)
- Chedva Levin
- Faculty of School of Life and Health Sciences, Nursing Department, The Jerusalem College of Technology-Lev Academic Center, Jerusalem, Israel
| | - Yishai Bachar-Kirshenboim
- Department of Occupational Therapy, School of Health Professions, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Debbie Rand
- Department of Occupational Therapy, School of Health Professions, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Phan A, Askim T, Lydersen S, Indredavik B, Wethal T. Accelerometer-measured physical activity at 3 months as a predictor of symptoms of depression and anxiety 1 year after stroke: a multicentre prospective cohort study in central Norway. J Rehabil Med 2023; 55:jrm12309. [PMID: 37970656 PMCID: PMC10666064 DOI: 10.2340/jrm.v55.12309] [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: 04/14/2023] [Accepted: 10/24/2023] [Indexed: 11/17/2023] Open
Abstract
OBJECTIVES To study sedentary behaviour and physical activity at 3 months as predictors for symptoms of depression and anxiety at 1-year post-stroke. DESIGN A prospective cohort study. PATIENTS Patients with first-ever ischaemic stroke. METHODS Mood was assessed 3- and 12-months post-stroke using the Hospital Anxiety and Depression Scale. Sedentary behaviour and physical activity were measured using accelerometry 3 months post-stroke. RESULTS A total of 292 participants (116 (39.7%) females; mean age 71.7 (standard deviation 11.3) years) were included. At 12 months, 16.7% experienced depression and 19.5% anxiety, respectively. Adjusting for age and sex, regression analysis showed that comorbidity burden (β 0.26; 95% confidence interval (95% CI) 0.02, 0.51; p = 0.038), stroke severity (β 0.22; 95% CI 0.10, 0.35; p = 0.001), functional disability (β 0.89, 95% CI 0.49, 1.30; p = 0.000), and global cognition (β-0.15; 95% CI -0.25, -0.05; p = 0.004) predicted depression. Multi-adjusted analysis showed sedentary behaviour and physical activity did not significantly predict depression or anxiety (p > 0.05). CONCLUSION Sedentary behaviour and physical activity did not significantly predict mood after stroke. Comorbidity burden, stroke severity, functional disability, and global cognition were identified as possible predictors of depression. More research is needed to determine the impact of physical activity on depression and anxiety symptoms.
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Affiliation(s)
- Ailan Phan
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Torunn Askim
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Stian Lydersen
- Regional Centre for Child and Youth Mental Health and Child Welfare, Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Bent Indredavik
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Department of Medical Quality Registries, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Stroke Unit, Department of Internal Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Torgeir Wethal
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Stroke Unit, Department of Internal Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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Mathunny JJ, Karthik V, Devaraj A, Jacob J. A scoping review on recent trends in wearable sensors to analyze gait in people with stroke: From sensor placement to validation against gold-standard equipment. Proc Inst Mech Eng H 2023; 237:309-326. [PMID: 36704959 DOI: 10.1177/09544119221142327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The purpose of the review is to evaluate wearable sensor placement, their impact and validation of wearable sensors on analyzing gait, primarily the postural instability in people with stroke. Databases, namely PubMed, Cochrane, SpringerLink, and IEEE Xplore were searched to identify related articles published since January 2005. The authors have selected the articles by considering patient characteristics, intervention details, and outcome measurements by following the priorly set inclusion and exclusion criteria. From a total of 1077 articles, 142 were included in this study and classified into functional fields, namely postural stability (PS) assessments, physical activity monitoring (PA), gait pattern classification (GPC), and foot drop correction (FDC). The review covers the types of wearable sensors, their placement, and their performance in terms of reliability and validity. When employing a single wearable sensor, the pelvis and foot were the most used locations for detecting gait asymmetry and kinetic parameters, respectively. Multiple Inertial Measurement Units placed at different body parts were effectively used to estimate postural stability and gait pattern. This review article has compared results of placement of sensors at different locations helping researchers and clinicians to identify the best possible placement for sensors to measure specific kinematic and kinetic parameters in persons with stroke.
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Affiliation(s)
- Jaison Jacob Mathunny
- Department of Biomedical Engineering, SRM Institute of Science and Technology, Chennai, India
| | - Varshini Karthik
- Department of Biomedical Engineering, SRM Institute of Science and Technology, Chennai, India
| | - Ashokkumar Devaraj
- Department of Biomedical Engineering, SRM Institute of Science and Technology, Chennai, India
| | - James Jacob
- Department of Physical Therapy, Kindred Healthcare, Munster, IN, USA
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Self-management to promote physical activity after discharge from in-patient stroke rehabilitation: a feasibility study. Top Stroke Rehabil 2023; 30:32-42. [PMID: 34581249 DOI: 10.1080/10749357.2021.1978630] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVES To investigate the feasibility of a self-management program aimed at increasing physical activity in community-dwelling ambulators after stroke in a middle-income country with high income inequality. METHODS A Phase 1, pre-post intervention study was conducted with 20 sub-acute stroke participants. The self-management program was delivered in six home-based sessions over 3 months. Feasibility of recruitment, intervention, and measurement was determined. Physical activity, cardiovascular risk, depression, walking speed, self-efficacy for exercise, participation, and quality of life were measured at baseline, 3, and 6 months. RESULTS 16% of eligible participants were recruited. 90% completed the program and were measured at 3 months, and 65% at 6 months. The most common reasons for withdrawal were return to work, lack of interest/motivation and surgery. 92% of the sessions were delivered for 59 (SD 23) minutes per session. Participants did not increase physical activity at 3 months (MD 364 steps/day, 95% CI -282 to 1010) or 6 months (MD 312 steps/day, 95% CI -881 to 1504). Post-hoc analysis showed that sedentary participants increased their step count at 3 months by 1,300 (95% CI 152 to 2447) and at 6 months by 1,701 (95% CI -556 to 3959) more steps than non-sedentary participants. CONCLUSIONS A Phase 2 study of the self-management program appears to be feasible in a middle-income country with high income inequality and has the potential to increase physical activity levels in sedentary individuals with mild disability after stroke. TRIAL REGISTRATION RBR-6bdmsk.
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Holubová A, Malá E, Hoidekrová K, Pětioký J, Ďuriš A, Mužík J. The Accuracy of Commercially Available Fitness Trackers in Patients after Stroke. SENSORS (BASEL, SWITZERLAND) 2022; 22:7392. [PMID: 36236491 PMCID: PMC9573007 DOI: 10.3390/s22197392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/23/2022] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
Background: Fitness trackers could represent an easy-to-use and cheap tool for continuous tracking of physical activity of stroke survivors during the period of their recovery at home. The aim of the study was to examine the accuracy of the Fitbit activity tracker in locomotor activity monitoring of stroke survivors with respect to gait disorders, walking speed, walking aid, and placement of the tracker on body. Methods: Twenty-four ambulatory stroke survivors (15 men and 9 women) with locomotion/gait disorder were involved in the study. Patients underwent two walking tests with the Fitbit Alta HR trackers attached on 5 different places on body. The accuracy of the trackers has been analyzed on 3 groups of patients-those walking without any walking aid, those using a single-point stick and those using a rolling walker. Results: For no-aid patients, the most accurate place was the waist. Patients with a single-point stick revealed the smallest deviations for a tracker attached to a healthy lower limb, and patients with a rolling walker revealed the smallest deviations for a tracker attached on the paretic lower limb. Conclusions: An accuracy comparable with the healthy population can be reached for all of the three groups of patients, while fulfilling the conditions for minimum speed of 2 km/h and optimal placement of the trackers with respect to a walking aid and aspect to impairment.
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Affiliation(s)
- Anna Holubová
- Faculty of Biomedical Engineering, Czech Technical University in Prague, 272 01 Kladno, Czech Republic
| | - Eliška Malá
- Faculty of Biomedical Engineering, Czech Technical University in Prague, 272 01 Kladno, Czech Republic
| | - Kristýna Hoidekrová
- First Faculty of Medicine, Charles University and General University Hospital, 128 00 Prague, Czech Republic
- Rehabilitation Centre Kladruby, 257 62 Kladruby, Czech Republic
| | - Jakub Pětioký
- Rehabilitation Centre Kladruby, 257 62 Kladruby, Czech Republic
- Third Faculty of Medicine, Charles University in Prague, 100 00 Prague, Czech Republic
| | - Andrea Ďuriš
- Rehabilitation Centre Kladruby, 257 62 Kladruby, Czech Republic
| | - Jan Mužík
- Faculty of Biomedical Engineering, Czech Technical University in Prague, 272 01 Kladno, Czech Republic
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Pohl J, Ryser A, Veerbeek JM, Verheyden G, Vogt JE, Luft AR, Easthope CA. Accuracy of gait and posture classification using movement sensors in individuals with mobility impairment after stroke. Front Physiol 2022; 13:933987. [PMID: 36225292 PMCID: PMC9549863 DOI: 10.3389/fphys.2022.933987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Stroke leads to motor impairment which reduces physical activity, negatively affects social participation, and increases the risk of secondary cardiovascular events. Continuous monitoring of physical activity with motion sensors is promising to allow the prescription of tailored treatments in a timely manner. Accurate classification of gait activities and body posture is necessary to extract actionable information for outcome measures from unstructured motion data. We here develop and validate a solution for various sensor configurations specifically for a stroke population.Methods: Video and movement sensor data (locations: wrists, ankles, and chest) were collected from fourteen stroke survivors with motor impairment who performed real-life activities in their home environment. Video data were labeled for five classes of gait and body postures and three classes of transitions that served as ground truth. We trained support vector machine (SVM), logistic regression (LR), and k-nearest neighbor (kNN) models to identify gait bouts only or gait and posture. Model performance was assessed by the nested leave-one-subject-out protocol and compared across five different sensor placement configurations.Results: Our method achieved very good performance when predicting real-life gait versus non-gait (Gait classification) with an accuracy between 85% and 93% across sensor configurations, using SVM and LR modeling. On the much more challenging task of discriminating between the body postures lying, sitting, and standing as well as walking, and stair ascent/descent (Gait and postures classification), our method achieves accuracies between 80% and 86% with at least one ankle and wrist sensor attached unilaterally. The Gait and postures classification performance between SVM and LR was equivalent but superior to kNN.Conclusion: This work presents a comparison of performance when classifying Gait and body postures in post-stroke individuals with different sensor configurations, which provide options for subsequent outcome evaluation. We achieved accurate classification of gait and postures performed in a real-life setting by individuals with a wide range of motor impairments due to stroke. This validated classifier will hopefully prove a useful resource to researchers and clinicians in the increasingly important field of digital health in the form of remote movement monitoring using motion sensors.
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Affiliation(s)
- Johannes Pohl
- Department of Neurology, University of Zurich and University Hospital Zurich, Zurich, Switzerland
- Department of Rehabilitation Sciences, KU Leuven—University of Leuven, Leuven, Belgium
- *Correspondence: Johannes Pohl,
| | - Alain Ryser
- Department of Computer Science, ETH Zurich, Zurich, Switzerland
| | | | - Geert Verheyden
- Department of Rehabilitation Sciences, KU Leuven—University of Leuven, Leuven, Belgium
| | | | - Andreas Rüdiger Luft
- Department of Neurology, University of Zurich and University Hospital Zurich, Zurich, Switzerland
- Cereneo, Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Chris Awai Easthope
- Cereneo Foundation, Center for Interdisciplinary Research (CEFIR), Vitznau, Switzerland
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Twardzik E, Clarke PJ, Lisabeth LL, Brown SH, Hooker SP, Judd SE, Colabianchi N. The Relationship Between Environmental Exposures and Post-Stroke Physical Activity. Am J Prev Med 2022; 63:251-261. [PMID: 35361506 PMCID: PMC9310088 DOI: 10.1016/j.amepre.2022.01.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 01/10/2022] [Accepted: 01/14/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Post-stroke physical activity has widespread health benefits. Environmental exposures may shape post-stroke physical activity behavior. This study investigates the relationships between environmental exposures and post-stroke physical activity. METHODS Stroke survivors (n=374) from a cohort of Black and White adults with post-stroke accelerometer data (2009-2013) were eligible for this study. Participants' home addresses were linked with secondary data to capture environmental characteristics, including annual density of neighborhood resources (e.g., parks, physical activity facilities, and intellectual stimulation destinations), 2010 neighborhood SES, 2010 neighborhood crime, and daily information on extremely cold days. Post-stroke light physical activity and moderate-to-vigorous physical activity were captured using accelerometers over a 7-day period. Linear regression and 2-part/hurdle models were used to estimate the relationship between the density of neighborhood resources with light physical activity and with moderate-to-vigorous physical activity, respectively. Analyses were conducted in 2021. RESULTS A 10% increase in the number of extremely cold days was associated with 6.37 fewer minutes of daily light physical activity (95% CI= -11.37, -1.37). A 1-SD increase in neighborhood SES was associated with greater odds (OR=1.10, 95% CI=1.02, 1.19) of doing any moderate-to-vigorous physical activity. Among participants obtaining any moderate-to-vigorous physical activity, a 1-unit (count/km2) increase in destinations for intellectual stimulation was associated with 0.99 (95% CI=0.02, 1.97) more minutes of daily moderate-to-vigorous physical activity. All other environmental exposures were not associated with post-stroke light physical activity or moderate-to-vigorous physical activity. CONCLUSIONS Environmental exposures may facilitate physical activity participation among stroke survivors. This study found that weather, neighborhood SES, and proximity to destinations for intellectual stimulation were associated with physical activity over and above individual factors.
