Assessment of functional fitness impacted by hospital rehabilitation in post-stroke patients who additionally contracted COVID-19

Background

The aim of the study was to assess the effects of rehabilitation in post-stroke patients, or post-stroke patients with simultaneous COVID-19 infection, in relation to: improved locomotion efficiency, improved balance, reduced risk of falling as well as the patients' more effective performance in everyday activities.

Methods

The study involved 60 patients in the early period (2-3 months) after a stroke. Group I consisted of 18 patients (30.0%) who, in addition to a stroke, also contracted COVID-19. Group II consisted of 42 patients (70%) post-stroke, with no SARS-CoV2 infection. The effects were assessed on the basis of: Tinetti test, Timed Up & Go test and Barthel scale.

Results

Both groups achieved a statistically significant improvement in their Barthel score after therapy (p < 0.001). The Tinetti test, assessing gait and balance, showed that participants in Group I improved their score by an average of 4.22 points. ±4.35, and in Group II, on average, by 3.48 points ± 3.45 points. In the Timed Up & Go test over a distance of 3 m, significant improvement was achieved in both groups, as well but the effect was higher in Group I (p < 0.001).

Conclusions

Hospital rehabilitation in the early period after stroke improved locomotion efficiency and balance, and reduced the risk of falls in post-stroke patients, both with and without COVID-19 infection.

Validating stroke-induced bilateral ankle coordination deficits using bilateral ankle measure relationship with motor functions in lower limbs

BACKGROUND

Coordinated control between the bilateral ankle joints plays an important role in performing daily life functions, such as walking and running. However, few studies have explored the impact of stroke on movement disorders that decrease the coordination control of the bilateral extremities and may decrease daily activities that require coordination control of the bilateral ankles. This study aimed to investigate the coordination control of the bilateral ankles using a novel bilateral ankle measurement system and evaluate the relationship of bilateral movement coordination control deficits with motor and functional performances of the lower extremities in patients with stroke.

METHODS

Twenty-one healthy adults (36.5 ± 13.2 y/o) and 19 patients with chronic stroke (58.7 ± 10.5 y/o) were enrolled. A novel measurement device with embedded rotary potentiometers was used to evaluate bilateral ankle coordination control. Participants were asked to move their dominant (non-paretic) foot from dorsiflexion to plantarflexion position and non-dominant (paretic) foot from dorsiflexion to plantarflexion position (condition 1) simultaneously, and vice versa (condition 2). Alternating time and angle for coordination control with movements of both ankles were calculated for each condition. Motor and functional performance measurements of the lower extremities included the lower-extremity portion of the Fugl-Meyer assessment (FMA-LE), Berg Balance Test (BBS), Timed Up and Go Test (TUG), and Barthel Index (BI).

RESULTS

Compared with the healthy group, alternating time was shorter in the stroke group by 8.3% (p = 0.015), and the alternating angles of conditions 1 and 2 were significantly higher than those of the healthy group by 1.4° (p = 0.001) and 2.5° (p = 0.013), respectively. The alternating angle in condition 2 showed moderate correlations with TUG (r = 0.512; p = 0.025), 10-m walk (r = 0.747; p < 0.001), gait speed (r =  - 0.497 to - 0.491; p < 0.05), length (r =  - 0.518 to - 0.551; p < 0.05), and BI (r =  - 0.457; p = 0.049).

CONCLUSION

Stroke decreases alternating time, increases alternating angle, and shows bilateral ankle coordination control deficits temporally and spatially. A higher alternating angle is moderately to highly associated with motor function and lower limb function in patients with stroke.

Study on the Cutoff Value of Backward Walking Speed to Distinguish the Mobility Deficits of Stroke Patients

