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Cheng JY, Yang YR, Yeh NC, Cho H, Wang V, Li JC, Wang RY. Effects of inclined treadmill training on inadequate ankle control during walking in individuals after stroke: A pilot randomized controlled trial. NeuroRehabilitation 2022; 51:171-180. [DOI: 10.3233/nre-220002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Inadequate ankle control influences walking ability in people after stroke. Walking on inclined surface activates ankle muscles and movements. However, the effect of inclined treadmill training on ankle control is not clear. OBJECTIVE: To investigate the effects of inclined treadmill training on ankle control in individuals with inadequate ankle control after chronic stroke. METHODS: This was a randomized single-blinded study. Eighteen participants were randomly assigned to receive 12 sessions of 30 min inclined (n = 9) or regular (n = 9) treadmill training and 5 min over-ground walking training. The outcomes included ankle control during walking, muscle strength of affected leg, walking performance, and stair climbing performance. RESULTS: Inclined treadmill training significantly improved ankle dorsiflexion at initial contact (p = 0.002), increased tibialis anterior activities (p = 0.003 at initial contact, p = 0.006 in swing phase), and decreased dynamic plantarflexors spasticity (p = 0.027) as compared with regular treadmill training. Greater improvements were also shown in stair climbing with affected leg leading (p = 0.006) and affected knee extensors strength (p = 0.002) after inclined treadmill training. CONCLUSIONS: Inclined treadmill training was proposed to improve inadequate ankle control after chronic stroke. Inclined treadmill training also improved the stair climbing ability accompanied with increased muscle strength of the affected lower extremity.
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Affiliation(s)
- Ju-Yu Cheng
- Department of Rehabilitation, Cardinal Tien Hospital, New Taipei City, Taiwan
| | - Yea-Ru Yang
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Nai-Chen Yeh
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hsin Cho
- Department of Rehabilitation, Cardinal Tien Hospital, New Taipei City, Taiwan
| | - Vinchi Wang
- School of Medicine, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Jui-Chang Li
- Department of Rehabilitation, Cardinal Tien Hospital, New Taipei City, Taiwan
| | - Ray-Yau Wang
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Guerra ZF, Bellose LC, Ferreira AP, Faria CD, Paz CC, Lucchetti G. Effects of mental practice on mobility of individuals in the early subacute post-stroke phase: A randomized controlled clinical trial. J Bodyw Mov Ther 2022; 32:82-90. [DOI: 10.1016/j.jbmt.2022.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 04/04/2022] [Accepted: 04/24/2022] [Indexed: 10/18/2022]
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Martins JC, Nadeau S, Aguiar LT, Scianni AA, Teixeira-Salmela LF, De Morais Faria CDC. Efficacy of task-specific circuit training on physical activity levels and mobility of stroke patients: A randomized controlled trial. NeuroRehabilitation 2020; 47:451-462. [PMID: 33136078 DOI: 10.3233/nre-203207] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Impaired mobility is related to low physical activity (PA) levels observed after stroke. Therapeutic approaches, such as task-specific circuit training (TSCT), used to improve mobility in individuals with stroke, could also improve PA levels. OBJECTIVE To investigate the efficacy of TSCT, focused on both upper (UL) and lower (LL) limbs, in improving PA levels and mobility (primary outcomes), as well as muscle strength, exercise capacity, and quality of life (secondary outcomes) in subjects with stroke. METHODS A randomized controlled trial with 36 subjects with chronic stroke was conducted. Experimental group: TSCT, involving both UL and LL. CONTROL GROUP global stretching, memory exercises, and education sessions. Both groups received 60 minute sessions/week over 12 weeks. Outcomes were measured at baseline, post-intervention and 16 week follow-up. RESULTS No changes were found for primary and secondary outcomes (0.11≤p≤0.99), except for quality of life, which improved in the experimental group post-intervention and 16 week follow-up (p = 0.02). CONCLUSION TSCT focused on both UL and LL was not effective on PA levels and mobility of individuals with chronic stroke, however, improvements in quality of life were observed. Since this is the first study to investigate this combined training aimed at improving PA levels, future studies are necessary to better understand the impact of this type of intervention.