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Affiliation(s)
- Erica Twardzik
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan; Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan.
| | - Philippa J Clarke
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan; Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | - Lynda L Lisabeth
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Susan H Brown
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan
| | - Steven P Hooker
- College of Health and Human Services, San Diego State University, San Diego, California
| | - Suzanne E Judd
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Natalie Colabianchi
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan; Institute for Social Research, University of Michigan, Ann Arbor, Michigan
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A Pilot Randomized Controlled Trial of Botulinum Toxin Treatment Combined with Robot-Assisted Therapy, Mirror Therapy, or Active Control Treatment in Patients with Spasticity Following Stroke. Toxins (Basel) 2022; 14:toxins14060415. [PMID: 35737076 PMCID: PMC9228472 DOI: 10.3390/toxins14060415] [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: 05/26/2022] [Revised: 06/12/2022] [Accepted: 06/14/2022] [Indexed: 11/17/2022] Open
Abstract
Effects of the combined task-oriented trainings with botulinum toxin A (BoNT-A) injection on improving motor functions and reducing spasticity remains unclear. This study aims to investigate effects of 3 task-oriented trainings (robot-assisted therapy (RT), mirror therapy (MT), and active control treatment (AC)) in patients with stroke after BoNT-A injection. Thirty-seven patients with chronic spastic hemiplegic stroke were randomly assigned to receive RT, MT, or AC following BoNT-A injection over spastic upper extremity muscles. Each session of RT, MT, and AC was 75 min, 3 times weekly, for 8 weeks. Outcome measures were assessed at pretreatment, post-treatment, and 3-month follow-up, involving the Fugl-Meyer Assessment (FMA), Modified Ashworth Scale (MAS), Motor Activity Log (MAL), including amount of use (AOU) and quality of movement (QOM), and arm activity level. All 3 combined treatments improved FMA, MAS, and MAL. The AC induced a greater effect on QOM in MAL at the 3-month follow-up than RT or MT. All 3 combined trainings induced minimal effect on arm activity level. Our findings suggest that for patients with stroke who received BoNT-A injection over spastic UE muscles, the RT, MT, or AC UE training that followed was effective in improving motor functions, reducing spasticity, and enhancing daily function.
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Heye AL, Kersting C, Kneer M, Barzel A. Suitability of accelerometry as an objective measure for upper extremity use in stroke patients. BMC Neurol 2022; 22:220. [PMID: 35705906 PMCID: PMC9199226 DOI: 10.1186/s12883-022-02743-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 05/31/2022] [Indexed: 11/26/2022] Open
Abstract
Background Upper limb (UL) paresis is one of the most common stroke consequences and significantly restricts patients in everyday life. Instruments objectively measuring direct arm use in stroke patients are lacking, but might be helpful to understand patients’ impairment. Aiming to examine whether accelerometry is a suitable objective measure for everyday UL use in stroke patients, we conducted a systematic review on the association between accelerometer-derived measurements and clinical scales. Methods Articles were systematically searched in PubMed, Scopus, Cochrane Library, PeDro and LIVIVO through December 12th, 2021, screened for inclusion by AH, and subsequently independently screened by CK and MK. Disagreements were discussed until consensus. We included English and German peer-reviewed articles dealing with the validity of accelerometers as a measurement of UL use in stroke patients and eligible systematic reviews. Studies exclusively using accelerometry as an outcome parameter, book contributions, conference abstracts and case studies were excluded. Data extraction was conducted by AH and confirmed by CK focussing on study type, objective, accelerometer device, sample size, stroke status, assessments conducted, measurement method, wearing time and key results. We analysed all eligible articles regarding the correlation between accelerometry and other clinical assessments and the validity in accordance with the type of accelerometer. Results Excluding duplicates, the initial search yielded 477 records. In the 34 eligible studies accelerometers was used with a predominance of tri-axial accelerometery (n = 12) and only few with two-axial application (n = 4). Regarding measures to examine association to accelerometer data different clinical scales were applied depending on the setting, the degree of impairment and/or the status of stroke. Cut-off values to determine correlations varied largely; most significant correlations are reported for the MAL [Range 0.31- 0.84] and the ARAT [Range 0.15–0.79]. Conclusions Accelerometers can provide reliable data about daily arm use frequency but do not supply information about the movements´ quality and restrictions on everyday activities of stroke patients. Depending on the context, it is advisable to use both, accelerometry and other clinical measures. According to the literature there is currently no accelerometer device most suitable to measure UL activity. High correlations indicate that multi-dimensional accelerometers should be preferred. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-022-02743-w.
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Affiliation(s)
- Anne-Lisa Heye
- Chair of General Practice I and Interprofessional Care, Institute of General Practice and Primary Care, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Str. 50, 58448, Witten, Germany.
| | - Christine Kersting
- Chair of General Practice II and Patient-Centeredness in Primary Care, Institute of General Practice and Primary Care, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Str. 50, 58448, Witten, Germany
| | - Malte Kneer
- Chair of General Practice II and Patient-Centeredness in Primary Care, Institute of General Practice and Primary Care, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Str. 50, 58448, Witten, Germany
| | - Anne Barzel
- Institute of General Medicine, Ulm University, Albert-Einstein-Allee 23, 89081, Ulm, Germany
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Metabolic Energy Expenditure and Accelerometer-Determined Physical Activity Levels in Post-Stroke Hemiparetic Patients. J Stroke Cerebrovasc Dis 2022; 31:106397. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/04/2022] [Accepted: 02/05/2022] [Indexed: 11/18/2022] Open
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Qian H, Chen S, Chen Y, Chang Y, Li Y, Dou S, Chen Q, Wang G, Xie M. Community-Based Rehabilitation Promotes the Functional Recovery of Patients After Intracerebral Hemorrhage. Neurologist 2022; 27:89-94. [PMID: 34855671 DOI: 10.1097/nrl.0000000000000375] [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: 11/27/2022]
Abstract
BACKGROUND Intracerebral hemorrhage (ICH), a severe disorder with the high death rate, high recurrence rate and high disability rate, affected the quality of human life. Community-based rehabilitation (CBR) helps disabled people at both community and family levels. However, the effect of CBR on the recovery of people after ICH remains unclear. METHODS Patients were treated with the CBR training program, subsequently, medication compliance test, clinical neural impairment measurements, functional comprehensive assessments, improved Barthel index score, and life qualities assessments were to performed at 3-month or 6-month intervention of CBR to evaluate the influence of CBR on the medication compliance, physical function and life quality of patients after ICH. RESULTS After the treatment of CBR, we observed that, the rate of medication compliance, motor function, functional comprehensive rating scale score, modified Barthel index score, and generic quality of life inventory-74 in the CBR-treated group were significantly higher than that in the control group; the neural impairment measure score in the CBR-treated group was significantly decreased in comparison to the control group. CONCLUSION CBR increased the medication compliance, promoted the recovery of the neurological function and improved the life qualities of ICH patients.
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Affiliation(s)
- Hong Qian
- Department of Neurology, The First Affiliated Hospital, University of South China, Hengyang
- Department of Rehabilitation, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Shuangxi Chen
- Department of Neurology, The First Affiliated Hospital, University of South China, Hengyang
| | - Yarui Chen
- Department of Neurology, The First Affiliated Hospital, University of South China, Hengyang
| | - Yunqian Chang
- Department of Neurology, The First Affiliated Hospital, University of South China, Hengyang
| | - Yihui Li
- Department of Neurology, The First Affiliated Hospital, University of South China, Hengyang
| | - Shiying Dou
- Department of Neurology, The First Affiliated Hospital, University of South China, Hengyang
| | - Qianlan Chen
- Department of Neurology, The First Affiliated Hospital, University of South China, Hengyang
| | - Gang Wang
- Department of Rehabilitation, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Ming Xie
- Department of Neurology, The First Affiliated Hospital, University of South China, Hengyang
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13
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Daniel CR, Yazbek P, Santos ACA, Battistella LR. Validity study of a triaxial accelerometer for measuring energy expenditure in stroke inpatients of a physical medicine and rehabilitation center. Top Stroke Rehabil 2022; 30:402-409. [PMID: 35383539 DOI: 10.1080/10749357.2022.2058292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Establish the validity of a triaxial accelerometer (Dynaport®) for evaluating the energy expenditure of patients with stroke sequelae at a rehabilitation hospital. METHODS This is a cross-sectional study with 24 stroke inpatients of a rehabilitation hospital. The participants were assessed on energy expenditure by an ergospirometer system and the triaxial accelerometer simultaneously during a walk test. The data collected by both devices were compared by intraclass correlation coefficient (ICC) and Bland-Altman limits of agreement. RESULTS An almost perfect agreement (ICC = 0,94) in the energy expenditure measured by the accelerometer compared to the results of the ergospirometer system was found during the exercise test. The Bland-Altman analysis has shown suitable limits of agreement. Post hoc analyses with the maximum volume of oxygen and the total energy expenditure measured by the ergospirometer system evidenced significant correlation with the energy expenditure measurements by the accelerometer. CONCLUSION Our results evidence that the triaxial accelerometer Dynaport® and its built-in software are valid for estimating the energy expenditure of stroke sequelae during a walk exercise.
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Affiliation(s)
- Christiane Riedi Daniel
- Instituto de Medicina Fisica e Reabilitacao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil.,Departamento de Fisioterapia, Universidade Estadual do Centro Oeste, Gruarapuava, Brazil
| | - Paulo Yazbek
- Instituto de Medicina Fisica e Reabilitacao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Artur Cesar Aquino Santos
- Instituto de Medicina Fisica e Reabilitacao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
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14
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Renke MB, Marcinkowska AB, Kujach S, Winklewski PJ. A Systematic Review of the Impact of Physical Exercise-Induced Increased Resting Cerebral Blood Flow on Cognitive Functions. Front Aging Neurosci 2022; 14:803332. [PMID: 35237146 PMCID: PMC8882971 DOI: 10.3389/fnagi.2022.803332] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 01/11/2022] [Indexed: 12/16/2022] Open
Abstract
Brain perfusion declines with aging. Physical exercise represents a low-cost accessible form of intervention to increase cerebral blood flow; however, it remains unclear if exercise-induced amelioration of brain perfusion has any impact on cognition. We aimed to provide a state-of-the art review on this subject. A comprehensive search of the PubMed (MEDLINE) database was performed. On the basis of the inclusion and exclusion criteria, 14 studies were included in the analysis. Eleven of the studies conducted well-controlled exercise programs that lasted 12–19 weeks for 10–40 participants and two studies were conducted in much larger groups of subjects for more than 5 years, but the exercise loads were indirectly measured, and three of them were focused on acute exercise. Literature review does not show a direct link between exercise-induced augmentation of brain perfusion and better cognitive functioning. However, in none of the reviewed studies was such an association the primary study endpoint. Carefully designed clinical studies with focus on cognitive and perfusion variables are needed to provide a response to the question whether exercise-induced cerebral perfusion augmentation is of clinical importance.
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Affiliation(s)
- Maria B. Renke
- Functional Near Infrared Spectroscopy Lab, Department of Human Physiology, Medical University of Gdańsk, Gdańsk, Poland
- Department of Electronics, Telecommunication and Informatics, Gdańsk University of Technology, Gdańsk, Poland
- *Correspondence: Maria B. Renke
| | - Anna B. Marcinkowska
- Applied Cognitive Neuroscience Lab, Department of Human Physiology, Medical University of Gdańsk, Gdańsk, Poland
- Second Department of Radiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Sylwester Kujach
- Functional Near Infrared Spectroscopy Lab, Department of Human Physiology, Medical University of Gdańsk, Gdańsk, Poland
- Department of Physiology, Gdańsk University of Physical Education and Sport, Gdańsk, Poland
| | - Paweł J. Winklewski
- Second Department of Radiology, Medical University of Gdańsk, Gdańsk, Poland
- Department of Human Physiology, Medical University of Gdańsk, Gdańsk, Poland
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15
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Abstract
Internet-connected devices, including personal computers, smartphones, smartwatches, and voice assistants, have evolved into powerful multisensor technologies that billions of people interact with daily to connect with friends and colleagues, access and share information, purchase goods, play games, and navigate their environment. Digital phenotyping taps into the data streams captured by these devices to characterize and understand health and disease. The purpose of this article is to summarize opportunities for digital phenotyping in neurology, review studies using everyday technologies to obtain motor and cognitive information, and provide a perspective on how neurologists can embrace and accelerate progress in this emerging field.