BACKGROUND: Backward walking speed is an objective index to evaluate motor ability, but it is not clear whether it can screen stroke patients with mobility disorders. This study aims to test the diagnostic efficacy of backward maximum walking speed (BMWS) and backward comfortable walking speed (BCWS) on mobility defects in stroke patients and obtain the cutoff values of them. METHODS: We conducted a cross-sectional study of poststroke patients who were hospitalized from July 2021 to January 2022. 98 poststroke patients were selected for 6 functional tests and divided into the high–mobility function group and low–mobility function group by K-means cluster analysis. According to the test results of BMWS and BCWS, the receiver operating characteristic curve was drawn to determine the cutoff values and compare the diagnostic efficiency of the 2 indexes. RESULTS: The BMWS of stroke patients was 0.54 (0.29) m/s, and the BCWS was 0.37 (0.19) m/s. Receiver operating characteristic results showed that the cutoff value of BMWS for the diagnosis of mobility impairment in stroke patients was 0.3 m/s, the area under the curve was 0.95 (95% confidence interval, 0.89–0.98), the specificity was 0.86, and the sensitivity was 0.93. The cutoff value of BCWS was 0.27 m/s, the area under the curve was 0.91 (95% confidence interval, 0.84–0.96), the specificity was 0.91, and the sensitivity was 0.8. There was no significant difference between the 2 indexes in the diagnosis of mobility defects in stroke patients (P > .05). CONCLUSIONS: Backward walking speed is a useful indicator for discriminating stroke patients with mobility deficits. Considering the risks associated with backward walking, BCWS can be used in clinical assessments to guide nurses in the development and implementation of rehabilitation programs.

Psychometric Properties of the Trail Walking Test for People With Stroke

Objective

To investigate (i) the inter-rater and test–retest reliability of the trail walking test (TWT) and the minimum detectable change in the TWT completion time; (ii) the correlations between the TWT completion time and stroke-specific impairments; and (iii) the cutoff TWT completion time to distinguish between people with stroke and healthy older adults according to dual-tasking ambulation ability.

Design

Cross-sectional study.

Setting

University-based rehabilitation center.

Participants

In total, 104 people with stroke and 53 healthy older adults.

Main Outcome Measures

The TWT, the Fugl–Meyer Assessment of Lower Extremity (FMA-LE), the ankle muscle strength test, the limit of stability (LOS) test, the Berg Balance Scale (BBS), the Timed Up and Go test (TUG), and the Community Integration Measure (CIM).

Results

The mean TWT completion time in subjects with stroke was 124.906 s. The TWT demonstrated excellent inter-rater reliability [intraclass correlation (ICC) = 0.999] and good test–retest reliability (ICC = 0.876) in people with stroke. The TWT performance demonstrated significant negative correlations with the FMA-LE scores (r = −0.409), LOS movement velocity (affected and unaffected sides; r = −0.320 and −0.388, respectively), and LOS endpoint excursion (affected and unaffected sides; r = −0.357 and −0.394, respectively); a significant positive correlation with the LOS reaction time (affected side; r = 0.256); a moderate negative correlation with the BBS scores (r = −0.72); and an excellent positive correlation with the TUG completion time (r = 0.944). The receiver operating characteristic curve analysis revealed that an optimal cutoff of 69.61 s for the TWT completion time had an outstanding diagnostic power to distinguish between people with stroke and healthy older adults (area under the curve = 0.919) with high sensitivity (88.5%) and specificity (83.0%).

Conclusion

Results of our preliminary study demonstrated that the TWT is a reliable, valid, sensitive, and specific clinical test for evaluating dual-tasking ambulation ability in people with stroke aged 45 years or above and without cognitive impairments. It can differentiate the dual-tasking ambulation ability between people with stroke and healthy older adults.

Comparison of 360° Turn Cycles among Individuals after Stroke and Healthy Older Adults

Stroke survivors are at high risk of falling during turning. The kinematics of performing a 360° turn have not been fully analyzed among individuals after stroke. Quantitative differences in the parameters of turning between healthy older adults and those after stroke could provide detailed information on turning ability among these groups. The purpose of the current study was to characterize differences between healthy older adults and adults after stroke in 360° turn kinematics. Fourteen individuals with chronic stroke (mean age: 69 ± 8.4 years) and 14 healthy older adults (mean age: 74 ± 8.7 years) performed three trials of 360° turning. Kinematics data were collected using 26 reflective markers at several body landmarks. This new method for quantifying turning revealed that stroke significantly affected the number of turn cycles, number of single support (SS) critical phases, and critical time. In some cases, falls among individuals with stroke may be related to the combination of impaired movement patterns and the complexity of tasks such as turning. Understanding turning kinematics can inform clinical interventions targeting improvements in turning ability and consequently, fall risk reduction in individuals after stroke.