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Affiliation(s)
- Júlia Caetano Martins
- Universidade Federal de Minas Gerais (UFMG), Department of Physical Therapy, Belo Horizonte, Brazil
| | - Sylvie Nadeau
- Université de Montreal (UdeM), Centre de recherche interdisciplinaire en réadaptation (CRIR), Institut de réadaptation Gingras-Lindsay de Montréal (IRGLM), CIUSSS Centre-Sud-de-l'île-de-Montréal, Montréal, Canada
| | - Larissa Tavares Aguiar
- Universidade Federal de Minas Gerais (UFMG), Department of Physical Therapy, Belo Horizonte, Brazil
| | - Aline Alvim Scianni
- Universidade Federal de Minas Gerais (UFMG), Department of Physical Therapy, Belo Horizonte, Brazil
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Kongwattanakul K, Hiengkaew V, Jalayondeja C, Sawangdee Y. A structural equation model of falls at home in individuals with chronic stroke, based on the international classification of function, disability, and health. PLoS One 2020; 15:e0231491. [PMID: 32275692 PMCID: PMC7147784 DOI: 10.1371/journal.pone.0231491] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 03/24/2020] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To use structural equation model (SEM) to explain falls at home in individuals with chronic stroke, based on the International Classification of Functioning, Disability and Health (ICF). MATERIALS AND METHODS A cross sectional observation study was conducted in home-dwelling individuals with chronic stroke (N = 236; 148 non-fallers, 88 fallers). Participants were assessed; structural impairments using Modified Ashworth Scale, Fugl-Meyer Assessment upper (FMA-UE), lower (FMA-LE), and sensory function, ankle plantarflexor strength; activity limitations using Timed Up and Go Test, Step Test, Berg Balance Scale, Barthel Index (BI); participation restrictions using Stroke Impact Scale-participation (SIS-P); and contextual factors using home hazard environments, home safety surroundings, risk behaviors, and Fall-related Self Efficacy. The measurement model was analyzed by confirmatory factor analysis. The SEM was conducted to analyze a structural model of falls at home. RESULTS FMA-UE was significantly (p<0.01) associated with FMA-LE, combining as one variable in the structural impairments. In the measurement model, variables were fit to their domains, except variables of contextual factors, but the ICF domains did not correspond to disability. A structural model of falls at home demonstrated a significant (p<0.01) direct path of contextual factors and activity limitations with falls at home. The structural impairments showed a significant (p<0.01) direct path with activity limitations. All variables, except BI, SIS-P and risk behaviors, related to their domains in the structural model. CONCLUSIONS A structural model of falls at home proposes contextual factors being the strongest association with falls at home that home hazard environments seem the most influence in its domain. The activity limitations presented by balance ability are directed to falls at home. The structural impairments are associated with falls at home through activity limitations. Home assessment to decrease home hazard environments is suggested to prevent falls at home for individuals with chronic stroke.
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Affiliation(s)
| | - Vimonwan Hiengkaew
- Faculty of Physical Therapy, Mahidol University, Salaya, Nakhon Pathom, Thailand
- * E-mail:
| | - Chutima Jalayondeja
- Faculty of Physical Therapy, Mahidol University, Salaya, Nakhon Pathom, Thailand
| | - Yothin Sawangdee
- Institute for Population and Social Research, Mahidol University, Salaya, Nakhon Pathom, Thailand
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Franco J, Quintino LF, Faria CDCDM. Does grip strength predict lower limb global strength in subjects with stroke? FISIOTERAPIA EM MOVIMENTO 2020. [DOI: 10.1590/1980-5918.033.ao24] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Abstract Introduction: Grip strength is an important clinical measure and has been used for several purposes in different populations, including those to predict the global strength of lower limbs (LL) and upper limbs. However, little is known about the association between grip strength and lower limb (LL) global strength in subjects with stroke. Objective: To investigate the relationship between grip strength and LL global strength in stroke with subjects at both subacute and chronic phases. Method: Measures of grip strength (handgrip dynamometer) and LL global strength (hand-held dynamometer) were obtained in 20 subjects in the subacute phase of the stroke and 18 in the chronic phase. Pearson correlation coefficient was used to investigate the correlation between grip strength and LL global strength (α = 0.05). Results: Subjects in the subacute phase showed a moderate statistically significant correlation between paretic grip strength and global strength of the non-paretic LL (r = 0.50; p < 0.05), but no correlation with the paretic LL was found (p = 0.25). The non-paretic grip strength showed no statistically significant correlation with global strength of the paretic LL (p = 0.93) and of the non-paretic LL (p = 0.64). In chronic subjects, no statistically significant correlation (0.50 ≤ p ≤ 0.97) was observed. Conclusion: Grip strength does not seem to be an adequate indicator to predict LL global strength of subjects with stroke. This conclusion is different from that obtained for other populations.