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Affiliation(s)
- Anoopum S. Gupta
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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16
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Mulder M, Nikamp C, Nijland R, van Wegen E, Prinsen E, Vloothuis J, Buurke J, Kwakkel G. Can telerehabilitation services combined with caregiver-mediated exercises improve early supported discharge services poststroke? A study protocol for a multicentre, observer-blinded, randomized controlled trial. BMC Neurol 2022; 22:29. [PMID: 35039010 PMCID: PMC8762867 DOI: 10.1186/s12883-021-02533-w] [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: 09/28/2021] [Accepted: 12/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recovery of walking ability is an important goal for patients poststroke, and a basic level of mobility is critical for an early discharge home. Caregiver-mediated exercises could be a resource-efficient strategy to augment exercise therapy and improve mobility in the first months poststroke. A combination of telerehabilitation and face-to-face support, blended care, may empower patient-caregiver dyads and smoothen the transition from professional support to self-management. The Armed4Stroke study aims to investigate the effects of a caregiver-mediated exercise program using a blended care approach in addition to usual care, on recovery of mobility in the first 6 months poststroke. METHODS A multicentre, observer-blinded randomized clinical trial in which 74 patient-caregiver dyads will be enrolled in the first 3 months poststroke. Dyads are randomly allocated to a caregiver-mediated exercises intervention or to a control group. The primary endpoint is the self-reported mobility domain of the Stroke Impact Scale. Secondary endpoints include care transition preparedness and psychological functioning of dyads, length of inpatient stay, gait-related measures and extended ADL of patients, and caregiver burden. Outcomes are assessed at enrolment, end of treatment and 6 months follow-up. RESULTS During 8 weeks, caregivers are trained to become an exercise coach using a blended care approach. Dyads will receive a tailor-made, progressive training program containing task-specific exercises focusing on gait, balance, physical activity and outdoor activities. Dyads are asked to perform the training program a minimum of 5 times a week for 30 min per session, supported by a web-based telerehabilitation system with instruction videos and a messaging environment to communicate with their physiotherapist. CONCLUSIONS We hypothesize that the Armed4Stroke program will increase self-reported mobility and independence in ADL, facilitating an early discharge poststroke. In addition, we hypothesize that active involvement of caregivers and providing support using blended care, will improve the care transition when professional support tapers off. Therefore, the Armed4Stroke program may complement early supported discharge services. TRIAL REGISTRATION Netherlands Trial Register, NL7422 . Registered 11 December 2018.
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Affiliation(s)
- Marijn Mulder
- Department of Rehabilitation Medicine, Amsterdam University Medical Centre, location VU University Medical Centre, Amsterdam Movement Sciences, PO Box 7057, 1007, MB, Amsterdam, The Netherlands.,Amsterdam Rehabilitation Research Centre
- Reade, Amsterdam, The Netherlands
| | - Corien Nikamp
- Roessingh Research and Development, Enschede, The Netherlands.,Department of Biomedical Signals and Systems, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Rinske Nijland
- Amsterdam Rehabilitation Research Centre
- Reade, Amsterdam, The Netherlands
| | - Erwin van Wegen
- Department of Rehabilitation Medicine, Amsterdam University Medical Centre, location VU University Medical Centre, Amsterdam Movement Sciences, PO Box 7057, 1007, MB, Amsterdam, The Netherlands.,Amsterdam Neuroscience, Vrije Universiteit, Amsterdam, The Netherlands
| | - Erik Prinsen
- Roessingh Research and Development, Enschede, The Netherlands.,Department op Biomechanical Engineering, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Judith Vloothuis
- Amsterdam Rehabilitation Research Centre
- Reade, Amsterdam, The Netherlands
| | - Jaap Buurke
- Roessingh Research and Development, Enschede, The Netherlands.,Department of Biomedical Signals and Systems, Technical Medical Centre, University of Twente, Enschede, the Netherlands.,Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA.,Roessingh, Centre for Rehabilitation, Enschede, The Netherlands
| | - Gert Kwakkel
- Department of Rehabilitation Medicine, Amsterdam University Medical Centre, location VU University Medical Centre, Amsterdam Movement Sciences, PO Box 7057, 1007, MB, Amsterdam, The Netherlands. .,Amsterdam Rehabilitation Research Centre
- Reade, Amsterdam, The Netherlands. .,Amsterdam Neuroscience, Vrije Universiteit, Amsterdam, The Netherlands. .,Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA.
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17
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Levin C, Zisberg A, Gil E, Rand D, Agmon M. ‘Behind the scenes’ of accelerometer use to quantify in-hospital mobility of older adults. Arch Phys Med Rehabil 2022; 103:1676-1683.e1. [DOI: 10.1016/j.apmr.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 10/29/2021] [Accepted: 01/17/2022] [Indexed: 11/29/2022]
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18
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Handlery R, Regan E, Lewis AF, Larsen C, Handlery K, Flach A, Fritz S. Active Participation of Care Partners in a Physical Activity Intervention Alongside People with Stroke: A Feasibility Study. Physiother Can 2022; 74:97-110. [PMID: 35185254 PMCID: PMC8816353 DOI: 10.3138/ptc-2020-0035] [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: 04/15/2020] [Revised: 07/20/2020] [Accepted: 09/16/2020] [Indexed: 01/03/2023]
Abstract
Purpose: This study investigated the feasibility of a physical activity intervention for people with stroke and their care partners and the role social support plays in physical activity adherence. Method: The study used a single-group, pretest-posttest design with follow-up. Participants were adults with chronic stroke and their care partners. The intervention consisted of 8 weeks of structured, group-based physical activity classes, followed by 19 weeks of self-directed physical activity. Recruitment, adherence, safety, and retention were assessed. Familial social support was assessed before and after the 8-week structured portion and again 19 weeks later. Results: A total of 21 participants (15 people with stroke, 6 care partners), mean age 67.6 (SD 11.6) years, were recruited; 19 (90.5%) completed the 19-week assessment. No adverse events were experienced during the programme. Attendance during the 8-week portion was better than during the 19-week portion (mean difference 0.95; p < 0.001; 95% CI: 0.71, 1.19 visits/wk). No relationship was found between social support and physical activity adherence (p > 0.05). Conclusions: Involvement of care partners in a physical activity intervention is feasible and safe. Both people with stroke and their care partners may require ongoing support to participate in long-term physical activity. The relationship between social support and physical activity adherence requires further study.
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Affiliation(s)
- Reed Handlery
- Physical Therapy Program, Department of Exercise Science, University of South Carolina, Columbia, South Carolina, United States
| | - Elizabeth Regan
- Physical Therapy Program, Department of Exercise Science, University of South Carolina, Columbia, South Carolina, United States
| | - Allison Foster Lewis
- Physical Therapy Program, Department of Exercise Science, University of South Carolina, Columbia, South Carolina, United States
| | - Chelsea Larsen
- Physical Therapy Program, Department of Exercise Science, University of South Carolina, Columbia, South Carolina, United States
| | - Kaci Handlery
- Physical Therapy Program, Department of Exercise Science, University of South Carolina, Columbia, South Carolina, United States
| | - Alicia Flach
- Physical Therapy Program, Department of Exercise Science, University of South Carolina, Columbia, South Carolina, United States
| | - Stacy Fritz
- Physical Therapy Program, Department of Exercise Science, University of South Carolina, Columbia, South Carolina, United States
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19
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Brauer SG, Kuys SS, Paratz JD, Ada L. High-intensity treadmill training and self-management for stroke patients undergoing rehabilitation: a feasibility study. Pilot Feasibility Stud 2021; 7:215. [PMID: 34876235 PMCID: PMC8650326 DOI: 10.1186/s40814-021-00941-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 10/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Physical activity undertaken by stroke survivors is generally low. This trial investigated the feasibility of delivering a high-intensity treadmill and self-management program to people with stroke undergoing inpatient rehabilitation and determine whether physical activity, walking ability and cardiorespiratory fitness could be increased. METHOD A phase I, single-group, pre-post intervention study was conducted with stroke survivors undergoing inpatient rehabilitation who could walk. Participants undertook a high-intensity treadmill and self-management program for up to 30 min, three times a week for 8 weeks under the supervision of their usual physiotherapist. Feasibility was determined by examining compliance, satisfaction and adverse events. Clinical outcomes were amount of physical activity, walking ability, and cardiorespiratory fitness collected pre-training (week 0), post-training (week 8), and at follow-up (week 26). RESULTS Forty stroke survivors participated, completing 10 (SD 6) sessions, 94% at the specified training intensity, with high satisfaction and no adverse events related to the intervention. At week 8, participants completed 2749 steps/day (95% CI 933 to 4564) more physical activity than at week 0. Walking distance increased by 110 m (95% CI 23 to 196), walking speed by 0.24 m/s (95% CI 0.05 to 0.42), and VO2 peak by 0.29 ml/kg/min (95% CI 0.03 to 0.56). At week 26, increases in physical activity, walking distance and speed, and cardiorespiratory fitness were maintained. CONCLUSIONS A high-intensity treadmill training program embedded within a self-management approach during inpatient rehabilitation appears feasible and potentially may offer sustained improvements in physical activity, walking ability, fitness, and quality of life. A randomised trial is warranted. TRIAL REGISTRATION This feasibility study was registered with the Australian New Zealand Clinical Trials Registry ( ACTRN12613000764730 ).
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Affiliation(s)
- Sandra G Brauer
- Discipline of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia.
| | - Suzanne S Kuys
- School of Physiotherapy, Australian Catholic University, Banyo, Queensland, Australia
| | - Jennifer D Paratz
- Burns, Trauma and Critical Care Research Centre, University of Queensland, Brisbane, Queensland, Australia.,School of Allied Health Sciences, Griffith University, Southport, Queensland, Australia
| | - Louise Ada
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
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20
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Chen S, Huang J, Yao L, Zeng Y, Quan H, Kang H, Ou Y, Chen S. Internet+Continuing Nursing (ICN) Program Promotes Motor Function Rehabilitation of Patients With Ischemic Stroke. Neurologist 2021; 27:56-60. [PMID: 34842574 DOI: 10.1097/nrl.0000000000000364] [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
BACKGROUND AND PURPOSE Ischemic stroke is a severe disorder with high rates of death and recurrence that causes disability in patients and for which there is currently no effective treatment. Internet-based rehabilitation helps patients with disability recover at home with the help of their household or family members in a nonclinical setting. However, the effects of the internet+continuing nursing (ICN) program on the recovery of patients after ischemic stroke remains unknown. METHODS In the present study, patients were treated with an ICN-based rehabilitation training program; subsequently, the Self-efficacy Scale for Chronic Disease, Questionnaire of Exercise Adherence, Motor Assessment Scale, Activities of Daily Living, and Stroke-specific Quality of Life were performed to evaluate the effects of the ICN program on patient self-confidence to persist with rehabilitation, functional exercise compliance, motor function, ability to live independently and quality of life following ischemic stroke. RESULTS We observed that, after the ICN intervention for 6 weeks and 3 months, the scores of Self-efficacy Scale for Chronic Disease, Questionnaire of Exercise Adherence, Motor Assessment Scale, Activities of Daily Living, and Stroke-specific Quality of Life in the ICN-treated group were significantly higher compared with those in the control group. CONCLUSION These results suggested that the ICN program may promote the recovery of patients after ischemic stroke.
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Affiliation(s)
- Shuangqin Chen
- Department of Neurology, The First Affiliated Hospital, University of South China, Hengyang, Hunan, People's Republic of China
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21
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Nayak P, Mahmood A, Kumaran D S, Natarajan M, Unnikrishnan B, Solomon JM. Adaptive sports for promoting physical activity in community-dwelling adults with stroke: A feasibility study. J Bodyw Mov Ther 2021; 28:341-347. [PMID: 34776162 DOI: 10.1016/j.jbmt.2021.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 06/01/2021] [Accepted: 07/13/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite proven health benefits of regular participation in physical activities (PA), adults with stroke fail to achieve recommended levels of PA. Sports being an enjoyable activity is more likely to encourage participation. Therefore, the objectives of the present study are i) to develop and test the feasibility of adaptive sports for promoting PA and Quality of Life (QoL) in community-dwelling adults with stroke, and ii) to explore the participants perception and experiences of playing adaptive sports. METHODS Two focus groups were conducted among the eight experts and a person with stroke to develop adaptive sports. To test the feasibility of these adaptive sports, in a multi methods study eighteen community dwelling adults with stroke were recruited. Participants played adaptive sports twice a week for two months in a community center. Participants pre and post intervention PA levels and QoL were measured. Participants were also interviewed at the end of the program to explore their experiences of participation in adaptive sports. RESULTS At the end of the program retention rate of the participants was 83.33% and there was a significant improvement in PA levels, while the improvement in QoL was not statistically significant. Participants expressed positive experience with the program. There were no adverse events during or after the participation. Health benefits, fitness, and fun were reported as facilitators, while lack of access to the sporting facility and lack of caregiver support were reported as barriers to participation. CONCLUSION Adaptive sports appear to be safe, feasible, and well accepted by the adults with stroke.