The effects of lower extremity cross-training on gait and balance in stroke patients: a double-blinded randomized controlled trial

BACKGROUND

Cross-training is an indirect intervention to promote muscle activity on the affected side by applying resistance exercise to stronger parts of the body. Indirect interventions are useful for treating patients who have difficulty with direct interventions. Previous studies have focused on measuring increased muscle strength and muscle activity in healthy individuals.

AIM

This study aimed to investigate the effects of cross-training on gait and balance in hemiplegic patients when applied to the affected and unaffected lower extremities.

DESIGN

Double-blinded randomised controlled trial.

SETTING

In-patients attending the rehabilitation treatment room of a single center.

POPULATION

Fifty-two stroke patients were randomly allocated to a control group (N.=19), affected side cross-training group (N.=15), and unaffected side cross-training group (N.=18).

METHODS

Patients were administered general neurological physiotherapy for 30 mins, twice daily, 5 days/week for 4 weeks. The two intervention groups underwent 30 mins of cross-training instead of general neurological physiotherapy once daily, 3 days/week for 4 weeks (postintervention). For data analysis, one-way ANOVA for between-group comparisons and paired t-tests were performed for within-group comparisons between pre- and postintervention groups (significance level of 0.05).

RESULTS

In the Timed Up and Go Test (TUG), comparing pre- and postintervention, the control group showed no significant change (P>0.05), while the affected side and unaffected side cross-training groups showed significant improvements in function (P<0.05). In the 10-meter Walk Test, the control group showed no significant change (P>0.05), while the affected side and unaffected side cross-training groups showed significant increases in speed (P<0.05). In balance testing, the limits of stability showed a significantly increase in all three groups (P<0.05). There were no pre- or postintervention differences in gait or balance between the groups (P>0.05).

CONCLUSIONS

Gait and balance improved in hemiplegic stroke patients who participated in cross-training, regardless of the intervention applied to the affected or unaffected side.

CLINICAL REHABILITATION IMPACT

In clinical settings, for patients who experience difficulties with direct interventions on the affected side, we propose indirect interventions to improve gait and balance.

Assessment of dynamic balancing responses following perturbations during slow walking in relation to clinical outcome measures for high-functioning post-stroke subjects

BACKGROUND

Generating appropriate balancing reactions in response to unexpected loss of balance during walking is important to prevent falls. The purpose of this study was to assess dynamic balancing responses following pushes to the pelvis in groups of post-stroke and healthy subjects.

METHODS

Forty-one post-stroke subjects and forty-three healthy subjects participated in the study. Dynamic balancing responses to perturbations triggered at heel strike of the left or right leg, directed in the forward, backward, inward and outward directions during slow treadmill walking were assessed. Responses of the healthy group provided reference values used to classify responses of the post-stroke group into two subgroups; one within the reference responses ("inside" subgroup) and the other that falls out ("outside" subgroup). A battery of selected clinical outcome measures (6-Minute Walk Test, 10-Meter Walk Test, Timed-Up-and-Go test, Four Square Step Test, Functional Gait Assessment, Functional Independence Measure and One-legged stance test) was additionally assessed in the post-stroke group.

RESULTS

The "inside" subgroup of post-stroke subjects was able to appropriately modulate centre-of-pressure and ground-reaction-force both under the impaired and non-impaired leg in response to perturbations. The "outside" subgroup of post-stroke subjects showed limited modulation of centre-of-pressure and ground-reaction-force under the impaired leg; instead stepping strategy was used in which the non-impaired leg was placed such as to make a longer step (forward perturbation), to make a shorter step (backward perturbation) or to make a cross-step (outward perturbation). Consequently, peak centre-of-mass displacements following perturbations were significantly higher in the "outside" subgroup compared to the "inside" subgroup. Responses in both subgroups following inward perturbations did not differ. Majority of clinical outcome measures moderately correlated with the peak centre-of-mass displacements for forward perturbations and exhibited weak correlations for other perturbation directions.

CONCLUSIONS

Substantial number of post-stroke subjects, that were considered to be independent walkers, have reduced capabilities to execute appropriate balancing responses following perturbations commencing on the hemiparetic leg and may thus benefit from perturbation-based training. Timed-Up-and-Go and Functional Independence Measure tests may provide an indication on the abilities of each subject to counteract unexpected loss of balance. However, a reliable assessment should be done through perturbation-based measures.