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Aguiar LT, Martins JC, Quintino LF, de Brito SAF, Teixeira‐Salmela LF, de Morais Faria CDC. A Single Trial May Be Used for Measuring Muscle Strength With Dynamometers in Individuals With Stroke: A Cross‐Sectional Study. PM R 2019; 11:372-378. [DOI: 10.1016/j.pmrj.2018.08.377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 08/04/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Larissa Tavares Aguiar
- Department of Physical TherapyUniversidade Federal de Minas Gerais (UFMG) Belo Horizonte Minas Gerais Brazil
| | - Júlia Caetano Martins
- Department of Physical TherapyUniversidade Federal de Minas Gerais (UFMG) Belo Horizonte Minas Gerais Brazil
| | - Ludmylla Ferreira Quintino
- Department of Physical TherapyUniversidade Federal de Minas Gerais (UFMG) Belo Horizonte Minas Gerais Brazil
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Guerra ZF, Bellose LC, Coelho de Morais Faria CD, Lucchetti G. The effects of mental practice based on motor imagery for mobility recovery after subacute stroke: Protocol for a randomized controlled trial. Complement Ther Clin Pract 2018; 33:36-42. [PMID: 30396624 DOI: 10.1016/j.ctcp.2018.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 06/25/2018] [Accepted: 08/05/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND PURPOSE Mental practice of motor imagery has shown beneficial effects in stroke recovery. However, there are few clinical trials investigating it on the subacute phase. This study will investigate the effects of mental practice in the mobility of patients with subacute stroke. MATERIALS AND METHODS Randomized controlled trial including persons with subacute stroke (<3 months). All participants will receive physical exercises and will be randomly allocated into an experimental group (Mental Practice) or into a control group (cognitive training) for 4 weeks(12 sessions). RESULTS Primary outcomes will be assessed at baseline and after intervention and will be related to mobility, using Timed Up and Go test and 5 m walking speed test. Whereas secondary outcomes will be muscular strength, biomechanical strategies, mental health and quality of life. CONCLUSION The beneficial effects that may be found in this trial can be greatly relevant in clinical practice, justifying this scientific question.
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Affiliation(s)
- Zaqueline Fernandes Guerra
- Post Graduation Health Program, Federal University of Juiz de Fora, Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (SUPREMA) and UNIVERSO - Universidade Salgado de Oliveira, Brazil
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Aguiar LT, Camargo LBA, Estarlino LD, Teixeira-Salmela LF, Faria CDCDM. Strength of the lower limb and trunk muscles is associated with gait speed in individuals with sub-acute stroke: a cross-sectional study. Braz J Phys Ther 2018; 22:459-466. [PMID: 29588151 PMCID: PMC6235746 DOI: 10.1016/j.bjpt.2018.03.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 02/22/2018] [Accepted: 03/02/2018] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVES To investigate the association between measures of strength of the lower limb and trunk muscles and gait speed and to identify the muscle group that would best predict gait speed in individuals with sub-acute stroke. METHODS Using a cross-sectional observational study design, forty-four individuals with sub-acute stroke (62 years, SD=14; 4 months, SD=1 post-stroke) were assessed. The evaluations were performed at a university laboratory, participants' homes, or community-based settings. Bilateral maximum isometric strength (hip, knee, and ankle flexors/extensors, hip abductors, trunk flexors/extensors, and trunk lateral flexors and rotators) was measured using a portable dynamometer. Comfortable and maximum gait speeds were measured using the 10-m walk test. RESULTS Weak to moderate associations were found between measures of strength of the lower limb muscles and comfortable (0.36≤r≤0.53; p<0.05) and maximum (0.37≤r≤0.59; p<0.05) gait speeds, except for the non-paretic knee flexors and comfortable gait speed (p=0.06). Weak to moderate associations were also found between measures of strength of the trunk muscles and comfortable (0.39≤r≤0.50; p<0.05) and maximum (0.39≤r≤0.61; p<0.05) gait speeds. Stepwise multiple regression analyses revealed that the non-paretic dorsiflexors and the left lateral trunk flexors explained 29% and 42% of the variance in the maximum and comfortable gait speeds, respectively. CONCLUSIONS The strength of the lower limb and trunk muscles was positively associated with comfortable and maximum gait speeds. The muscle strength of the non-paretic dorsiflexors and the left lateral trunk flexors might have a role to play in determining comfortable and maximum gait speeds of individuals with sub-acute stroke.