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Affiliation(s)
- Pradeepa Nayak
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India; Centre for Comprehensive Stroke Rehabilitation and Research (CCSRR), Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - Amreen Mahmood
- Department of Physiotherapy, Kasturba Medical College, Mangalore, India; Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - Senthil Kumaran D
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India; Centre for Comprehensive Stroke Rehabilitation and Research (CCSRR), Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - Manikandan Natarajan
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India; Centre for Comprehensive Stroke Rehabilitation and Research (CCSRR), Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - Bhaskaran Unnikrishnan
- Manipal Academy of Higher Education, Manipal, Karnataka, India; Department of Community Medicine, Kasturba Medical College, Mangalore, India.
| | - John M Solomon
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India; Centre for Comprehensive Stroke Rehabilitation and Research (CCSRR), Manipal Academy of Higher Education, Manipal, Karnataka, India.
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22
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Phybrata Sensors and Machine Learning for Enhanced Neurophysiological Diagnosis and Treatment. SENSORS 2021; 21:s21217417. [PMID: 34770729 PMCID: PMC8587627 DOI: 10.3390/s21217417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/03/2021] [Accepted: 11/03/2021] [Indexed: 11/29/2022]
Abstract
Concussion injuries remain a significant public health challenge. A significant unmet clinical need remains for tools that allow related physiological impairments and longer-term health risks to be identified earlier, better quantified, and more easily monitored over time. We address this challenge by combining a head-mounted wearable inertial motion unit (IMU)-based physiological vibration acceleration (“phybrata”) sensor and several candidate machine learning (ML) models. The performance of this solution is assessed for both binary classification of concussion patients and multiclass predictions of specific concussion-related neurophysiological impairments. Results are compared with previously reported approaches to ML-based concussion diagnostics. Using phybrata data from a previously reported concussion study population, four different machine learning models (Support Vector Machine, Random Forest Classifier, Extreme Gradient Boost, and Convolutional Neural Network) are first investigated for binary classification of the test population as healthy vs. concussion (Use Case 1). Results are compared for two different data preprocessing pipelines, Time-Series Averaging (TSA) and Non-Time-Series Feature Extraction (NTS). Next, the three best-performing NTS models are compared in terms of their multiclass prediction performance for specific concussion-related impairments: vestibular, neurological, both (Use Case 2). For Use Case 1, the NTS model approach outperformed the TSA approach, with the two best algorithms achieving an F1 score of 0.94. For Use Case 2, the NTS Random Forest model achieved the best performance in the testing set, with an F1 score of 0.90, and identified a wider range of relevant phybrata signal features that contributed to impairment classification compared with manual feature inspection and statistical data analysis. The overall classification performance achieved in the present work exceeds previously reported approaches to ML-based concussion diagnostics using other data sources and ML models. This study also demonstrates the first combination of a wearable IMU-based sensor and ML model that enables both binary classification of concussion patients and multiclass predictions of specific concussion-related neurophysiological impairments.
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23
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Hobo K, Kurita H, Momose K. The relationship between energy expenditure and physical functions in patients hospitalised for stroke. Sci Rep 2021; 11:21685. [PMID: 34737355 PMCID: PMC8568978 DOI: 10.1038/s41598-021-01135-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/21/2021] [Indexed: 11/09/2022] Open
Abstract
We assessed the relationship between energy expenditure (EE) and Functional Independence Measure motor items (FIM-M) score, Berg Balance Scale (BBS) score, and comfortable walking speed (CWS) in patients hospitalised for stroke. The total EE per day (TEE), EE during rehabilitation (REE), and EE during activities other than rehabilitation (OEE) were measured using a single-axis acceleration sensor in 36 patients hospitalised for the first stroke episode. In addition, the relationships between each type of EE and FIM-M, BBS, and CWS were investigated. In these patients (mean age 66.2 ± 10.6 years), the median values of TEE, REE, and OEE were 41.8 kcal, 18.5 kcal, and 16.6 kcal, respectively. Correlations were observed between each EE type and all physical function indices. Following the stratification of patients into two groups (high and low) based on the level of physical function, a significant correlation between EE type and physical function was observed only in the low BBS group. EE was correlated with overall physical function indices, but the trend differed depending on physical ability. When patients were stratified based on ability, there were several groups with no significant correlation. Therefore, several patients were unable to achieve an appropriate EE for their level of physical function.
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Affiliation(s)
- Kota Hobo
- Department of Rehabilitation, Setagaya Rehabilitation Hospital, 6-37-1 Matsubara, Setagaya, Tokyo, 156-0043, Japan.
| | - Hideaki Kurita
- Department of Physical Therapy, School of Health Sciences, Tokyo University of Technology, Tokyo, Japan
| | - Kimito Momose
- Department of Physical Therapy, School of Health Sciences, Shinshu University, Matsumoto, Japan
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24
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Pauly T, Ashe MC, Murphy R, Gerstorf D, Linden W, Madden KM, Hoppmann CA. Active With Whom? Examining the Social Context of Physical Activity in Individuals After Stroke and Their Partners. Front Public Health 2021; 9:754046. [PMID: 34660523 PMCID: PMC8511423 DOI: 10.3389/fpubh.2021.754046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 08/30/2021] [Indexed: 11/13/2022] Open
Abstract
Engaging in regular moderate-to-vigorous intensity physical activity (MVPA) is crucial to reduce future health risk for individuals living with the effects of a stroke and their partners. Although numerous studies point to the importance of social factors in physical activity engagement, little is known about with whom individuals after stroke and their partners engage in physical activity with and whether different physical activity companions are uniquely associated with MVPA. Eighty-nine community-dwelling individuals after stroke (Mage = 68.64, SD = 10.44; 74% male) and 83 partners (Mage = 66.04, SD = 9.91; 24% male) completed 14 consecutive days of daily life assessments that included wearing physical activity monitors (accelerometers) and self-reporting physical activity companions (n = 1,961 days). Results show that average levels of MVPA were correlated between partners (r = 0.38), as were day-to-day MVPA fluctuations (r = 0.34). Importantly, for individuals after stroke, being active with their partner, but not with any other physical activity companion, was linked with elevated daily MVPA. In contrast, for partners of individuals after stroke, engaging in physical activity with a variety of different companions (partner, other family member, friend, colleague) was each associated with higher MVPA in daily life. For both individuals after stroke and their partners being active by oneself (without a companion) on a given day was not associated with elevated MVPA. Findings suggest that interventions that promote physical activity engagement should consider the role of meaningful others, with the partner being particularly key for individuals living with chronic health conditions.
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Affiliation(s)
- Theresa Pauly
- Department of Psychology, University of Zurich, Zurich, Switzerland.,University Research Priority Program "Dynamics of Healthy Aging," University of Zurich, Zurich, Switzerland
| | - Maureen C Ashe
- Center for Hip Health and Mobility, University of British Columbia, Vancouver, BC, Canada.,Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Rachel Murphy
- BC Cancer Research Centre, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Denis Gerstorf
- Department of Psychology, Humboldt University Berlin, Berlin, Germany
| | - Wolfgang Linden
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Kenneth M Madden
- Center for Hip Health and Mobility, University of British Columbia, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Christiane A Hoppmann
- Center for Hip Health and Mobility, University of British Columbia, Vancouver, BC, Canada.,Department of Psychology, University of British Columbia, Vancouver, BC, Canada
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Joundi RA, Patten SB, Lukmanji A, Williams JVA, Smith EE. Association Between Physical Activity and Mortality Among Community-Dwelling Stroke Survivors. Neurology 2021; 97:e1182-e1191. [PMID: 34380748 PMCID: PMC8480482 DOI: 10.1212/wnl.0000000000012535] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 06/22/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVE To determine the relationship between physical activity (PA) and mortality in community-dwelling stroke survivors. METHODS The Canadian Community Health Survey was used to obtain self-reported PA across 4 survey years and was linked to administrative databases to obtain prior diagnosis of stroke and subsequent all-cause mortality. PA was measured as metabolic equivalents (METs) per week and meeting minimal PA guidelines was defined as 10 MET-h/wk. Cox proportional hazard regression models and restricted cubic splines were used to determine the relationship between PA and all-cause mortality in respondents with prior stroke and controls, adjusting for sociodemographic factors, comorbidities, and functional health status. RESULTS The cohort included 895 respondents with prior stroke and 97,805 controls. Adhering to PA guidelines was associated with lower hazard of death for those with prior stroke (adjusted hazard ratio [aHR] 0.46, 95% confidence interval [CI] 0.29-0.73) and controls (aHR 0.69, 95% CI 0.62-0.76). There was a strong dose-response relationship in both groups, with a steep early slope and the vast majority of associated risk reduction occurring between 0 and 20 MET-h/wk. In the group of stroke respondents, PA was associated with greater risk reduction in those <75 years of age (aHR 0.21, 95% CI 0.10-0.43) compared to those ≥75 years of age (aHR 0.68, 95% CI 0.42-1.12). DISCUSSION PA was associated with lower all-cause mortality in an apparent dose-dependent manner among those with prior stroke, particularly in younger stroke survivors. Our findings support efforts towards reducing barriers to PA and implementation of PA programs for stroke survivors in the community. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that in community-dwelling survivors of stroke, adhering to physical activity guidelines was associated with lower hazard of death.
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Affiliation(s)
- Raed A Joundi
- From the Departments of Clinical Neurosciences (R.A.J., E.E.S.) and Community Health Sciences (R.A.J., S.B.P., A.L., J.V.A.W., E.E.S.), Cumming School of Medicine, University of Calgary, Canada.
| | - Scott B Patten
- From the Departments of Clinical Neurosciences (R.A.J., E.E.S.) and Community Health Sciences (R.A.J., S.B.P., A.L., J.V.A.W., E.E.S.), Cumming School of Medicine, University of Calgary, Canada
| | - Aysha Lukmanji
- From the Departments of Clinical Neurosciences (R.A.J., E.E.S.) and Community Health Sciences (R.A.J., S.B.P., A.L., J.V.A.W., E.E.S.), Cumming School of Medicine, University of Calgary, Canada
| | - Jeanne V A Williams
- From the Departments of Clinical Neurosciences (R.A.J., E.E.S.) and Community Health Sciences (R.A.J., S.B.P., A.L., J.V.A.W., E.E.S.), Cumming School of Medicine, University of Calgary, Canada
| | - Eric E Smith
- From the Departments of Clinical Neurosciences (R.A.J., E.E.S.) and Community Health Sciences (R.A.J., S.B.P., A.L., J.V.A.W., E.E.S.), Cumming School of Medicine, University of Calgary, Canada
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Hassan EB, Phu S, Warburton E, Humaith N, Wijeratne T. Frailty in Stroke-A Narrated Review. Life (Basel) 2021; 11:life11090891. [PMID: 34575040 PMCID: PMC8468803 DOI: 10.3390/life11090891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/20/2021] [Accepted: 08/26/2021] [Indexed: 12/22/2022] Open
Abstract
This narrative review provides a summary introduction to the relationship between stroke and physical and cognitive frailty syndromes and the neuro-inflammatory similarities (including inflammaging) between the two. The review argues the potential effects of Post COVID-19 Neurological Syndrome (PCNS, also known as Long COVID) with similar pathophysiology. Many patients who have suffered from acute stroke experience long-lasting symptoms affecting several organs including fatigue, brain fog, reduced physical activity, loss of energy, and loss of cognitive reserve, culminating in the loss of independence and poor quality of life. This is very similar to the emerging reports of PCNS from different parts of the world. Stroke, particularly in older adults with comorbidities appears to impact the health and welfare of patients by reducing central neuronal input and neuromuscular function, with muscular atrophy and neuropsychiatric complications. The cumulative effects can potentially lead to a range of physical and cognitive frailty syndromes, which, in many cases may be attributed to persistent, maladapted, low grade, chronic inflammation. Meanwhile, post-COVID-19 Neurological Syndrome (also known as Long COVID Syndrome) appears to share a similar trajectory, adding further urgency for investigations into the mechanisms underlying this constellation of symptoms.
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Affiliation(s)
- Ebrahim Bani Hassan
- Department of Medicine, Australia Institute of Muscular Skeletal Health, Western Health, The University of Melbourne, 176 Furlong Road, St Albans, VIC 3021, Australia; (E.B.H.); (S.P.)
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia (NeuRA), Randwick, NSW 2031, Australia
| | - Steven Phu
- Department of Medicine, Australia Institute of Muscular Skeletal Health, Western Health, The University of Melbourne, 176 Furlong Road, St Albans, VIC 3021, Australia; (E.B.H.); (S.P.)
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia (NeuRA), Randwick, NSW 2031, Australia
| | - Elyce Warburton
- Department of Neurology, Sunshine Hospital, 176 Furlong Road, St Albans, VIC 3021, Australia; (E.W.); (N.H.)
| | - Nihara Humaith
- Department of Neurology, Sunshine Hospital, 176 Furlong Road, St Albans, VIC 3021, Australia; (E.W.); (N.H.)
| | - Tissa Wijeratne
- Department of Medicine, Australia Institute of Muscular Skeletal Health, Western Health, The University of Melbourne, 176 Furlong Road, St Albans, VIC 3021, Australia; (E.B.H.); (S.P.)
- Department of Neurology, Sunshine Hospital, 176 Furlong Road, St Albans, VIC 3021, Australia; (E.W.); (N.H.)
- Department of Public Health, La Trobe University, Bundoora, VIC 3083, Australia
- Department of Medicine, Faculty of Medicine, University of Rajarata, Saliyapura, Anurdhapura 50008, Sri Lanka
- Correspondence:
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Gunnes M, Aksetøy ILA, Follestad T, Indredavik B, Askim T. Can functional walk tests add value to the prediction of cardiorespiratory fitness after stroke? A prospective cohort study. PLoS One 2021; 16:e0255308. [PMID: 34339475 PMCID: PMC8328339 DOI: 10.1371/journal.pone.0255308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 07/04/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cardiorespiratory fitness is often impaired following stroke, and peak oxygen consumption (VO2peak) is an important prognostic value of all-cause mortality. The primary objective was to investigate whether functional walk tests assessed in the subacute phase after stroke added value in predicting VO2peak in chronic stroke, in addition to age, sex and functional dependency. Secondary objectives were to investigate associations between daily physical activity and functional walk tests, and with VO2peak in chronic stroke. METHODS This prospective cohort study included eligible participants originally included in the randomized controlled trial Life After Stroke. Functional walk tests, i.e., six-minute walk test (6MWT) and maximal gait speed, were assessed at inclusion and 18 months later. VO2peak [ml/kg/min] was assessed by a cardiopulmonary exercise test on a treadmill 20 months after inclusion. Daily physical activity was measured by a uniaxial accelerometer (activPAL) at 18-month follow-up. RESULTS Ninety-two community-dwelling individuals, with a mean (SD) age of 69.2 (10.6) years and 33 (35.9%) women, were included 3 months after stroke onset. Eighty-three (90.2%) participants had a modified Rankin Scale (mRS) score of 1 or 2, indicating functional independence. An overall assessment of four prediction models indicated the combination of age, sex, mRS and 6MWT as predictors to be the best fitted model in predicting VO2peak (adjusted R2 = 0.612). Secondary results showed statistically significant, but not clinically significant, associations between daily physical activity and functional walk tests, and with VO2peak. CONCLUSIONS 6MWT add significant value to the prediction of mean VO2peak in the chronic phase in mild strokes, in combination with age, sex and functional dependency. This prediction model may facilitate clinical decisions and rehabilitation strategies for mildly affected stroke survivors in risk of low levels of VO2peak. Future studies should validate the model in various stages after stroke and in patients moderately and severely affected.
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Affiliation(s)
- Mari Gunnes
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Stroke Unit, Department of Internal Medicine, St. Olav’s University Hospital, Trondheim, Norway
| | - Inger-Lise Aamot Aksetøy
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Turid Follestad
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Bent Indredavik
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Stroke Unit, Department of Internal Medicine, St. Olav’s University Hospital, Trondheim, Norway
| | - Torunn Askim
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Stroke Unit, Department of Internal Medicine, St. Olav’s University Hospital, Trondheim, Norway
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Torriani-Pasin C, Demers M, Polese JC, Bishop L, Wade E, Hempel S, Winstein C. mHealth technologies used to capture walking and arm use behavior in adult stroke survivors: a scoping review beyond measurement properties. Disabil Rehabil 2021; 44:6094-6106. [PMID: 34297652 DOI: 10.1080/09638288.2021.1953623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE We aimed to provide a critical review of measurement properties of mHealth technologies used for stroke survivors to measure the amount and intensity of functional skills, and to identify facilitators and barriers toward adoption in research and clinical practice. MATERIALS AND METHODS Using Arksey and O'Malley's framework, two independent reviewers determined eligibility and performed data extraction. We conducted an online consultation survey exercise with 37 experts. RESULTS Sixty-four out of 1380 studies were included. A majority reported on lower limb behavior (n = 32), primarily step count (n = 21). Seventeen studies reported on arm-hand behaviors. Twenty-two studies reported metrics of intensity, 10 reported on energy expenditure. Reliability and validity were the most frequently reported properties, both for commercial and non-commercial devices. Facilitators and barriers included: resource costs, technical aspects, perceived usability, and ecological legitimacy. Two additional categories emerged from the survey: safety and knowledge, attitude, and clinical skill. CONCLUSIONS This provides an initial foundation for a field experiencing rapid growth, new opportunities and the promise that mHealth technologies affords for envisioning a better future for stroke survivors. We synthesized findings into a set of recommendations for clinicians and clinician-scientists about how best to choose mHealth technologies for one's individual objective.Implications for RehabilitationRehabilitation professionals are encouraged to consider the measurement properties of those technologies that are used to monitor functional locomotor and object-interaction skills in the stroke survivors they serve.Multi-modal knowledge translation strategies (research synthesis, educational courses or videos, mentorship from experts, etc.) are available to rehabilitation professionals to improve knowledge, attitude, and skills pertaining to mHealth technologies.Consider the selection of commercially available devices that are proven to be valid, reliable, accurate, and responsive to the targeted clinical population.Consider usability and privacy, confidentiality and safety when choosing a specific device or smartphone application.
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Affiliation(s)
- Camila Torriani-Pasin
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil.,Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | - Marika Demers
- Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | - Janaine C Polese
- Department of Physiotherapy, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil
| | - Lauri Bishop
- Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | - Eric Wade
- Department of Mechanical Engineering, California Polytechnic State University, San Luis Obispo, CA, USA
| | - Susanne Hempel
- Southern California Evidence Review Center, University of Southern California, Los Angeles, CA, USA
| | - Carolee Winstein
- Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA.,Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Waddell KJ, Patel MS, Clark K, Harrington TO, Greysen SR. Leveraging insights from behavioral economics to improve mobility for adults with stroke: Design and rationale of the BE Mobile clinical trial. Contemp Clin Trials 2021; 107:106483. [PMID: 34129953 DOI: 10.1016/j.cct.2021.106483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/06/2021] [Accepted: 06/10/2021] [Indexed: 11/29/2022]
Abstract
Physical inactivity post-stroke can negatively impact long-term health outcomes and contribute to cardiovascular deconditioning, muscle loss, and increased risk for recurrent stroke. The limited number of interventions designed to improve daily physical activity post-stroke have lacked precision in step goals, are resource intensive, and difficult to scale. The purpose of the Leveraging Insights from Behavioral Economics to Improve Mobility for Adults with Stroke (BE Mobile) trial is to examine the preliminary effectiveness of a novel gamification with social incentives intervention for improving physical activity post-stroke. This trial includes adults who have experienced an ischemic or hemorrhagic stroke ≥3 months prior to the time of recruitment who are randomized to a control or gamification arm. All participants receive a Fitbit Inspire 2 wearable device to quantify daily steps and complete a 2-week baseline run-in period followed by an 8-week intervention period. All participants select a daily step goal and the gamification arm is enrolled in a game with loss-framed points and levels to help participants achieve their daily step goal. Participants in the gamification arm also select a support partner who receives weekly updates on their progress in the game. The primary outcome is change in daily steps from baseline during the intervention period. The secondary outcome is difference in the proportion of days participants achieved their daily step goal. Results from this trial will inform future, larger studies that leverage insights from behavioral economics to help improve daily physical activity post-stroke. Trial registration: NCT #04607811.
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Affiliation(s)
- Kimberly J Waddell
- Penn Medicine Nudge Unit, University of Pennsylvania, Philadelphia, PA, USA; Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA.
| | - Mitesh S Patel
- Penn Medicine Nudge Unit, University of Pennsylvania, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; The Wharton School, University of Pennsylvania, Philadelphia, PA, USA; The LDI Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA; Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Kayla Clark
- Penn Medicine Nudge Unit, University of Pennsylvania, Philadelphia, PA, USA
| | - Tory O Harrington
- Penn Medicine Nudge Unit, University of Pennsylvania, Philadelphia, PA, USA
| | - S Ryan Greysen
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Mediano MFF, Mok Y, Coresh J, Kucharska-Newton A, Palta P, Lakshminarayan K, Rosamond WD, Matsushita K, Koton S. Prestroke Physical Activity and Adverse Health Outcomes After Stroke in the Atherosclerosis Risk in Communities Study. Stroke 2021; 52:2086-2095. [PMID: 33784831 PMCID: PMC8154698 DOI: 10.1161/strokeaha.120.032695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 01/26/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE The association of physical activity (PA) before stroke (prestroke PA) with long-term prognosis after stroke is still unclear. We examined the association of prestroke PA with adverse health outcomes in the ARIC study (Atherosclerosis Risk in Communities). METHODS We included 881 participants with incident stroke occurring between 1993 and 1995 (visit 3) and December 31, 2016. Follow-up continued until December 31, 2017 to allow for at least 1-year after incident stroke. Prestroke PA was assessed using a modified version of the Baecke questionnaire in 1987 to 1989 (visit 1) and 1993 to 1995 (visit 3), evaluating PA domains (work, leisure, and sports) and total PA. We used Cox proportional hazards models to quantify the association between tertiles of accumulated prestroke PA levels over the 6-year period between visits 1 and 3 and mortality, risk of cardiovascular disease, and recurrent stroke after incident stroke. RESULTS During a median follow-up of 3.1 years after incident stroke, 676 (77%) participants had adverse outcomes. Highest prestroke total PA was associated with decreased risks of all-cause mortality (hazard ratio, 0.78 [95% CI, 0.63-0.97]) compared with lowest tertile. In the analysis by domain-specific PA, highest levels of work PA were associated with lower risk for all-cause (hazard ratio, 0.77 [95% CI, 0.62-0.96]) and cardiovascular mortality (hazard ratio, 0.45 [95% CI, 0.29-0.70]), and highest levels of leisure PA were associated with lower all-cause mortality (hazard ratio, 0.72 [95% CI, 0.58-0.89]) compared with lowest tertile of PA. No significant associations for sports PA were observed. CONCLUSIONS Higher levels of total prestroke PA as well as work and leisure PA were associated with lower risk of mortality after incident stroke. Public health strategies to increase lifetime PA should be encouraged to decrease long-term mortality after stroke.
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Affiliation(s)
- Mauro F. F. Mediano
- Evandro Chagas National Institute of Infectious Disease, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Department of Research and Education, National Institute of Cardiology, Rio de Janeiro, Brazil
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Yejin Mok
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Anna Kucharska-Newton
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Priya Palta
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Kamakshi Lakshminarayan
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Wayne D. Rosamond
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Silvia Koton
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
- Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Equations for estimating the oxygen cost of walking in stroke patients: a systematic review. Ann Phys Rehabil Med 2021; 65:101514. [PMID: 33857653 DOI: 10.1016/j.rehab.2021.101514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 12/05/2020] [Accepted: 12/08/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To report all equations that can potentially be used to estimate the oxygen cost of walking (Cw) without using a respiratory gas exchange analyzer and to provide the level of reliability of each equation. DATA SOURCES Webline, Medline, Scopus, ScienceDirect, Bielefeld Academic Search Engine (BASE), and Wiley Online Library databases from 1950 to August 2019 with search terms related to stroke and oxygen cost of walking. METHODS This systematic review was reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and the methodological quality of included studies was determined with the Critical Appraisal Skills Programme (CASP). RESULTS We screened 2065 articles, and 33 were included for full-text analysis. Four articles were included in the data synthesis (stroke individuals=184). Analysis reported 4 equations estimating Cw that were developed from logistic regression equations between Cw and self-selected walking speed. The equations differed in several methodological aspects (characteristics of individuals, type of equation, Cw reference measurement methods). The Compagnat et al. study had the highest quality (CASP score=9/9). CONCLUSIONS This literature review highlighted 4 equations for estimating Cw from self-selected walking speed. Compagnat et al. presented the best quality parameters, but this work involved a population restricted to individuals with hemispheric stroke sequelae.