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Affiliation(s)
- Larissa Tavares Aguiar
- Universidade Federal de Minas Gerais (UFMG), Departamento de Fisioterapia, Belo Horizonte, MG, Brazil
| | | | - Lorena Dasdores Estarlino
- Universidade Federal de Minas Gerais (UFMG), Departamento de Fisioterapia, Belo Horizonte, MG, Brazil
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Aguiar LT, Martins JC, Brito SAFD, Mendes CLG, Teixeira-Salmela LF, Faria CDCDM. Knee extensor muscles strength indicates global lower-limb strength in individuals who have suffered a stroke: A cross-sectional study. Braz J Phys Ther 2018; 23:221-227. [PMID: 30143356 DOI: 10.1016/j.bjpt.2018.08.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 07/18/2018] [Accepted: 08/03/2018] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES This study had three aims: (1) to evaluate the relationships between the paretic knee extensor muscle strength and global lower-limb strength in individuals who had suffered a sub-acute/chronic stroke, (2) to determine whether global lower-limb strength, sex, body mass index, or age could predict knee extensor muscle strength, and 3) to investigate whether the results obtained via a Modified Sphygmomanometer Test (MST) would be similar to those obtained using a hand-held dynamometer. METHODS This was a cross-sectional study, performed at a research laboratory, at participants' homes, or at outpatient clinics. Forty-two individuals with a sub-acute stroke and 45 individuals with a chronic stroke participated. Maximum isometric strength of the paretic lower-limb muscles (i.e. hip, knee, and ankle flexors/extensors, hip abductors) was measured using the MST and a hand-held dynamometer. RESULTS Significant and high correlation coefficients were found between knee extensor muscle strength and global lower-limb strength as measured by the combined strength values of 6 lower limb muscle groups in individuals with sub-acute (0.81≤r≤0.88; p<0.05) and chronic (0.82≤r≤0.85; p<0.05) stroke. Step-wise multiple regression analysis revealed that only global lower-limb strength was retained in the model and accounted for 66-78% and 67-72% (p<0.001) of the variance in knee extensor muscle strength at the sub-acute and chronic phases post-stroke, respectively. The results obtained via the MST were similar to those obtained using the hand-held dynamometer. CONCLUSION Paretic knee extensor muscles strength, assessed using a MST or a hand-held dynamometer, indicates global lower-limb strength in individuals with a sub-acute or chronic stroke.
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Affiliation(s)
- Larissa Tavares Aguiar
- Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Júlia Caetano Martins
- Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | | | - Camila Lima Gervásio Mendes
- Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
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Menezes KKP, Nascimento LR, Faria CDCM, Avelino PR, Scianni AA, Polese JC, Faria-Fortini I, Teixeira-Salmela LF. Deficits in motor coordination of the paretic lower limb best explained activity limitations after stroke. Physiother Theory Pract 2018; 36:417-423. [DOI: 10.1080/09593985.2018.1488193] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Kênia KP Menezes
- NeuroGroup, Discipline of Physiotherapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Lucas R Nascimento
- NeuroGroup, Discipline of Physiotherapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Center of Health Sciences, Discipline of Physiotherapy, Universidade Federal do Espírito Santo, Vitória, Brazil
| | - Christina DCM Faria
- NeuroGroup, Discipline of Physiotherapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Patrick R Avelino
- NeuroGroup, Discipline of Physiotherapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Aline A Scianni
- NeuroGroup, Discipline of Physiotherapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Janaine C Polese
- NeuroGroup, Discipline of Physiotherapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Iza Faria-Fortini
- NeuroGroup, Discipline of Physiotherapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Luci F Teixeira-Salmela
- NeuroGroup, Discipline of Physiotherapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Martins JC, Aguiar LT, Nadeau S, Scianni AA, Teixeira-Salmela LF, Faria CDCDM. Efficacy of Task-Specific Training on Physical Activity Levels of People With Stroke: Protocol for a Randomized Controlled Trial. Phys Ther 2017; 97:640-648. [PMID: 28371936 DOI: 10.1093/physth/pzx032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 03/15/2017] [Indexed: 11/14/2022]
Abstract
BACKGROUND The majority of people after stroke demonstrate mobility limitations, which may reduce their physical activity levels. Task-specific training has been shown to be an effective intervention to improve mobility in individuals with stroke, however, little is known about the impact of this intervention on levels of physical activity. OBJECTIVES The main objective is to investigate the efficacy of task-specific training, focused on both upper and lower limbs, in improving physical activity levels and mobility in individuals with stroke. The secondary objective is to investigate the effects of the training on muscle strength, exercise capacity, and quality of life. DESIGN This is a randomized controlled trial. SETTING The setting is public health centers. PARTICIPANTS Community-dwelling people with chronic stroke. INTERVENTIONS Participants will be randomized to either an experimental or control group, who will receive group interventions 3 times per week over 12 weeks. The experimental group will undertake task-specific training, while the control group will undertake global stretching, memory exercises, and health education sessions. MEASUREMENTS Primary outcomes include measures of physical activity levels and mobility, whereas secondary outcomes are muscle strength, exercise capacity, and quality of life. The outcomes will be measured at baseline, postintervention, and at the 4- and 12-week follow-ups. CONCLUSIONS The findings of this trial have the potential to provide important insights regarding the effects of task-specific training, focused on both upper and lower limbs, in preventing secondary poststroke complications and improving the participants' general health through changes in physical activity levels.
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Affiliation(s)
- Júlia Caetano Martins
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| | - Larissa Tavares Aguiar
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| | - Sylvie Nadeau
- Centre de Recherche Interdisciplinaire en Réadaptation, Institut de Réadaptation Gingras-Lindsay de Montréal, Université de Montreal, CIUSSS Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
| | - Aline Alvim Scianni
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
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