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Garcia Oliveira S, Lourenço Nogueira S, Alex Matos Ribeiro J, Carnaz L, Regina Rocha Urruchia V, Alcantara CC, L Russo T. Concurrent validity and reliability of an activity monitoring for rehabilitation (AMoR) platform for step counting and sitting/lying time in post-stroke individuals. Top Stroke Rehabil 2021; 29:103-113. [PMID: 33605190 DOI: 10.1080/10749357.2021.1886639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Objective and reliable measurements to investigate daily behavior patterns in people with stroke could help therapeutic interventions after a stroke. OBJECTIVE To evaluate whether the Activity Monitoring for Rehabilitation (AMoR) platform has adequate concurrent validity and reliability for step counting and time spent sitting/lying in people post-stroke and to investigate its percentage accuracy for step counting at different walking speeds. METHODS Cross-sectional observational study. Fifty chronic post-stroke subjects used the AMoR platform and SAM simultaneously while a Video camera recorded the same activities during clinical trials. Spearman's correlation coefficient, the mean absolute percentage error, the intraclass correlation coefficient and Bland-Altman plot analyses were used to estimate the validity and reliability of the AMoR platform and StepWatchTM Activity Monitor (SAM). The accuracy percentage was calculated for each device and plotted as a function of the walking speed during the 10-meter walk test (10MWT). RESULTS There was a very high correlation for step counting in all tests and a high correlation for time spent sitting/lying. The mean absolute percentage error values remained below 4% for step counting and time sitting/lying. The AMoR platform also showed excellent reliability for step counting and sitting/lying time, with values within the limit of agreement in the Bland-Altman plots. A high percentage of accuracy for step counting in the AMoR platform was observed during the 10MWT. CONCLUSION The AMoR platform is valid and reliable for step counting and time spent sitting/lying, with a high percentage of accuracy at different walking speeds in the post-stroke population.
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Affiliation(s)
| | | | | | - Letícia Carnaz
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
| | | | | | - Thiago L Russo
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
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Hamre C, Fure B, Helbostad JL, Wyller TB, Ihle-Hansen H, Vlachos G, Ursin MH, Tangen GG. Factors Associated with Level of Physical Activity After Minor Stroke. J Stroke Cerebrovasc Dis 2021; 30:105628. [PMID: 33508728 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105628] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/05/2021] [Accepted: 01/17/2021] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVES To explore factors from the acute phase, and after three and 12 months, associated with level of self-reported physical activity 12 months after a minor ischemic stroke with National Institutes of Health Stroke Scale (NIHSS) score ≤ 3 in persons 70 years or younger. MATERIALS AND METHOD In this longitudinal cohort study patients were recruited consecutively from two stroke units. Activity level were measured with three sets of questions addressing the average number of frequency (times exercising each week), the average intensity, and duration (the average time), and a sum score was constructed. The association between physical activity 12 months after stroke and sociodemographic factors, NIHSS, body mass index, balance, and neuropsychiatric symptoms were explored using multiple linear regression. RESULTS This study included 101 patients, with mean age (SD) 55.5 (11.4) years, NIHSS median (Q1, Q3) 0.0 (0.0, 1.0), and 20 % were female. Multiple linear regression analyses showed sick leave status at stroke onset, balance at three and 12 months, and anxiety, depression, apathy, and fatigue at 12 months to be factors associated with physical activity at 12 months after stroke. CONCLUSION We found that pre-stroke sick leave, post-stroke balance, and neuropsychiatric symptoms were associated with the level of physical activity one year after minor stroke. This might be of importance when giving information about physical activity and deciding about post-stroke follow-up.
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Affiliation(s)
- Charlotta Hamre
- Department of Physiotherapy, Oslo University Hospital (OUS), Norway; Department of Geriatric Medicine, OUS, Norway; Institute of Clinical Medicine, University of Oslo (UiO), Norway; Department of Neurology, OUS, Norway.
| | - Brynjar Fure
- Department of Internal Medicine, Central Hospital, Karlstad, Sweden; Department of Neurology, Central Hospital, Karlstad and Örebro, Sweden; School of Medical Sciences, Örebro University, Sweden.
| | - Jorunn Lægdheim Helbostad
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Norway.
| | - Torgeir Bruun Wyller
- Department of Geriatric Medicine, OUS, Norway; Institute of Clinical Medicine, University of Oslo (UiO), Norway.
| | - Hege Ihle-Hansen
- Department of Geriatric Medicine, OUS, Norway; Department of Neurology, OUS, Norway.
| | | | - Marie Helene Ursin
- Department of Geriatric Medicine, Bærum Hospital, Vestre Viken Trust, Norway
| | - Gro Gujord Tangen
- Department of Geriatric Medicine, OUS, Norway; Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Norway.
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Katzan I, Schuster A, Kinzy T. Physical Activity Monitoring Using a Fitbit Device in Ischemic Stroke Patients: Prospective Cohort Feasibility Study. JMIR Mhealth Uhealth 2021; 9:e14494. [PMID: 33464213 PMCID: PMC7854036 DOI: 10.2196/14494] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 05/01/2020] [Accepted: 05/13/2020] [Indexed: 12/12/2022] Open
Abstract
Background Continuous tracking of ambulatory activity in real-world settings using step activity monitors has many potential uses. However, feasibility, accuracy, and correlation with performance measures in stroke patients have not been well-established. Objective The primary study objective was to determine adherence with wearing a consumer-grade step activity monitor, the Fitbit Charge HR, in home-going ischemic stroke patients during the first 90 days after hospital discharge. Secondary objectives were to (1) determine accuracy of step counts of the Fitbit Charge HR compared with a manual tally; (2) calculate correlations between the Fitbit step counts and the mobility performance scores at discharge and 30 days after stroke; (3) determine variability and change in weekly step counts over 90 days; and (4) evaluate patient experience with using the Fitbit Charge HR poststroke. Methods A total of 15 participants with recent mild ischemic stroke wore a Fitbit Charge HR for 90 days after discharge and completed 3 mobility performance tests from the National Institutes of Health Toolbox at discharge and Day 30: (1) Standing Balance Test, (2) 2-Minute Walk Endurance Test, and (3) 4-Meter Walk Gait Speed Test. Accuracy of step activity monitors was assessed by calculating differences in steps recorded on the step activity monitor and a manual tally during 2-minute walk tests. Results Participants had a mean age of 54 years and a median modified Rankin scale score of 1. Mean daily adherence with step activity monitor use was 83.6%. Mean daily step count in the first week after discharge was 4376. Daily step counts increased slightly during the first 30 days after discharge (average increase of 52.5 steps/day; 95% CI 32.2-71.8) and remained stable during the 30-90 day period after discharge. Mean step count difference between step activity monitor and manual tally was –4.8 steps (–1.8%). Intraclass correlation coefficients for step counts and 2-minute walk, standing balance, and 4-meter gait speed at discharge were 0.41 (95% CI –0.14 to 0.75), –0.12 (95% CI –0.67 to 0.64), and 0.17 (95% CI –0.46 to 0.66), respectively. Values were similarly poor at 30 days. Conclusions The use of consumer-grade Fitbit Charge HR in patients with recent mild stroke is feasible with reasonable adherence and accuracy. There was poor correlation between step counts and gait speed, balance, and endurance. Further research is needed to evaluate the association between step counts and other outcomes relevant to patients, including patient-reported outcomes and measures of physical function.
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Affiliation(s)
- Irene Katzan
- Neurological Institute Center for Outcomes Research and Evaluation, Cleveland Clinic, Cleveland, OH, United States.,Cerebrovascular Center, Cleveland Clinic, Cleveland, OH, United States
| | - Andrew Schuster
- Neurological Institute Center for Outcomes Research and Evaluation, Cleveland Clinic, Cleveland, OH, United States
| | - Tyler Kinzy
- Neurological Institute Center for Outcomes Research and Evaluation, Cleveland Clinic, Cleveland, OH, United States
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Barth J, Lohse KR, Konrad JD, Bland MD, Lang CE. Sensor-based categorization of upper limb performance in daily life of persons with and without neurological upper limb deficits. FRONTIERS IN REHABILITATION SCIENCES 2021; 2. [PMID: 35382114 PMCID: PMC8979497 DOI: 10.3389/fresc.2021.741393] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background: The use of wearable sensor technology (e. g., accelerometers) for tracking human physical activity have allowed for measurement of actual activity performance of the upper limb (UL) in daily life. Data extracted from accelerometers can be used to quantify multiple variables measuring different aspects of UL performance in one or both limbs. A limitation is that several variables are needed to understand the complexity of UL performance in daily life. Purpose: To identify categories of UL performance in daily life in adults with and without neurological UL deficits. Methods: This study analyzed data extracted from bimanual, wrist-worn triaxial accelerometers from adults from three previous cohorts (N = 211), two samples of persons with stroke and one sample from neurologically intact adult controls. Data used in these analyses were UL performance variables calculated from accelerometer data, associated clinical measures, and participant characteristics. A total of twelve cluster solutions (3-, 4-, or 5-clusters based with 12, 9, 7, or 5 input variables) were calculated to systematically evaluate the most parsimonious solution. Quality metrics and principal component analysis of each solution were calculated to arrive at a locally-optimal solution with respect to number of input variables and number of clusters. Results: Across different numbers of input variables, two principal components consistently explained the most variance. Across the models with differing numbers of UL input performance variables, a 5-cluster solution explained the most overall total variance (79%) and had the best model-fit. Conclusion: The present study identified 5 categories of UL performance formed from 5 UL performance variables in cohorts with and without neurological UL deficits. Further validation of both the number of UL performance variables and categories will be required on a larger, more heterogeneous sample. Following validation, these categories may be used as outcomes in UL stroke research and implemented into rehabilitation clinical practice.
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Affiliation(s)
- Jessica Barth
- Washington University in St. Louis, Program in Physical Therapy, St. Louis, MO, USA
| | - Keith R Lohse
- Washington University in St. Louis, Program in Physical Therapy, St. Louis, MO, USA
| | - Jeffrey D Konrad
- Washington University in St. Louis, Program in Physical Therapy, St. Louis, MO, USA
| | - Marghuertta D Bland
- Washington University in St. Louis, Program in Physical Therapy, St. Louis, MO, USA.,Washington University in St. Louis, Program in Occupational Therapy, MO, USA.,Washington University in St. Louis, Neurology, MO, USA
| | - Catherine E Lang
- Washington University in St. Louis, Program in Physical Therapy, St. Louis, MO, USA.,Washington University in St. Louis, Program in Occupational Therapy, MO, USA.,Washington University in St. Louis, Neurology, MO, USA
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Tabacu L, Ledbetter M, Leroux A, Crainiceanu C, Smirnova E. Quantifying the Varying Predictive Value of Physical Activity Measures Obtained from Wearable Accelerometers on All-Cause Mortality over Short to Medium Time Horizons in NHANES 2003-2006. SENSORS 2020; 21:s21010004. [PMID: 33374911 PMCID: PMC7792606 DOI: 10.3390/s21010004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/09/2020] [Accepted: 12/14/2020] [Indexed: 11/18/2022]
Abstract
Physical activity measures derived from wearable accelerometers have been shown to be highly predictive of all-cause mortality. Prediction models based on traditional risk factors and accelerometry-derived physical activity measures are developed for five time horizons. The data set contains 2978 study participants between 50 and 85 years old with an average of 13.08 years of follow-up in the NHANES 2003–2004 and 2005–2006. Univariate and multivariate logistic regression models were fit separately for five datasets for one- to five-year all-cause mortality as outcome (number of events 46, 94, 155, 218, and 297, respectively). In univariate models the total activity count (TAC) was ranked first in all five horizons (AUC between 0.831 and 0.774) while the active to sedentary transition probability (ASTP) was ranked second for one- to four-year mortality models and fourth for the five-year all-cause mortality model (AUC between 0.825 and 0.735). In multivariate models age and ASTP were significant in all one- to five-year all-cause mortality prediction models. Physical activity measures are consistently among the top predictors, even after adjusting for demographic and lifestyle variables. Physical activity measures are strong stand-alone predictors and substantially improve the prediction performance of models based on traditional risk factors.
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Affiliation(s)
- Lucia Tabacu
- Department of Mathematics and Statistics, Old Dominion University, Norfolk, VA 23529, USA
- Correspondence:
| | - Mark Ledbetter
- Department of Mathematics, University of Lynchburg, Lynchburg, VA 24501, USA;
| | - Andrew Leroux
- Department of Biostatistics & Informatics, Colorado School of Public Health, University of Colorado, Aurora, CO 80045, USA;
| | - Ciprian Crainiceanu
- Department of Biostatistics, Johns Hopkins University, Baltimore, MD 21205, USA;
| | - Ekaterina Smirnova
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA 23298, USA;
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Yoon HM, Han EY, Joo SJ. Significance of Cycle Ergometer as a Measure of Peak Aerobic Capacity in the Disabled. J Stroke Cerebrovasc Dis 2020; 30:105477. [PMID: 33249339 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105477] [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: 09/27/2020] [Revised: 11/09/2020] [Accepted: 11/11/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND To compare different physiological responses between treadmill and cycle ergometer in stroke patients in regard to community ambulation, and to determine strong predictors of equipment-dependent VO2peak and its related factors among physical fitness parameters and finally to establish the significance of cycle ergometer as a measure of VO2peak in the disabled according to gait function. METHODS Sixty-three stroke survivors were enrolled in this study and were grouped according to the gait speed (32 non-community ambulators <0.8 m/s:31 community ambulators ≥0.8 m/s). All participants performed exercise stress test (EST) with treadmill and cycle ergometer and rehabilitation function tests. RESULTS Community ambulators achieved higher VO2peak by treadmill, but non-community ambulators showed similar VO2peak between treadmill and cycle ergometer due to gait problems. The gait speed and endurance were strong predictors of difference of peak aerobic capacity between treadmill and cycle ergometer (multiple regression analysis, adjusted R2=0.458). CONCLUSION Cycle ergometer might be more appropriate for non-community ambulatory stroke patients to assess the peak aerobic capacity. Gait speed and gait distance could affect equipment-dependent cardiopulmonary performance significantly in the disabled. Therefore, the careful consideration of comprehensive and objective physical function including gait endurance, and speed and prescription of appropriate exercise intensity and equipment depending on the severity should be needed to improve the cardiopulmonary fitness and physical function adequately in stroke rehabilitation.
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Affiliation(s)
- Ho Min Yoon
- Department of Medicine, Graduate School, Jeju National University, Jeju, Korea
| | - Eun Young Han
- Department of Rehabilitation Medicine, Jeju National University, College of Medicine, Jeju, Korea.
| | - Seung-Jae Joo
- Department of Internal Medicine, Division of Cardiology, Jeju National University, College of Medicine, Jeju, Korea
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Lang CE, Barth J, Holleran CL, Konrad JD, Bland MD. Implementation of Wearable Sensing Technology for Movement: Pushing Forward into the Routine Physical Rehabilitation Care Field. SENSORS (BASEL, SWITZERLAND) 2020; 20:E5744. [PMID: 33050368 PMCID: PMC7601835 DOI: 10.3390/s20205744] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/06/2020] [Accepted: 10/08/2020] [Indexed: 01/01/2023]
Abstract
While the promise of wearable sensor technology to transform physical rehabilitation has been around for a number of years, the reality is that wearable sensor technology for the measurement of human movement has remained largely confined to rehabilitation research labs with limited ventures into clinical practice. The purposes of this paper are to: (1) discuss the major barriers in clinical practice and available wearable sensing technology; (2) propose benchmarks for wearable device systems that would make it feasible to implement them in clinical practice across the world and (3) evaluate a current wearable device system against the benchmarks as an example. If we can overcome the barriers and achieve the benchmarks collectively, the field of rehabilitation will move forward towards better movement interventions that produce improved function not just in the clinic or lab, but out in peoples' homes and communities.
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Affiliation(s)
- Catherine E. Lang
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO 63122, USA; (J.B.); (C.L.H.); (J.D.K.); (M.D.B.)
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO 63122, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63122, USA
| | - Jessica Barth
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO 63122, USA; (J.B.); (C.L.H.); (J.D.K.); (M.D.B.)
| | - Carey L. Holleran
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO 63122, USA; (J.B.); (C.L.H.); (J.D.K.); (M.D.B.)
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63122, USA
| | - Jeff D. Konrad
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO 63122, USA; (J.B.); (C.L.H.); (J.D.K.); (M.D.B.)
| | - Marghuretta D. Bland
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO 63122, USA; (J.B.); (C.L.H.); (J.D.K.); (M.D.B.)
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO 63122, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63122, USA
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Bunketorp-Käll L, Pekna M, Pekny M, Samuelsson H, Blomstrand C, Nilsson M. Motor Function in the Late Phase After Stroke: Stroke Survivors' Perspective. Ann Rehabil Med 2020; 44:362-369. [PMID: 32986939 PMCID: PMC7655232 DOI: 10.5535/arm.20060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 06/03/2020] [Indexed: 11/10/2022] Open
Abstract
Objective To examine the association between observer-assessed functional status and perceived recovery in the late phase after stroke. The study also aimed to determine whether observer-assessed functional improvements as a result of horse-riding therapy (H-RT) are related to enhanced perception of stroke recovery. Methods This is a descriptive correlational study using data derived from a three-armed randomized controlled trial in which 123 individuals were enrolled, among whom 43 received H-RT for 12 weeks. The measures included the Modified Motor Assessment Scale, Berg Balance Scale, Timed Up and Go, timed 10-m walk, and perceived recovery from stroke indicated by item #9 in the Stroke Impact Scale (version 2.0). Spearman rank order correlation (rs) was used in the analyses. Results There were moderate to strong positive or negative correlations between all four observer-assessed motor variables and participants’ ratings of perceived late-phase stroke recovery at trial entrance, ranging from rs=-0.49 to rs=0.54 (p<0.001). The results of the correlational analyses of variable changes showed that, after the end of the H-RT intervention, both self-selected and fast gait speed improvement were significantly correlated with increments in self-rated stroke recovery (rs=-0.41, p=0.01 and rs=-0.38, p=0.02, respectively). Conclusion This study provided data supporting the association between individual ratings of self-perceived recovery after stroke and observer-assessed individual motor function. The results further demonstrate that enhancement in perceived stroke recovery after completing the intervention was associated with objectively measured gains in both self-selected and fast gait speed.
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Affiliation(s)
- Lina Bunketorp-Käll
- Center for Brain Repair, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Center for Advanced Reconstruction of Extremities (CARE), Sahlgrenska University Hospital, Mölndal, Sweden
| | - Marcela Pekna
- Center for Brain Repair, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Florey Institute of Neuroscience and Mental Health, Melbourne, Australia.,University of Newcastle, Newcastle, Australia
| | - Milos Pekny
- Center for Brain Repair, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Florey Institute of Neuroscience and Mental Health, Melbourne, Australia.,University of Newcastle, Newcastle, Australia
| | - Hans Samuelsson
- Center for Brain Repair, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Christian Blomstrand
- Center for Brain Repair, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Stroke Center West, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Michael Nilsson
- Center for Brain Repair, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Florey Institute of Neuroscience and Mental Health, Melbourne, Australia.,Centre for Rehab Innovations (CRI), University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Zhou B, Wang H, Hu F, Feng N, Xi H, Zhang Z, Tang H. Accurate recognition of lower limb ambulation mode based on surface electromyography and motion data using machine learning. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 193:105486. [PMID: 32402846 DOI: 10.1016/j.cmpb.2020.105486] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 03/17/2020] [Accepted: 03/30/2020] [Indexed: 06/11/2023]
Abstract
Background and Objective The lower limb activity of recognition of the elderly, the weak, the disabled and the sick is an irreplaceable role in the caring of daily life. The main purpose of this study is to assess the feasibility of using the surface electromyography (sEMG) signal and inertial measurement units (IMUs) data to determine the optimal fusion features and classifier for the study of daily ambulation mode recognition. Methods We have carried out several steps of experiments to obtain and test the optimal combination of the sEMG data and the body motion data at the feature level and the most suitable machine learning classification algorithm. Firstly, the sEMG and IMUs signals of eighteen participants performing four different ambulatory activities have recorded using wearable sensors. Secondly, several features of the sEMG sensors and IMU data were extracted and tested by the Markov Random Field based Fisher-Markov feature selector. Finally, four ML classifiers with several feature combinations were estimated with sensitivity, precision and recognition accurate rate of ambulatory activity classification. Results The results of this work showed that all selected features were significantly statistical difference in four ambulation modes. The principal component analysis was used to reduce the dimension of selected sEMG features and IMU features to form a fusion feature input support vector machine classifier, which could predict ambulatory activities with good classification performance. Conclusions It is concluded that the results demonstrate the feasibility of the ML classification model, which could provide a more novel way to guarantee the recognition rate and effectiveness of monitor daily ambulatory activity.
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Affiliation(s)
- Bin Zhou
- Department of Mechanical Engineering and Automation, Northeastern University, Shenyang 110819, China
| | - Hong Wang
- Department of Mechanical Engineering and Automation, Northeastern University, Shenyang 110819, China.
| | - Fo Hu
- Department of Mechanical Engineering and Automation, Northeastern University, Shenyang 110819, China
| | - Naishi Feng
- Department of Mechanical Engineering and Automation, Northeastern University, Shenyang 110819, China
| | - Hailong Xi
- Department of Mechanical Engineering and Automation, Northeastern University, Shenyang 110819, China
| | - Zhihan Zhang
- Department of Mechanical Engineering and Automation, Northeastern University, Shenyang 110819, China
| | - Hao Tang
- Department of Mechanical Engineering and Automation, Northeastern University, Shenyang 110819, China
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Toma J, Hammond B, Chan V, Peacocke A, Salehi B, Jhingan P, Brooks D, Hébert AA, Marzolini S. Inclusion of People Poststroke in Cardiac Rehabilitation Programs in Canada: A Missed Opportunity for Referral. CJC Open 2020; 2:195-206. [PMID: 32695969 PMCID: PMC7365786 DOI: 10.1016/j.cjco.2020.01.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 01/29/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Evidence supports establishing a continuum of care from stroke rehabilitation (SR) to cardiac rehabilitation programs (CRPs). It is not known to what extent people poststroke are being integrated. This study aimed to determine the proportion of CRPs that accept referrals poststroke, barriers/facilitators, and eligibility criteria. METHODS A web-based questionnaire was sent to CRPs across Canada. RESULTS Of 160 questionnaires sent, 114 representatives (71%) of 130 CRPs responded. Of respondents, 65% (n = 74) reported accepting people with a diagnosis of stroke and doing so for a median of 11 years, 11 offering stroke-specific classes and an additional 6 planning inclusion. However, 62.5% of CRPs reported that < 11 patients participated in the last calendar year despite 88.5% reporting no limit to the number they could enroll. Among CRPs, 25% accepted only patients with concurrent cardiac diagnoses, living in the community (47.8%), and without severe mobility (70.1%), communication (80.6%), or cognitive (85.1%) deficits. The 2 most influential barriers and facilitators among all CRPs were funding and staffing. The fourth greatest barrier was lack of poststroke referrals, and third to sixth facilitators were SR/CRP collaboration to ensure appropriate referrals (third) and to increase referrals (sixth), toolkits for prescribing resistance (fourth), and aerobic training (fifth). CRP characteristics associated with accepting stroke were a hybrid program model, a medium program size, and having a falls prevention component. CONCLUSIONS Most CRPs accept patients poststroke, but few participate. Therefore, establishing SR/CRP partnerships to increase appropriate referrals, using a toolkit to help operationalize exercise components, and allocating funding/resources to CRPs may significantly increase access to secondary prevention strategies.
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Affiliation(s)
- Jelena Toma
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Brittany Hammond
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Vito Chan
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Alex Peacocke
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Baharak Salehi
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Prateek Jhingan
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Dina Brooks
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- KITE Research Institute, Toronto Rehab-University Health Network, Toronto, Ontario, Canada
- Heart and Stroke Foundation, Canadian Partnership for Stroke Recovery, Ottawa, Ontario, Canada
- McMaster University, Hamilton, Ontario, Canada
| | | | - Susan Marzolini
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- KITE Research Institute, Toronto Rehab-University Health Network, Toronto, Ontario, Canada
- Heart and Stroke Foundation, Canadian Partnership for Stroke Recovery, Ottawa, Ontario, Canada
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Nascimento LR, Flores LC, de Menezes KK, Teixeira-Salmela LF. Water-based exercises for improving walking speed, balance, and strength after stroke: a systematic review with meta-analyses of randomized trials. Physiotherapy 2020; 107:100-110. [DOI: 10.1016/j.physio.2019.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Indexed: 11/25/2022]
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Compagnat M, Mandigout S, Batcho C, Vuillerme N, Salle J, David R, Daviet J. Validity of wearable actimeter computation of total energy expenditure during walking in post-stroke individuals. Ann Phys Rehabil Med 2020; 63:209-215. [DOI: 10.1016/j.rehab.2019.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 07/02/2019] [Accepted: 07/05/2019] [Indexed: 10/26/2022]
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Caetano LCG, Pacheco BD, Samora GAR, Teixeira-Salmela LF, Scianni AA. Self-Efficacy to Engage in Physical Exercise and Walking Ability Best Predicted Exercise Adherence after Stroke. Stroke Res Treat 2020; 2020:2957623. [PMID: 32190284 PMCID: PMC7073491 DOI: 10.1155/2020/2957623] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 02/21/2020] [Indexed: 11/18/2022] Open
Abstract
AIM To describe exercise preferences and to investigate the contribution of exercise preferences, walking ability, and current levels of physical activity in predicting exercise adherence in individuals with chronic stroke. METHODS For this exploratory study, exercise adherence was measured using the first question of the first section of the Exercise Preference Questionnaire (stroke)-Brazil (EPQ (stroke)-Brazil). Nine independent variables were included as potential predictors of exercise adherence: the seven factors of the EPQ (stroke)-Brazil, walking speed, and level of physical activity. RESULTS Participated 93 individuals with stroke, who had a mean age of 62 (SD 12) years and a mean time since the onset of the stroke of 58 (SD 67) months. The most preferable exercise was walking. Logistic regression analysis revealed that self-efficacy to engage in physical exercise and walking ability predicted and explained 80% of the variance in exercise adherence. CONCLUSION The findings showed that feeling able to perform physical exercise and having higher walking ability predicted higher exercise adherences in individuals with chronic stroke. The knowledge of potential contributors to exercise adherence may help in designing exercise programs for individuals with stroke.
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Affiliation(s)
- Lívia C. G. Caetano
- Graduate Program in Rehabilitation Sciences, Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil
| | - Bruna D. Pacheco
- Graduate Program in Rehabilitation Sciences, Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil
| | - Giane A. R. Samora
- Graduate Program in Rehabilitation Sciences, Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil
| | - Luci F. Teixeira-Salmela
- Graduate Program in Rehabilitation Sciences, Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil
| | - Aline A. Scianni
- Graduate Program in Rehabilitation Sciences, Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil
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Marzolini S, Fong K, Jagroop D, Neirinckx J, Liu J, Reyes R, Grace SL, Oh P, Colella TJF. Eligibility, Enrollment, and Completion of Exercise-Based Cardiac Rehabilitation Following Stroke Rehabilitation: What Are the Barriers? Phys Ther 2020; 100:44-56. [PMID: 31588512 DOI: 10.1093/ptj/pzz149] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 03/09/2019] [Accepted: 06/09/2019] [Indexed: 11/13/2022]
Abstract
BACKGROUND People after stroke benefit from comprehensive secondary prevention programs including cardiac rehabilitation (CR), yet there is little understanding of eligibility for exercise and barriers to use. OBJECTIVE The aim of this study was to examine eligibility for CR; enrollment, adherence, and completion; and factors affecting use. DESIGN This was a prospective study of 116 consecutive people enrolled in a single outpatient stroke rehabilitation (OSR) program located in Toronto, Ontario, Canada. METHODS Questionnaires were completed by treating physical therapists for consecutive participants receiving OSR and included reasons for CR ineligibility, reasons for declining participation, demographics, and functional level. CR eligibility criteria included the ability to walk ≥100 m (no time restriction) and the ability to exercise at home independently or with assistance. People with or without hemiplegic gait were eligible for adapted or traditional CR, respectively. Logistic regression analyses were used to examine factors associated with use indicators. RESULTS Of 116 participants receiving OSR, 82 (70.7%) were eligible for CR; 2 became eligible later. Sixty (71.4%) enrolled in CR and 49 (81.7%) completed CR, attending 87.1% (SD = 16.6%) of prescribed sessions. The primary reasons for ineligibility included being nonambulatory or having poor ambulation (52.9%; 18/34 patients) and having severe cognitive deficits and no home exercise support (20.6%; 7/34). Frequently cited reasons for declining CR were moving or travel out of country (17.2%; 5/29 reasons), lack of interest (13.8%; 4/29), transportation issues (10.3%; 3/29), and desiring a break from therapy (10.3%; 3/29). In a multivariate analysis, people who declined CR were more likely to be women, have poorer attendance at OSR, and not diabetic. Compared with traditional CR, stroke-adapted CR resulted in superior attendance (66.1% [SD = 22.9%] vs 87.1% [SD = 16.6%], respectively) and completion (66.7% vs 89.7%, respectively). The primary reasons for dropping out were medical (45%) and moving (27%). LIMITATIONS Generalizability to other programs is limited, and other, unmeasured factors may have affected outcomes. CONCLUSIONS An OSR-CR partnership provided an effective continuum of care, with approximately 75% of eligible people participating and more than 80% completing. However, just over 1 of 4 eligible people declined participation; therefore, strategies should target lack of interest, transportation, women, and people without diabetes. An alternative program model is needed for people who have severe ambulatory or cognitive deficits and no home exercise support.
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Affiliation(s)
- Susan Marzolini
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada; Canadian Partnership for Stroke Recovery, Toronto, Ontario, Canada; University of Toronto, Ontario, Canada; and York University, Toronto, Ontario, Canada
| | - Karen Fong
- Toronto Rehabilitation Institute, University Health Network
| | - David Jagroop
- Toronto Rehabilitation Institute, University Health Network
| | | | - Jean Liu
- Toronto Rehabilitation Institute, University Health Network
| | - Rina Reyes
- Toronto Rehabilitation Institute, University Health Network
| | - Sherry L Grace
- Toronto Rehabilitation Institute, University Health Network; and York University
| | - Paul Oh
- Toronto Rehabilitation Institute, University Health Network; and Canadian Partnership for Stroke Recovery
| | - Tracey J F Colella
- Toronto Rehabilitation Institute, University Health Network; and University of Toronto
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47
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Bunketorp-Käll L, Pekna M, Pekny M, Blomstrand C, Nilsson M. Effects of horse-riding therapy and rhythm and music-based therapy on functional mobility in late phase after stroke. NeuroRehabilitation 2019; 45:483-492. [PMID: 31868694 PMCID: PMC7029334 DOI: 10.3233/nre-192905] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Persons with stroke commonly have residual neurological deficits that seriously hamper mobility. OBJECTIVE To investigate whether horse-riding therapy (H-RT) and rhythm and music-based therapy (R-MT) affect functional mobility in late phase after stroke. METHODS This study is part of a randomized controlled trial in which H-RT and R-MT was provided twice weekly for 12 weeks. Assessment included the timed 10-meter walk test (10 mWT), the six-minute walk test (6 MWT) and Modified Motor Assessment Scale (M-MAS). RESULTS 123 participants were assigned to H-RT (n = 41), R-MT (n = 41), or control (n = 41). Post-intervention, the H-RT group completed the 10 mWT faster at both self-selected (-2.22 seconds [95% CI, -3.55 to -0.88]; p = 0.001) and fast speed (-1.19 seconds [95% CI, -2.18 to -0.18]; p = 0.003), with fewer steps (-2.17 [95% CI, -3.30 to -1.04]; p = 0.002 and -1.40 [95% CI, -2.36 to -0.44]; p = 0.020, respectively), as compared to controls. The H-RT group also showed improvements in functional task performance as measured by M-MAS UAS (1.13 [95% CI, 0.74 to 1.52]; p = 0.001). The gains were partly maintained at 6 months among H-RT participants. The R-MT did not produce any immediate gains. However, 6 months post-intervention, the R-MT group performed better with respect to time; -0.75 seconds [95% CI, -1.36 to -0.14]; p = 0.035) and number of steps -0.76 [95% CI, -1.46 to -0.05]; p = 0.015) in the 10 mWT at self-selected speed. CONCLUSIONS The present study supports the efficacy of H-RT in producing immediate gains in gait and functional task performance in the late phase after stroke, whereas the effectiveness of R-MT is less clear.
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Affiliation(s)
- Lina Bunketorp-Käll
- Center for Brain Repair, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Center for Advanced Reconstruction of Extremities C.A.R.E. Institute of Clinical Sciences, Sahlgrenska University Hospital/Mölndal, Sweden
| | - Marcela Pekna
- Center for Brain Repair, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Florey Institute of Neuroscience and Mental Health, Parkville, Melbourne, Australia
| | - Milos Pekny
- Center for Brain Repair, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Florey Institute of Neuroscience and Mental Health, Parkville, Melbourne, Australia
- University of Newcastle, New South Wales, Australia
| | - Christian Blomstrand
- Center for Brain Repair, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Neuroscience, Stroke Center West, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Michael Nilsson
- Center for Brain Repair, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Florey Institute of Neuroscience and Mental Health, Parkville, Melbourne, Australia
- Centre for Rehab Innovations (CRI), University of Newcastle and Hunter Medical Research Institute (HMRI) Newcastle, Australia
- LKC School of Medicine, Nanyang Technological University, Singapore
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48
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Ribeiro JAM, Oliveira SG, Thommazo-Luporini LD, Monteiro CI, Phillips SA, Catai AM, Borghi-Silva A, Russo TL. Energy Cost During the 6-Minute Walk Test and Its Relationship to Real-World Walking After Stroke: A Correlational, Cross-Sectional Pilot Study. Phys Ther 2019; 99:1656-1666. [PMID: 31504975 DOI: 10.1093/ptj/pzz122] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 05/01/2018] [Accepted: 03/31/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND After experiencing stroke, individuals expend more energy walking than people who are healthy. However, among individuals who have experienced stroke, the correlation between the energy cost of walking, as measured by validated tests (such as the 6-minute walk test), and participation in walking, as measured by more sensitive tools (such as an ambulatory activity monitor), remains unknown. OBJECTIVE The main objective of this study was to determine whether the energy cost of walking is correlated with participation in walking. DESIGN This study was a correlational, cross-sectional pilot study. METHODS Data from 23 participants who had experienced chronic stroke were analyzed. On the first day, data on oxygen uptake were collected using a portable metabolic system while participants walked during the 6-minute walk test. Then, the ambulatory activity monitor was placed on the participants' nonparetic ankle and removed 9 days later. The energy cost of walking was calculated by dividing the mean oxygen uptake recorded during the steady state by the walking speed. RESULTS The energy cost of walking was correlated with the following: the number of steps (Spearman rank correlation coefficient [rs] = -0.59); the percentage of time spent in inactivity (rs = 0.48), low cadence (rs = 0.67), medium cadence (rs = -0.56), high cadence (rs = -0.65), and the percentages of steps taken at low cadence (rs = 0.65) and high cadence (rs = -0.64). LIMITATIONS Individuals who were physically inactive, convenience sampling, and a small sample size were used in this study. CONCLUSIONS Higher energy costs of walking were associated with fewer steps per day and lower cadence in real-world walking in individuals who had experienced stroke.
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Affiliation(s)
- Jean A M Ribeiro
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Simone G Oliveira
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | | | - Clara I Monteiro
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Shane A Phillips
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, Illinois
| | - Aparecida M Catai
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Audrey Borghi-Silva
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Thiago L Russo
- Laboratório de Pesquisa em Fisioterapia Neurológica, Department of Physical Therapy, Federal University of São Carlos, São Paulo, Brazil
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49
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Bianchim MS, McNarry MA, Larun L, Mackintosh KA. Calibration and validation of accelerometry to measure physical activity in adult clinical groups: A systematic review. Prev Med Rep 2019; 16:101001. [PMID: 31890467 PMCID: PMC6931234 DOI: 10.1016/j.pmedr.2019.101001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 09/25/2019] [Accepted: 09/27/2019] [Indexed: 02/06/2023] Open
Abstract
A growing body of research calibrating and validating accelerometers to classify physical activity intensities has led to a range of cut-points. However, the applicability of current calibration protocols to clinical populations remains to be addressed. The aim of this review was to evaluate the accuracy of the methods for calibrating and validating of accelerometers to estimate physical activity intensity thresholds for clinical populations. Six databases were searched between March and July to 2017 using text words and subject headings. Studies developing moderate-to-vigorous intensity physical activity cut-points for adult clinical populations were included. The risk of bias was assessed using the health measurement instruments and a specific checklist for calibration studies. A total of 543,741 titles were found and 323 articles were selected for full-text assessment, with 11 meeting the inclusion criteria. Twenty-three different methods for calibration were identified using different models of ActiGraph and Actical accelerometers. Disease-specific cut-points ranged from 591 to 2717 counts·min-1 and were identified for two main groups of clinical conditions: neuromusculoskeletal disorders and metabolic diseases. The heterogeneity in the available clinical protocols hinders the applicability and comparison of the developed cut-points. As such, a mixed protocol containing a controlled laboratory exercise test and activities of daily-life is suggested. It is recommended that this be combined with a statistical approach that allows for adjustments according to disease severity or the use of machine learning models. Finally, this review highlights the generalisation of cut-points developed on healthy populations to clinical populations is inappropriate.
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Affiliation(s)
- Mayara S Bianchim
- School of Sport and Exercise Sciences, Swansea University, Bay Campus, Fabian Way, SA1 8EN Swansea, Wales, United Kingdom
| | - Melitta A. McNarry
- School of Sport and Exercise Sciences, Swansea University, Bay Campus, Fabian Way, SA1 8EN Swansea, Wales, United Kingdom
| | - Lillebeth Larun
- Norwegian Institute of Public Health, Division of Health Services, PO Box 222, Skøyen N-0213, Oslo, Norway
| | - Kelly A. Mackintosh
- School of Sport and Exercise Sciences, Swansea University, Bay Campus, Fabian Way, SA1 8EN Swansea, Wales, United Kingdom
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50
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Nayak P, Kumaran SD, Babu AS, Maiya AG, Solomon JM. Levels of physical activity and quality of life among community-dwelling adults with stroke in a developing country. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2019. [DOI: 10.1080/21679169.2019.1663927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Pradeepa Nayak
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Senthil D. Kumaran
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Abraham Samuel Babu
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Arun G. Maiya
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - John M. Solomon
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
- Centre for Comprehensive Stroke Rehabilitation and Research, Manipal Academy of Higher Education, Manipal, India
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